[Skip to Content]

Claim CME

Health Policy

Association of Limited In-Person Attendance in US National Football League and National Collegiate Athletic Association Games With County-Level COVID-19 Cases

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: August 17, 2021

Original Investigation

Article Information and Disclosures

Asmae Toumi, BS¹;

Haoruo Zhao, BS²;

Jagpreet Chhatwal, PhD^1,3;

Benjamin P. Linas, MD, MPH^4,5;

Turgay Ayer, PhD²

Author Affiliations

¹Institute for Technology Assessment, Massachusetts General Hospital, Boston
²Georgia Institute of Technology, Atlanta
³Harvard Medical School, Boston, Massachusetts
⁴Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts
⁵Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts

Read article on JAMA Network

Read Article Claim CME

Key Points

Question Are football games with limited in-person attendance associated with increased county-level COVID-19 cases?

Findings This cross-sectional study of US counties that hosted National Football League and National Collegiate Athletic Association football games used a matching and difference-in-differences design to estimate the association of games with limited in-person attendance with county-level COVID-19 spread. There was no association between higher county-level COVID-19 cases and hosting football games with limited in-person attendance.

Meaning This study suggests that football games held with limited in-person attendance were not associated with increased COVID-19 cases in the counties they were held.

Abstract

Importance In 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) opted to host football games in stadiums across the country. The in-person attendance of games varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games is associated with COVID-19 case numbers on a county-level.

Objective To assess whether NFL and NCAA football games with limited in-person attendance were associated with increased COVID-19 cases in the counties they were held compared with a matched set of counties.

Design, Setting, and Participants In this time-series cross-sectional study, every county hosting NFL or NCAA games with in-person attendance (treated group) in 2020 and 2021 was matched with a county that that did not host a game on the corresponding day but had an identical game history for up to 14 days prior (control group). A standard matching method was used to further refine this matched set so that the treated and matched control counties had similar population size, nonpharmaceutical interventions in place, and COVID-19 trends. The association of hosting games with in-person attendance with COVID-19 cases was assessed using a difference-in-difference estimator. Data were analyzed from August 29 to December 28, 2020.

Exposures Hosting NFL or NCAA games.

Main Outcomes and Measures The main outcome was estimation of new COVID-19 cases per 100 000 residents at the county level reported up to 14 days after a game among counties with NFL and NCAA games with in-person attendance.

Results A total of 528 games with in-person attendance (101 NFL games [19.1%]; 427 NCAA games [80.9%]) were included. The matching algorithm returned 361 matching sets of counties. The median (interquartile range [IQR]) number of attendance for NFL games was 9949 (6000 to 13 797) people. The median number of attendance for NCAA games was not available, and attendance was recorded as a binary variable. 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.

Conclusions and Relevance This cross-sectional study did not find a consistent increase in the daily COVID-19 cases per 100 000 residents in counties where NFL and NCAA games were held with limited in-person attendance. 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.

Claim CME

Sign in to take quiz and track your certificates

Buy This Activity

Article Information

Accepted for Publication: May 30, 2021.

Published: August 17, 2021. doi:10.1001/jamanetworkopen.2021.19621

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Toumi A et al. JAMA Network Open.

Corresponding Author: Turgay Ayer, PhD, Georgia Institute of Technology, 765 Ferst Dr, Atlanta, GA 30332 (ayer@isye.gatech.edu).

Author Contributions: Ms Toumi had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Ms Toumi and Ms Zhao are co–first authors.

Concept and design: Toumi, Zhao, Chhatwal, Ayer.

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

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Toumi, Zhao, Ayer.

Obtained funding: Chhatwal, Linas, Ayer.

Administrative, technical, or material support: Toumi, Zhao, Chhatwal.

Supervision: Chhatwal, Linas, Ayer.

Conflict of Interest Disclosures: Dr Chhatwal reported receiving personal fees from Value Analytics Labs outside the submitted work. Dr Ayer reported serving as a managing partner at Value Analytics Labs outside the submitted work. No other disclosures were reported.

Funding/Support: This work was supported by award Nos. 2035360 and 2035361 from the National Science Foundation, and grant No. GBMF9634 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.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.