Was participation in collegiate athletics associated with increased SARS-CoV-2 test positivity?
In this cross-sectional study using data for 555 372 student athlete and 3 482 845 nonathlete student SARS-CoV-2 tests reported from 12 National Collegiate Athletic Association Division I institutions, participation in collegiate athletics was not associated with increased test positivity in student athletes compared with nonathlete students.
This finding suggests that collegiate athletics may be held safely in the COVID-19 pandemic without associated increases in test positivity among student athletes.
The COVID-19 pandemic initially led to the abrupt shutdown of collegiate athletics until guidelines were established for a safe return to play for student athletes. Currently, no literature exists that examines the difference in SARS-CoV-2 test positivity between student athletes and nonathletes at universities across the country.
To identify the difference in risk of COVID-19 infection between student athlete and nonathlete student populations and evaluate the hypothesis that student athletes may display increased SARS-CoV-2 test positivity associated with increased travel, competition, and testing compared with nonathletes at their respective universities.
Design, Setting, and Participants
In this cross-sectional analysis, a search of publicly available official university COVID-19 dashboards and press releases was performed for all 65 Power 5 National Collegiate Athletic Association (NCAA) Division I institutions during the 2020 to 2021 academic year. Data were analyzed at the conclusion of the academic year. Schools that released at least 4 months of testing data, including the fall 2020 football season, for student athletes and nonathlete students were included in the analysis. Power 5 NCAA Division I student athletes and their nonathlete student counterparts were included in the analysis.
Designation as a varsity student athlete.
Main Outcomes and Measures
The main outcome was SARS-CoV-2 test positivity for student athletes and nonathlete students at the included institutions for the 2020 to 2021 academic year, measured as a relative risk for student athletes.
Among 12 schools with sufficient data available included in the final analysis, 555 372 student athlete tests and 3 482 845 nonathlete student tests were performed. There were 9 schools with decreased test positivity in student athletes compared with nonathlete students (University of Arkansas: 0.01% vs 3.52%; University of Minnesota: 0.63% vs 5.96%; Penn State University: 0.74% vs 6.58%; Clemson University: 0.40% vs 1.88%; University of Louisville: 0.75% vs 3.05%; Purdue University: 0.79% vs 2.97%; University of Michigan: 0.40% vs 1.12%; University of Illinois: 0.17% vs 0.40%; University of Virginia: 0.64% vs 1.04%) (P < .001 for each). The median (range) test positivity in these 9 schools was 0.46% (0.01%-0.79%) for student athletes and 1.04% (0.40%-6.58%) for nonathlete students. In 1 school, test positivity was increased in the student athlete group (Stanford University: 0.20% vs 0.05%; P < .001). Overall, there were 2425 positive tests (0.44%) among student athletes and 30 567 positive tests (0.88%) among nonathlete students, for a relative risk of 0.50 (95% CI, 0.48-0.52; P < .001). There was no statistically significant difference in student athlete test positivity between included schools; however, test positivity among nonathlete students varied considerably between institutions, ranging from 133 of 271 862 tests (0.05%) at Stanford University to 2129 of 32 336 tests (6.58%) at Penn State University.
Conclusions and Relevance
This study found that in the setting of SARS-CoV-2 transmission mitigation protocols implemented by the NCAA, participation in intercollegiate athletics was not associated with increased SARS-CoV-2 test positivity. This finding suggests that collegiate athletics may be held without an associated increased risk of infection among student athletes.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: December 1, 2021.
Published: February 9, 2022. doi:10.1001/jamanetworkopen.2021.47805
Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Schultz EA et al. JAMA Network Open.
Corresponding Author: Calvin E. Hwang, MD, Department of Orthopaedic Surgery, Stanford University School of Medicine, 341 Galvez St, Lower Level, Stanford, CA 94305 (firstname.lastname@example.org).
Author Contributions: Dr Hwang 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.
Concept and design: All authors.
Acquisition, analysis, or interpretation of data: Schultz, Jerome, Hwang.
Drafting of the manuscript: Schultz, Kussman, Jerome, Hwang.
Critical revision of the manuscript for important intellectual content: Schultz, Kussman, Abrams, Hwang.
Statistical analysis: Schultz, Jerome, Hwang.
Administrative, technical, or material support: Abrams.
Supervision: Kussman, Abrams, Hwang.
Conflict of Interest Disclosures: Dr Kussman reported receiving personal fees from Fresno Madera Medical Society outside the submitted work. Dr Abrams reported owning stock or stock options from AxGen and Cytonics; serving as a board or committee member for the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; receiving cadaver labs and equipment for educational purposes from Arthrex and Stryker; receiving consulting fees from Cytonics, Fidia Pharma, RubiconMD, and Sideline Sports Doc; and serving as an unpaid consultant for TeachAids. No other disclosures were reported.
Additional Contributions: We would like to thank Nicole Segovia, MPH (Stanford University Department of Orthopaedic Surgery), for her assistance with the statistical analysis of our data. She did not receive specific compensation for this work.
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