Several outbreak investigation reports have shown that COVID-19 transmission can be particularly effective in crowded, confined indoor spaces such as workplaces including factories, churches, restaurants, ski resorts, shopping centres, worker dormitories, cruise ships and vehicles, or events occurring indoor such as, parties, and dance classes, [171]. They indicated that transmission can be linked with specific activities, such as singing in a choir [172] or religious services that may be characterised by increased production of respiratory droplets through loud speech and singing.
In a study of 318 outbreaks in China, transmission in all cases except one occurred in indoor spaces [173]. The only case of outdoor transmission identified in this study involved two persons. However, outdoor events have also been implicated in the spread of COVID-19, typically those associated with crowding such as carnival celebrations [174] and football matches [175] suggesting a risk of transmission linked to crowding even at outdoor events. However, exposure in crowded indoor spaces is also very common during such events.