California Department of Public Health: Mass Gatherings Guidance on Novel Coronavirus or COVID-19

TO: Public Event Organizers
FROM: California Department of Public Health
DATE: March 7, 2020
SUBJECT: Mass Gatherings Guidance on Novel Coronavirus or COVID-19

This guidance is based on what is currently known about the transmission and severity of coronavirus disease 2019 (COVID-19). The California Department of Public Health (CDPH) will update this guidance as needed and as additional information becomes available.

Background
COVID-19 is a respiratory illness caused by a novel virus that has been spreading worldwide. Community-acquired cases have now been confirmed in California. We are gaining more understanding of COVID-19’s epidemiology, clinical course, immunogenicity, and other factors as time progresses, and the situation is changing daily.

CDPH is in the process of monitoring COVID-19, conducting testing with local and federal partners, and providing guidance and resources to prevent, detect and respond to the occurrence of COVID-19 cases in California.

At this time, community transmission of COVID-19 has occurred in California. Public event organizers should prepare for possible impacts of COVID-19 and take precautions to prevent the spread of COVID-19 as well as other infectious diseases, including influenza and gastroenteritis.

Illness Severity
The complete clinical picture with regard to COVID-19 is not fully understood. Reported illnesses have ranged from mild to severe, including illness resulting in death. Older people and people with certain underlying health conditions like heart disease, lung disease and diabetes, for example, seem to be at greater risk of serious illness.

Context
Mass gatherings and large community events bring people from multiple communities into close contact with each other and have the potential to increase COVID-19 transmission. One method to slow the spread of respiratory virus infections, including COVID-19, is by increasing social distancing (reduce close contact).

[Mass gatherings are events, including religious services, where large numbers of people are within an arm’s length of one another. They do not include typical office environments or stores.]

The goals of this guidance are:
(1) to protect people attending and working at the event and the local community from COVID-19 infection; and (2) to reduce community transmission and introductions of COVID-19 into new communities.

Below CDPH outlines two (2) scenarios that should be considered by event
organizers.

Scenario I: CDPH recommends for mass gatherings and large community events in counties without evidence of community transmission, organizers should follow these steps:

• As the COVID-19 situation is evolving, event organizers should create an
emergency contingency plan for how to modify, cancel, or postpone their mass gathering or large community event if a COVID-19 outbreak occurs in their community.

• Events may still need to be modified, canceled, or postponed if participants are traveling from communities with COVID-19 outbreaks.

• Event organizers should:
>> Collaborate and coordinate with community partners including the local
public health department, hotels where participants are staying, airlines, the event venue, and other partners.

>> Use event messaging and communications to promote everyday preventive health messages to your participants and staff, which include:

▪ Stay home when you are sick, except to get medical care.

▪ Cover your coughs and sneezes with a tissue or sleeve, then throw
the tissue in the trash.

▪ Wash your hands often with soap and water for at least 20 seconds,
especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing.

▪ Avoid touching your eyes, nose, and mouth with unwashed hands.

▪ Clean frequently touched surfaces and objects daily.

▪ Recommend that participants minimize close contact (e.g., recommending no hand shaking or hugging)

• Promote messages that discourage people who are sick from attending events. Create refund policies or remote participation capability such as live stream that permit participants the flexibility to stay home when they are sick, need to care for sick household members, or are at high risk for complications from COVID-19.

• Provide COVID-19 prevention supplies at your events, to the extent supplies are available. Plan to have extra supplies on hand for event staff and participants, including sinks with soap, hand sanitizers, and tissues. Promote proper and frequent hand hygiene.

• Isolate staff or participants in a designated space who become ill with symptoms consistent with COVID-19 at the event and provide a clean disposable procedure facemask, to the extent available, to wear for those who become ill. It is not necessary to distribute masks to healthy participants.

• Implement a strategy to prevent the theft of prevention supplies.

• CDPH does not recommend cancelation of community events at this time if no COVID-19 cases exist within the community.

Scenario II: CDPH recommends for mass gatherings and large community events in counties with evidence of community transmission, organizers should follow these steps:

• Event organizers should:

>> Anticipate that some non-essential events may need to be modified (e.g.,
conducted as a video webinar), canceled, or postponed.

>> Consider canceling non-essential events primarily for or attended by older adults and people with chronic medical conditions at higher risk for severe illness.

>> Stay informed about the local COVID-19 situation. Get up-to-date information about COVID-19 activity in California on the California Department of Public Health web page.

Current evidence indicates that the risk of severe illness increases with age. The median age of reported cases has been 59 years and the median age of critically ill cases has been 66 years. People with underlying medical problems, including cardiovascular disease, diabetes, cancer, chronic lung disease, and immunosuppression, are also likely at higher risk for severe illness.

>> Discuss event details with local health officials and prepare to implement an emergency contingency plan based on their specific guidance.

>> Collaborate and coordinate with event and community partners including the local public health department, hotels where participants are staying, airlines, the event venue, and other partners.

>> Use event messaging and communications to provide COVID-19 updates
and to promote everyday preventive health messages to your participants
and staff.

• If a mass gathering or large community event does take place, in addition to basic prevention messages, CDPH recommends that event organizers should:

Instruct any participants or event staff to not attend if they have any respiratory symptoms (cough or runny nose) or fever regardless of the presumed cause.

>>Remind participants and staff to not attend if they have travelled within the past 14 days to an area identified by the CDC as having a Level 3 Travel Health Notice due to COVID-19.

>> Recommend that participants and staff at higher risk of severe illness not attend.

>> Ensure that event venues are well ventilated and are adequately equipped with facilities for hand washing and supplies including hand sanitizer that contains at least 60% alcohol, tissues, and trash baskets.

>> Increase the frequency of cleaning commonly used areas with detergent
and water followed by a disinfectant that is EPA-approved for emerging viral pathogens.

List N: Disinfectants for Use Against SARS-CoV-2

>> Encourage participants to minimize close contact (e.g., recommend no
hand shaking or hugging).

>>Maintain a registration list of participants and staff; this will significantly
assist local public health in contact tracing in the event a COVID-19 case should later be identified as having attended the event.

>>Promote messages that discourage people who are sick from attending events. Create refund policies that permit participants the flexibility to stay
home when they are sick, need to care for sick household members, or are at high risk for complications from COVID-19.

>> Isolate staff or participants in a designated space who become ill with symptoms consistent with COVID-19 at the event and provide a clean disposable procedure facemask to wear for those who may become ill. It is not necessary to distribute masks to healthy participants. Establish procedures to help sick participants or staff leave the event as soon as possible without use of public transportation, shared rides, or taxis.

>> Provide alternative options for attending the event via phone, video, or web applications.