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Background
The COVID-19 pandemic has profoundly impacted community and professional sports. Throughout this time, sports organisations collaborated closely with the WHO, host national governments and their public health authorities. The common goals were to assess risk and to implement risk reduction measures to facilitate a stepwise return to sport, thus realising the physical and mental health benefits of sport for the participants, as well as the safe resumption of competitive events despite active SARS-CoV-2 transmission in many countries.
Returning the health benefits of community sport
At a community level, the WHO and many governments implemented policies to support opportunities for individuals to participate in health-enhancing physical activity for the longevity, mental health and physical health benefits conferred.1–3 Outdoor sport/physical activity carries a lower risk of transmission of SARS-CoV-2 due to physical distancing and ventilation.4 These sports were generally reintroduced before indoor or contact sports.5 Unfortunately, some regions were slow to recognise the low risks of outdoor, physically distanced sports activities and continued to restrict these despite their relative safety.
Professional sport: risk assessment and risk reduction
Professional sport provides cultural, economic and employment benefits. During the pandemic, sports organisations assessed the health risk associated with an event based on event size, sport risk, community transmission/prevalence and geographical location, and implemented risk reduction and mitigation measures in keeping with WHO and best practice guidance.4–7 Typically, this was done in a stepwise fashion,8 with timeframes and restrictions varying markedly across nations and sports systems.
A return to training and competition
Individual and group outdoor training present a low risk of viral transmission. Sports competition resumed in 2020, in most cases ‘behind closed doors’ or in ‘bubble environments’ with robust risk assessment and risk reduction and with no, or very limited, spectators on-site. Domestic events did not increase transmission,9 10 while very low case rates and transmission were seen in international sports, including the delayed 2020 Tokyo Summer Olympic and 2022 Beijing Winter Olympic Games, where all participants underwent regular testing.11
Guidance for athletes
Athletes returning to training and competition post lockdown were often grateful for the opportunity to resume sport. However, many informed us they were nervous about becoming infected by the virus (either personally or their family), while others expressed concern about the ‘bubble’ environment they had to endure, in many cases entailing significant isolation from their families.12 Collaborative return to sport guidelines were produced to advise athletes, coaches and sports organisations on adapting and applying public health principles to the sport-specific context.13
Greater attendance at sports events
Countries (eg, New Zealand and Australia) that had eliminated the virus or had lower community transmission of cases could sometimes introduce full or >50% spectators’ capacity ahead of widespread vaccine roll-out. With global vaccine roll-out, countries were able to move towards full audience capacity, despite high community transmission, as evidenced by the English Events Research Programme.14 This programme highlighted close collaboration between national governments, public health authorities and sports/events organisers. Also, it underscored the need to address the sports’ risks and the risks associated with participants’ and spectators’ travel and other event-related gatherings.
Returning to play
Allowing people to resume prepandemic activity became an increasing priority as it became clear that the pandemic would not be short-lived. Research showed that daily testing and enhanced public health protocols did not carry an additional risk of transmission compared with standard isolation for close contacts of SARS-CoV-2-positive persons in professional golf.15 16 This contributed to policy change for COVID-19-specific guidelines for the wider population.
A significant frontier: returning persons positive for SARS-CoV-2 to sport
With high rates of vaccination contributing to improved immunity17 and less severe variants prevalent, the balance between the risk of transmission and the known employment, cultural and economic benefits of prepandemic activity is changing. As a result, golf, for example, has collaborated with the Ministerial Advisory Committee and the National Institute for Communicable Diseases in South Africa to allow asymptomatic persons positive for SARS-CoV-2 to participate in golf while maintaining physical distancing and avoidance of shared indoor spaces.18 There is a gradual realisation that asymptomatic SARS-CoV-2 infection is not an absolute contraindication to participation in exercise/competition. This is contributing to many sports withdrawing from routine asymptomatic screening now that high rates of vaccination have been achieved.
What is next?
This editorial highlights that collaboration between governments and their public health authorities and sports organisations has successfully allowed sports events to recommence, using guidance based on the best available science and practical considerations. Further, this collaboration has informed wider population-level health policy decisions. The COVID-19 pandemic is not over, and ongoing risk assessment and proportionate risk reduction are merited as we adapt to life with SARS-CoV-2, and to decrease the impact of other illness, to the benefit of our athletes.
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Acknowledgments
We wish to acknowledge the expertise and leadership of Amaia Artazcoz Glaria, Maurizio Barbeschi, Maria Borodina and Albis Francesco Gabrielli, as well as the WHO Mass Gathering Cell, host national governments and public health authorities while collaborating on research, strategy and implementation during the COVID-19 pandemic.
Footnotes
Twitter @docandrewmurray, @docpluim, @margo.mountjoy
Contributors AMu and PGR: editorial idea. All authors contributed to writing and final approval of the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests AMu, BP, ECF and AMa received remuneration from sporting organisations as per authors' affiliations.
Provenance and peer review Not commissioned; externally peer reviewed.