Concerts and COVID: Can the rhythm continue?


Our world has changed. The pleasures we took for granted before the emergence of SARS-CoV-2 now require a risk assessment. The days and long nights of clubs and concerts are marred by fear of virus transmission and widely spread events. The so-called new adults, coming of age and coming out of the blockages of 2020 and 2021 may never have known the raw beat and emotions of live concerts that were an integral part of the fabric of social life in the pre-era. -COVID-19 era. But how risky are these big indoor events in terms of the transmission of the SARS-CoV-2 virus? Are precautions such as rapid antigen testing before the concert, wearing a mask and adequate ventilation sufficient to prevent transmission of the virus in situations where social distancing is not possible? How adherent are spectators wearing masks? What exactly is adequate ventilation and how important is it in reducing the risk of infection? How sensitive are rapid antigen tests up to 3 days before concerts as a tool for screening infected people? In The Lancet Infectious Diseases, Constance Delaugerre and her colleagues
1
  • Delaugerre C
  • Foissac F
  • Abdoul H
  • et al.
Prevention of the transmission of SARS-CoV-2 in a large indoor live gathering (SPRING): a controlled, randomized, non-inferiority trial.

take on the challenge of solving these puzzles, by comparing SARS-CoV-2 positivity rates (using RT-PCR saliva data on day 7 after the concert) in those who attended a large live concert on the 29th May 2021, in Paris and among non-participants. They assessed compliance with wearing a mask using an artificial intelligence tool. This is an ambitious, thoughtful and well-designed study and the authors address important practical questions that have major societal ramifications.

The results showed no significant increase in the risk of transmission of SARS-CoV-2 in participants compared to non-participants. Day 7 RT-PCR was positive for eight of 3917 participants (0.20%: 95% CI, 0.09-0.40) and three of 1947 non-participants (0.15% 0.03-0 45). Global mask adoption among spectators was estimated at 91.4%.

It is still not clear whether herd immunity to SARS-CoV-2 can be achieved, but high vaccination rates reduce the rate of transmission, the likelihood of infection, and the viral load among those infected. One-fifth of young adults participating in the SPRING trial had previously had symptoms of COVID-19 and therefore almost certainly developed a robust immunological response.
2
  • Jonsdottir HR
  • Bielecki M
  • Siegrist D
  • Bührer TW
  • Züst R
  • Deuel JW
SARS-CoV-2 neutralizing antibody titers are independent of symptoms of non-severe COVID-19 in young adults.

Although less than 10% of the participants had received two doses of the vaccine at the time of the concert, more than half had received at least one dose of the vaccine. The seroprevalence of virus neutralizing antibodies was not assessed in this trial, but some degree of herd protection can certainly be postulated since more than half of the population studied had received at least one dose of vaccination and one dose. fifth had previously suffered from COVID-19.

The infected cases were detected, before the concert, by means of rapid antigenic tests and not by PCR. Since rapid antigen testing has lower sensitivity (and specificity) than PCR, asymptomatically infected individuals are certainly underreported in this study, especially given the very low overall rate of infected individuals,
3
  • Dinnes J
  • Deeks JJ
  • Berhane S
  • et al.
Point-of-care rapid antigen and molecular tests for the diagnosis of SARS-CoV-2 infection.

and a bias in favor of asymptomatic infections with low viral loads in the exposed group cannot be ruled out due to the prevalent immunity and assumed low viral load to which they were exposed during the concert.

The masks work; they prevent direct person-to-person transmission associated with high infectious doses. They reduce the aerosolization of the SARS-CoV-2 virus and subsequent transmission to others. They protect even during the period of viral shedding 2-3 days before symptoms appear. Even in a crowded indoor event and in smaller enclosed environments,
4
  • Hendrix MJ
  • Walde C
  • Findley K
  • Trotman R
No apparent transmission of SARS-CoV-2 by two stylists after exposure at a hair salon with a universal face covering policy — Springfield, Missouri, May 2020.

Universal use of the mask has proven to be effective. During the Paris concert, the wearing of the mask was compulsory and supervised and a membership of more than 90% was confirmed. The use of an artificial intelligence tool to monitor masking compliance has been effectively used in airports,

5
  • Elachola H
  • Ebrahim SH
  • Gozzer E
COVID-19: Prevalence of Face Mask Use at International Airports in Asia, Europe and the Americas, March 2020.

and was also successful at the Paris concert and could be applicable to other indoor events. What if alcohol and other drugs were involved? Alcohol is a strong entactogen, and alcohol consumption can also lead to reduced mask compliance. As alcoholic drinks are prohibited during the PRINTEMPS concert, the strong wearing of a mask cannot be generalized to concerts serving alcoholic drinks.

The role of aerosol transmission in interior spaces is important. Wearing masks and keeping your distance will prevent inhalation of aerosols, but during events such as indoor concerts, social distancing is not possible and this is when ventilation systems are used. of paramount importance. In the SPRING study in Paris, optimal ventilation was available. Ventilation was provided by eight air handling units operating with 100% outside air and without recirculated air. All areas accessible to concert spectators were ventilated in the same way and ventilation was started 3 hours before the audience entered. This powerful system was designed for a full capacity concert of some 20,000 participants, more than four times the number actually present. The positive effect of such ventilation,
6
  • Tang JW
  • Marr LC
  • Li Y
  • SJ dancer
The Covid-19 has redefined airborne transmission.

and air quality cannot be underestimated, especially in the context of indoor concerts. Air replacement systems are essential for removing exhaled virus-laden particles. More research is needed in aerosol science and in creating better ventilation systems, and applying this research in the context of concerts and indoor environments will be a game-changer for such events.

As of May 2021, most SARS-CoV-2 infections in France were caused by the alpha variant. The delta variant is more transmissible and associated with higher viral densities. Would the results of the SPRING study be different now with delta dominance and circulation of highly transmissible variants of SARS-CoV-2? Hopefully not, as transmission barriers such as masks and ventilation will also protect against variants, and that bodes well for the concerts to continue. This study is hopeful, but caution is also in order. The SPRING concert represents an epidemiologically near optimal setting, involving mask warrants, the ban on alcoholic beverages, universal testing before the event and a study population of healthy young adults not prone to severe COVID-19 , as well as the circulation of a less transmissible. viral variant – all factors in favor of a low rate of transmission.

Further studies are needed to assess the effect of the most transmissible emerging variants in large gatherings and under real conditions. Event managers and policy makers must appreciate the power of ventilation in creating safe indoor environments to mitigate the transmission of SARS-VOC-2 as well as the transmission of other respiratory infections, whether it is emerging variants or influenza. Increasing vaccination rates in younger age groups, the use of proven mitigation measures including masks and ventilation systems, and agile adaptation to the results of evidence-based studies are paramount if indoor concerts are to resume safely. And the rhythm continues….
7
the whispers
And the rhythm continues.

We do not declare any competing interests.

The references

  1. 1.
    • Delaugerre C
    • Foissac F
    • Abdoul H
    • et al.

    Prevention of the transmission of SARS-CoV-2 in a large indoor live gathering (SPRING): a controlled, randomized, non-inferiority trial.

    Lancet Infect Dis. 2021; ()

  2. 2.
    • Jonsdottir HR
    • Bielecki M
    • Siegrist D
    • Bührer TW
    • Züst R
    • Deuel JW

    SARS-CoV-2 neutralizing antibody titers are independent of symptoms of non-severe COVID-19 in young adults.

    Virus. 2021; 13: 284

  3. 3.
    • Dinnes J
    • Deeks JJ
    • Berhane S
    • et al.

    Point-of-care rapid antigen and molecular tests for the diagnosis of SARS-CoV-2 infection.

    Cochrane Database System Rev. 2021; 3CD013705

  4. 4.
    • Hendrix MJ
    • Walde C
    • Findley K
    • Trotman R

    No apparent transmission of SARS-CoV-2 by two stylists after exposure at a hair salon with a universal face covering policy — Springfield, Missouri, May 2020.

    MMWR Morb Mortal Wkly Rep. 2020; ()

  5. 5.
    • Elachola H
    • Ebrahim SH
    • Gozzer E

    COVID-19: Prevalence of Face Mask Use at International Airports in Asia, Europe and the Americas, March 2020.

    Travel Med Infect Dis. 2020; 35101637

  6. 6.
    • Tang JW
    • Marr LC
    • Li Y
    • SJ dancer

    The Covid-19 has redefined airborne transmission.

    BMJ. 2021; 373: n913

  7. 7.

    And the rhythm continues.

    The sound of Los Angeles records,
    Los Angeles, CA1979

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