Infographic. Football-specific strategies to reduce COVID-19 transmission

Looking back on the COVID-19 pandemic in an elite sports team using whole genome sequencing

Objectives

The aim of this study was to investigate the effectiveness of infection control measures to prevent transmission of SARS-CoV-2 within a professional sports team using whole genome sequencing (WGS).

Design

Prospective cohort study.

Methods

74 players and staff members of a Dutch professional male football team were followed from August 2020 until May 2021. A set of health and safety measures were introduced and all participants underwent regular SARS-CoV-2 RNA testing. All positive samples were subsequently sequenced (Nanopore sequencing) to assess whether infections were acquired within the training center or in the community.

Results

Throughout the study period, 13 participants tested positive for SARS-CoV-2. The phylogenetic analysis revealed 3 clusters (of 2 and 3 cases respectively), indicating that 3/13 cases (23%) acquired infection from another player or staff member. The first cluster was diagnosed upon enrolment, thus transmission had occurred prior to the implementation of health and safety protocols. Finally, 4 cases were diagnosed prior to symptom onset, emphasizing that frequent testing leads to early detection and isolation.

Conclusion

These data show that a combination of regular testing and basic control measures can prevent outbreaks of COVID-19 in a professional sports team. WGS is an important tool to distinguish between infections introduced from the community and infections transmitted between athletes.

Leadership experiences of elite football team physicians during the COVID-19 pandemic: a pilot study

Objectives

The purpose of this study was to explore the leadership experiences of elite football team physicians during the COVID-19 pandemic.

Methods

A pilot-study based on a cross-sectional design by means of an electronic survey was conducted. The survey relied on 25 questions divided into distinct sections including among others professional and academic experience, leadership experiences and perspectives.

Results

A total of 57 physicians (91% male; mean age: 43 years) gave their electronic informed consent and completed the survey. All participants agreed that the demands of their role had increased during the COVID-19 pandemic. Fifty-two (92%) participants reported that they felt they were expected to take more of a leadership role during the COVID-19 pandemic. Eighteen (35%) reported feeling under pressure to make clinical decisions which were not in keeping with best clinical practice. Additional roles, duties and demands expected of team doctors during the COVID-19 pandemic were subdivided into communication, decision-making, logistical, and public health demands.

Conclusion

The findings from this pilot study suggest that the way in which team physicians at professional football clubs operate has altered since the onset of the COVID-19 pandemic, with greater demands placed on leadership skills including decision-making, communication and ethical stewardship. This has potential implications for sporting organisations, clinical practice and research.

Designing Infographics: Visual Representations for Enhancing Education, Communication, and Scientific Research

Infographics are graphic visual representations of educational content, used to deliver complex information, disseminate scientific research, and drive behavioral change. Herein, we review some of the factors pertinent to designing infographics and the potential for automation in the future. To guide high-impact design, it is vital to clearly define the objectives of the infographic and its target audience. Designing an effective infographic necessitates careful consideration of the layout, colors, font, and context. More recently, technical support to develop infographics are increasingly available through online software (Canva, Adobe, and Venngage) and emerging artificial intelligence programs. References can also become a visual representation of trends in scientific discovery. It is crucial for clinicians, researchers and scientists to have the knowledge and skills to design compelling infographics. In the era of social media, the uptake and effects of infographics for disseminating scientific research and public health education need to be further studied to understand their full potential.

Case Report: Assessing COVID-19 Transmission in Professional Volleyball in Germany, September to December 2020: An Epidemiological Study

Introduction

The SARS-CoV-2 pandemic poses extraordinary challenges in all fields of daily life. The WHO recommended social distancing guidelines and person-to-person contact was strongly discouraged to contain transmission. Team-based sports were questioned and widely debated. However, there is a lack of available evidence on the risk of in-game SARS-CoV-2 transmission. We aim to derive new insights regarding the risk of SARS-CoV2 infection during team sports and provide current opinion on how to behave during training and competition.

Methods

We report on six competitive male volleyball players (national level) of the same team who were infected with COVID-19. The mode of transmission and potential virus spreading within the team was investigated. The entire course of infection was documented by detailed medical history of the players and RT-PCR tests confirmed suspected infections. Serological testing was performed to establish the antibody status of the team.

Results

The investigation did not show strong evidence of viral transmission within the team during sporting activities. Only two players with PCR-proven infection hat detectable antibodies in two antibody assays.

Conclusion

Private and social gatherings can spread infection into team sports. Clearly defined test strategies and strict adherence to standard COVID-19 hygiene guidelines during sports seasons cannot be overemphasized.

Decision-Making in Sport During a Pandemic

OBJECTIVE

The COVID-19 pandemic has affected all elements of global society, and sport is not exempt. Many sporting events have been either postponed or canceled, and national sporting organizations have had to make highly complex decisions in the face of scientific uncertainty and risk. This article applies these lessons to the world of sport with the goal of assisting sporting organizations to make sound and reasoned decisions during a pandemic.

DATA SOURCES

A narrative approach using both academic literature sources and live examples from the authors' experience. We use Daniels and Sabin's accountability for reasonableness framework to facilitate decision-making in the face of such uncertainty.

MAIN RESULTS

Decision-making in the context of uncertainty has the potential to create conflict and disengagement from key stakeholders. Evidence from recent pandemics has illustrated that an ethical approach to decision-making results in reasoned decision-making and confers a legitimacy to decisions that ultimately supports engagement and satisfaction from stakeholders.

CONCLUSIONS

The incorporation of ethical considerations into risk assessment and management when making complex decisions, which incorporate high levels of uncertainty, will assist sporting organizations have positive outcomes.

Relationship between Training Load Management and Immunoglobulin A to Avoid Immunosuppression after Soccer Training and Competition: A Theoretical Framework Based on COVID-19 for Athletes' Healthcare

Immunoglobulin A (IgA), which is the main effector against upper respiratory tract viruses such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been related to training load management. The aim of this systematic review was to establish the relationship between training load and salivary IgA based on current evidence in order to avoid immunosuppression after exercise and players´ vulnerability to virus contagion. A systematic review of relevant articles was carried out using two electronic databases (PubMed and Web of Science) until 19 May 2021. From a total of 127 studies initially found, 23 were included in the qualitative synthesis. These studies were clustered depending on stress level. The salivary IgA was analysed considering soccer-specific treadmill exercise and repeated sprint drills (n = 5), matches (n = 7), and during certain periods during the season or pre-season (n = 11). Repeated sprint ability tests and treadmill exercises are suitable exercises for the first steps on return to play periods yet still maintain social distance. A rest or moderate training sessions (technical/tactical) are suggested after official matches to ensure 16-18 h to recover IgA levels, while periods with multiple matches per week with limited recovery time should be avoided. Weekly training load should assume a small increment (<10%) to ensure IgA immune responses, especially, during the post coronavirus disease 2019 (COVID-19) season.

Running Patterns in LaLiga Before and After Suspension of the Competition Due to COVID-19

In the first wave of the COVID-19 outbreak (spring 2020), the first division of professional soccer in Spain (LaLiga) was suspended for 12 weeks as part of the lockdown imposed by the Spanish health authorities. Professional soccer players were confined to home for 8 weeks and then a retraining period of 4 weeks was set before the first competitive match. When competition was resumed, professional soccer teams competed in a congested calendar (11 matchdays in 39 days) while some in-game regulations were altered (up to 5 substitutions, refreshment pauses). The current research presents an analysis of running patterns before suspension and after resumption of LaLiga to determine how the lockdown affected players’ physical performance. To aid in this purpose, a pairwise comparison was performed of running patterns of the 2019–2020 vs. 2018–2019 season (i.e., control season). Using a two-way ANOVA (season x matchday), it was found that there was no main effect of the season on total running distance per match (P = 0.288) nor in the distances covered < 14.0 km/h (P = 0.294), at 21.0–23.9 km/h (P = 0.266), and at ≥ 24.0 km/h (P = 0.112). Only the distance at 14.0–20.9 km/h was affected by the season (P = 0.019) with a lower running distance on matchday 34 in the 2019–2020 vs. 2018–2019 season. The number of substitutions (from 2.9 to 4.5 substitutions per game; P < 0.001) and match duration (96 vs. 100 min; P < 0.001) significantly increased after resumption respect to the previous season. These data suggest that high-intensity running performance of professional soccer teams was maintained after the resumption of the competition while the alterations likely aided in the in-game regulations facilitated the maintenance of soccer physical performance.

Preparing Infographics for Post-publication Promotion of Research on Social Media

Infographics are pictorial representations of information intended to disseminate information quickly and clearly. Their use has increased in the past decade due to wider and easy access to technology. Infographics are being increasingly used for public advisories, disseminating protocols for healthcare professionals, and post-publication promotion of research. Due to their potential to rapidly reach a vast audience, these have gained larger importance during the coronavirus disease 2019 pandemic. Two key aspects determine the quality of infographics, content and visual appeal. In this brief, the authors attempt to delineate the key aspects of designing an infographic, and the freeware that they may have at their disposal for creating informative, appealing, and useful infographics.

Playing Non-Professional Football in COVID-19 Time: A Narrative Review of Recommendations, Considerations, and Best Practices

The coronavirus disease (COVID-19) pandemic in 2020 resulted in widespread interruption of team sports training and competitions. Our aim was to review the recommendations and best practices in return to play in non-professional football after activity lockdown. The authors searched two electronic databases (PubMed, Web of Science) to extract studies published before September 15 2020. Twenty studies explained recommendations, considerations, or best practices in return to play in football, and all of them were clustered into three groups: (1) training load management (n = 10), (2) medical recommendations (n = 9), and (3) recovery related issues (n = 5). The way to establish a progression in training process should be based on training load management and managing the number of stimuli per time. Following the studies, this training process should be divided into three phases: phase 1-physical distancing should be maintained; phases 2 and 3-group training should start. Medical considerations were clustered into different groups: general, pre- and post- training, during training, education, planning to return to competition, and suggestions for post confinement weeks. In particular, social issues, strict hygiene questions, and continuous PCR testing should be considered in return to play over football season. Finally, since a correlation has been found between high-intensive training loads and immunoglobulin A, nutritional and lifestyle recovery strategies should be performed. Moreover, since immunosuppression has been related to congested schedules (<72 h between matches), football federations should avoid this situation.