The Association of COVID-19 Incidence With Sport and Face Mask Use in United States High School Athletes.

The relationships among different sports, face mask use, and COVID-19 risk among high school athletes remain unknown. To evaluate the influence of sport characteristics and face mask use on the COVID-19 incidence among high school athletes. Descriptive epidemiology study. US high school athletic departments. Athletic directors. Surveys were completed regarding sport reinitiation, COVID-19 cases, and risk-reduction procedures in fall 2020. Separate mixed-effects Poisson regression models were developed to evaluate the associations between the reported COVID-19 incidence and (1) sport characteristics (indoor versus outdoor, individual versus team, contact versus noncontact) and (2) face mask use while playing (yes or no). A total of 991 schools had restarted fall sports, representing 152 484 athletes on 5854 teams. There were 2565 reported cases of COVID-19, representing a case rate of 1682 cases per 100 000 athletes and an incidence rate of 24.6 cases per 100 000 player-days. The COVID-19 incidence was lower for outdoor versus indoor sports (incidence rate ratio [IRR] = 0.54; 95% CI = 0.49, 0.60; P <.001) and noncontact versus contact sports (IRR = 0.78; 95% CI = 0.70, 0.87; P <.001), but not team versus individual sports (IRR = 0.96; 95% CI = 0.84, 1.1; P =.49). Face mask use was associated with a decreased incidence in girls' volleyball (IRR = 0.53; 95% CI = 0.37, 0.73; P <.001), boys' basketball (IRR = 0.53; 95% CI = 0.33, 0.83; P =.008), and girls' basketball (IRR = 0.36; 95% CI = 0.19, 0.63; P <.001) and approached statistical significance in football (IRR = 0.79; 95% CI = 0.59, 1.04; P =.10) and cheer or dance (IRR = 0.75; 95% CI = 0.53, 1.03; P =.081). In this nationwide survey of high school athletes, a lower COVID-19 incidence was independently associated with participation in outdoor versus indoor and noncontact versus contact sports but not team versus individual sports. Face mask use was associated with a decreased COVID-19 incidence among indoor sports and may be protective in outdoor sports with prolonged close contact among participants. [ABSTRACT FROM AUTHOR]