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An Outbreak of COVID-19 Associated with a Recreational Hockey Game – Florida, June 2020

Our take —

This study is an outbreak investigation of a hockey game in Tampa Bay, Florida, which found that, the day following the game, an index case began experiencing symptoms, and ultimately a total of 15 of 22 players and one rink staff member tested positive or experienced symptoms (68.2%). The study was unable to determine exactly where exposure occurred, but hypothesizes it was at the evening hockey game, due to the heavy breathing that occurs, the lack of masks covering the mouth and nose, the transition from ice to bench where players continue heavy breathing or in the locker rooms and lack of other common exposures or time spent together. Asymptomatic players were not tested, thus the true attack could have been underestimated.

Study design

Prospective Cohort

Study population and setting

On June 19, 2020, the Florida Department of Health (DOH) was notified of a player on a hockey team experiencing fever, cough, sore throat, and headache beginning on June 17, following an indoor hockey game played on June 16. The Florida DOH obtained a nasal swab on June 19, which showed evidence of SARS-CoV-2 by antigen test. Further investigation found that 8 of the 10 players on Team A, excluding the index patient, 5 of 11 players on Team B, and one rink staff member also had symptoms. Testing was conducted on all individuals with symptoms, but asymptomatic players did not seek testing.

Summary of Main Findings

Following the hockey game on the evening of June 16, the index patient experienced symptoms the following day (June 17), followed by 2 additional Team A members and 1 Team B member on June 18. Overall, a total of 8 out of 10 (80%) Team A players besides the index patient tested positive, and 5 of 11 (45.5%) Team B players tested positive, alongside the 1 symptomatic rink staff member. There were 13 presumed total cases among players (62% of 21 total players). Of the 15 total cases in the outbreak (including the rink staff member and the index case), 11 showed evidence of SARS-CoV-2 by PCR, 2 patients with two positive antigen tests, and 2 patients who were not tested. The on-site referees did not experience symptoms or seek testing, and no asymptomatic players received testing. No new cases were reported after June 22, 5 days following the initial game.

Study Strengths

The study benefited from quick notification about player symptoms, which allowed the Florida DOH to identify the index case and the likely time of exposure. Most of the potential cases also received some testing to confirm their diagnosis. The study provides many details about the specific exposure conditions, which bolsters their argument that this likely occurred at the game itself, due to the heavy breathing, the lack of face masks, the inadequacy of the upper-face shields and face cages that were used, and the transition from ice to bench where contact may occur. They also collected histories from the players to ensure they did not have a prior common exposure.

Limitations

The study was not able to test asymptomatic individuals, which may underestimate the number of cases in this outbreak. Additionally, they are not able to fully determine if additional cases were due to this specific game, or if additional cases occurred from other exposure sources. For instance, rink staff generally do not interact significantly with players, and therefore the rink staff member may not have been exposed at this game, and the investigation would not be able to determine this.

Value added

This study is one of the few to examine potential transmission during a sports game in the US. Prior studies of this were derived from global populations, including South Korea, and Slovenia.

This review was posted on: 16 November 2020