Incidence of respiratory infections and SARS-CoV-2 is higher during contact phases in student rugby players - Lessons learnt from COVID-19 risk mitigation strategies-AWARE V

Abstract

The incidence of acute respiratory infections (ARinf), including SARS-CoV-2, in unvaccinated student rugby players during phases from complete lockdown during the COVID-19 pandemic to returning to competition is unknown. The aim of the study was to determine the incidence of ARinf (including SARS-CoV-2) during non-contact and contact phases during the COVID-19 pandemic to evaluate risk mitigation strategies. In this retrospective cohort study, 319 top tier rugby players from 17 universities completed an online questionnaire. ARinf was reported during 4 phases over 14 months (April 2020-May 2021): phase 1 (individual training), phase 2 (non-contact team training), phase 3 (contact team training) and phase 4 (competition). Incidence (per 1 000 player days) and Incidence Ratio (IR) for ‘All ARinf’, and subgroups (SARS-CoV-2; ‘Other ARinf’) are reported. Selected factors associated with ARinf were also explored. The incidence of ‘All ARinf’ (0.31) was significantly higher for SARS-CoV-2 (0.23) vs. ‘Other ARinf’ (0.08) (p ​< ​0.01). The incidence of ‘All ARinf’ (IR ​= ​3.6; p ​< ​0.01) and SARS-CoV-2 (IR ​= ​4.2; p ​< ​0.01) infection was significantly higher during contact (phases 3 ​+ ​4) compared with non-contact (phases 1 ​+ ​2). Demographics, level of sport, co-morbidities, allergies, influenza vaccination, injuries and lifestyle habits were not associated with ARinf incidence. In student rugby, contact phases are associated with a 3-4 times higher incidence of ARinf/SARS-CoV-2 compared to non-contact phases. Infection risk mitigation strategies in the contact sport setting are important. Data from this study serve as a platform to which future research on incidence of ARinf in athletes within contact team sports, can be compared.

Keywords

COVID-19 / Athletes / Risk / Prevention / Epidemiology

Funding

This work was supported by funding of the International Olympic Committee (IOC). CS received a scholarship made possible through funding by the South African Medical Research Council through its Division of Research Capacity Development under the SAMRC Clinician Researcher Programme. Research reported in this publication was also supported by Self-Initiated Research Grants from the South African Medical Research Council awarded to NS. The content hereof is the sole responsibility of the authors and does not necessarily represent the official views of the SAMRC. Funders were not involved in the preparation of this manuscript.

Authors' contributions

Carolette Snyders: Writing - review & editing, Writing - original draft, Methodology, Conceptualization. Nicola Sewry: Writing - review & editing, Writing - original draft, Project administration, Methodology, Funding acquisition, Conceptualization. Wayne Derman: Writing - review & editing, Writing - original draft, Project administration, Methodology, Conceptualization. Maaike Eken: Writing - review & editing, Writing - original draft, Project administration, Methodology, Conceptualization. Esme Jordaan: Writing - review & editing, Formal analysis. Sonja Swanevelder: Writing - review & editing, Formal analysis. Martin Schwellnus: Writing - review & editing, Writing - original draft, Project administration, Methodology, Funding acquisition, Conceptualization.

Conflict of interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgements

The authors would like to acknowledge Dr Kelly Kaulback and Prof Paola Wood for assisting in compiling the questionnaire and to Mr Ishen Seocharan for developing the questionnaire on the data capture platform. We are also grateful to the coaches for distributing the questionnaires, and to the players for participating in the study.

Special issue articles

References

[1] B. Gualano, G.M. Brito, A.J. Pinto, et al.. High SARS-CoV-2 infection rate after resuming professional football in São Paulo, Brazil. Br J Sports Med, 56 ( 2022), pp. 1004-1007, DOI: 10.1136/bjsports-2021-104431

[2] L. Pedersen, J. Lindberg, R.R. Lind, H. Rasmusen. Reopening elite sport during the COVID-19 pandemic: experiences from a controlled return to elite football in Denmark. Scand J Med Sci Sports, 31 (4) ( 2021), pp. 936-939, DOI: 10.1111/sms.13915

[3] T. Meyer, D. Mack, K. Donde, et al.. Successful return to professional men's football (soccer) competition after the COVID-19 shutdown: a cohort study in the German Bundesliga. Br J Sports Med, 55 (1) ( 2021), pp. 62-66, DOI: 10.1136/bjsports-2020-103150

[4] Y.O. Schumacher, M. Tabben, K. Hassoun, et al.. Resuming professional football (soccer) during the COVID-19 pandemic in a country with high infection rates: a prospective cohort study. Br J Sports Med, 55 (17) ( 2021), pp. 1092-1098, DOI: 10.1136/bjsports-2020-103724

[5] R. Bahr, B. Clarsen, W. Derman, et al.. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sports 2020 (including the STROBE extension for sports injury and illness surveillance (STROBE-SIIS)). Orthop J Sports Med, 8 (2) ( 2020), Article 2325967120902908, DOI: 10.1177/2325967120902908

[6] B. Jones, G. Phillips, S. Kemp, et al.. SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players?. Br J Sports Med, 55 (14) ( 2021), pp. 807-813, DOI: 10.1136/bjsports-2020-103714

[7] N. Sewry, M. Schwellnus, C. Readhead, S. Swanevelder, E. Jordaan. The incidence and transmission of SARS-CoV-2 infection in South African professional rugby players-AWARE II. J Sci Med Sport, 25 (8) ( 2022), pp. 639-643, DOI: 10.1016/j.jsams.2022.06.004

[8] World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA, 310 (20) ( 2013), pp. 2191-2194, DOI: 10.1001/jama.2013.281053

[9] P.A. Harris, R. Taylor, B.L. Minor, et al.. The REDCap consortium: building an international community of software platform partners. J Biomed Inf, 95 ( 2019), Article 103208, DOI: 10.1016/j.jbi.2019.103208

[10] P.A. Harris, R. Taylor, R. Thielke, J. Payne, N. Gonzalez, J.G. Conde. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf, 42 (2) ( 2009), pp. 377-381, DOI: 10.1016/j.jbi.2008.08.010.

[11] Johns Hopkins University of Medicine. Number of daily cases. Johns Hopkins University of Medicine. Accessed January 17, 2024.

[12] B.C. Dixon, R.S. Fischer, H. Zhao, C.S. O’Neal, J.R. Clugston, S.G. Gibbs. Contact and SARS-CoV-2 infections among college football athletes in the Southeastern Conference during the COVID-19 pandemic. JAMA Netw Open, 4 (10) ( 2021), Article e2135566, DOI: 10.1001/jamanetworkopen.2021.35566

[13] W. Derman, M. Badenhorst, M.M. Eken, et al.. Incidence of acute respiratory illnesses in athletes: a systematic review and meta-analysis by a subgroup of the IOC consensus on 'acute respiratory illness in the athlete'. Br J Sports Med, 56 (11) ( 2022), pp. 630-638, DOI: 10.1136/bjsports-2021-104737

[14] L.R. Lopes, V.A. Miranda, R.A. Goes, et al.. Repercussions of the COVID-19 pandemic on athletes: a cross-sectional study. Biol Sport, 38 (4) ( 2021), p. 703, DOI: 10.5114/biolsport.2021.106147

[15] C. Snyders, D.B. Pyne, N. Sewry, J.H. Hull, K. Kaulback, M. Schwellnus. Acute respiratory illness and return to sport: a systematic review and meta-analysis by a subgroup of the IOC consensus on ‘acute respiratory illness in the athlete’. Br J Sports Med, 56 (4) ( 2022), pp. 223-231, DOI: 10.1136/bjsports-2021-104719

[16] V. Thakur, R.K. Ratho, P. Kumar, et al.. Multi-organ involvement in COVID-19: beyond pulmonary manifestations. J Clin Med, 10 (3) ( 2021), p. 446, DOI: 10.3390/jcm10030446

[17] M.W. Martinez, A.M. Tucker, O.J. Bloom, et al.. Prevalence of inflammatory heart disease among professional athletes with prior COVID-19 infection who received systematic return-to-play cardiac screening. JAMA Cardiol, 6 (7) ( 2021), pp. 745-752, DOI: 10.1001/jamacardio.2021.0565

[18] J.C. van Hattum, J.L. Spies, S.M. Verwijs, et al.. Cardiac abnormalities in athletes after SARS-CoV-2 infection: a systematic review. BMJ Open Sport Exerc Med, 7 (4) ( 2021), Article e001164, DOI: 10.1136/bmjsem-2021-001164

[19] K. Kaulback, D.B. Pyne, J.H. Hull, C. Snyders, N. Sewry, M. Schwellnus. The effects of acute respiratory illness on exercise and sports performance outcomes in athletes - a systematic review by a subgroup of the IOC consensus group on “Acute respiratory illness in the athlete. Eur J Sport Sci, 23 (7) ( 2023), pp. 1356-1374, DOI: 10.1080/17461391.2022.2089914