COVID-19-Positive Testing in Minnesota High School Fall and Winter Sports: A Guide for Sports Risk

Objective:To assess the effectiveness of coronavirus disease 2019 (COVID-19) prevention strategies used during sports participation.Design:To analyze prospective reports of student-athletes with COVID-19-positive tests to assess prevention strategies and risk factors by sports and seasons.Setting:Minnesota high schools.Participants:Fall 2020 (August 24-October 30) and winter 2021 (January 2-March 12) student-athletes.Assessment of Risk Factors:Sports, indoor location, mask use, physical distancing, and season.Main Outcome Measures:COVID-19-positive test rates.Methods:Self-selected schools voluntarily reported, in 2-week intervals, the number of student-athletes with COVID-19-positive tests in each sport and the number of athletes participating in each sport during the fall and winter sports seasons. The positive testing rates per 100 000 athletes were calculated for participants in each sport and compared by sports type and risk variables.Results:The high school age community-positive testing rate was 1298 per 100 000 students in the fall and 2396 in the winter. The student-athlete positive testing rate was 1500 per 100 000 athletes during the fall and 2800 during the winter (χ²= 1.98, df = 1, P = 0.350). Positive tests per 100 000 athletes ranged from 197 (girls alpine skiing) to 4151 (wrestling). The incidence rates comparing indoor with outdoor sports (P = 0.001) and close-contact with physically distanced sports (P = 0.023) were significantly different, but the incidence rates comparing indoor masked with unmasked sports (P = ns) were not different.Conclusion:Athletes competing in outdoor individual sports have less risk of a COVID-19-positive test compared with age-matched individuals in the community and indoor sports participants either wearing or not wearing masks during competition. Unmasked athletes in close proximity have the highest positive test rates, and unenforced masking is not associated with lower positive testing rates. More study is needed to understand mask effectiveness.