Study shows UK led way in reopening big cultural events safely after COVID lockdowns

Liverpool researchers have authored a new study detailing definitive population-based evidence of risks of COVID-19 transmission around the early reopening of mass cultural events before restrictions were lifted.

Liverpool City Region hosted the world's first regional cluster of experimental reopening of mass cultural events after COVID lockdowns as part of the UK Events Research Program (ERP), including a business festival, two nightclubs (Circus' First Dance) and a music festival (the Sefton Park Pilot).

All ticket holders were required to take a lateral flow test ahead of the events—a negative test would allow them access. Attendees were encouraged to take a PCR test on the day of the event, and a second one five days later, and gave consent for their routine NHS COVID testing data to be linked.

The analysis, published in the Journal of the Royal Society of Medicine, finds that of 12,256 individuals attending one or more events over five days, there were just 15 linked cases detected through research, public health and clinical testing using population-wide linked data.

Half of the cases were likely primary or secondary, reflecting transmission no higher than the background rate at the time, in contrast to a concurrent outbreak of more than 50 linked cases associated with a local swimming pool.

The key strengths of the study are its population-wide design and the realistic way the events were run. The Liverpool City Region was the first region in the world to introduce voluntary open-access asymptomatic testing, and used real-time linked data systems to study patterns of SARS-CoV-2 transmission and coordinate public health responses from November 2020 through the COVID-19 pandemic.

The University of Liverpool's Professor Iain Buchan, Principal Investigator for the Events Research Program in Liverpool, said, "Around the May Bank Holiday of 2021, the Liverpool City Region ran the world's first experimental reopening of a realistic set of mass cultural events after COVID-lockdowns. We studied the feasibility and effects of risk-mitigations including supervised self-testing, contact-tracing and joint communications between event organizers and public health teams."

"The events were designed to be realistic, so mask-wearing was not compulsory. Out of 12,256 eventgoers there were 15 event-linked cases detected through research and routine NHS testing—no greater than background rates, which were low then—just before the Delta variant surged. The same surveillance system detected over 50 cases linked to a swimming pool in the area at the time, which did not have pre-attendance testing."

He added, "This public health initiative was a response to the social development and mental health needs of young people, who were last to be vaccinated, and among whom mental health referrals were rising. It was also a response to rising unemployment in the events and hospitality sector, and the importance of this sector for social well-being. Future pandemic recovery might take greater advantage of digital links between ticketing, events management, and public health systems, including testing and risk communications."

The live links between different data sources, including events ticketing and public health testing were built by the Liverpool City Region Civic Data Cooperative (CDC). The CDC is the UK's first Civic Data Cooperative and was launched just before the COVID-19 pandemic to mobilize health-related data across the city region to improve the health and well-being of its residents.

Mayor of the Liverpool City Region, Steve Rotheram, said, "Being the first region in the country to reopen its hospitality and events sector in the midst of a global pandemic was no mean feat, yet we knew it was essential one—not only for our economic recovery, but for our collective well-being.

"While the rest of the world watched on, we worked with our world-leading scientists, researchers and our ethical Civic Data Cooperative, to safely reopen our visitor economy to the public. Few areas can claim to have made a bigger impact on global health than the Liverpool City Region—and it's a legacy that we're proud to be continuing today."

Director of Culture Liverpool Claire McColgan CBE, said, "The Events Research Program remains one of the most challenging projects I have ever been involved with and one that I'm incredibly proud of. At a time when restrictions were in place, we couldn't mix indoors with family and friends, and mask wearing was the norm—Liverpool stepped up to be the focal point of a pilot project which would help shape national policy and breathe life back into the culture and leisure sector.

"This industry represents more than half of our local economy and it was in our interests to do everything we could to start to bring a sense of normality back. The eyes of the world were on us as we blazed the trail, and worked around the clock with the University, Government and event organizers to make each activity a safety success, and help unlock live events for the rest of the country. And in terms of legacy, our learning from those projects has been invaluable, shaping how we now deliver major events, such as the highly-acclaimed Eurovision host city program, and as a result are regarded as an exemplar of best practice in this field."