The Effect of NFL and NCAA Football Games on the Spread of COVID-19 in the United States: An Empirical Analysis

  1. Asmae Toumi
  2. Haoruo Zhao
  3. Jagpreet Chhatwal
  4. Benjamin P. Linas
  5. Turgay Ayer

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Abstract

Importance

In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) had opted to host games in stadiums across the country. The in-person attendance of games has varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games has caused a substantial increase in coronavirus disease 2019 (COVID-19) cases.

Objective

To assess whether NFL and NCAA football games with limited in-person attendance have contributed to a substantial increase in COVID-19 cases in the counties they were held.

Design

In this time-series cross-sectional study, we matched every county hosting game(s) with in-person attendance (treated) in 2020 and 2021 with a county that has an identical game history for up to 14 days (control). We employed a standard matching method to further refine this matched set so that the treated and matched control counties have similar population size, non-pharmaceutical intervention(s) in place, and COVID-19 trends. We assessed the effect of hosting games with in-person attendance using a difference-in-difference estimator.

Setting

U.S. counties.

Participants

U.S. counties hosting NFL and/or NCAA games.

Exposure

Hosting NFL and/or NCAA games.

Main outcomes and measures

Estimating the impact of NFL and NCAA games with in-person attendance on new, reported COVID-19 cases per 100,000 residents at the county-level up to 14 days post-game.

Results

The matching algorithm returned 361 matching sets of counties. The effect of in-person attendance at NFL and NCAA games on community COVID-19 spread is not significant as it did not surpass 5 new daily cases of COVID-19 per 100,000 residents on average.

Conclusions and relevance

This time-series, cross-sectional matching study with a difference-in-differences design did not find an increase in COVID-19 cases per 100,000 residents in the counties where NFL and NCAA games were held with in-person attendance. Our study suggests that NFL and NCAA football games hosted with limited in-person attendance do not cause a significant increase in local COVID-19 cases.

Key points

Question

Did NFL and NCAA football games with limited in-person attendance cause a substantia increase in coronavirus disease 2019 (COVID-19) cases in the U.S. counties where the games were held?

Findings

This time-series, cross-sectional study of U.S. counties with NFL and NCAA football games used matching and difference-in-differences design to estimate the effect of games with limited in-person attendance on county-level COVID-19 spread. Our study does not find an increase in county-level COVID-19 cases per 100,000 residents due to NFL and NCAA football games held with limited in-person attendance.

Meaning

This study suggests that NFL and NCAA games held with limited in-person attendance do not cause an increase in COVID-19 cases in the counties they are held.

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  1. ScreenIT

    SciScore for 10.1101/2021.02.15.21251745: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are limitations to this study. The Stable Unit Treatment Value Assignment (SUTVA) assumption stipulates that each unit receives the same form or version of the treatment[15]. The treatment in this study, namely in-person attendance, was defined as a binary (yes or no fans) and therefore the results do not capture the possible impact of differing attendance numbers (Figure 2) on the outcomes. When the NCAA attendance numbers are made publicly available, additional sensitivity analyses can be performed to establish whether varying attendance numbers have an impact on COVID-19 spread. We also did not control for other large gathering events, such as political rallies, as some have been found to cause a local spread in COVID-19 cases[16]. We also did not account for the spillover effects to the counties adjacent to the ones hosting NFL/NCAA games. Finally, our analysis could not assess whether the Super Bowl LV game held on February 7th, 2021 in Tampa, Florida is associated with an increase in the spread of COVID-19 cases because of post-game celebrations. Our study provides new information on the effect of football games with in-person attendance on COVID-19 spread. This time-series, cross-sectional study with difference-in-differences design suggests that NFL and NCAA games held with limited in-person attendance do not cause an increase in COVID-19 cases in the counties they are held. Further research is needed to account for spillover effects to counties adjacent to the ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2021.02.15.21251745v1 on medRxiv