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

doi:10.17159/2078-516X/2021/v33i1a11210

Review

. 2021 Jan 15;33(1):v33i1a11210.

doi: 10.17159/2078-516X/2021/v33i1a11210. eCollection 2021.

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

B Jones^{1

2

3

4

5}, G Phillips^{1

2

6}, F Valeriani⁷, T Edwards⁸, E R Adams⁸, L Bonadonna⁹, R J Copeland¹⁰, M J Cross^{11

12}, C Dalton¹⁰, L Hodgson^{13

14}, A Jimenez^{10

15}, S P Kemp^{16

17}, J Patricios¹⁸, V Romano Spica⁷, K A Stokes^{11

16}, M Weed¹⁹, C Beggs¹

Affiliations

¹ Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
² England Performance Unit, The Rugby Football League, Leeds, UK.
³ Leeds Rhinos Rugby League club, Leeds, UK.
⁴ Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, the University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa.
⁵ School of Science and Technology, University of New England, Armidale, NSW, Australia.
⁶ Hull Kingston Rovers, Hull, UK.
⁷ Public Health Unit, Department of Movement, Human and Health Sciences; University of Rome "Foro Italico", Rome, Italy.
⁸ Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
⁹ Italian National Institute of Health, Rome Italy.
¹⁰ Advanced Wellbeing Research Centre, Sheffield Hallam University, UK.
¹¹ University of Bath, Bath, UK.
¹² Premiership Rugby, Twickenham, UK.
¹³ The Football Association, St George's Park, Burton-Upon-Trent, UK.
¹⁴ School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK.
¹⁵ Centre for Sport Studies, King Juan Carlos University, Fuenlabrada, Madrid, Spain.
¹⁶ Rugby Football Union, Twickenham, UK.
¹⁷ London School of Hygiene and Tropical Medicine, London, UK.
¹⁸ Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁹ Centre for Sport, Physical Education and Activity Research (spear), Canterbury Christ Church University, UK.

PMID: 39498368
PMCID: PMC11534289
DOI: 10.17159/2078-516X/2021/v33i1a11210

Review

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

B Jones et al. S Afr J Sports Med. 2021.

. 2021 Jan 15;33(1):v33i1a11210.

doi: 10.17159/2078-516X/2021/v33i1a11210. eCollection 2021.

Authors

Affiliations

¹ Carnegie Applied Rugby Research (CARR) centre, Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
² England Performance Unit, The Rugby Football League, Leeds, UK.
³ Leeds Rhinos Rugby League club, Leeds, UK.
⁴ Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, the University of Cape Town and the Sports Science Institute of South Africa, Cape Town, South Africa.
⁵ School of Science and Technology, University of New England, Armidale, NSW, Australia.
⁶ Hull Kingston Rovers, Hull, UK.
⁷ Public Health Unit, Department of Movement, Human and Health Sciences; University of Rome "Foro Italico", Rome, Italy.
⁸ Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
⁹ Italian National Institute of Health, Rome Italy.
¹⁰ Advanced Wellbeing Research Centre, Sheffield Hallam University, UK.
¹¹ University of Bath, Bath, UK.
¹² Premiership Rugby, Twickenham, UK.
¹³ The Football Association, St George's Park, Burton-Upon-Trent, UK.
¹⁴ School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK.
¹⁵ Centre for Sport Studies, King Juan Carlos University, Fuenlabrada, Madrid, Spain.
¹⁶ Rugby Football Union, Twickenham, UK.
¹⁷ London School of Hygiene and Tropical Medicine, London, UK.
¹⁸ Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁹ Centre for Sport, Physical Education and Activity Research (spear), Canterbury Christ Church University, UK.

PMID: 39498368
PMCID: PMC11534289
DOI: 10.17159/2078-516X/2021/v33i1a11210

Abstract

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.

Keywords: COVID-19; illness; infection; virus.

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Figures

**Fig. 1**
SARS-CoV-2 main transmission routes and risks for sport

**Fig. 2**
End-to-end transmission risk activities for sports

**Fig. 3**
**(a)** A list of rugby league game-specific actions, **(b)** Application of Team Sport Risk Exposure Framework (TS-REF)^[7], **(c)** Rugby league game-specific actions following potential risk-reduction interventions

**Fig. 4**
The Team Sport Risk Exposure Framework 2; TS-REF-2 to identify increased risk contacts in sport ^[88]

See this image and copyright information in PMC

References

1. Stokes KA, Jones B, Bennett M, et al. Returning to play after prolonged training restrictions in professional collision sports. Int J Sports Med. 2020;41(13):895–911. doi: 10.1055/a-1180-3692. - DOI - PMC - PubMed
1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544. doi: 10.1038/s41564-020-0695-z. - DOI - PMC - PubMed
1. Jayaweera M, Perera H, Gunawardana B, et al. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res. 2020;188:109819. doi: 10.1016/j.envres.2020.109819. - DOI - PMC - PubMed
1. Wang J, Du G. COVID-19 may transmit through aerosol. Ir J Med Sci. 2020;189(4):1143–1144. doi: 10.1007/s11845-020-02218-2. - DOI - PMC - PubMed
1. Wang H, Li X, Li T, et al. The genetic sequence, origin, and diagnosis of SARS-CoV-2. Eur J Clin Microbiol Infect Dis. 2020;39(9):1629–1635. doi: 10.1007/s10096-020-03899-4. - DOI - PMC - PubMed

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[1] Stokes KA, Jones B, Bennett M, et al. Returning to play after prolonged training restrictions in professional collision sports. Int J Sports Med. 2020;41(13):895–911. doi: 10.1055/a-1180-3692. - DOI - PMC - PubMed

[2] Stokes KA, Jones B, Bennett M, et al. Returning to play after prolonged training restrictions in professional collision sports. Int J Sports Med. 2020;41(13):895–911. doi: 10.1055/a-1180-3692. - DOI - PMC - PubMed

[3] Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544. doi: 10.1038/s41564-020-0695-z. - DOI - PMC - PubMed

[4] Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;5(4):536–544. doi: 10.1038/s41564-020-0695-z. - DOI - PMC - PubMed

[5] Jayaweera M, Perera H, Gunawardana B, et al. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res. 2020;188:109819. doi: 10.1016/j.envres.2020.109819. - DOI - PMC - PubMed

[6] Jayaweera M, Perera H, Gunawardana B, et al. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res. 2020;188:109819. doi: 10.1016/j.envres.2020.109819. - DOI - PMC - PubMed

[7] Wang J, Du G. COVID-19 may transmit through aerosol. Ir J Med Sci. 2020;189(4):1143–1144. doi: 10.1007/s11845-020-02218-2. - DOI - PMC - PubMed

[8] Wang J, Du G. COVID-19 may transmit through aerosol. Ir J Med Sci. 2020;189(4):1143–1144. doi: 10.1007/s11845-020-02218-2. - DOI - PMC - PubMed

[9] Wang H, Li X, Li T, et al. The genetic sequence, origin, and diagnosis of SARS-CoV-2. Eur J Clin Microbiol Infect Dis. 2020;39(9):1629–1635. doi: 10.1007/s10096-020-03899-4. - DOI - PMC - PubMed

[10] Wang H, Li X, Li T, et al. The genetic sequence, origin, and diagnosis of SARS-CoV-2. Eur J Clin Microbiol Infect Dis. 2020;39(9):1629–1635. doi: 10.1007/s10096-020-03899-4. - DOI - PMC - PubMed

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

Affiliations

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

Authors

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Abstract

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