COVID-19 in Wisconsin High School Athletics: Study Summary
BACKGROUND
COVID-19 has had an unprecedented impact on virtually every aspect of our lives. We recognize that the cancelation of school and sports has had profound negative impacts on the physical and mental health of adolescent athletes, but there is little information regarding the risk of contracting COVID-19 through sport participation. In an attempt to provide some initial information to inform ongoing discussions around youth sports, we collaborated with the Wisconsin Intercollegiate Athletic Association (WIAA) to collect data regarding the incidence of COVID-19 among high school athletes and the procedures being utilized by high schools to reduce the spread of COVID-19.
In May of 2020, we conducted a nationwide survey of over 13,000 adolescent athletes regarding the impacts of school and sport cancelation due to COVID-19 on physical activity and mental health. Comparing the data from 3,200 Wisconsin athletes within this sample to data we had collected from over 5,000 Wisconsin adolescent athletes prior to COVID-19, we found that physical activity levels had dropped by 50% during the pandemic, and symptoms of depression had increased dramatically. Prior to 2020, less than 10% of Wisconsin athletes reported moderate to severe symptoms of depression. Following the widespread cancelation of school and spring sports due to COVID-19, this number had risen to 33%. In the full nationwide sample, 38% of adolescent athletes reported moderate to severe depression and 35% reported moderate to severe anxiety. (The full study results are available here.)
Nonetheless, we acknowledge that COVID-19 is a dangerous disease that continues to spread throughout the country. It remains unclear, however, whether sport participation with risk mitigation procedures in place increases the risk of children contracting COVID-19 and potentially passing the virus on to other individuals. Together with the WIAA, we distributed a survey to all of the high schools in Wisconsin regarding sport reinitiation, COVID-19 cases, and risk reduction procedures being utilized during fall of 2020. The information presented here is intended to contribute to ongoing discussions and add to the growing body of evidence regarding the risk of COVID-19 within youth sports.
MAJOR FINDINGS
Surveys were completed by 207 schools that had restarted sports, representing over 30,000 student-athletes, over 16,000 practices and over 4,000 competitive games in September 2020.
∙ 271 cases of COVID-19 were reported among student-athletes. No cases resulted in hospitalization or death. ∙ This represents lower case and incidence rates than 14-17 year olds in Wisconsin from 9/6/2020 to 10/3/2020:
WI High School Athletes WI 14-17 Year Oldsa
Total Cases 271 2318
Total Population 30074 223936
Total Person-Daysb 846705 6270198
Case Rate (cases per 100,000 children) 901 1035
Incidence Rate (cases per person-day)c 0.000320 0.000370
aData accessed 10/20/20 at https://www.dhs.wisconsin.gov/covid-19/cases.htm#youth.bPerson-days represents the total number of days all individuals participated during the study period. cIncidence rate ratio 0.86 [95% CI: 0.58-1.3], p=0.59.
COVID-19 cases and incidence were determined for the fall sports in which 50 or more schools reported participation.
∙ No sports were found to have a higher incidence rate of COVID-19 than 14-17 year olds in Wisconsin from 9/6/2020 to 10/3/2020:
Schools Players Cases Person-Days Case RateaIncidence RatebIRR [95%CI]c Pc Cheer/Dance 73 1337 19 49520 1420 0.000384 1.05 [0.64-1.60] 0.87 Cross Country 186 4708 41 182293 871 0.000225 0.61 [0.44-0.82] 0.001 Football 162 8228 86 187881 1050 0.000458 1.24 [0.99-1.50] 0.051 Golf - Girls 68 831 7 33819 842 0.000207 0.57 [0.24-1.10] 0.12 Soccer - Boys 103 3147 27 72494 858 0.000372 1.01 [0.67-1.50] 0.97 Swimming 62 1202 15 44411 1250 0.000338 0.93[0.53-1.50] 0.73 Tennis - Girls 78 2138 13 84611 608 0.000154 0.42 [0.23-0.69] 0.001 Volleyball - Girls 179 7454 59 170211 792 0.000347 0.94 [0.72-1.20] 0.63
aCases per 100,000 players. bCases per person-day, in which person-days represents the total number of days all individuals participated during the study period.. cIncidence rate ratio [95% Confidence Interval] and significance level for comparison to COVID-19 incidence among 14-17 year olds in Wisconsin from 9/6/2020 to 10/3/2020; IRR >1 indicates increased COVID-19 incidence rate relative to WI 14-17 year olds, while IRR<1 indicates lower incidence rate. Data accessed 10/20/20 at https://www.dhs.wisconsin.gov/covid-19/cases.htm#youth.
Schools were asked to report the source of the transmission of any positive cases, if known. ∙ Of the 209 cases among players with a known source, only 1 (<0.5%) was attributed to participation in sports:
Source Number (%)
Household Contact 115 (55.0%)
School Contact (not sport) 5 (2.4%)
Community Contact (not sport or school) 85 (40.7%)
Sport Contact 1 (0.5%)
Other Contact 3 (1.4%)
Unknown 62 (29.7%)
Schools were asked if classes were being conducted in-person or virtually during the study period.
∙ The incidence of COVID-19 among athletes did not differ between schools with virtual versus in-person instruction:
In-Person Virtual
Number of Schoolsa 182 16
Total Cases 243 25
Total Population 26342 2523
Total Person-Daysb 774726 71979
Cases Rate (cases per 100,000 Student-Athletes) 922 991
Incidence Rate (cases per player-day)c 0.000314 0.000347
aNine schools did not respond regarding in-person versus virtual school instruction.bPerson-days represents the total number of days all individuals participated during the study period. cIncidence rate ratio 0.86 [95% CI: 0.58-1.3], p=0.59.
Schools were asked about the presence of a formal plan regarding COVID-19 and risk mitigation procedures.
∙ 100% of the schools reported that they had a formal plan in place regarding COVID-19 risk reduction. The median number of procedures utilized was 8 per school. The number and proportion of schools reporting the use of specific procedures:
Risk mitigation procedure Number of Schools (%)
Player/staff symptom monitoring 186 (89.9%)
Player/staff temperature checks at home 137 (66.2%)
Player/staff temperature checks on site 86 (41.5%)
Face mask use for players off the field 176 (85.0%)
Face mask use for staff 203 (98.1%)
Social distancing for players off the field 171 (82.6%)
Social distancing for staff 176 (85.0%)
Increased facility disinfection 195 (94.2%)
Staggered arrival and departure times for events 91 (44.0%)
Face mask use for players while playing 173 (83.6%)
Social distancing for players while playing 89 (43.0%)
CONCLUSIONS
These findings suggest that participation in sports is not associated with an increased risk of COVID-19 among Wisconsin high school student-athletes. The total case rate and incidence rate reported by this statewide sample representing over 30,000 student-athletes are lower than those reported by the Wisconsin Department of Health Services for 14-17 year olds during the same time period. In fact, no specific sport had a statistically higher incidence rate than the background incidence among adolescents across the state during the same time period. Furthermore, while the number of schools utilizing virtual instruction was small, we identified no difference in COVID-19 incidence between student athletes from schools with in-person versus virtual instruction.
In addition, these findings agree with the existing literature regarding COVID-19 severity in children, as none of the cases were reported to result in hospitalization or death. Although 30% of the reported cases did not have an identified source, only 1 (<0.5%) of the cases with a reported source was attributed to transmission during sports activities. Finally, all of the respondent high schools reported having a formal COVID-19 plan in place, and the majority reported utilizing a broad range of risk mitigation procedures.
While we hope that this information will help contribute to the ongoing discussions about the relative risks and benefits of youth sport participation, we should recognize that COVID-19 risk will vary in different areas of the country and across age groups. Therefore, efforts to assess COVID-19 risk among youth athletes should be expanded and replicated in other populations in order to provide a more complete picture of the risk of COVID-19 transmission during sport participation.