SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players?

Causes of COVID-19 Outbreaks During Sports and Exercise: A Systematic Review

BACKGROUND

Physical activity is beneficial for preventing non-communicable and infectious diseases, such as pneumonia. Physical activity is also a potential protective factor for reducing coronavirus disease 2019 (COVID-19) severity. Conversely, outbreaks of respiratory viral infections are more likely to occur owing to group activities, opportunities for contact with individuals and vocalisations. Since the onset of the COVID-19 pandemic, several cases of COVID-19 outbreaks during various sports and exercise have been reported. However, the common causes underlying these outbreaks remain unclear.

OBJECTIVE

The objective of this study is to identify the causes of COVID-19 outbreaks during sports and exercise using systematic review approach.

METHODS

Our eligibility criteria were published articles reporting case investigation on COVID-19 outbreaks and the cause during sports and exercise. Studies such as reviews and observational studies without case investigations were excluded. PubMed, CINAHL, WHO COVID-19 Research Database and Ichushi Web were searched on 28 August 2023. The quality of included studies was rated using a quality criteria checklist adapted from a previous systematic review of influenza outbreaks. Vote counting of outbreak causes was performed by type of sports (team or individual).

RESULTS

Twenty-one articles reporting 22 outbreaks were identified (quality: high, 9; medium, 9; and low, 3). The outbreaks were most frequently reported in fitness classes, followed by soccer. Most studies listed multiple causes of the outbreaks. The most common suspected cause of outbreaks in individual exercise, mostly from fitness classes, was poor ventilation and not wearing masks, followed by not maintaining physical distance and participation of individuals with some symptoms. In team sports, the most common cause was interaction outside the game, such as social events.

CONCLUSIONS

This systematic review found a limited number of case investigations suggesting that COVID-19 outbreaks during sports and exercise may be associated with the inhalation of aerosols in indoor settings, interactions outside of team sports games and participation of individuals with some symptoms. Prevention strategies that focus on mitigating these issues may be effective at preventing sports and exercise-associated respiratory infectious diseases outbreaks.

PROSPERO REGISTRATION NUMBER

CRD42023443158.

Incidence of respiratory infections and SARS-CoV-2 is higher during contact phases in student rugby players - Lessons learnt from COVID-19 risk mitigation strategies-AWARE V

The incidence of acute respiratory infections (ARinf), including SARS-CoV-2, in unvaccinated student rugby players during phases from complete lockdown during the COVID-19 pandemic to returning to competition is unknown. The aim of the study was to determine the incidence of ARinf (including SARS-CoV-2) during non-contact and contact phases during the COVID-19 pandemic to evaluate risk mitigation strategies. In this retrospective cohort study, 319 top tier rugby players from 17 universities completed an online questionnaire. ARinf was reported during 4 phases over 14 months (April 2020-May 2021): phase 1 (individual training), phase 2 (non-contact team training), phase 3 (contact team training) and phase 4 (competition). Incidence (per 1 000 player days) and Incidence Ratio (IR) for 'All ARinf', and subgroups (SARS-CoV-2; 'Other ARinf') are reported. Selected factors associated with ARinf were also explored. The incidence of 'All ARinf' (0.31) was significantly higher for SARS-CoV-2 (0.23) vs. 'Other ARinf' (0.08) (p ​< ​0.01). The incidence of 'All ARinf' (IR ​= ​3.6; p ​< ​0.01) and SARS-CoV-2 (IR ​= ​4.2; p ​< ​0.01) infection was significantly higher during contact (phases 3 ​+ ​4) compared with non-contact (phases 1 ​+ ​2). Demographics, level of sport, co-morbidities, allergies, influenza vaccination, injuries and lifestyle habits were not associated with ARinf incidence. In student rugby, contact phases are associated with a 3-4 times higher incidence of ARinf/SARS-CoV-2 compared to non-contact phases. Infection risk mitigation strategies in the contact sport setting are important. Data from this study serve as a platform to which future research on incidence of ARinf in athletes within contact team sports, can be compared.

Systematic review of best practices for GPS data usage, processing, and linkage in health, exposure science and environmental context research

Global Positioning System (GPS) technology is increasingly used in health research to capture individual mobility and contextual and environmental exposures. However, the tools, techniques and decisions for using GPS data vary from study to study, making comparisons and reproducibility challenging.

OBJECTIVES

The objectives of this systematic review were to (1) identify best practices for GPS data collection and processing; (2) quantify reporting of best practices in published studies; and (3) discuss examples found in reviewed manuscripts that future researchers may employ for reporting GPS data usage, processing and linkage of GPS data in health studies.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases searched (24 October 2023) were PubMed, Scopus and Web of Science (PROSPERO ID: CRD42022322166).

ELIGIBILITY CRITERIA

Included peer-reviewed studies published in English met at least one of the criteria: (1) protocols involving GPS for exposure/context and human health research purposes and containing empirical data; (2) linkage of GPS data to other data intended for research on contextual influences on health; (3) associations between GPS-measured mobility or exposures and health; (4) derived variable methods using GPS data in health research; or (5) comparison of GPS tracking with other methods (eg, travel diary).

DATA EXTRACTION AND SYNTHESIS

We examined 157 manuscripts for reporting of best practices including wear time, sampling frequency, data validity, noise/signal loss and data linkage to assess risk of bias.

RESULTS

We found that 6% of the studies did not disclose the GPS device model used, only 12.1% reported the per cent of GPS data lost by signal loss, only 15.7% reported the per cent of GPS data considered to be noise and only 68.2% reported the inclusion criteria for their data.

CONCLUSIONS

Our recommendations for reporting on GPS usage, processing and linkage may be transferrable to other geospatial devices, with the hope of promoting transparency and reproducibility in this research.

PROSPERO REGISTRATION NUMBER

CRD42022322166.

Genomic Epidemiology of a Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak in a US Major League Soccer Club: Was It Travel Related?

Background

Professional soccer athletes are at risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). United States Major League Soccer (MLS) uses protocol-based SARS-CoV-2 testing for identification of individuals with coronavirus disease 2019.

Methods

Per MLS protocol, fully vaccinated players underwent SARS-CoV-2 real-time polymerase chain reaction testing weekly; unvaccinated players were tested every other day. Demographic and epidemiologic data were collected from individuals who tested positive, and contact tracing was performed. Whole genome sequencing (WGS) was performed on positive specimens, and phylogenetic analyses were used to identify potential transmission patterns.

Results

In the fall of 2021, all 30 players from 1 MLS team underwent SARS-CoV-2 testing per protocol; 27 (90%) were vaccinated. One player who had recently traveled to Africa tested positive for SARS-CoV-2; within the following 2 weeks, 10 additional players and 1 staff member tested positive. WGS yielded full genome sequences for 10 samples, including 1 from the traveler. The traveler's sample was Delta sublineage AY.36 and was closely related to a sequence from Africa. Nine samples yielded other Delta sublineages including AY.4 (n = 7), AY.39 (n = 1), and B.1.617.2 (n = 1). The 7 AY.4 sequences clustered together; suggesting a common source of infection. Transmission from a family member visiting from England to an MLS player was identified as the potential index case. The other 2 AY.4 sequences differed from this group by 1-3 nucleotides, as did a partial genome sequence from an additional team member.

Conclusions

WGS is a useful tool for understanding SARS-CoV-2 transmission dynamics in professional sports teams.

Sport and academic engagement of 1,387 Slovenian dual-career athletes before and during COVID-19 lockdown-what did we learn?

Introduction

Since the coronavirus disease outbreak in 2019, there have been several preventive measures and restrictions applied to minimize the transmission of the virus. While lockdown has affected our everyday lives, it has negatively impacted sport and athletes as well.

Methods

1,387 Slovenian dual-career (DC) athletes (47.4% females, 52.6% males) participated in the 22-item questionnaire to gather information on their sports and academic engagement before and during COVID-19 lockdown period. Half of the athletes were enrolled in education at the secondary level (n = 819, aged 15-18  years), while the others were enrolled in primary (n = 301, 8-14 years) and tertiary (n = 267, 19-36  years) education. All participants in the current study have a valid athlete categorization by the Slovenian Olympic Committee and are competing at either junior (31.7%), national (26.9%), prospective (29.5%), international (8.5%), world (2.3%) or Olympic (1.2%) level.

Results

DC athletes spent less time on training (-4.7 h; p < 0.001), learning (-1.0 h; p < 0.001), exams (-0.9 h; p < 0.001), laboratory work (-0.6 h; p < 0.001), and other educational activities (-0.3 h; p < 0.001) during COVID-19 lockdown compared to period before the lockdown. Their training environment was changed so they trained either at home or outdoors. Results showed that indoor (-3.7 h; p < 0.001) and team sport athletes (-1.3 h; p < 0.001) trained less than outdoor and individual sports. Male athletes spent more time on training both before (1.3 h; p < 0.001) and during lockdown (1.3 h; p < 0.001) and other sport-related activities (1.3 h; p < 0.001). On the other hand, female athletes spent more time on studying both before (1.5 h; p < 0.001) and during lockdown (2.6 h; p < 0.001). Both sport and educational activities were influenced by athletes' age (p ≤ 0.017).

Conclusion

Indoor and team sport athletes were more affected by the governmental measures than outdoor and individual sport athletes. Male athletes experienced a greater decline in learning time compared to female athletes. DC is shown to be beneficial for athletes even in times of COVID-19 lockdown, as DC athletes report smaller decline in motivation, shifting attention from sport to study and having fewer mental problems due to uncertain sports future. The feedback of the preventive measures could serve to assist policy makers and athlete's support staff to form and apply preventive measures that are more effective for DC athletes' training and education.

Are Football Players More Prone to Muscle Injury after COVID-19 Infection? The "Italian Injury Study" during the Serie a Championship

INTRODUCTION

Football was the first sport to resume competitions after the coronavirus disease 2019 (COVID-19) lockdown and promptly the hypothesis was raised of a potential relationship between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and musculoskeletal injuries in athletes. This study aimed to confirm the association between SARS-CoV-2 infection and muscle strain injury in a large population of elite football players and to investigate if the COVID-19 severity level could affect the risk of injury.

METHODS

A retrospective cohort study involving 15 Italian professional male football teams was performed during the Italian Serie A 2020-2021 season. Injuries and SARS-CoV-2 positivity data were collected by team doctors through an online database.

RESULTS

Of the 433 included players, we observed 173 SARS-CoV-2 infections and 332 indirect muscle strains. COVID-19 episodes mostly belonged to severity level I and II. The injury risk significantly increased after a COVID-19 event, by 36% (HR = 1.36, CI_95% 1.05; 1.77, p-value = 0.02). The injury burden demonstrated an 86% increase (ratio = 1.86, CI_95% 1.21; 2.86, p-value = 0.005) in the COVID-19 severity level II/III versus players without a previous SARS-CoV-2 infection, while level I (asymptomatic) patients showed a similar average burden (ratio = 0.92, CI_95% 0.54; 1.58, p-value = 0.77). A significantly higher proportion of muscle-tendon junction injuries (40.6% vs. 27.1%, difference = 13.5%, CI_95% 0.002%; 26.9%, p-value = 0.047) was found when comparing level II/III versus Non-COVID-19.

CONCLUSIONS

This study confirms the correlation between SARS-CoV-2 infection and indirect muscle injuries and highlights how the severity of the infection would represent an additional risk factor.

Contact times in professional football before and during the SARS-CoV-2 pandemic: Tracking data from the German Bundesliga

The global SARS-CoV-2 pandemic led to a lockdown in team sports in March 2020. Because the risk of virus transmission seems to correlate with the duration of close contacts, data on contact times are necessary to assess the risk of virus transmission in sports. In this study, an optical tracking system was used to determine contact times between players of the two highest men's professional football leagues in Germany in the 2019-20 season and in the first half of the 2020-21 season. Contacts between players were defined as being within a two-metre radius during matches and were differentiated as either match-specific or non-match-specific. In total, 918 matches with 197,087 contacts were analysed. The mean overall contact time of one-to-one situations of 36 s (SD: ± 66) before the lockdown was reduced to 30 s after the lockdown (SD: ± 60) (p < 0.0001). In professional football, contacts between two players infrequently occur within a two-metre radius, averaging less than 35 s. Only 36 player pair contacts lasted for more than 15 min (0.00018%). The mean accumulated contact time per player with all others was 10.6 ± 6.9 min per match, with a decrease from 11.6 ± 7.0 min before the lockdown to 10.0 ± 6.6 min (p < 0.0001) after lockdown in the season 2019-20. The SARS-CoV-2 pandemic has resulted in a reduction in match-specific contacts of 25%. It seems questionable if such short contacts in open-air sports may lead to considerable virus transmission.

Identifying High-Risk Events for COVID-19 Transmission: Estimating the Risk of Clustering Using Nationwide Data

The transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be overdispersed, meaning that only a fraction of infected cases contributes to super-spreading. While cluster interventions are an effective measure for controlling pandemics due to the viruses' overdispersed nature, a quantitative assessment of the risk of clustering has yet to be sufficiently presented. Using systematically collected cluster surveillance data for coronavirus disease 2019 (COVID-19) from June 2020 to June 2021 in Japan, we estimated the activity-dependent risk of clustering in 23 establishment types. The analysis indicated that elderly care facilities, welfare facilities for people with disabilities, and hospitals had the highest risk of clustering, with 4.65 (95% confidence interval [CI]: 4.43-4.87), 2.99 (2.59-3.46), and 2.00 (1.88-2.12) cluster reports per million event users, respectively. Risks in educational settings were higher overall among older age groups, potentially being affected by activities with close and uncontrollable contact during extracurricular hours. In dining settings, drinking and singing increased the risk by 10- to 70-fold compared with regular eating settings. The comprehensive analysis of the COVID-19 cluster records provides an additional scientific basis for the design of customized interventions.

Impact of the Euro 2020 championship on the spread of COVID-19

Large-scale events like the UEFA Euro 2020 football (soccer) championship offer a unique opportunity to quantify the impact of gatherings on the spread of COVID-19, as the number and dates of matches played by participating countries resembles a randomized study. Using Bayesian modeling and the gender imbalance in COVID-19 data, we attribute 840,000 (95% CI: [0.39M, 1.26M]) COVID-19 cases across 12 countries to the championship. The impact depends non-linearly on the initial incidence, the reproduction number R, and the number of matches played. The strongest effects are seen in Scotland and England, where as much as 10,000 primary cases per million inhabitants occur from championship-related gatherings. The average match-induced increase in R was 0.46 [0.18, 0.75] on match days, but important matches caused an increase as large as +3. Altogether, our results provide quantitative insights that help judge and mitigate the impact of large-scale events on pandemic spread.

"Is the focus in professional rugby ever really on health?": A qualitative study on the uptake of illness prevention guidelines in rugby

Illness prevention is essential for athlete health management, but little is known about its uptake in sport. Prior to the pandemic, the International Olympic Committee (IOC) published a consensus statement recommending illness prevention guidelines are implemented in sports. Yet, little is known about guideline uptake. Therefore, this study aimed to explore the (1) illness experiences of rugby players and athlete support personnel and (2) barriers and enablers to illness prevention guideline uptake in rugby, using the lens of behaviour change theory. In a bid to inform and enhance athlete welfare, we sought to amplify the voices of participants through qualitative inquiry. Between August 2020 and May 2021, 16 semi-structured interviews were undertaken with players and athlete support personnel working across rugby. Analysis was conducted using Braun and Clarke's reflexive thematic analysis. Prior to COVID-19, participants deemed illness to be of little concern, with experience of illnesses and the global pandemic critical enablers to guideline uptake. The rugby environment was a barrier to illness prevention, particularly in women's and academy teams where resource deficiency was highlighted. 'Rugby identity' acted as both a barrier and enabler with participants' passion for rugby driving both guideline adherence and non-adherence. Tackling resource inequalities between men's and women's cohorts is critical to effectively implement guidelines. Coach and player education is essential, and emphasis must be placed on continuing preventative behaviours adopted due to COVID-19. Our findings offer new insight into illness prevention, moving away from prevailing quantitative research, and instead voicing players' experiences.

Physical education student teachers' wellbeing during Covid-19: Resilience resources and challenges from school placement

The coronavirus 2019 (Covid-19) pandemic has given rise to significant global challenges across education, and specifically in the physical education teacher education (PETE) community. Students attending teacher education programmes during the Covid-19 pandemic have experienced an abrupt and unprecedented pedagogical transition from a face-to-face capacity to remote teaching, learning, and assessment environments. Crucially, student teachers' school placement experiences faced increased challenges and practical implications from additional environmental and social changes. In the context of continued global and national challenges for initial teacher education (ITE) programmes, the present qualitative study, using a representative sample of 24 student physical education (PE) teachers from a PETE programme, investigates the perceived implications of the Covid-19 pandemic on student teachers' practice and wellbeing during their final 2020/2021 academic year. Results indicate that student teachers maintain that exercise, connections with the university and school placement communities, alongside personal and professional organisation skills serve as resilience resources protecting their wellbeing. Conversely, student teachers express that school placement isolation, restricted PE delivery, increased workload, low teacher efficacy, and the responsibility to implement Covid-19 behaviour regulations presented as challenges that negatively affect their wellbeing. The paper concludes with practices that may further support PETE and ITE programmes and their student teachers to maintain a stable level of wellbeing throughout their careers.

International Olympic Committee (IOC) consensus statement on acute respiratory illness in athletes part 1: acute respiratory infections

Acute illnesses affecting the respiratory tract are common and form a significant component of the work of Sport and Exercise Medicine (SEM) clinicians. Acute respiratory illness (ARill) can broadly be classified as non-infective ARill and acute respiratory infections (ARinf). The aim of this consensus is to provide the SEM clinician with an overview and practical clinical approach to ARinf in athletes. The International Olympic Committee (IOC) Medical and Scientific Commission appointed an international consensus group to review ARill (non-infective ARill and ARinf) in athletes. Six subgroups of the IOC Consensus group were initially established to review the following key areas of ARill in athletes: (1) epidemiology/risk factors for ARill, (2) ARinf, (3) non-infective ARill including ARill due to environmental exposure, (4) acute asthma and related conditions, (5) effects of ARill on exercise/sports performance, medical complications/return-to-sport and (6) acute nasal/vocal cord dysfunction presenting as ARill. Several systematic and narrative reviews were conducted by IOC consensus subgroups, and these then formed the basis of sections in the consensus documents. Drafting and internal review of sections were allocated to 'core' members of the consensus group, and an advanced draft of the consensus document was discussed during a meeting of the main consensus core group in Lausanne, Switzerland on 11 to 12 October 2021. Final edits were completed after the meeting. This consensus document (part 1) focusses on ARinf, which accounts for the majority of ARill in athletes. The first section of this consensus proposes a set of definitions and classifications of ARinf in athletes to standardise future data collection and reporting. The remainder of the consensus paper examines a wide range of clinical considerations related to ARinf in athletes: epidemiology, risk factors, pathology/pathophysiology, clinical presentation and diagnosis, management, prevention, medical considerations, risks of infection during exercise, effects of infection on exercise/sports performance and return-to-sport guidelines.

Case Report: Assessing COVID-19 Transmission in Professional Volleyball in Germany, September to December 2020: An Epidemiological Study

Introduction

The SARS-CoV-2 pandemic poses extraordinary challenges in all fields of daily life. The WHO recommended social distancing guidelines and person-to-person contact was strongly discouraged to contain transmission. Team-based sports were questioned and widely debated. However, there is a lack of available evidence on the risk of in-game SARS-CoV-2 transmission. We aim to derive new insights regarding the risk of SARS-CoV2 infection during team sports and provide current opinion on how to behave during training and competition.

Methods

We report on six competitive male volleyball players (national level) of the same team who were infected with COVID-19. The mode of transmission and potential virus spreading within the team was investigated. The entire course of infection was documented by detailed medical history of the players and RT-PCR tests confirmed suspected infections. Serological testing was performed to establish the antibody status of the team.

Results

The investigation did not show strong evidence of viral transmission within the team during sporting activities. Only two players with PCR-proven infection hat detectable antibodies in two antibody assays.

Conclusion

Private and social gatherings can spread infection into team sports. Clearly defined test strategies and strict adherence to standard COVID-19 hygiene guidelines during sports seasons cannot be overemphasized.

The incidence and transmission of SARS-CoV-2 infection in south African professional rugby players - AWARE II

Objectives

To describe the incidence and transmission of SARS-CoV-2 infections in South African professional rugby union players in different phases of return-to-competition during a pandemic.

Design

Prospective cohort study.

Methods

Players reported their history of SARS-CoV-2 infection before/during a national competition, using an online questionnaire (physician verified). Three periods of return to training/competition after a nation-wide complete lockdown during a pandemic were studied: 1) non-contact training, 2) contact training, 3) competition. The total period was 184 days (20/07/2020–20/01/2021) including 45 matches. Outcomes were: 1) incidence of SARS-CoV-2 infection (I: per 1000 player days; 95%CI) in each period (calculated using a Poisson distribution), 2) player symptoms, 3) median days to return-to-training following SARS-CoV-2 infection, 4) method of transmission, and 5) percentage matches cancelled due to SARS-CoV-2 infections.

Results

185 players had 42 physician verified positive SARS-CoV-2 infections (I = 1.23; 95%CI: 0.86–1.61). Incidences during the three periods were: non-contact training = 0, contact training (I = 1.04; 0.36–1.71; mostly forwards), and competition (I = 1.54; 1.00–2.10). 83 % of the infected players were symptomatic and 52 % of the 42 positive players had systemic symptoms. Median return-to-training was 14 days. 22 (52 %) SARS-CoV-2 infections were rugby-related: 13 off-field (31 %), 9 on-field (21 %). 11 % of matches were cancelled due to SARS-CoV-2 infections.

Conclusions

As contact in rugby was introduced back into the game following lockdowns there was an increasing incidence of SARS-CoV-2 infection. On-field rugby activities were responsible for 21 % of SARS-CoV-2 infections and 11 % of matches had to be cancelled, indicating the need for risk mitigation strategies.

Acute and post-acute COVID-19 presentations in athletes: a systematic review and meta-analysis

OBJECTIVE

To describe acute/postacute COVID-19 presentations in athletes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

The search was conducted in four databases (MEDLINE, EMBASE, SCOPUS, SPORTDiscus) and restricted to studies published from 2019 to 6 January 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Studies were required to (1) include professional, amateur or collegiate/university athletes with COVID-19; (2) present data on acute/postacute COVID-19 symptoms and (3) have an observational design. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tools.

RESULTS

43 studies with 11 518 athletes were included. For acute presentation, the pooled event rates for asymptomatic and severe COVID-19 were 25.5% (95% CI: 21.1% to 30.5%) and 1.3% (95% CI: 0.7% to 2.3%), respectively. For postacute presentations, the pooled estimate of persistent symptoms was 8.3% (95% CI: 3.8% to 17.0%). Pooled estimate for myocardial involvement was 5.0% (95% CI: 2.5% to 9.8%) in athletes undergoing any cardiac testing, and 2.5% (95% CI: 1.0% to 5.8%) in athletes undergoing MRI, although clinical symptoms were not characterised. None of the studies with a control group (eg, non-infected athletes) could confirm a causal relationship between COVID-19 and myocardial involvement.

CONCLUSION

This broad characterisation of COVID-19 presentations in athletes indicates that ~94% exhibited mild or no acute symptoms. The available evidence did not confirm a causal relationship between COVID-19 and myocardial involvement. A small proportion of athletes experienced persistent symptoms while recovering from infection, which were mostly mild in nature, but could affect return-to-play decisions and timing.

Risk assessment and implementation of risk reduction measures is not associated with increased transmission of SARS-CoV-2 compared with standard isolation at professional golf events

Objectives

The purpose of this prospective study was to report incidence and transmission of SARS-CoV-2, among professional golfers and essential support staff undergoing risk assessment and enhanced risk reduction measures when considered a close contact as opposed to standard isolation while competing on the DP World Tour during the 2021 season.

Methods

This prospective cohort study included all players and essential support staff participating in 26 DP World Tour events from 18 April 2021 to 21 November 2021. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with reverse transcriptase-polymerase chain reaction (RT-PCR) tesing on day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts typically received rapid antigen testing every 48 hours and RT-PCR testing on day 5.

Results

The total study cohort compromised 13 394 person-weeks of exposure. There were a total of 30 positive cases over the study period. Eleven contacts were stratified as 'high risk'. Two of these subsequently tested positive for SARS-CoV-2. There were 79 moderate-risk contact and 73 low-risk contacts. One moderate-risk contact subsequently tested positive for SARS-CoV-2 but did not transmit the virus. All other contacts, remained negative and asymptomatic to the end of the tournament week.

Conclusions

A risk assessment and risk reduction-based approach to contact tracing was safe in this professional golf event setting when Alpha and Delta were the predominant variants. It enabled professional golfers and essential support staff to work.

The Impact of Post-traumatic Stress of SARS-CoV-2 Affliction on Psychological and Mental Health of Student Survivors: Cross Sectional Study

Background

COVID-19 survivor's population is often associated with a long term impact on mental and psychological health. Recent included studies have also stated affliction of mental health due to fear of virus and preventive policies among the college students.

Objectives

The research was conducted to find the psychological and mental impacts of SARS-CoV-2 affliction among the students' survivors in the university.

Methods

The study design of the experiment was cross-sectional, sampling technique was non probability and sampling method being applied was convenience sampling. IBM Statistical Package for the Social Sciences version 20 was used for analyses. Descriptive data was examined and results were showed as mean and standard deviations, percentages, frequencies for continuous variables of IES-R scale (Intrusion, Avoidance, and Hyperarousal) using the total sample of n = 34.

Results

Out of 34 only 24 student survivors responded to the online survey post COVID-19 recovery, with an overall participation level of 71%. Grading was given for the total IES-R score which was subdivided into a predefined range. Out of 24 participants, 9 (38%) participants showed the symptoms of mild (n = 2)-severe (n = 7) psychological impacts. On correlation of factors total IES-R score and taste and sense of smell were moderately correlated. The ordinal regression for complete loss of sense of taste and smell was also significant.

Conclusion

The results from IES-R evaluation clearly outlines the presence of psychological sequels post recovery of COVID-19 episodes among the young college survivors. Complete loss of sense of smell and taste may be an indicator of psychological sequelae as compared to reduce sense of smell.

Returning persons with SARS-CoV-2 to the field of play in professional golf: a risk assessment and risk reduction approach

Objectives

This pilot study aimed to see whether a risk assessment and risk reduction approach was a practical and feasible approach, as compared with standard isolation for fully vaccinated, asymptomatic persons positive for SARS-CoV-2.

Methods

This prospective cohort study included all players and caddies participating in two large professional golf events from 7 to 20 February 2022 in South Africa. Fully vaccinated persons testing positive who were asymptomatic were subject to risk assessment and risk reduction measures to protect the integrity of the event. Asymptomatic individuals who could socially distance in outdoor areas were allowed to participate. Close contacts were subject to daily rapid antigen tests and asked to prioritise outdoor space.

Results

The protocols put in place for the events were practical, feasible, and well accepted by event participants and staff during the study period. There was a total of 378 player-week episodes and 378 caddie-week episodes during the study period. Three persons tested positive while registered at events during the study period (0.4% of person episodes). The positive tests were returned from two players and one caddie, all of which were asymptomatic at the time of testing. There was one high-risk contact who consistently returned negative antigen tests. There was no evidence of transmission.

Conclusions

The approach was practical and feasible. A risk assessment and risk reduction approach allowed fully vaccinated asymptomatic persons with SARS-CoV-2 to participate in golf, an outdoor sport where social distancing is possible, compared with standard isolation.

Reported COVID-19 Incidence in Indoor Winter Sports Among US High-School Athletes

OBJECTIVE

To evaluate the association between COVID-19 incidence among high-school athletes participating in different indoor winter sports and attending schools with in-person versus virtual instructional delivery.

DESIGN

Cross-sectional survey.

SETTING

US high schools.

PARTICIPANTS

High-school athletic directors.

INDEPENDENT VARIABLES

Indoor winter sports, school instructional delivery method, and state COVID-19 incidence.

MAIN OUTCOME MEASURES

Surveys were distributed to high-school athletic directors throughout the United States regarding sport reinitiation and COVID-19 cases in winter 2020 to 2021. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and (1) different sports and (2) school instructional delivery method, while adjusting for the background, state COVID-19 incidence.

RESULTS

Four hundred thirty schools had restarted fall sports, representing 31 274 athletes on 1404 teams from 14 states. One thousand four hundred sixty cases of COVID-19 were reported, representing a case rate of 4668 cases per 100 000 athletes and an incidence rate of 58.7 cases per 100 000 player-days. Reported COVID-19 incidence was greatest among girls' hockey (82.1 cases per 100 000 player-days (95% CI, 56.8-115) and boys' hockey [76.7 (61.8-94.2)] and lowest among swimming [39.0 (31.1-48.2)] and gymnastics [28.5 (13.1-54.2)]. No difference in reported COVID-19 incidence was identified among athletes attending schools with virtual versus in-person instruction [incidence rate ratio = 0.86 (0.52-1.4)].

CONCLUSIONS

In this nationwide survey of US high-school athletic directors regarding indoor winter sports, reported COVID-19 incidence was lower in noncontact sports but unrelated to school instructional delivery method. This information may help guide decision-making regarding high-school sport participation during the COVID-19 pandemic.

COVID-19 Infection among Elite Football Players: A Nationwide Prospective Cohort Study

Little is known about the risk of COVID-19 infection among footballers. We aimed to investigate the incidence and characteristics of COVID-19 infection among footballers. In total, 480 football players of Super League Greece and 420 staff members participated in a prospective cohort study, which took place from May 2020 to May 2021. Nasopharyngeal swabs were collected from footballers and staff members weekly. All samples (n = 43,975) collected were tested using the reverse transcriptase polymerase chain reaction (RT-PCR) test for the detection of “SARS-CoV-2”. In total, 190 positive cases (130 among professional football players and 60 among staff) were recorded. Out of the 190 cases that turned positive, 64 (34%) cases were considered as symptomatic, and 126 (66%) cases were asymptomatic. The incidence rate of a positive test result for footballers was 0.57% (confidence interval (CI) 0.48−0.68%) and for staff members it was 0.27% (CI 0.20%, 0.34%), respectively. Footballers recorded a twofold increased risk of COVID-19 infection in comparison to staff members (relative risk = 2.16; 95% CI = 1.59−2.93; p-value < 0.001). No significant transmission events were observed during the follow-up period. We found a low incidence of COVID-19 infection among professional footballers over a long follow-up period. Furthermore, the implementation of a weekly diagnostic testing (RT-PCR) was critical to break the transmission chain of COVID-19, especially among asymptomatic football players and staff members.

A video-based analysis of situations bearing the risk of respiratory disease transmission during football matches

We aimed to analyze the number and type of contacts involving the risk of respiratory disease transmission during football match play. We analysed 50 matches from different playing levels. Two reviewers evaluated the contacts of all players in each match. We focused on between-player contacts, crowding, actions with potentially increased aerosol and droplet production and within-player hand-to-head contacts. We categorized the duels with direct contact into frontal and other ones and measured contact duration. The number of between-player contacts were similar between playing levels (median 28.3 [IQR 22.6, 33] contacts per player-hour). Frontal contacts summed up to 8% of all contacts. Contacts involving the head occurred less than once per player and match with none lasting longer than 3 s. Crowding included between two and six players and the duration was mostly less than 10 s. Aerosol and droplet producing activities were three to four times more frequent in adult compared to youth players. Our results suggest that the risk of respiratory pathogen transmission is low during football matches. This conclusion is based on the finding that most close contact situations are of short duration and on the fact that it is an outdoor sport.

The risk of COVID-19 transmission upon return to sport: a systematic review

OBJECTIVES

To evaluate COVID-19 transmission rates in athletes upon return to sport (RTS), as well as the effectiveness of preventive and surveillance measures associated with RTS.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on RTS during COVID-19. Articles were excluded on the basis of the following criteria: (1) non-English text, (2) only abstract available, (3) population not athlete-specific, (4) outcome not RTS-specific, (5) COVID-19 transmission data not quantified, (6) editorial, or (7) review article or meta-analysis. Study characteristics; athlete demographics; COVID-19 preventive, surveillance, and diagnostic measures; COVID-19 transmission outcomes; and RTS recommendations were collected from each included article and analyzed.

RESULTS

10 studies were included in the final analysis, comprising over 97,000 athletes across a wide variety of sports, levels of play, and RTS settings. Of the 10 studies, eight identified low transmission rates and considered RTS to be safe/low risk. Overall, COVID-19 transmission rates were higher in athletes than in contacts, and more prevalent in the greater community than in athletes specifically. The risk of COVID-19 did not appear to be necessarily higher for athletes who played high-contact team sports, shared common facilities, or lived in communities impacted by high transmission rates, provided that rigorous COVID-19 safety and testing protocols were implemented and followed. Mask wearing and physical distancing during active play presented the greatest challenge to athletes.

CONCLUSION

Rigorous preventive and surveillance measures can mitigate the risk of COVID-19 transmission in athletes upon RTS. However, the heterogeneity of RTS playing conditions, availability of COVID-19 resources, rise of unforeseen novel variants, and undetermined long-term impact of vaccination on athletes remain a challenge to safe and effective RTS in the era of COVID-19.

Risk of SARS-CoV-2 transmission from on-field player contacts in amateur, youth and professional football (soccer)

OBJECTIVE

To investigate the risk of transmission among potentially infectious SARS-CoV-2-positive football players while participating in training or matches at amateur, youth and professional levels.

METHODS

Between August 2020 and March 2021, football players who tested positive for SARS-CoV-2 and participated in matches or training during the period of potential contagiousness were identified through media search (professional level) and a nationwide registry in Germany (amateur and youth level) to determine symptoms, source of infection and hygiene measures adopted. The definition of potentially infectious players was based on the time of a positive PCR testing and symptom onset. Transmission-relevant contacts on the pitch were evaluated through doubly reviewed video analysis.

RESULTS

Out of 1247 identified football matches and training sessions (1071 amateur and youth level, 176 professional level), 104 cases (38 training sessions, 66 matches) with 165 potentially infectious players were detected. Follow-up PCR testing at the professional level (44 cases) revealed no transmission. At the amateur and youth level, the combination of partial PCR testing (31 of 60 cases) and symptom monitoring within 14 days post-exposure (46 of 60 cases) identified 2 of 60 matches in which follow-up infections occurred that were attributed to non-football activities. This is consistent with the video analysis of 21 matches demonstrating frontal contacts were <1 per player-hour (88%, 30 of 34 players), each lasting no longer than 3 s.

CONCLUSION

On-field transmission risk of SARS-CoV-2 in football is very low. Sources of infections in football players are most likely not related to activities on the pitch.

SARS-CoV-2 viability on sports equipment is limited, and dependent on material composition

The control of the COVID-19 pandemic in the UK has necessitated restrictions on amateur and professional sports due to the perceived infection risk to competitors, via direct person to person transmission, or possibly via the surfaces of sports equipment. The sharing of sports equipment such as tennis balls was therefore banned by some sport's governing bodies. We sought to investigate the potential of sporting equipment as transmission vectors of SARS-CoV-2. Ten different types of sporting equipment, including balls from common sports, were inoculated with 40 μl droplets containing clinically relevant concentrations of live SARS-CoV-2 virus. Materials were then swabbed at time points relevant to sports (1, 5, 15, 30, 90 min). The amount of live SARS-CoV-2 recovered at each time point was enumerated using viral plaque assays, and viral decay and half-life was estimated through fitting linear models to log transformed data from each material. At one minute, SARS-CoV-2 virus was recovered in only seven of the ten types of equipment with the low dose inoculum, one at five minutes and none at 15 min. Retrievable virus dropped significantly for all materials tested using the high dose inoculum with mean recovery of virus falling to 0.74% at 1 min, 0.39% at 15 min and 0.003% at 90 min. Viral recovery, predicted decay, and half-life varied between materials with porous surfaces limiting virus transmission. This study shows that there is an exponential reduction in SARS-CoV-2 recoverable from a range of sports equipment after a short time period, and virus is less transferrable from materials such as a tennis ball, red cricket ball and cricket glove. Given this rapid loss of viral load and the fact that transmission requires a significant inoculum to be transferred from equipment to the mucous membranes of another individual it seems unlikely that sports equipment is a major cause for transmission of SARS-CoV-2. These findings have important policy implications in the context of the pandemic and may promote other infection control measures in sports to reduce the risk of SARS-CoV-2 transmission and urge sports equipment manufacturers to identify surfaces that may or may not be likely to retain transferable virus.

Youth ice hockey COVID-19 protocols and prevention of sport-related transmission

OBJECTIVES

This observational study evaluated the impact of return-to-play protocols to prevent transmission of SARS-CoV-2 in a youth ice hockey programme in Virginia Beach, Virginia.

METHODS

Following an outbreak of SARS-CoV-2 in November 2020, a COVID-19 Response Team evaluated the epidemiological data to identify transmission dynamics and develop enhanced protocols to prevent transmission. During the subsequent 18-week study period, incident cases were investigated to identify the likely transmission source; testing, quarantine and isolation recommendations were provided to families in accordance with Centers for Disease Control and Prevention guidelines.

RESULTS

Simple but stringent protocols were implemented among 148 youth ice hockey players ages 6-18. Players were required to arrive at the rink in full gear; locker rooms were closed, building entry was limited to one parent per player, and masks were required at all times except for players on the ice. Following implementation of the enhanced protocols, more than 500 practices and games were completed with at least 15 858 athlete-hours of exposure and no within-programme COVID-19 transmission was detected despite high community incidence and sporadic household exposures.

CONCLUSION

This study suggests indoor youth sports can operate safely with appropriate protocols in place, even within communities of high COVID-19 transmission, even when athletes are not yet vaccinated or wearing masks during play. Transmission appears to be more likely in congested indoor areas involving adults than on the ice during play. Protocols should be developed in collaboration with programme participants. Strong collaboration in the interest of youth sports can motivate adoption of protocols which prevent within-team transmission.

Longitudinal changes in Super League match locomotor and event characteristics: A league-wide investigation over three seasons in rugby league

The 2019 and 2020 Super League (SL) seasons included several competition rule changes. This study aimed to quantify the difference between the 2018, 2019 and 2020 SL seasons for duration, locomotor and event characteristics of matches. Microtechnology and match event data were analysed from 11 SL teams, comprising 124 players, from 416 competitive matches across a three-year data collection period. Due to an enforced suspension of league competition as a consequence of COVID-19 restrictions, and subsequent rule changes upon return to play, season 2020 was divided into season 2020a (i.e. Pre-COVID suspension) and season 2020b (i.e. Post-COVID suspension). Duration, locomotor variables, and match events were analysed per whole-match and ball-in-play (BIP) periods with differences between seasons determined using mixed-effects models. There were significant (ρ ≤ 0.05) reductions in whole-match and BIP durations for adjustables and backs in 2019 when compared to 2018; albeit the magnitude of reduction was less during BIP analyses. Despite reduced duration, adjustables reported an increased average speed suggesting reduced recovery time between bouts. Both forwards and adjustables also experienced an increase in missed tackles between 2018 and 2019 seasons. When comparing 2019 to 2020a, adjustables and backs increased their average speed and distance whilst all positional groups increased average acceleration both for whole-match and BIP analyses. When comparing 2020a to 2020b, all positional groups experienced reduced average speed and average acceleration for both whole-match and BIP analyses. Forwards experienced an increased number of tackles and carries, adjustables experienced an increased number of carries, and backs experienced an increased number of missed tackles when comparing these variables between season 2020a and 2020b. Rule changes have a greater effect on whole-match duration and locomotor characteristics than those reported during BIP periods which suggests the implemented rule changes have removed stagnant time from matches. Amendments to tackle related rules within matches (e.g., introduction of the 'six-again' rule) increases the number of collision related events such as carries and tackles.

The Association of COVID-19 Incidence with Sport and Face Mask Use in United States High School Athletes

CONTEXT

The relationships between different sports, face mask use and COVID-19 risk among high school athletes remains unknown.

OBJECTIVE

The purpose of this study was to evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes.

DESIGN

Descriptive Epidemiology Study Setting: United States High School Athletic Departments Participants: Athletic Directors Interventions: None Main Outcome Measures: Surveys were completed regarding sport re-initiation, COVID-19 cases, and risk reduction procedures in fall 2020. Separate mixed effects Poisson regression models were developed to evaluate the associations between reported COVID-19 incidence and 1) sport characteristics (contact/non-contact, individual/team, indoor/outdoor) and 2) face mask use while playing (yes/no).

RESULTS

991 schools had restarted fall sports, representing 152,484 athletes on 5,854 teams. 2,565 cases of COVID-19 were reported, representing a case rate of 1,682 cases per 100,000 athletes and an incidence rate of 24.6 cases per 100,000 player-days. COVID-19 incidence was lower among outdoor versus indoor sports (incidence rate ratio [IRR]=0.54, 95% CI=0.49-0.60, p<0.001) and non-contact versus contact sports (IRR=0.78 [0.70-0.87], p<0.001), but not team versus individual sports (IRR=0.96 [0.84-1.1], p=0.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR=0.53 [0.37-0.73], p<0.001), boys' basketball (IRR=0.53 [0.33-0.83], p=0.008) and girls' basketball (IRR=0.36 [0.19-0.63], p<0.001), and approached statistical significance in football (IRR=0.79 [0.59-1.04], p=0.10) and cheer/dance (IRR=0.75 [0.53-1.03], p=0.081).

CONCLUSIONS

In this nationwide survey of high school athletes, lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and non-contact versus contact sports, but not team versus individual sports. Face mask use was associated with decreased COVID-19 incidence among indoor sports, and may be protective among outdoor sports with prolonged close contact between participants.

The COVID-19 Pandemic Impact on Away and Home Victories in Soccer and Rugby Union

Objective: To measure the impact of restrictions due to COVID on the proportion of matches won at home, away and draw in professional soccer and rugby union.

Materials and Methods: Two samples of professional soccer and rugby union matches were collected from 2012–13 to 2020–21 seasons. For soccer, data involved first and second division matches of the England, Spain, Germany, Italy, France, Belgium, Scotland, Greece, Portugal, and Turkey championships. For rugby union, championships concerned are Premiership Rugby, Celtic League, Top 14, and Pro D2. The proportions of home, away wins and draw were calculated and compared. A chi-square test of independence between years and types of result was realized to identify an overall inhomogeneity.

Results: The proportion of away matches won between the 2012–13 and 2020–21 seasons increased significantly from 28.5 ± 1.2% to 32.5 ± 1.5% in soccer and from 38.0 ± 3.6% to 42.8 ± 5.0% in rugby union. In Premiership Rugby championship, the victory percentage at home dropped from 55.8 ± 3.1% when tifosi were present to 45.8 ± 12.8% when they were not.

Conclusion: The home advantage was drastically reduced in empty stadiums for several European soccer and rugby union professional championships. It vanished in the Premiership Rugby and Celtic League during the 2020–21 season.

The COVID-19 Pandemic Upended Youth Sports

The American Academy of Pediatrics estimates that approximately 35 to 45 million young people age 6 to 18 years participate in some type of athletics every year. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic interrupted youth sports and left many children unable to train in-person with teammates and coaches. Given the large impact sports and physical activity have on the lives of children and adolescents, the effect that coronavirus disease 2019 restrictions have had on the psychological and physical well-being of young athletes is significant. The youth sports community has worked hard to find creative ways to safely bring children and adolescents back to the fields and courts with rules and regulations in place. Youth practices and competitions are potential spreader events for SARS-CoV-2, especially given the challenge of identifying young athletes and other participants with asymptomatic active viral infection. With the implementation of rapid result testing programs and the US Food and Drug Administration approval of a highly effective vaccine in adolescents and, most recently, in younger children, youth sports are once again becoming a place for young athletes to train, socialize, and learn invaluable lessons in teamwork and leadership. [Pediatr Ann. 2021;50(11):e450-e453.].

SARS-CoV-2 transmission during an indoor professional sporting event

Sporting events with spectators can present a risk during the COVID-19 pandemic of becoming potential superspreader events that can result in mass-infection amongst participants-both sportspeople and spectators alike. In order to prevent disease transmission, many professional sporting bodies have implemented detailed hygiene regulations. This report analyzes SARS-CoV-2 transmission during a professional sports event (2nd division professional basketball in Germany). Whilst social distancing in this context is not always possible, the rate of infection was significantly reduced by wearing face masks that cover the mouth and nose. There was no infection amongst individuals who continuously wore medical particle filter masks (Category KN95/FFP2 or higher) during this sporting event.

Contact and SARS-CoV-2 Infections Among College Football Athletes in the Southeastern Conference During the COVID-19 Pandemic

This cohort study of college football players in a single athletic conference examines the association of close contact events among players on opposing teams and subsequent positive SARS-CoV-2 tests.

The COVID-19 pandemic and physical activity during intermittent fasting, is it safe? A call for action

Intermittent fasting (IF) has recently gained popularity, and has been used for centuries in many religious practices. The Ramadan fasting is a mandatory form of IF practiced by millions of healthy adult Muslims globally for a whole lunar month every year. In Islam, the "Sunna" also encourages Muslims to practice IF all along the year (e.g.; two days a week). The 2019-Coronavirus disease (COVID-19) pandemic in the context of Ramadan has raised the question whether fasting is safe practice during the COVID-19 pandemic health crisis, and what would be the healthy lifestyle behaviors while fasting that would minimize the risk of infection. As COVID-19 lacks a specific therapy, IF and physical activity could help promote human immunity and be part of holistic preventive strategy against COVID-19. In this commentary, the authors focus on this dilemma and provide recommendations to the fasting communities for safely practicing physical activity in time of COVID-19 pandemic.

Soccer in the time of COVID-19: 1 year report from an Italian top league club, March 2020-February 2021

We report the events of an Italian top league soccer club that took place in 1 year (from March 2020 to February 2021) at the time of coronavirus disease 2019 (COVID-19) pandemic. In early March 2020, just before sport competitions were called off due to the national lockdown in Italy, the team, which included 27 players and 26 staff at the time, faced a COVID-19 outbreak, with 16 confirmed and seven probable cases, including three staff members who had to be hospitalised. In May 2020, at the resumption of the training sessions, a high prevalence of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G positivity (35/53, 66%) was detected among the members of the group. In the following months, sport activities were organised behind closed doors with stringent risk mitigation procedures in place. As of February 2021, only two new cases of SARS-CoV-2 infection were detected within the group, against more than 3500 nasopharyngeal swabs and 1000 serological tests.

Resumption of professional football during the COVID-19 pandemic. Study findings from Iran

Due to concerns of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) transmission, professional football (soccer) was terminated almost everywhere in the world in early 2020. These are the results from a prospective cohort study conducted in Iran to analyze the resumption of professional football during the coronavirus disease 2019 (COVID-19) pandemic under assigned protocols and regulations. Sixteen teams consisting of 805 individuals formally agreed to follow the rules assigned by the ministry of health and CORONA headquarters in sport, and were subject to study monitoring. The resumption process was implemented over a 5-month period, beginning with a training phase followed by 14 match weeks of professional football. A self-declaration form was provided for the subjects to report any suspicious symptoms immediately and serial PCR testing was performed every 10 days using nasal swab samples. Those with positive tests were to be isolated until the symptoms were resolved or a negative test was returned. Of the 805 individuals included, 17.89% subjects were infected by the SARS-CoV‑2 virus (85 players and 59 staff members and officials). Only two matches were canceled in accordance with the regulations, and no severe cases were found. Case-tracing suggested that most transmissions occurred off the pitch. In conclusion, applying strict hygiene protocols and early case identification by performing repetitive PCR testing could benefit the resumption of professional football competitions.

Pilot evaluation of risk assessment and enhanced protocols regarding contacts at an international professional golf event

Objectives

The aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021 and could inform further pilot work regarding disease transmission during elite sporting events.

Methods

This prospective cohort study included all international attendees. All participants required a minimum of one negative reverse transcriptase PCR (RT-PCR) test prior to travelling to each tournament. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts received rapid antigen testing every 48 hours and PCR testing on day 5.

Results

A total of 550 persons were accredited and were required to undergo RT-PCR testing before the event. Two of these tests were positive (0.36%). Of these, case 1 had 1 high, 23 moderate and 48 low-risk contacts. Case 2 did not have any significant travel history within 2 days of positive test and had one high-risk contact. There were no further positive tests on site in the wider cohort of attendees, from a total of 872 RT-PCR and 198 rapid antigen tests.

Conclusions

This pilot study showed it is practical, feasible and well accepted to provide enhanced (daily) virus testing and risk-mitigating measures at a professional golf event. Further study is required to assess the efficacy of these interventions; however, no transmission was found in this pilot study.

Considerations on the Update of the Risk Assessment Document During the Pandemic State by COVID-19 in Italy

Immediately after the outbreak of the SARS-CoV-2 epidemic (which had risen to the level of a pandemic according to the World Health Organization), the question arose whether or not to update the risk assessment, which, as required by Legislative Decree 81/2008, with the consequent updating of the prevention measures. In light of these forecasts, we asked ourselves whether the risk of coronavirus infection should be taken into account by the employer by updating the risk assessment or not. An in-depth analysis of current legislation has led to the conclusion that the biological risk from SARS-CoV-2 is to be considered specific only in health-related activities, in other activities it can be considered exclusively generic or generic aggravated. The Risk Assessment Document can therefore only be integrated.

High SARS-CoV-2 infection rate after resuming professional football in São Paulo, Brazil

OBJECTIVE

To examine the SARS-CoV-2 infection rate in a cohort of 6500 professional athletes and staff during the 2020 football (soccer) season in São Paulo, Brazil.

METHODS

This retrospective cohort study included 4269 players (87% male, age: 21.7±4.2 years) and 2231 staff (87% male, age: 42.6±11.9 years) from 122 teams (women: n=16) involved in eight leagues (women: n=2), which took place in São Paulo, Brazil. Between 4 July 2020 and 21 December 2020, swab samples were collected weekly (n=29 507) and tested for SARS-Cov-2 via reverse transcription-PCR by an accredited laboratory commissioned by the São Paulo Football Federation. We contacted the medical staff of each team with positive cases to collect information on disease severity.

RESULTS

Among 662 PCR-confirmed cases, 501 were athletes and 161 were staff. The new infection rate was 11.7% and 7.2% for athletes and staff, respectively. Athletes were more susceptible to infection than staff (OR: 1.71, 95% CI: 1.42, 2.06, p<0.001), although with lower chance for moderate to severe disease (OR: 0.06, 95% CI: 0.01, 0.54, p=0.012). Six teams had ≥20 individuals testing positive for SARS-CoV-2, whereas 19 teams had ≥10 confirmed cases. Twenty-five mass outbreaks were identified (≥5 infections within a team in a 2-week period). The prevalence of SARS-CoV-2 infections was similar in athletes and staff as the general population in São Paulo.

CONCLUSION

Despite weekly testing and other preventive measures, we found a high SARS-CoV-2 infection rate in athletes and staff after resuming football, which coincides with the high prevalence of infection in the community during the same period. These data may assist policy-makers and sports federations for determining if and when it is safe to resume competitions.

Assessing the risk of SARS-CoV-2 transmission in international professional golf

Objectives

There is no published data on the incidence or risk of SARS-CoV-2 transmission when playing golf, a sport played outdoors where social distancing is possible. The purpose of this prospective study was to report incidence and transmission regarding SARS-CoV-2, of professional golfers competing on the PGA European Tour across 23 events in 11 countries.

Methods

Daily symptom and temperature checks and weekly reverse transcriptase PCR (RT-PCR) screening were performed to determine potential carriage of SARS-CoV-2. Onset and type of symptomology were analysed. Gene expression and cycle thresholds (Cts) were reviewed for all positive cases. Repeat PCR testing was performed on all positive players. RT-PCR analysis included human housekeeping genes and various RNA genes specific for SARS-CoV-2.

Results

During the study period, there were 2900 RT-PCR tests performed on 195 professional golfers competing on the European Tour. Four players tested positive on-site during the study period (0.14% of tests; positive results were declared with Ct <40). Two positive tests were returned as part of routine protocols, while two reported a history of close contact with an individual who had tested positive for SARS-CoV-2 and were isolated and target tested. All were asymptomatic at time of testing, with three developing symptoms subsequently. None required hospital admission. There was no transmission from player to player.

Conclusion

Golf is an outdoor sport where social distancing is possible, meaning risks can be low if guidance is followed by participants. Risk of transmission of SARS-CoV-2 can be mitigated by highly accurate RT-PCR testing of participants and by setting up a safe bubble that includes testing players and support staff, as well as all persons coming into contact with them during the course of the tournament, for example, drivers and hotel staff. This report can also provide reassurance for participants and policy makers regarding community golf, which can be encouraged for the health benefits it provides, in a relatively low-risk environment, with minimal risk of transmission by observing sensible viral hygiene protocols.

COVID-19 Risk in Youth Club Sports: A nationwide sample representing over 200,000 Athletes

CONTEXT

The COVID-19 pandemic has affected almost every aspect of life including youth sports. Little data exists on COVID-19 incidences and risk mitigation strategies in youth club sports.

OBJECTIVE

To determine the reported incidence of COVID-19 cases among youth club sport athletes and the information sources used to develop COVID-19 risk mitigation procedures.

DESIGN

Cross-sectional study.

SETTING

Online surveys.

PATIENTS

Soccer and volleyball youth club directors.

INTERVENTION

A survey was completed by directors of youth volleyball and soccer clubs across the country in October 2020. Surveys included self-reported date of re-initiation, number of players, player COVID-19 cases, sources of infection, COVID-19 mitigation strategies, and information sources for the development of COVID-19 mitigation strategies.

MAIN OUTCOME MEASURES

Total number of cases reported, number of players, and days since club re-initiation were used to calculate an incidence rate of cases per 100,000 player-days. To compare reported incidence rates between soccer and volleyball, a negative binomial model was developed to predict player cases with sport and state incidence as covariates and log(player-days) as an offset. Estimates were exponentiated to yield a reported incidence rate ratio (IRR) with Wald confidence intervals.

RESULTS

A total of 205,136 athletes (soccer=165,580; volleyball=39,556) were represented by 437 clubs (soccer=159; volleyball=278). Club organizers reported 673 COVID-19 cases (soccer=322; volleyball=351), for a reported incidence rate of 2.8 cases per 100,000 player-days (soccer=1.7, volleyball=7.9). Volleyball had a significantly higher reported COVID-19 incidence rate compared to soccer (reported IRR = 3.06 [2.0-4.6], p<0.001). Out of 11 possible mitigation strategies, the median number of strategies used by all clubs was 7 with an interquartile range of 2.

CONCLUSIONS

The incidence of self-reported cases of COVID-19 was lower in soccer clubs than volleyball clubs. Most clubs report using many COVID-19 mitigation strategies to reduce the risk of COVID-19.

SARS-CoV-2 and the role of close contact in transmission: a systematic review

Background: SARS-CoV-2 transmission has been reported to be associated with close contact with infected individuals. However, the mechanistic pathway for transmission in close contact settings is unclear. Our objective was to identify, appraise and summarise the evidence from studies assessing the role of close contact in SARS-CoV-2 transmission.  Methods: This review is part of an Open Evidence Review on Transmission Dynamics of SARS-CoV-2. We conduct ongoing searches using WHO Covid-19 Database, LitCovid, medRxiv, PubMed and Google Scholar; assess study quality based on the QUADAS-2 criteria and report important findings on an ongoing basis. Results: We included 278 studies: 258 primary studies and 20 systematic reviews. The settings for primary studies were predominantly in home/quarantine facilities (39.5%) and acute care hospitals (12%). The overall reporting quality of the studies was low-to-moderate. There was significant heterogeneity in design and methodology. The frequency of attack rates (PCR testing) varied between 2.1-75%; attack rates were highest in prison and wedding venues, and in households. The frequency of secondary attack rates was 0.3-100% with rates highest in home/quarantine settings. Three studies showed no transmission if the index case was a recurrent infection. Viral culture was performed in four studies of which three found replication-competent virus; culture results were negative where index cases had recurrent infections. Eighteen studies performed genomic sequencing with phylogenetic analysis - the completeness of genomic similarity ranged from 77-100%. Findings from systematic reviews showed that children were significantly less likely to transmit SARS-CoV-2 and household contact was associated with a significantly increased risk of infection. Conclusions: The evidence from published studies demonstrates that SARS-CoV-2 can be transmitted in close contact settings. The risk of transmission is greater in household contacts. There was a wide variation in methodology. Standardized guidelines for reporting transmission in close contact settings should be developed.

Public health considerations regarding golf during the COVID-19 pandemic: a narrative review

BACKGROUND

Golf is a sport played worldwide by >60 million people from a variety of backgrounds and abilities. Golf's contribution to physical and mental health benefits are becoming increasingly recognised. Countries have adopted a range of restrictions to playing golf during the COVID-19 pandemic.

AIMS

The purpose of this narrative review was to (1) explore the literature related to the possible health benefits and risks of playing golf during the COVID-19 pandemic and (2) provide recommendations on golf-related activity from the relevant available literature.

RESULTS

Golf can provide health-enhancing physical activity. Regular physical activity is associated with physical/mental health, immune system and longevity benefits. Sense of belonging and life satisfaction significantly improved when golfing restrictions were relaxed after the first lockdown in the UK. Golf is an outdoor sport, where social distancing is possible, and if rules are followed, risk of COVID-19 transmission is likely to be low.

CONCLUSIONS

Policy-makers and governing bodies should support the promotion of golf because participation brings wide ranging benefits for physical health and mental well-being. When effective risk reduction measures are used, the benefits of playing golf in most circumstances outweigh the risk of transmission.

End-to-end SARS-CoV-2 transmission risks in sport: Current evidence and practical recommendations

The coronavirus disease 2019 (COVID-19) pandemic has caused disruption to professional and recreational sports across the world. The SARS-CoV-2 virus can be transmitted by relatively large respiratory droplets that behave ballistically, and exhaled aerosol droplets, which potentially pose a greater risk. This review provides a summary of end-to-end SARS-CoV-2 transmission risk factors for sport and an overview of transmission mechanisms to be considered by all stakeholders. The risk of SARS-CoV-2 transmission is greatest indoors, and primarily influenced by the ventilation of the environment and the close proximity of individuals. The SARS-CoV-2 transmission risks outdoors, e.g. via water, and from fomites, appear less than initially thought. Mitigation strategies include good end-to-end scenario planning of activities to optimise physical distancing, face mask wearing and hygiene practice of individuals, the environment and equipment. The identification and removal of infectious individuals should be undertaken by means of the taking of temperature and COVID-19 symptom screening, and the use of diagnostic monitoring tests to identify asymptomatic individuals. Using adequate video footage, data from proximity technology and subject interviews, the identification and isolation of 'close contacts' should also be undertaken to limit SARS-CoV-2 transmission within sporting environments and into the wider community. Sports should aim to undertake activities outdoors where possible, given the lower SARS-CoV-2 transmission risk, in comparison to indoor environments.