Which strategies are countries using for mass gatherings and community events and how have they changed throughout the pandemic?

Cross-Country Analysis

Which strategies are countries using for mass gatherings and community events and how have they changed throughout the pandemic?

Mass gatherings or community events are hotspots of infectious disease diffusion and can lead to a surge of cases.

The COVID-19 pandemic has forced authorities and governments to reassess their approach to these gatherings. This analysis outlines the most commonly adopted strategies across the European Region. Information was collected from the COVID-19 Health Systems Response Monitor (HSRM) (up to 15 February 2021). The main purpose of restrictions on mass gatherings and community events is to mitigate or prevent superspreading events (SSE), one of the main drivers of COVID-19. SSEs occur when one person infects a disproportionate number of other individuals. This can lead to explosive growth in cases, as well as sustained transmission in later stages. Usually, they are catalysed through circumstantial factors at gatherings such as those with large crowd sizes, close contact between people, and poorly ventilated indoor areas. Thus, the prevention of SSE resulting from gatherings is highly important. 

Most countries adopted policies on gatherings during the first wave in March 2020, and were then reimposed in October 2020 during the subsequent waves. The series of measures taken can be divided into two categories: restrictions on mass gatherings and limitations on the number of people in private social gatherings.

During the first wave of COVID-19 restrictions on mass gatherings were among the first measures taken by governments

The WHO considers an event a mass gathering if the number of people at a specific location is so large that it has the potential to strain the planning and response resources of the host country or community. Mass gatherings are often sporting, musical, cultural, and religious events.

In March 2020, the majority of countries across Europe chose to restrict mass gatherings based on the number of attendees. Most countries enforced an initial ban of all events with more than 1000 participants, such as Germany, the Netherlands, and Spain. Romania allowed events with 200 to 1000 attendees, provided that the organisers acquired permission from the authorities. However, several prominent events across Europe had already been cancelled, or postponed, before the initial ban.       

Additionally, most countries introduced different policies for indoor and outdoor gatherings – albeit with widely differing attendee numbers. Luxembourg allowed a maximum of 100 people in confined places and a maximum of 500 people in non-confined places. By contrast, Malta limited the number of people attending outdoor and indoor gatherings to 1000 and 750, respectively. Along with these restrictions, countries such as the United Kingdom, released regulations for those arranging or planning to attend mass gatherings as well as guidance and advice for physical distancing and appropriate hygiene measures.

Some countries, such as Montenegro, Slovakia and North Macedonia, banned all mass gatherings, whether they were held indoors or outdoors, regardless of the number of participants. On the other end, Belarus was the only European country not to suspend the national football championship, although other countries, such as Belgium allowed football matches with smaller crowds.

As cases increased substantially across the continent, measures in many countries were tightened, with fewer people being allowed to attend or a complete ban on mass gatherings. A decrease in new cases in late May and June 2020 led to many countries briefly lifting restrictions.

Restrictions on mass gatherings were reimposed during the second wave

However, due to a new resurgence of cases, the restrictions have been reinstated and reinforced in many countries over the autumn months. In some countries, such as Austria and Bulgaria, the restrictions were reimposed in September 2020 and were tightened by the end of October. In most countries, restrictions limiting the number of people in a gathering were reinstated in October 2020.

These limitations were also accompanied by a requirement for people to wear protective masks (for example Germany), or the organisers to acquire approval for their events (for example Croatia). The WHO Regional Office for Europe provides a Public Health and Social Measures (PHSM) Severity Index with standardized data on the ways in which countries have tackled the community spread of COVID-19. It provides graphics on the severity of gathering restrictions implemented over time and captures six public health measures which enable analysis of the interventions across countries in the WHO European region. Moreover, this tool facilitates analysis of emergent patterns, as well as distinguishing outliers.  

Countries have implemented contact restrictions and limited community events

After the first wave of COVID-19, as case numbers again started to increase, governments introduced contact restrictions, such as limits on the number of people that were allowed to gather in groups and number of households that could have contact (for example Malta, North Macedonia, Greece). This was aimed at reducing the contact with people outside one’s own household to a minimum and to create a social bubble to avoid clustering. For example, in early July 2020, in the United Kingdom, contact was limited to two to three households depending on the region. In September, the restrictions were relaxed, and people were allowed up to six people from different households. Due to the new variant B.1.1.7, by mid-December 2020, the government imposed new restrictions and prohibited any mixing of households. As the new variant posed a new threat, most of the United Kingdom once again went into lockdown as of January 7, 2021. Concurrently, these contact restrictions limited community events, such as weddings, funerals, and birthday parties.

The number of people allowed to gather in groups and the level of implementation has differed from country to country. During the months following the first wave, the Netherlands, Ukraine and the United Kingdom opted for groups of up to two people. Meanwhile, Malta and Uzbekistan adopted a policy for three people instead. Switzerland, Norway and Serbia were some of the countries that opted for five people. Some countries made exceptions for specific events. For example, the Netherlands allowed funerals of up to 30 people.     

Adjustments to these policies were made depending on the respective government’s assessment of the pandemic situation. For example, Norway changed from groups of five to groups of 20 after the first wave, whereas Malta changed from three people being allowed to gather in outdoor spaces, to four and then to six. As of June 30, 2020, all bans on gatherings were lifted in Malta; however, following the second wave in late August 2020, restrictions on gatherings in public spaces were once again reinstated to no more than 15 people.

Similarly, to the restrictions on mass gatherings, contact limitations were relaxed after the first wave and reinstated during the second wave. Since October, in Belgium for example, one is allowed to have one close contact outside the household and meet three other people outdoors. In Germany, one is allowed to meet with another household up to a maximum of 10 people. Lastly, since late November in Luxembourg, meeting with only two people outside the household (including children) is allowed.

A swift and localised response is essential in containing superspreading events

If an SSE occurs at a gathering, most countries across the European Region pursue similar containment strategies: re-introducing social distancing measures in the affected areas. An example from Germany will be used to illustrate this. Following the festivities of mid-February 2020, the city of Gangelt observed a superspreading event. Since the city is relatively small, with 12,597 inhabitants as of January 2020, the event helped better understand the mechanics of SARS-CoV2 spreading. By February 28, 2020, the town completely shut down, including the closing of schools, museums, theatres, and stores. PCR positive COVID-19 cases officially declined after a month of the shutdown, between the 7-day period of March 31-April 6, while observing a maximum of cases around March 13.  This example shows that a swift and localized response to SSE is key in containment. 

Thus, limits on mass gatherings and large community events remain an important component of COVID-19 infection prevention.

ASPHER COVID-19 Taskforce

Leo Gkekos, Carolina Díaz Luévano, Carlo Signorelli