Original Title: Efectividad de las medidas de cierre o restricción de aforos en espacios destinados a ceremonias y culto, en el contexto de la pandemia por SARS-CoV-2

Authors' objectives: The objectives of this report are to identify, critically evaluate and synthesize the available scientific evidence on the effectiveness of slowing down the evolution of the SARS-CoV-2 pandemic in the population and reducing its possible consequences on people and health systems by means of 1) closing, or 2) restricting the occupancy of any type of space (closed or open) used for ceremonial or religious purposes.

Authors' results and conclusions: Seven publications corresponding to 5 studies were included, since three publications coincided in describing, in an almost identical way, the effects of the implementation of a capacity restriction policy, accompanied by an additional set of preventive measures to celebrate the pilgrimage to La Mecca. The following outcomes correspond to the most relevant results of the included studies. Hsiang, through an ecological study, reports that the effect size obtained for the reduction of infection rates associated with the closure of religious activities could only be evaluated in Korea and the United States of America, with results of different signs. While in Korea the infection rate fell –0.30, but with a very wide confidence interval (–0.60, –0.01), and a daily growth percentage of -26.21%; in the United States of America the effect was almost nil, 0.01 (–0.03, 0.05), with a daily growth percentage of 0.80%. Chang et al, using simulation models, in the context of another ecological study, suggests that in order to reduce the incidence of COVID19, restricting the capacity above 20% is more effective than reducing mobility globally, given that the majority of infections occur in a limited number of establishments that allow policies to restrict access and redistribution of visits; identifying places of worship and restaurants as responsible for the highest rates of infection; due to the density of visits and the length of stay. Benzell et al, through another ecological study, propose a chronological ordering to guide the reopening of different types of facilities, from a social perspective, attending to an integrated model that considers the dynamic epidemiological situation, the real mobility of the population, the preferences of citizens, and economic aspects, in the following order, provided that the epidemiological situation allows it: first, banks, dental clinics, universities, places of worship, among others.

Authors' recommendations: Conclusions The scientific knowledge identified for the preparation of this report was obtained, analyzed and interpreted during the first and second pandemic waves; in conditions very different from the current ones, characterized, in Spain, by high and increasing vaccination coverage rates, and low and decreasing rates of incidence, hospital occupancy and deaths. None of the studies included in this report were specifically designed to evaluate the effect of closing or opening with restricted capacity religious establishments and / or ceremonial activities. All of them were devoted to assess a broad set of NPIs, allowing the extraction of data relative to the effect related to religious activities. No valid original studies have been identified for this report that provide information on the effects of closing or opening with limited capacity for wedding, funeral, academic ceremonies, etc. The availability of valid studies, evaluating the specific effects of the closure of religious and / or ceremonial facilities of interest for this report, during the early stages of the SARS-COV-2 pandemic, has been severely limited by the inability of the existing international NPIs databases to provide appropriate information focused on these types of facilities. There is very scant (one study) and low-quality evidence that provides inconsistent information (different sign) on the effect of closing religious facilities on the incidence of COVID-19. There is evidence from three studies, of low quality, that suggests that the reduction of capacity in the facilities with the highest risk, among which were religious organizations, substantially reduced the risk of transmission of the virus, without requiring drastic reductions of general mobility; provided that the reopening and the restriction of capacity is accompanied by the use of a mask and distancing. It is still necessary to have independent research with clear protocols on the effectiveness of NPIs consisting of opening with capacity restrictions in the current epidemiological scenario. As a recommendation supported by the previous conclusions, in the Spanish context, characterized by a high vaccination coverage rate, preventive measures in the face of new outbreaks, could be made more flexible accordingly with the epidemiological scenario and the situation of the health services. To ensure that the risk of transmission in religious or ceremonial events held in closed spaces with prolonged permanence is kept low, it is advisable to restrict capacity and reduce exposures to unprotected situations (without a mask); ensuring adequate ventilation, as well as maintaining interpersonal distance.

Authors' methods: A systematic review of the available scientific literature has been carried out, including previous systematic reviews, primary studies (clinical trial; quasi-experimental (before-after) studies; observational cohort studies; time series; case-control studies; descriptive studies; modeling studies and natural experiments), and other documents from official organizations published in English and Spanish in the period 2020-2021. The primary outcome measures selected are the incidence rate of SARS-CoV-2 cases with any time frame; changes in the value of the effective reproduction number (Rt); the risk ratios (RR) for Rt between different NPIs; and the mortality rate attributed to SARS-COV-2.

Project Status: Completed

Year Published: 2021

URL for published report: https://sescs.es/efectividad-de-las-medidas-de-cierre-o-restriccion-de-aforos-en-espacios-destinados-a-ceremonias-y-culto-en-el-contexto-de-la-pandemia-por-sars-cov-2/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es