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(STATE-XXX = Wisconsin) ABSTRACT Objective: To describe the incidence of COVID-19 in STATE-XXX high school athletes, and to investigate the relationship of COVID-19 incidence with sport and face mask use. Design: Retrospective survey. Setting: High schools across STATE-XXX during September, 2020. Participants: Athletic directors representing 30,074 high school athletes with and without SARS-CoV-2. Independent Variables: COVID-19 rates among athletes, counties, and STATE-XXX, school instruction type (virtual vs in-person), sport type, face mask use. Main Outcome Measurements: Reported athlete case rates compared to their county's general population. Associations between COVID-19 incidence and sport type and face mask use, adjusting for each school's county incidence using multivariable negative binomial regression models. Results: COVID-19 incidence rates for 207 of 244 responding schools were 32.6 cases per 100,000 player-days. Reported case rates for athletes in each county were positively correlated with the county's general population case rates (β=1.14±0.20, r=0.60, p<0.001). One case (0.5%) was attributed to sport contact by the reporting schools. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49–2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23–1.3], p=0.14). Outdoor sports had a lower incidence rate than indoor sports, although this did not reach statistical significance (IRR=0.52 [0.26–1.1], p=0.07). There were no significant associations between COVID-19 incidence and face mask use during play for those sports with greater than 50 schools reporting on face mask use (p>0.05 for all). Conclusions: Incidence of reported COVID-19 among high school athletes was related to county incidence and most cases were attributed to non-sport contact. A lower COVID-19 incidence in outdoor sports approached statistical significance. The lack of a significant benefit of face mask use may be due to relatively low rates of COVID-19 in STATE-XXX during September 2020. Further research is needed to better define COVID-19 transmission risk factors during adolescent sport participation.

Introduction: The purpose of this study was to describe the reported incidence of COVID-19 in Wisconsin high school athletes in September 2020, and to investigate the relationship of COVID-19 incidence with sport and face mask use. Methods: Surveys were sent to athletic directors of all Wisconsin high schools regarding sports during September 2020. The association between reported case rates in athletes in each county and the county general population were evaluated with a weighted linear model. Multivariable negative binomial regression models evaluated the associations between COVID-19 incidence and sport type and face mask use by players, adjusting for the county COVID-19 incidence for each school. Results: 207 schools that had reinitiated sport reported 270 COVID-19 cases among 30,074 players, for case and incidence rates of 809 cases per 100,000 players and 32.6 cases per 100,000 player-days, respectively. The case rates for athletes in each county were positively correlated with the case rates for their respective county general population (β=1.14±0.20, r=0.60, p<0.001). One hundred fifteen (55%) of cases were attributed to household contact, 85 (41%) to contact outside sport or school, 5 (2.4%) to school contact, and 1 (0.5%) to sport contact. No difference was identified between team and individual sports (incidence rate ratio (IRR)=1.03 [95% CI=0.49-2.2], p=0.93) or between non-contact and contact sports (IRR=0.53 [0.23-1.3], p=0.14), although the difference between outdoor and indoor sports approached statistical significance (IRR=0.52 [0.26-1.1], p=0.07). 84% of schools required face masks while playing. For those sports with >50 participating schools, there were no significant associations between COVID-19 incidence and face mask use in cross country (IRR=0.71 [0.2-2.2], p=0.52), football (IRR=1.6 [0.6-5.1], p=0.404), boys soccer (IRR=2.3 [0.5-17], p=0.31), or girls volleyball (IRR=1.4 [0.3-6.6], p=0.64). Conclusions: Incidence of reported COVID-19 among athletes was related to background county incidence and most cases were attributed to household and community contact. Although not statistically significant, reported COVID-19 incidence may be lower in outdoor sports. Face mask use did not have a significant benefit, which may be due to relatively low rates of COVID-19 and the small number of schools that did not report using face masks.

Background: Research into improving player safety of sport-related concussion (SRC) in American football has been an ongoing endeavor. In an attempt to better understand the incidence of SRCs in American football, research has focused on the characteristics of SRC during gameplay. Determining SRC specifics and assessing them quantitatively can help identify high-risk scenarios and predict exposure risk. Purpose: To identify and assess the incidence of SRCs in a National Collegiate Athletic Association football team by comparing field location, player positions, collision partners, and player cues. Study Design: Descriptive epidemiology study. Methods: We used physician sideline reports of diagnosed concussions from a Division I football team from September 2010 to December 2018. Game videos were analyzed to identify the field location where the SRC occurred, collision partner, and player behavior postconcussion. The incidence of in-game SRCs by position was also assessed. We used the “words of estimative probability” model to categorize each concussion as certain, almost certain, probable, or even on the basis of our confidence in identifying them using game film. Results: This study examined 44 SRCs that occurred over 9 seasons. The SRC incidence was significantly higher in the middle defense (5-20 yards from the line of scrimmage) compared with all other field locations (relative risk, 2.46; 95% CI, 1.14-5.29; P < .05). In-game collision partners were most commonly defensive backs. The most common player cue was a hand to helmet/face mask. The positions with the highest SRC incidence by athlete-exposure, game position, and position play belonged to the defensive backs, wide receivers, and running backs. Conclusion: The middle defense had a significantly higher incidence of SRCs than all other field locations. We pose a new method to categorize concussions during video analysis by using words of estimative probability. Knowledge of SRC gameplay characteristics can potentially guide the medical staff and medical observer to better identify them.

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