A cautious approach should be taken to lifting Covid-19 restrictions at mass gatherings, the State’s health watchdog has advised.

Any easing should take consideration of infection levels in the community, levels of vaccination coverage, the risk posed by circulating variants of concern, and the capacity of the healthcare system, the Health Information and Quality Authority says.

Based on an analysis of international studies, it says implementing a broad range of public health measures can reduce, but not eliminate, the risk of transmission of the SARS-CoV-2 virus that causes Covid-19.

Hospital Report

A review of public health guidance from 22 countries and two international agencies found that all countries examined had begun to ease restrictions on mass gatherings, according to the advice provided to the National Public Health Emergency Team. However, the speed and triggers to easing restrictions varied considerably.

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Twelve of the 22 countries are undertaking, or plan to carry out, pre-event testing. This varies in timing from seven days prior to the event to onsite testing; in test type, from antigen to PCR; and in relation to antigen testing, some countries are allowing self-testing while others says it must be done by the event provider.

“Not every mass gathering carries the same risk,” Dr Máirín Ryan, Hiqa deputy chief executve said. “While no event is risk-free, high occupancy, indoor events with reduced use of facemasks, prolonged contact and poor ventilation pose the highest risk of transmission.

“In the first instance, any organised gathering should ideally involve shorter duration, outdoor seated events, with significantly reduced capacity.”

When planning events, risk assessments should be conducted in advance and public health measures such as physical distancing, mask use, adequate ventilation and hand hygiene should be implemented, she advised. “These measures should also be encouraged when considering shared transportation and socialisation, before and after the event.”

Austria, Denmark, Czech Republic, France, the Netherlands and Portugal require attendees to prove they are fully vaccinated, have immunity through infection or have a recent negative test in order to access events.

Another six countries - Belgium, Germany, Italy, Norway, Sweden, and Switzerland - have plans to introduce similar health certification over the coming months, while England is currently piloting this process.

‘Green pass’

In contrast, Israel, which had led the world on vaccination, has cancelled its "green pass" requirement due to low infection rates. There is now unrestricted access to all establishments and sectors there, without any certification requirements.

Among countries carrying out pre-event testing, PCR or antigen tests are specified by Austria, Czech Republic, France, Italy, Norway and Switzerland. PCR tests only are specified by Belgium, Denmark and Portugal, while, antigen tests only are specified by England, Germany and the Netherlands.

While restrictions on mass gatherings are set to be removed over the summer in many countries, Denmark, the Netherlands and Sweden will only lift them when certain targets or indicators have been met.

Out of studies into 11 real-world events ranging from festivals to protest rallies and business conferences, positive cases were detected afterwards in four of the studies. Ten of the 11 events took place outdoors, in indoors with specified minimum levels of ventilation.

“The avoidance of mass gatherings in indoor, crowded and poorly ventilated settings was felt to be crucial to prevent superspreading events,” according to the expert group advising Hiqa. “Particular concerns were raised about holding mass gathering events in such settings without face masks and physical distancing.

“A clear preference was stated, in the first instance, for outdoor, seated events, involving relatively small numbers, and for a short period of time, with no eating or drinking permitted.

“Thereafter, an incremental, step-wise approach to easing restrictions was suggested as a means to enable mass gatherings to recommence safely in all settings, while population vaccination coverage increases,” it said.

Using vaccination or immunity status as a requirement for accessing mass gatherings could result in legal challenges, the group said. While proof of vaccination was viewed as a potential incentive for young people to get immunised, there would also have to be a testing option.