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

Abstract

To describe the incidence of COVID-19 in Wisconsin high school athletes and investigate the relationship of COVID-19 incidence with sport and face mask use.

Design

Retrospective survey.

Setting

High schools across Wisconsin during September 2020.

Patients or Other Participants

Athletic directors representing 30 074 high school athletes with or without SARS-CoV-2.

Main Outcome Measurement(s)

The COVID-19 rates among athletes, counties, states, as well as school instruction type (virtual versus in person), sport type, and face mask use were assessed. Reported athlete case rates were compared with the county's general population and 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

The 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 < .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 = .93) or between noncontact and contact sports (IRR = 0.53 [0.23, 1.3], P = .14). Outdoor sports had a lower incidence rate than indoor sports, although this finding did not reach statistical significance (IRR = 0.52 [0.26, 1.1], P = .07). No significant associations were found between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (P values > .05).

Conclusions

The incidence of reported COVID-19 among high school athletes was related to the county incidence, and most cases were attributed to nonsport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit demonstrated for face mask use may be due to relatively low rates of COVID-19 in Wisconsin during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

SciScore for 10.1101/2021.02.18.21251986: (What is this?)

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

Table 1: Rigor

Institutional Review Board Statement	IRB: Study Design: All procedures performed in this study were deemed exempt from by the Institutional Review Board of the University of Wisconsin-Madison.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	not detected.

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:

Limitations: This study has several limitations. We are unable to verify the information provided by athletic directors through a separate independent source. Local, county-level daily COVID-19 case data was often not available for adolescents or children, so our adjusted models could only account for the population-level background incidence from each county. Nonetheless, we found that reported case rates from our sample and the case rates from the county general populations were highly related. It is difficult to fully interpret comparisons of COVID-19 cases reported by athletic directors and those collected by public health agencies, but we have included public health data to add context for our findings and to adjust our incidence models. As mentioned above, the incidence of COVID-19 was relatively low during September 2020 in Wisconsin, and this may have limited our ability to detect statistically significant associations in some cases. Reported sources of infection were provided by the schools themselves and it is unknown whether these represent the results of formal contact tracing by local health authorities. Finally, this data represents information regarding athletes from a single state and may not be generalizable to other populations.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We found bar graphs of continuous data. We recommend replacing bar graphs with more informative graphics, as many different datasets can lead to the same bar graph. The actual data may suggest different conclusions from the summary statistics. For more information, please see Weissgerber et al (2015).

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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