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

Abstract

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

Objective

To evaluate the influence of sport characteristics and face mask use on the COVID-19 incidence among high school athletes.

Design

Descriptive epidemiology study.

Setting

US high school athletic departments.

Patients or Other Participants

Athletic directors.

Main Outcome Measure(s)

Surveys were completed regarding sport reinitiation, COVID-19 cases, and risk-reduction procedures in fall 2020. Separate mixed-effects Poisson regression models were developed to evaluate the associations between the reported COVID-19 incidence and (1) sport characteristics (indoor versus outdoor, individual versus team, contact versus noncontact) and (2) face mask use while playing (yes or no).

Results

A total of 991 schools had restarted fall sports, representing 152 484 athletes on 5854 teams. There were 2565 reported cases of COVID-19, representing a case rate of 1682 cases per 100 000 athletes and an incidence rate of 24.6 cases per 100 000 player-days. The COVID-19 incidence was lower for outdoor versus indoor sports (incidence rate ratio [IRR] = 0.54; 95% CI = 0.49, 0.60; P < .001) and noncontact versus contact sports (IRR = 0.78; 95% CI = 0.70, 0.87; P < .001), but not team versus individual sports (IRR = 0.96; 95% CI = 0.84, 1.1; P = .49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR = 0.53; 95% CI = 0.37, 0.73; P < .001), boys' basketball (IRR = 0.53; 95% CI = 0.33, 0.83; P = .008), and girls' basketball (IRR = 0.36; 95% CI = 0.19, 0.63; P < .001) and approached statistical significance in football (IRR = 0.79; 95% CI = 0.59, 1.04; P = .10) and cheer or dance (IRR = 0.75; 95% CI = 0.53, 1.03; P = .081).

Conclusions

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

SciScore for 10.1101/2021.01.19.21250116: (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 approved 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:

This study has several limitations. The information is self-reported by the athletic directors of each school and cannot be directly verified through medical records or another independent source. Local, state-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 state. Nonetheless, we found that reported case rates from our sample and the case rates from the state general populations were highly related. As mentioned above, the incidence of COVID-19 was likely not stable throughout the fall in many areas, and those sports that initiated play during periods of increased local incidence (winter sports in October, for example) may be biased toward a higher incidence that is not directly attributable to the sport itself. Reported sources of infection were provided by the schools themselves and not through formal contact tracing by local health authorities. We cannot directly account for the possibility of transmission between players that went unidentified. Finally, while this data represents information regarding a large number of male and female high school athletes from a nationwide sample, it may not be generalizable to other populations. In conclusion, this study suggests that certain high school sports and sport characteristics may have a greater relative risk of COVID-19 and that face mask use may help reduce the risk of COVID-19 among adolescent...

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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