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      Healthcare Policies, Precautionary Measures and Outcomes of Mass Gathering Events in the Era of COVID-19 Pandemic: Expedited Review

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          Abstract

          With the onset of the COVID-19 pandemic in early 2020, several countries suspended or restricted mass gathering (MG) events to mitigate the risk of superspreading events. Prohibiting MGs aimed to lessen the likelihood of highly infectious persons coming into close contact with many others. Now that the world has opened its doors wide and removed most of precautionary measures, many questions arise. In this review, we aimed to summarize the current evidence regarding the policies and regulations that were implemented for the safe return of MG events. Besides, we highlighted the impact of the return of MG events during 2021 on the trajectory of COVID-19 spread. Canceling MG events can carry religious, societal, economic, and public negative consequences necessitating the safe return of these events. The experience with the COVID-19 pandemic was the foundation for the recommendations for the safe conduction of MG events during the pandemic by international public health bodies. When policymakers adequately applied precautionary measures and strategic approaches, we witnessed the safe holding of huge MG events without aggravating the COVID-19 situation or increasing the number of new cases beyond the capacity and readiness of the national healthcare system.

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          High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020

          On March 17, 2020, a member of a Skagit County, Washington, choir informed Skagit County Public Health (SCPH) that several members of the 122-member choir had become ill. Three persons, two from Skagit County and one from another area, had test results positive for SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Another 25 persons had compatible symptoms. SCPH obtained the choir's member list and began an investigation on March 18. Among 61 persons who attended a March 10 choir practice at which one person was known to be symptomatic, 53 cases were identified, including 33 confirmed and 20 probable cases (secondary attack rates of 53.3% among confirmed cases and 86.7% among all cases). Three of the 53 persons who became ill were hospitalized (5.7%), and two died (3.7%). The 2.5-hour singing practice provided several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization (1). Certain persons, known as superemitters, who release more aerosol particles during speech than do their peers, might have contributed to this and previously reported COVID-19 superspreading events (2-5). These data demonstrate the high transmissibility of SARS-CoV-2 and the possibility of superemitters contributing to broad transmission in certain unique activities and circumstances. It is recommended that persons avoid face-to-face contact with others, not gather in groups, avoid crowded places, maintain physical distancing of at least 6 feet to reduce transmission, and wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.
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            Spread of a novel influenza A (H1N1) virus via global airline transportation.

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                Author and article information

                Journal
                J Infect Public Health
                J Infect Public Health
                Journal of Infection and Public Health
                The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.
                1876-0341
                1876-035X
                28 March 2023
                28 March 2023
                Affiliations
                [a ]Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
                [b ]Department of Emergency Medicine, College of Medicine, King Saud University, Saudi Arabia
                [c ]Global Centre of Mass Gatherings Medicine, Family Medicine, Primary Health Centre, Ministry of Health, Riyadh, Saudi Arabia
                [d ]Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
                [e ]Global Centre for Mass Gatherings Medicine, Ministry of Health, Saudi Arabia
                [f ]Deputyship of Public Health, Ministry of Health, Riyadh, Saudi Arabia
                Author notes
                [* ]Corresponding author.
                [1]

                https://orcid.org/0000–0003-0096–1314

                [2]

                https://orcid.org/0000–0001-5075–7392

                [3]

                https://orcid.org/0000–0002-7336–162X

                [4]

                https://orcid.org/0000–0001-6483–0028

                Article
                S1876-0341(23)00106-5
                10.1016/j.jiph.2023.03.026
                10049799
                37059635
                e2bd0a42-d752-4c80-8d0d-634a54336db3
                © 2023 The Authors. Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 5 January 2023
                : 14 March 2023
                : 23 March 2023
                Categories
                Article

                health security,mass gatherings,public health emergency,public health preparedness,pandemic,covid-19

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