The protection concept at a glance
Sports and cultural events play a special role in the context of the pandemic, as large numbers of people come together here in indoor and outdoor areas. The B-FAST network is devoting a separate consideration to this area within the framework of the "Risk Areas" working group in order to provide solution approaches and concepts that also enable the breaking of infection chains in these contexts. Together with other university locations, comprehensive solution concepts for the cultural sector are to be developed. The information presented in the following sections focuses on the scientific activities of the University Medical Centre Mannheim in this area.
Even if, outside of the lockdown phases, events were sometimes possible on a smaller scale locally due to legal relaxations, the observance of minimum distances, capacity reductions, the wearing of effective mouth-nose coverings and the application of hygiene concepts, this is by no means the case for the majority of organisers in the cultural sector.
Large festivals, concerts with a free choice of seats without seating and especially clubs or venues that are not open-air can only hold events under strict conditions. Organisers in these areas must calculate with regard to the economic viability of their events either with full capacity or at least a 60% occupancy of their venue in order to reach the economic break-even point.
So, every ticket buyer counts. Under the restrictions mentioned above, most events are neither feasible nor economically viable.
The problem with the Corona pandemic is that more than half of all COVID-19 cases are asymptomatic, in which the affected persons unknowingly spread viruses for several days. Concepts around preventive testing at events can help to make events safe again. The "Safe Cultural Events" concept provides for variably scalable measures that can be adapted to local pandemic events.
In order to gain knowledge as quickly as possible, various acceptance modalities are tested during cultural events, among other things, and aerosol and droplet exposure are assessed on a situation-specific basis.
The implementation of a standardised and adaptable process of surveillance at cultural events as well as risk management of selected cultural reference situations has proven to be possible. In addition, recommendations for action such as admission procedures and control of visitor flows can be made for large events.
The focus of the investigations of the B-FAST risk area of cultural events and of central importance are the preventive tests of event visitors. A prominent test procedure is the detection of viruses or viral material from saliva or by means of a nasopharyngeal swab. The classic swab test using a swab from the nasopharynx, but also the established testing using saliva or gargle water are equivalent when it comes to detecting the infection potential of a possibly infected person.
One test method for this is RT-PCR, in which the presence of viral genetic material is detected via an amplification process. This method can detect viruses early in their multiplication and is thus very sensitive, but correspondingly complex and requires a processing time of several hours. Despite the advantage of being able to identify persons who could later become infectious the earliest of all methods, this method has the disadvantages of imperfect sensitivity and imperfect specificity.
Antigen tests, on the other hand, use biological antibodies that bind to proteins on the surface of the virus. While the sensitivity of this method is lower than that of RT-PCR, performing inexpensive antigen tests provides a result after only 15 minutes, making them useful when combined with different measures in a targeted manner. A negative same-day antigen test and consistent wearing of effective mouth-nose covering is associated with a very low risk of spreading infection.
Tests that have already been successfully carried out at cultural events are described in the following sections.
Safe implementation of cultural events during the pandemic
B-FAST experts are currently working on the concept "Safe Cultural Events", a knowledge-based protection concept for events in indoor spaces, which defines the wearing of effective mouth-nose protection and the proof of a negative high-quality test (at least a rapid antigen test) as the basis.
The risk of infection is further reduced by a pre-event questionnaire that verifies the absence of symptoms and assures that there was a low risk of infection in the days before the event. The questionnaire also generates a risk classification and derives appropriate recommendations. These clusters can be used for guests at events, as well as for venue staff and artists.
Online health questionnaire
At the Frankfurt Book Fair from 14-18 October 2020, an online health questionnaire was used for self-declaration on COVID-19. This was used to record whether visitors had been in a risk area in the past 14 days, whether there had been risk contact with an infected person who had been tested positive or even whether the person had been diagnosed with an infection themselves. In addition, various symptoms were queried.
Admission to the fairgrounds was only permitted if the answers to the questions were deemed not to pose a risk in the sense of the local health authority. The questionnaire was offered and completed digitally. The associated ticket was automatically blocked for the electronic access control in case of an entry that did not authorise access.
Use of rapid antigen tests at cultural events
In the context of a cultural event on 31.10.2020, rapid antigen tests were tested for the first time. For this purpose, the venue was seated with a safety distance, masks were mandatory and certain hygiene rules applied. Visitors filled out a health questionnaire and could perform an antigen test on site after booking a timeslot online. For this purpose, a test lane was set up at the event location with two smear booths where medical professionals took a sample in the form of a throat swab. The test result was delivered by email or SMS.
If the result was negative and the questionnaire was included, admission could be granted with minimal residual risk of infection.
Project overview: Outdoor events
The test concept for large sporting events still needs to be tested.
DFL study: Concepts for football stadiums
The study by the German Football League (DFL) aims to validate the comprehensive hygiene concept for football clubs developed by the DFB and DFL.
The study design provides for visitors to generate a sample before the game using throat gargle water, which is obtained in the same way as a conventional throat swab and analysed in the laboratory using RT-PCR. In addition, an online health questionnaire will be completed to estimate the pre-test probability.
The next step in the study is for the visitors to fill out the questionnaire again after six days or after the onset of symptoms typical of COVID-19 and to give another gargle sample (test kit). If the sample tests positive, the retrospective cluster strategy will be used for contact tracing.
Contact tracing in the stadium
With the help of the complete list of participants and the seating plan of the stadium, contact persons of the index case can be identified. The evidence-based study is intended to prove the effectiveness of the hygiene concepts initiated by the DFL.
The implementation of a standardised and adaptable process of surveillance at cultural events as well as risk management of selected cultural reference situations has proven to be possible. In addition, recommendations for action such as admission procedures and management of visitor flows can be made for large events.