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SARS-CoV-2 Transmission Risk Among National Basketball Association Players, Staff, and Vendors Exposed to Individuals With Positive Test Results After COVID-19 Recovery During the 2020 Regular and Postseason

Educational Objective
To describe case characteristics, including viral dynamics and transmission of infection, for individuals who have clinically recovered from SARS-CoV-2 infection but continue to have positive test results following discontinuation of isolation precautions.
1 Credit CME
Key Points

Question  Do individuals who have clinically recovered from COVID-19 but continue to test positive still transmit SARS-CoV-2?

Findings  In this cohort study of 3648 participants, data were collected during the resumption of the 2020 National Basketball Association season in a closed environment. Individuals who recovered clinically from COVID-19 but continued to test positive did not transmit SARS-CoV-2 to others, despite close proximity with susceptible individuals.

Meaning  US Centers of Disease Control and Prevention guidelines to allow discontinuation of isolation precautions for asymptomatic individuals after 10 days from symptom onset or first reverse-transcription–polymerase chain reaction (RT-PCR) positive test result, without requiring a negative RT-PCR test result, was sufficient to prevent transmission of SARS-CoV-2 in this 2020 cohort.

Abstract

Importance  Clinical data are lacking regarding the risk of viral transmission from individuals who have positive reverse-transcription–polymerase chain reaction (RT-PCR) SARS-CoV-2 test results after recovery from COVID-19.

Objective  To describe case characteristics, including viral dynamics and transmission of infection, for individuals who have clinically recovered from SARS-CoV-2 infection but continued to have positive test results following discontinuation of isolation precautions.

Design, Setting, and Participants  This retrospective cohort study used data collected from June 11, 2020, to October 19, 2020, as part of the National Basketball Association (NBA) closed campus occupational health program in Orlando, Florida, which required daily RT-PCR testing and ad hoc serological testing for SARS-CoV-2 IgG antibodies. Nearly 4000 NBA players, staff, and vendors participated in the NBA’s regular and postseason occupational health program in Orlando. Persistent positive cases were those who recovered from a documented SARS-CoV-2 infection, satisfied US Centers for Disease Control and Prevention criteria for discontinuation of isolation precautions, and had at least 1 postinfection positive RT-PCR test(s) result.

Exposures  Person-days of participation in indoor, unmasked activities that involved direct exposure between persistent positive cases and noninfected individuals.

Main Outcomes and Measures  Transmission of SARS-CoV-2 following interaction with persistent positive individuals, as measured by the number of new COVID-19 cases in the Orlando campus program.

Results  Among 3648 individuals who participated, 36 (1%) were persistent positive cases, most of whom were younger than 30 years (24 [67%]) and male (34 [94%]). Antibodies were detected in 33 individuals (91.7%); all remained asymptomatic following the index persistent positive RT-PCR result. Cycle threshold values for persistent positive RT-PCR test results were typically above the Roche cobas SARS-CoV-2 limit of detection. Cases were monitored for up to 100 days (mean [SD], 51 [23.9] days), during which there were at least 1480 person-days of direct exposure activities, with no transmission events or secondary infections of SARS-CoV-2 detected (0 new cases).

Conclusions and Relevance  In this retrospective cohort study of the 2020 NBA closed campus occupational health program, recovered individuals who continued to test positive for SARS-CoV-2 following discontinuation of isolation were not infectious to others. These findings support time-based US Centers of Disease Control and Prevention recommendations for ending isolation.

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Article Information

Accepted for Publication: March 28, 2021.

Published Online: April 22, 2021. doi:10.1001/jamainternmed.2021.2114

Corresponding Author: Christina Mack, PhD, MSPH, IQVIA, Real World Solutions, 4820 Emperor Blvd, Durham, NC 27703 (christina.mack@iqvia.com).

Author Contributions: Drs Mack and Tai had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mack, DiFiori, Tai, Shiue, Grad, Anderson, Maragakis.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mack, Tai, Shiue, Anderson, Sims.

Critical revision of the manuscript for important intellectual content: Mack, DiFiori, Tai, Shiue, Grad, Ho, Sims, LeMay, Mancell, Maragakis.

Statistical analysis: Mack, Tai, Shiue, Grad, Sims, Mancell.

Administrative, technical, or material support: Mack, Tai, Shiue, Sims, LeMay, Maragakis.

Supervision: Mack, DiFiori, Tai, Grad, Ho, Sims, Maragakis.

Conflict of Interest Disclosures: Drs Mack and Tai and Ms Shiue reported being employees of IQVIA, which is in a paid consultancy with NBA, during the conduct of the study. Dr DiFiori reported consulting fees from the NBA outside the submitted work. Dr Grad reported personal fees from the NBA during the conduct of the study and grants from Merck and Pfizer and personal fees from GlaxoSmithKline outside the submitted work. Dr Anderson reported consulting fees from the NBA Players Association Fees during the conduct of the study as well as grants from the US Centers for Disease Control and Prevention (CDC), National Institutes of Health/National Institute of Allergy and Infectious Diseases, and the Agency for Healthcare Research and Quality, personal fees from UpToDate, and being a co-owner of Infection Control Education for Major Sports, LLC. Dr Mancell reported personal fees from the NBA during the conduct of the study and is a team physician for the Memphis Grizzlies. Dr Maragakis reported serving as cochair of the Healthcare Infection Control Practices Advisory Committee for the CDC. No other disclosures were reported.

Additional Contributions: We thank the NBA Players Association, NBA Team Physicians Association, athletic training staff and compliance officers, Sarah Jednak, BA, who played an advisory role on behalf of the NBA Players Association, and the IQVIA and NBA analytic and operational team, including David Weiss, JD, Miheer Mhatre, AB, JD, Taylor Walden, MS, Peter Meisel, MSPH, Rachel Davis, MPH, Samantha Engelhardt, MPA, Kelly Hogan, BA, and Wes Harris, MS, from the NBA (paid employees) and Kristina Zeidler, MPH, Melody Samant, MPH, and Helen Zhang, BSPH, from IQVIA (paid consultancy with the NBA).

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