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.

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

10.1101/2021.01.19.21250116 ◽

2021 ◽

Author(s):

Andrew M. Watson ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

Bethany Stevens ◽

...

Keyword(s):

United States ◽

High School ◽

Incidence Rate ◽

Athletic Directors ◽

Face Mask ◽

High School Athletes ◽

Contact Sports ◽

High School Athletic ◽

Individual Sports ◽

Indoor Sports

ABSTRACTPurposeTo evaluate the influence of sport characteristics and face mask use on COVID-19 incidence among high school athletes.MethodsSurveys were distributed to high school athletic directors throughout the United States 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).Results991 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).ConclusionsIn this nationwide survey of US high school athletic directors representing 152,484 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.

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Reported COVID-19 Incidence in Wisconsin High School Athletes in Fall 2020

Journal of Athletic Training ◽

10.4085/1062-6050-0185.21 ◽

2021 ◽

Author(s):

Phillip Sasser ◽

Timothy McGuine ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

...

Keyword(s):

High School ◽

General Population ◽

Incidence Rate ◽

Sport Participation ◽

Negative Binomial ◽

Statistical Significance ◽

Face Mask ◽

High School Athletes ◽

Outdoor Sports ◽

Sport Type

(STATE-XXX = Wisconsin) ABSTRACT Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use. Design: Retrospective survey. Setting: High schools across STATE-XXX during September, 2020. Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2. Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use. Main Outcome Measurements: Reported athlete case rates compared to their county's general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school's county incidence using multivariable negative binomial regression models. Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county's general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49–2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23–1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26–1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all). Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

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Reported COVID-19 Incidence in Wisconsin High School Athletes During Fall 2020

10.1101/2021.02.18.21251986 ◽

2021 ◽

Author(s):

Phillip Sasser ◽

Timothy McGuine ◽

Kristin Haraldsdottir ◽

Kevin Biese ◽

Leslie Goodavish ◽

...

Keyword(s):

High School ◽

General Population ◽

Negative Binomial ◽

Statistical Significance ◽

Negative Binomial Regression ◽

Face Mask ◽

Incidence Rates ◽

High School Athletes ◽

Outdoor Sports ◽

The Difference

ABSTRACTIntroductionThe purpose of this study was to describe the reported incidence of COVID-19 in Wisconsin high school athletes in September 2020, and to investigate the relationship of COVID-19 incidence with sport and face mask use.MethodsSurveys were sent to athletic directors of all Wisconsin high schools regarding sports during September 2020. The association between reported case rates in athletes in each county and the county general population were evaluated with a weighted linear model. Multivariable negative binomial regression models evaluated the associations between COVID-19 incidence and sport type and face mask use by players, adjusting for the county COVID-19 incidence for each school.Results207 schools that had reinitiated sport reported 270 COVID-19 cases among 30,074 players, for case and incidence rates of 809 cases per 100,000 players and 32.6 cases per 100,000 player-days, respectively. The case rates for athletes in each county were positively correlated with the case rates for the county’s general population (β =1.14±0.20, r=0.60, p<0.001). One hundred fifteen (55%) of cases were attributed to household contact, 85 (41%) to contact outside sport or school, 5 (2.4%) to school contact, and 1 (0.5%) to sport contact. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14), although the difference between outdoor and indoor sports approached statistical significance (IRR=0.52 [0.26-1.1], p=0.07). 84% of schools required face masks while playing. For those sports with >50 participating schools, there were no significant associations between COVID-19 incidence and face mask use in cross country (IRR=0.71 [0.2-2.2], p=0.52), football (IRR=1.6 [0.6-5.1], p=0.404), boys soccer (IRR=2.3 [0.5-17], p=0.31), or girls volleyball (IRR=1.4 [0.3-6.6], p=0.64).ConclusionsIncidence of reported COVID-19 among athletes was related to background county incidence and most cases were attributed to household and community contact. Although not statistically significant, reported COVID-19 incidence may be lower in outdoor sports. Face mask use did not have a significant benefit, which may be due to relatively low rates of COVID-19 and the small number of schools that did not report using face masks.

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Cognitive Development of High School Athletes Involved in Contact Sports: A Prospective Study

Clinical Journal of Sport Medicine ◽

10.1097/01.jsm.0000186718.83060.f7 ◽

2005 ◽

Vol 15 (5) ◽

pp. 395

Author(s):

P Fr??mont ◽

G Langlois ◽

C Goulet

Keyword(s):

High School ◽

Cognitive Development ◽

Prospective Study ◽

High School Athletes ◽

Contact Sports ◽

A Prospective Study

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Ice hockey injuries among United States high school athletes from 2008/2009–2012/2013

The Physician and Sportsmedicine ◽

10.1080/00913847.2015.1035210 ◽

2015 ◽

Vol 43 (2) ◽

pp. 119-125 ◽

Cited By ~ 6

Author(s):

George T. Matic ◽

Mark F. Sommerfeldt ◽

Thomas M. Best ◽

Christy L. Collins ◽

R. Dawn Comstock ◽

...

Keyword(s):

United States ◽

High School ◽

Ice Hockey ◽

High School Athletes ◽

Ice Hockey Injuries

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Concussion Symptom Characteristics and Resolution in 20 United States High School Sports, 2013/14-2017/18 Academic Years

Neurosurgery ◽

10.1093/neuros/nyaa091 ◽

2020 ◽

Vol 87 (3) ◽

pp. 573-583

Author(s):

Avinash Chandran ◽

Zachary Y Kerr ◽

Patricia R Roby ◽

Aliza K Nedimyer ◽

Alan Arakkal ◽

...

Keyword(s):

United States ◽

High School ◽

The United States ◽

Return To Play ◽

Health Concern ◽

Loss Of Consciousness ◽

Chi Square ◽

Convenience Sample ◽

Contact Sports ◽

Symptom Prevalence

Abstract BACKGROUND High school (HS) sport-related concussions (SRCs) remain a public health concern in the United States. OBJECTIVE To describe patterns in symptom prevalence, symptom resolution time (SRT), and return-to-play time (RTP) for SRCs sustained in 20 HS sports during the 2013/14-2017/18 academic years. METHODS A convenience sample of athletic trainers reported concussion information to the HS RIOTM surveillance system. Symptom prevalence, average number of symptoms, and SRT and RTP distributions were examined and compared by event type (practice, competition), injury mechanism (person contact, nonperson contact), sex, and contact level (collision, high contact, and low contact) with chi-square tests and Wilcoxon rank-sum tests. RESULTS Among all SRCs (n = 9542), headache (94.5%), dizziness (73.8%), and difficulty concentrating (56.0%) were commonly reported symptoms. On average, 4.7 ± 2.4 symptoms were reported per SRC. Overall, 51.3% had symptoms resolve in <7 d, yet only 7.9% had RTP < 7 d. Differential prevalence of amnesia was seen between practice and competition-related SRCs (8.8% vs 13.0%; P < .001); nonperson-contact and person-contact SRCs (9.3% vs 12.7%; P < .001); and female and male SRCs in low-contact sports (5.8% vs 17.5%; P < .001). Differential prevalence of loss of consciousness was seen between practice and game-related SRCs (1.3% vs 3.2%; P < .001); and female and male SRCs in high contact sports (1.2% vs 4.0%; P < .001). Differential longer SRT (>21 d) was seen between new and recurrent SRCs (9.4% vs 15.9%; P < .001). CONCLUSION Headache was the most commonly reported symptom. Notable group differences in the prevalence of amnesia, loss of consciousness, and SRT may be associated with more severe SRCs, warranting further attention.

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