Preparedness for containing COVID-19 outbreak in mass religious gathering with non-pharmaceutical interventions (NPIs)

Chen-Yang Hsu; Ya-Mei Chen; Chiu-Wen Su; Mei-Sheng Ku; Yeol Kim; Tim Jensen; Dih-Ling Luh

doi:10.1016/j.jfma.2021.04.017

Preparedness for containing COVID-19 outbreak in mass religious gathering with non-pharmaceutical interventions (NPIs)

J Formos Med Assoc. 2021 Jun:120 Suppl 1:S57-S68. doi: 10.1016/j.jfma.2021.04.017. Epub 2021 Jun 3.

Authors

Chen-Yang Hsu¹, Ya-Mei Chen², Chiu-Wen Su³, Mei-Sheng Ku⁴, Yeol Kim⁵, Tim Jensen⁶, Dih-Ling Luh⁷

Affiliations

¹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Daichung Hospital, Miaoli, Taiwan.
² Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ Institute of Environmental and Occupational Health Science, College of Public Health, National Taiwan University, Taipei, Taiwan.
⁵ National Cancer Control Institute, National Cancer Center, Goyang, South Korea.
⁶ Department of Teaching of the Study of Religions, University of Southern Denmark, Denmark.
⁷ Department of Public Health, Chung Shan Medical University, Taichung, Taiwan. Electronic address: luh@csmu.edu.tw.

Abstract

Background: The COVID-19 outbreaks associated with mass religious gatherings which have the potential of invoking epidemics at large scale have been a great concern. This study aimed to evaluate the risk of outbreak in mass religious gathering and further to assess the preparedness of non-pharmaceutical interventions (NPIs) for preventing COVID-19 outbreak in this context.

Methods: The risk of COVID-19 outbreak in mass religious gathering was evaluated by using secondary COVID-19 cases and reproductive numbers. The preparedness of a series of NPIs for preventing COVID-19 outbreak in mass religious gathering was then assessed by using a density-dependent model. This approach was first illustrated by the Mazu Pilgrimage in Taiwan and validated by using the COVID-19 outbreak in the Shincheonji Church of Jesus (SCJ) religious gathering in South Korea.

Results: Through the strict implementation of 80% NPIs in the Mazu Pilgrimage, the number of secondary cases can be substantially reduced from 1508 (95% CI: 900-2176) to 294 (95% CI: 169-420) with the reproductive number (R) significantly below one (0.54, 95% CI: 0.31-0.78), indicating an effective containment of outbreak. The expected number of secondary COVID-19 cases in the SCJ gathering was estimated as 232 (basic reproductive number (R₀) = 6.02) and 579 (R₀ = 2.50) for the first and second outbreak, respectively, with a total expected cases (833) close to the observed data on high infection of COVID-19 cases (887, R₀ = 3.00).

Conclusion: We provided the evidence on the preparedness of NPIs for preventing COVID-19 outbreak in the context of mass religious gathering by using a density-dependent model.

Keywords: COVID-19; Mass gathering; Non-pharmaceutical intervention; Religious activity.

MeSH terms

COVID-19* / prevention & control
Communicable Disease Control / methods*
Crowding*
Disease Outbreaks* / prevention & control
Humans
Religion
Republic of Korea / epidemiology
SARS-CoV-2
Taiwan / epidemiology