Academic and healthcare efforts from Cessation to complete resumption of professional football tournaments during COVID-19 pandemic: A narrative review

The Coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus led to over 626 million infections and 6.5 million deaths worldwide and forced to cancel or postpone several sporting events. Effective control techniques are therefore urgently required to avoid COVID-19 spread at these local and global events. This narrative review addressed the healthcare and research efforts on the intersections between COVID-19 and major professional sports leagues worldwide, with special reference to the FIFA World Cup football 2022. This explained how the broader transformation of COVID-19 from being a potential risk to an urgent pandemic public health emergency, caused the world of Football to halt between February and March 2020. This review could add to the growing literature on the importance of scientific research in understanding the relationship between mass sports events and COVID-19 trajectory, concerning studies conducted globally and particularly for the recommencement of major professional football competitions. The information outlined in the article may help sports organizations understand the risks associated with sports and their settings and improve their preparedness for future events under unprecedented circumstances. There were tremendous global healthcare and research efforts to deal with this unprecedented pandemic. The successful FIFA World Cup football tournament was an indicator of the success of these efforts.

FIFA Arab Cup tournament with full capacity of spectators during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

We sought to assess the risk of COVID-19 and seasonal flu including respiratory syncytial (RSV) and influenza viruses during the FIFA Arab Cup 2021 in Qatar with full capacity of spectators. We also, evaluated the post-event attitude toward resumption of mass football events.

METHODS

This was a cross-sectional study in which spectators (age ≥ 18 years) were invited for reverse-transcription PCR testing for COVID-19 and seasonal flu. At the same time, between 7 and 14 days after the event, the participants completed a self-administered questionnaire regarding their concerns during the tournament.

RESULTS

The tournament included 16 international football teams from the Arab countries. As per the study protocol, 10,000 spectators were approached and 6,475 participated. Among the participants, 4,195 (65.1%), 2,253 (34.9%) and 27 (0.4%) were vaccinated with 2 doses, vaccinated with 3 doses, and recovered from SARS-Cov-2 infection, respectively. There were 61 (0.9%), 41(0.6%) and 11(0.2%) participants who tested positive for COVID-19, RSV and influenza (A/B), respectively. The average cycle threshold (Ct) value for COVID-19 positive cases was 26.1±7.3. Among those who were electronically approached, 6,102 completed the survey whereas 373 had incomplete survey. Overall, 2069 (33.9%) participants reported symptoms that theoretically could be related to COVID-19, of them 39 had positive PCR test (1.9%). Spectators (94.3%) were optimistic about returning sport events to the pre-pandemic status.

CONCLUSIONS

There was no significant increase in the daily COVID-19 cases during FIFA Arab Cup 2021 with a full capacity of spectators. Therefore, upcoming mass football events can be held safely.

Bio-secure bubble during the COVID-19 pandemic to host the Asian Football Confederation (AFC) Champions League: A retrospective observational study

Background and Aims

To describe the COVID-19 positivity rate among football players, team staff, and local organizing committee members participated in the Asian Football Confederation (AFC) Champions League (West) tournament organized with the Bio-secure bubble protocol in place.

Methods

A retrospective observational study was carried out to include a total of 2184 participants during the AFC-West tournament in Qatar, which was a 3-week event (September 14-October 3, 2020). This event was undertaken under the Bio-secure bubble protocol, which was developed and implemented for sports events in Qatar during the pandemic. Within 72 h of departure and upon arrival in Qatar, all participants underwent reverse-transcriptase polymerase chain reaction testing (RT-PCR) to diagnose COVID-19. The test was considered positive based on the cycle threshold (cT) value which was <30, whereas, reactive if cT value was ≥30 and <40, and negative (cT > 40).

Results

Of the 2184 participants (528 players, 388 team staff, and 1268 local staff), 916 international participants were tested for COVID-19 PCR upon arrival at the Hamad International Airport, whereas the local staff (n = 1268) were tested 2 days before entering the bubble. The mean age of the players was 27.5 ± 9.8. Fifteen teams participated and as many as 60 matches were played over 3 weeks. Most participants tested negative (95.3%) and 3.9% tests were inconclusive. During the entire tournament, the positivity rate was 2.7% among all participants. Of the total positive cases, 0.8% were positive before entering the bubble system. The remaining (1.9%) tested positive during the tournament phase (19 players, 16 team officials, and 8 organizing committee staff).

Conclusion

Bio-secure bubble protocol operated in a controlled environment presents a minimal risk of COVID-19 infection for hosting international football events. This framework could be benchmarked to resume professional football competitions under unprecedented pandemic situations.

Recommencement of football competition with spectators during the active phase of the COVID-19 pandemic in a Middle Eastern country

Background

With the global spread of COVID-19 infection caused by the severe acute respiratory syndrome coronavirus-2 virus (SARS-CoV-2), all the national and international sports events were ceased early in 2020. The sport activities have been reinstated since then, albeit without spectators. However, several governments have established a variety of risk-mitigation measures to gradually reintroduce the spectators to stadiums.

Objectives

We aimed to evaluate the implementation of a strict health protocol to ensure the resumption of professional football with spectators and to access its effectiveness in limiting the spread of COVID-19 infections within the community.

Methods

This was a retrospective, observational study involving football players, match officials, local organizing committee members, working in close coordination, and over 16,000 spectators in the state of Qatar. We examined data from the Amir Cup final (December 18th, 2020), which was played under a strict protocol that included extensive reverse transcription-Polymerase chain reaction (RT-PCR) testing for players and match officials, as well as the utility of COVID-19 rapid antigen and antibody testings as screening tools for spectators to ensure their safe return to the stadiums. In addition, we reviewed the guidelines and protocols that were put in place to organize Qatar's Amir Cup Football Final, which drew over 16,000 spectators in the stadium.

Results

A total of 16,171 spectators undertook rapid antigen and antibody tests for the Amir cup final (from December16-December18, 2020). Fifteen Spectators (n = 15) returned with a positive result for COVID-19 infection during the final event (positivity rate = 0.12%). All players underwent RT-PCR testing 48 h before the match. None of the players tested positive for COVID-19 infections. 1311 individuals reported having symptoms related to COVID-19 post final of Amir Cup. These spectators were tested for COVID-19 RT-PCR with an overall positivity rate (positive/reactive) to be 0.42% (69/16171).

Conclusion

This report shows a meagre incidence rate of COVID-19 infections during and post-Amir Cup football final. Based on the low infectivity rate reported during and post the Amir Cup, we propose that supervised and controlled resumption of football matches with spectators can be carried out safely following a strict testing and tracing protocol. Similar infection control policies can be replicated with a higher number of spectators.