Mitigating from COVID-19 during Intercollegiate Sports Match

Coronavirus disease 2019 (COVID-19) pandemic has posed a significant threat not only to health outcomes but also to other societal sectors, including the educational system [1]. Apart from youth education, colleges and universities are characterized by the integration of in-depth theoretical and practical knowledge in young adulthood. The college festivals and matches between rivalry schools are another part of the tradition in university cultures that had been in place prior to the COVID-19 outbreak. These events add value to students’ learning experiences and boost social interaction among college students. Therefore, the recovery of college festivals has become an important issue that has drawn attention after the ease of COVID-19 pandemic quarantine measures [2].

Two long-standing private universities in Korea have co-hosted five annual intercollegiate sports matches since 1926. In 2020 and 2021, the matches were cancelled due to the social distancing policy of the COVID-19 pandemic. In 2022, after the increased number of COVID-19 vaccine coverage and switch from Delta to Omicron as the predominant strain characterized by lower case fatality, it was deemed necessary to recommence the intercollegiate sports match with spectators. Over the period of time, six types of COVID-19 vaccines, namely BNT162b2 (Pfizer Inc., New York, NY, USA), mRNA-1273 (Moderna Inc, Cambridge, MA, USA), NVX-CoV2373 (Novavax Inc, Gaithersburg, MD, USA), AZD1222 (AstraZeneca PLC, Cambridge, UK), Ad26.COV2.S (Janssen Vaccines, Leiden, Netherlands), and GBP510 (SK Bioscience, Seongnam, Korea), were available in Korea [3]. A sequential mass vaccination in prioritizing risk group was started since February 2021, reaching relatively high vaccine coverage among high risk group by late 2022 [4]. However, adolescents and young adults had relatively lower vaccine coverage rate compared to older adults [5].

The 2022 annual Korea-Yonsei intercollegiate sports match took place on October 28 and 29, 2022. In total, 59,500 tickets were sold in all sports matches, and there were 40,000 spectators in the main stadium. In both universities, students were mandated to take a leave of absence when that person had fever, respiratory symptoms, or laboratory confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We retrospectively assessed the number of COVID-19 cases before and after the intercollegiate matches in the two universities. The students were recommended to undergo a COVID-19 test when they had suspected symptoms. They were mandated to report the confirmation of COVID-19 to the college in order to excuse their absence from class. We collected community-onset COVID-19 cases from the government's database and calculated the 7-day average incidence per 100,000 COVID-19 cases in the communities and universities. We used multivariable Poisson regression model to identify the change over time; daily incidence in the community and linear trend per day were included in the model.

Figure 1 shows the incidence of COVID-19 in the community and universities before and after the intercollegiate sports matches. In the first week of October 2022, the community-onset COVID-19 cases ranged from 48 per 100,000 (95% confidence interval [CI]: 44 - 51 per 100,000) to 51 per 100,000 (95% CI: 48 - 54 per 100,000), whereas the university-onset COVID-19 cases were 25 per 100,000 (95% CI: 22 - 28 per 100,000). During the first week of November 2022 (one week after the intercollegiate match), the community-onset cases were 93 per 100,000 (95% CI: 90 - 96 per 100,000), whereas the university-onset cases were 100 per 100,000 (95% CI: 97 - 104 per 100,000). In the last week of November 2022, the community-onset cases were 108 per 100,000 (95% CI: 105 - 111 per 100,000) and the number of university-onset cases was 34 per 100,000 (95% CI: 31 - 37 per 100,000). Multivariable Poisson regression model showed a relative risk of 1.01 (95% CI: 1.00 - 1.01, P = 0.03) for community incidence affecting university outbreaks.

Figure 1
Temporal trend of COVID-19 detection in the community vs. university, before and after the intercollegiate sports match.
COVID-19, coronavirus disease 2019.

• Click for larger image
• Download as PowerPoint slide

During the match period, no additional policies other than mask-wearing and standard precaution measures were implemented. There were no notified SARS-CoV-2 critical infections nor deaths attributable to COVID-19 following the match. The intercollegiate sports match concluded with a surge in the incidence rate for a very short period, followed by leveling off of the outbreak, which was lower than that at the community level. There was no second wave of outbreak or sustained outbreak in the school provoked by a large intercollegiate sports match. Our findings are consistent with those from other countries, which showed a successful return to college or professional games in a controlled environment. In the United States, college football games hosted with limited in-person attendance were not associated with an increased risk of local COVID-19 cases [6]. In Germany, basic hygiene measures have led to the safe reopening of professional football training and matches [7]. In Qatar, the Amir Cup was associated with a reduced incidence of COVID-19 during the final match [8]. In line with these findings, our observations suggest that college fairs, sports matches, and extracurricular activities can be safely resumed when population-level immunity has reached herd protection.

Given that the sports event attracts young and healthy participants, primarily college students, the impact on public health in terms of a surge in temporary patients may not be significant. Nevertheless, it is important to consider that even though the worsening of an epidemic situation might only affect a small proportion of the population, there remains a possibility of it being linked to factors such as hospitalizations or deaths. While our finding indicates that mass gatherings could be feasible in typical endemic situations, it may not offer sufficient evidence to support the idea that they are also safe for high-risk groups.

The recovery of college sports matches is an important value that has been a cornerstone to the "return-to-normal" campaign in the midst of the end of the pandemic on the university campus. The sustainable and safe intercollegiate sports matches that were experienced show that the operation of mass-gathering sports events is feasible during the era of COVID-19 vaccination and in the predominance of Omicron variants.