Outdoor Football Games Not Associated with COVID-19 Outbreaks

A new cross-sectional study published by the JAMA Network on August 17, 2021, found professional and college football games played during the COVID-19 pandemic found 'no association between higher county-level COVID-19 cases and hosting football games with limited in-person attendance.'

This study's conclusion is important as 'there is currently no evidence on whether limited in-person attendance of (outdoor) games is associated with COVID-19 case numbers on a county-level.'

A total of 528 games with in-person attendance (101 NFL; 427 NCAA) were included in this study. The matching algorithm returned 361 matching sets of counties.

The median (IQR) daily new COVID-19 cases in treatment group counties hosting games was 26.14 (10.77-50.25) cases per 100 000 residents on game day. The median IQR daily new COVID-19 cases in control group counties where no games were played was 24.11 (9.64-48.55) cases per 100 000 residents on game day.

The treatment effect size ranged from −5.17 to 4.72, with a mean (SD) of 1.21 (2.67) cases per 100 000 residents, within the 14-day period in all counties hosting the games and the daily treatment effect trend remained relatively steady during this period.

'These findings suggest that NFL and NCAA football games hosted with limited in-person attendance were not associated with substantial risk for increased local COVID-19 cases,' stated these researchers.

In addition, Michael A. Rubin, M.D., Ph.D., MS, wrote an Invited Commentary also published by the JAMA Network, stating 'the sensitivity analysis on the duration of the pretreatment and posttreatment periods demonstrated the robustness of their results, even when the posttreatment period was extended to 21 days.'

'While the message is encouraging, the interpretation of the results requires some caution.'

'Because the authors did not have access to exact attendance figures for the NCAA games, the representation of in-person attendance as a binary value prevented a more precise understanding of how the number (or concentration) of spectators may have influenced the outcome.'

'Additionally, other unmeasured variables not included in the model, such as other types of mass indoor or outdoor gatherings that may have occurred in treatment or control counties, could have biased the observed results toward the null.'

'Furthermore, many NFL and NCAA football stadiums are outdoor, open-air facilities, where aerosols are rapidly dispersed, limiting the relevance of these results to leagues such as the NBA and NHL that largely hold indoor events.'

However, it is worth noting that emerging SARS-CoV-2 virus variants have less predictable implications at this point in time and might lead to more disruptive interruptions in the future.

Note: This work was supported by awards from the National Science Foundation and a grant from the Gordon and Betty Moore Foundation, paid to Johns Hopkins University to support the work of the Society for Medical Decision Making COVID-19 Decision Modeling Initiative. The researchers disclosed relevant industry conflicts.