Mass Gathering Events and Reducing Further Global Spread of COVID-19: a Political and Public Health Dilemma

Historically, sporting, religious, music, and other MGs have been the source of infectious diseases that have spread globally.3 However, the scale of the problem has declined over the years as better public health measures have been implemented at MGs in response to the World Health Assembly’s endorsement on Dec 22, 2011, of the 130th Executive Board Decision “Global mass gatherings: implications and opportunities for global health security” that encompassed joint planning, enhancement of health infrastructures, and taking proper pre-emptive and preventive measures to control infectious diseases on an international scale.4 Since then, many MGs have been held safely and successfully without any major communicable disease issues arising,3,5–7 even for MG events held during three WHO declared Public Health Emergencies of International Concern: the Vancouver 2010 Winter Olympics and the 2010 FIFA World Cup in South Africa during the H1N1 influenza pandemic; the 2015 Africa Cup of Nations Football tournament in Equatorial Guinea during the outbreak of Ebola virus disease; and the Rio 2016 Olympics during the Zika virus outbreak.8,9 The emergence of SARS-CoV-2 in China in 2019–20 as a pathogen transmitted by the respiratory route leading to the COVID-19 pandemic1 has refocused global attention on national, regional, and pandemic spread through MGs events. Since early March, 2020, there has been a step increase in cancellation of international and national religious, sporting, musical, and other MGs as countries worldwide take measures to contain the spread of SARS-CoV-2. Many prominent MGs have been cancelled or postponed, including sports fixtures such as the Union of European Football Associations Euro 2020 football championship, the Formula 1 Grand Prix in China, the Six Nations rugby championship in Italy and Ireland, Olympic boxing qualifying events, the Mobile World Congress in Barcelona, and the Umrah in Saudi Arabia.10 Although appropriate public health surveillance and interventions for reducing the risk of disease transmission at MGs are informed by previous experiences, the evidence base for infectious disease transmission during MGs is still evolving and needs to be more comprehensive.3,11 For COVID-19, in addition to the major public health risks at MGs, the management of enhanced media interest and public and political perceptions and expectations are major challenges.12 Fear, uncertainty, and a desire not to be seen to get things wrong can influence decisions about the risks of MGs, rather than an understanding of the risks and of the interventions available to reduce that risk. WHO, working with global partners in MG health, many of whom were involved in the Riyadh conferences and The Lancet’s 2014 Mass Gatherings Medicine Series,4–7,13 has developed comprehensive recommendations for managing the public health aspects of MGs that have been updated with interim key recommendations for COVID-19.14 These recommendations have to be used in consultation with updated technical guidance on COVID-19.15 Risk assessments for COVID-19 (panel) need to consider the capacity of host countries to diagnose and treat severe respiratory illness.