Abstract
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. 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. 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. Hosting NFL or NCAA games. 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. 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. 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.
Highlights
The Centers for Disease Control and Prevention has advised that mass in-person events have the potential for substantial spread of COVID-19.1 To curb the spread of COVID-19, states have implemented nonpharmaceutical interventions with varying intensity, including closure of work places, limit on indoor and outdoor gatherings, and travel restrictions.[2]
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
Limited In-Person Attendance at National Football League (NFL) and National Collegiate Athletic Association (NCAA) Football Games and County-Level COVID-19 Cases. 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
Summary
The Centers for Disease Control and Prevention has advised that mass in-person events have the potential for substantial spread of COVID-19.1 To curb the spread of COVID-19, states have implemented nonpharmaceutical interventions with varying intensity, including closure of work places, limit on indoor and outdoor gatherings, and travel restrictions.[2] Of note, sporting events have been banned or cancelled owing to the potential of mass gatherings to become super-spreader events.[3]. In early 2020, the National Basketball Association and National Hockey League temporarily suspended their 2019 to 2020 seasons in an effort to limit the spread of COVID-19. The National Basketball Association suspended their season a second time owing to a strike, while the National Hockey League resumed their season with no interruption. Despite various restrictions in place on sporting and nonsporting events, COVID-19 cases continued to increase nationally from 4.62 million in August 2020 to 13.84 million in December 2020; the increases in cases varied across counties and states.[4]
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