How large does a meeting or event need to be in order to be a “mass gathering”?
High profile international sporting events such as the Olympics or World Cups as well as international religious events such as the Hajj count as mass gatherings. However, lower profile conferences and events can also meet WHO’s definition of a mass gathering. An event counts as a “mass gatherings” if the number of people it brings together is so large that it has the potential to strain the planning and response resources of the health system in the community where it takes place. You need to consider the location and duration of the event as well as the number of participants. For example, if the event takes place over several days in a small island state where the capacity of the health system is quite limited then even an event with just a few thousand participants could place a big strain on the health system and then be considered a “mass gathering” event. Conversely, if the event is held in a big city in a country with a large, well-resourced health system and lasts just a few hours, the event may not constitute a “mass gathering” event.
Does WHO recommend that all international mass gatherings be cancelled because of COVID-19?
No. As each international mass gathering is different, the factors to consider when determining if the event should be cancelled may also differ. Any decision to change a planned international gathering should be based on a careful assessment of the risks and how they can be managed, and the level of event planning. The assessment should involve all stakeholders in the event, and in particular the health authorities in the country or community where the event is due to take place. These authorities and stakeholders are in the best position to assess the level of stress the event might place on the local health system and emergency services – and whether this level of stress is acceptable in the current situation.
It is WHO’s view that all countries with community transmission should seriously consider postponing or reducing mass gatherings that bring people together and have the potential to amplify disease and support the recommended best practice of physical distancing. Any decision will be supported through the use of WHO tools, in particular the Risk Assessment for Mass Gatherings during COVID-19.
If movement restrictions and further national measures have been established in the country, the WHO RA does not apply. However, when the process of re-opening/conducting mass gatherings is being considered post movement restrictions, it will be key to ensure any decisions are based on a risk assessment, such as the WHO Mass gatherings COVID-19 risk assessment.
What factors should organizers and health authorities look at when assessing whether the risks are acceptable or not?
For countries not currently known to be experiencing community transmission of COVID-19, the priority consideration will be whether the planned mass gathering event substantially increases the risk of the virus entering the country and becoming established, as well as the risk for participants to importing infection back to their home country and further increasing global spread. In making this assessment, the organizers and their national or local health authorities should recognize that the risk of imported cases of COVID-19 is naturally linked to international travel. They should also recognize that it is neither realistic or desirable to aim for zero risk. When organizers and health authorities are determining whether to hold a mass gathering, they should determine what is an acceptable risk and what additional measures should be implemented to mitigate the risks.
For countries where COVID-19 has already started to spread in the community, key consideration will be:
- aiming at containing or at least slowing down the spread of the virus in the local community/country.
- preventing participants from other countries being infected with COVID-19
In each case the risk should be considered in the context of the known features of COVID-19, its severity, its transmissibility and the effectiveness of measures to prevent or reduce transmission. The strain already placed on the local health system in responding to COVID-19 outbreak(s), and the additional strain the mass gathering might place on the system also need to be taken into account.
You can find more advice on what to look at in the WHO document Key planning recommendations for Mass Gatherings in the context of the current COVID-19 outbreak of 14 February 2020. See: https://www.who.int/publications-detail/key-planning-recommendations-for-mass-gatherings-in-the-context-of-the-current-covid-19-outbreak
What if my organization does not have the expertise to assess the risks COVID-19 poses for our planned mass gathering?
The national and local public health authorities in the country where you plan to hold the mass gathering will most likely know how to conduct a health risk assessment. If there is a WHO Country Office there they may also be able to provide some expert support. So too might the WHO Regional Office in your part of the world. You can find the names and contact details of the WHO Regional Offices at https://www.who.int/about/who-we-are/regional-offices
If we go ahead with an international mass gathering, what can we do to reduce the risk of participants catching COVID-19?
Promote hand washing, respiratory hygiene and social distancing at the event. Make sure you have emergency contact details for all participants, including where they are staying during the event. You should make it clear to them that this information will be shared with the local public health authorities to enable rapid contact tracing if a participant at the event becomes ill with COVID-19. The event organisers need to have an agreed preparedness plan in case one or more participants become ill with COVID-19 symptoms. This should include rapid isolation of the ill person and their safe transfer to a local health facility. You should consider whether the number of participants at the event could be reduced, making available participation by video or teleconference and possibly screening participants for COVID-19 symptoms (cough, fever, malaise) at points of entry to the venue. You can find advice on how individual participants can protect themselves and their loved ones from COVID-19 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
Where can I find more advice on assessing and managing health risks around international mass gatherings?
WHO has produced guidance and also a training course on how to plan for a mass gathering. The guidance and the course both look at how to conduct a risk assessment, plan for and manage health risks in partnership with the local authorities: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/points-of-entry-and-mass-gatherings You can find advice to give individual participants on how to protect themselves and their loved ones from COVID-19 at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public
What should be the criteria for excluding an athlete or other accredited participant from competing?
Agreed health criteria are needed for the exclusion of athletes from competing and for allowing them to return to competition wherever appropriate. These should be consistent with public health guidelines for the general population, with risk profiles based on recent travel to high-risk community transmission zones, recent contact with individuals diagnosed with or suspected of having COVID-19, current symptomatology, etc. Athletes who are feeling unwell should not participate in events.
If testing of athletes has been agreed with the local public health service there is a need to consider test availability, time taken for receipt of test results and host-country health services capacity.
Criteria for exclusion of officials/judges from competition and for allowing them to return to competition where appropriate should follow guidance and criteria for the workplace.
Requirements for the attendance of all athletes and other accredited participants should be put in place:
– health check: travel declaration and temperature screening
– contact tracing protocols ready (with all details of those present)
– allowing extra spacing (physical distancing)
– following all hygiene precautions.
Isolation procedures for athletes and other accredited participants (e.g. field-of-play staff, medical teams, officials who have close contact with the athletes) who feel unwell or become symptomatic should be clear and documented and rehearsed prior to holding the event, especially for higher risk sports, e.g. contact sports.
Should event organizers arrange screening at venues beyond national government requirements for point of entry (PoE)?
Temperature screening alone, at exit or entry, is not an effective way to stop international spread, since infected individuals may be in incubation period, may not express apparent symptoms early on in the course of the disease, or may dissimulate fever through the use of antipyretics; in addition, such measures require substantial investments for what may bear little benefits. It is more effective to provide prevention recommendation messages to travellers and to collect health declarations at arrival, with travellers’ contact details, to allow for a proper risk assessment and a possible contact tracing of incoming travellers.
Event organizers should also consider the capacity to undertake this and the management of suspected cases. However, sporting organizations may have criteria for participation that are stricter than government requirements for Ports of Entry into the country that are based on event risk assessment, including organizers' healthcare capacity.
Any additional screening questionnaires for participation in events need to be aligned with public health agencies in the jurisdiction. There is a need to consider how to manage different groups – athletes, officials and spectators, and the large numbers of individuals likely to arrive at a sporting event from many oversea countries – and to follow both host country and WHO travel advice and to assess whether there is difficulty in obtaining accurate information about the travel history of those individuals.
Should event organizers provide COVID-19 testing?
No, testing should be conducted in accordance with local health providers and national guidance. Anyone unwell or symptomatic should not be allowed to participate in the event. Establish close collaboration with local public health authorities well before the event, to facilitate testing for athletes, officials or spectators who meet pre-agreed suspect cases definitions.
Consider host-country health service capacity to manage any COVID-19 activity, and other public health issues happening at the event over and above its own national pandemic response.
Are there additional safeguards event organizers can implement or recommend to athletes/officials/visitors in the context of COVID-19?
Follow standard preventative advice to the general public, including physical distancing, in the athletes’ village.
Also promote:
- signage, digital messaging to all participants and their entourages about COVID-19 and how to prevent infection
- regular disinfection and cleaning of surfaces, in venues and in personal spaces
- non-sharing of equipment and cleaning of equipment after each user.
Organizers are recommended to develop a checklist (include hand gels stations, hygiene facilities, etc.). See the event mitigation recommendations checklist for event organizers above.
What are the risks arising from public transport to the venue(s)?
The extra risk from participants and spectators travelling on public transport in a major city may not be significant compared to the ongoing risk to the local population using the transport all the time if physical distancing is not possible on public transport.
