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Effectiveness of public health measures and strategies to reduce risk of spread of respiratory pathogens at sporting mass gatherings: systematic literature review[1]

Mullen L, Kobokovich Mui A, Watson C, Heymann D, McCloskey B, Hughes G, Bonell C · 2026 · Front Public Health

Summary

Systematic review (LSHTM / Johns Hopkins Center for Health Security; 12 sources searched to July 2025; CRD42023433619) of public health interventions against respiratory pathogen spread at sporting mass gatherings: 34 articles covering 37 events, Olympics most studied (n=10). Nearly all events used multi-layered packages — bubbles, routine testing, entry screening, masking, distancing, isolation/quarantine. Against the authors' effectiveness framework, 23 articles described effective packages, 3 non-effective, 6 indeterminate. Feasibility strained at high-spectator events (scalability); acceptability tracked with perceived work burden, compliance, and stakeholder engagement. First comprehensive map of pre-pandemic and pandemic-era sporting-MG planning.

So what

The rare EFFECTIVENESS synthesis in a field that mostly catalogues interventions: layered packages generally worked (23/34 effective), but the feasibility finding is the planning gold — bubble-style controls that succeeded for athletes do not scale to spectator populations, which is exactly the gap FIFA 2026 / LA28 planners must design around. Pairs with the Purple Guide pandemic chapter, Falender's wastewater layer, and the Memish surveillance lineage as the respiratory-risk backbone of the library, with heavyweight authorship (Heymann, McCloskey).

Key findings

  • 34 articles, 37 sporting events; Olympics most studied
  • Multi-layered packages near-universal: bubbles, testing, screening, masking, distancing
  • 23 effective / 3 non-effective / 6 indeterminate against a structured framework
  • Feasibility breaks down at spectator scale - athlete bubbles do not generalize
  • First comprehensive pre-pandemic + pandemic-era planning map; PROSPERO-registered

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