Team Sport Risk Exposure Framework-2 (TS-REF-2) to identify sports activities and contacts at increased SARS-CoV-2 transmission risk during the COVID-19 pandemic

The Team Sports Risk Exposure Framework (TS-REF) was developed in July 2020 by experts in sports medicine, virology, sports science and public health to facilitate the safe return of sport during the COVID-19 pandemic.1 The TS-REF was developed at the time when the outdoor transmission risk of SARS-CoV-2 during sport was unknown. The TS-REF has been adopted by Public Health England and the UK Government (Department for Digital, Culture, Media and Sport), for use within both elite and community sports,2 to both determine the risk of SARS-CoV-2 transmission during specific sporting activities (eg, rugby tackle),1 and to identify and isolate increased risk contacts during sport.3 The TS-REF classified increased risk contacts as player-to-player interactions ‘ within 1 m, directly face to face, for 3 or more seconds’.1 Increased risk contacts as defined in the TS-REF were studied in rugby league, following interactions with eight infectious players across four matches.3 Increased risk contacts were monitored for 14-days during their isolation period and serially tested for SARS-CoV-2. Of the 28 identified increased risk contacts from the matches, only one player subsequently tested positive for SARS-CoV-2, which was linked to an internal club outbreak and believed unrelated to training activities. Another study in professional soccer observed similar findings,4 collectively suggesting the risk of outdoor transmission during sports appears lower than first thought.3 4 Consequently, the TS-REF may require players to unnecessarily isolate who are not at an increased risk of infection. Our aim was to update the TS-REF based on our evolving understanding of SARS-CoV-2 transmission during sports. SARS-CoV-2 can be transmitted by both exhaled large ‘ballistic’ respiratory (>100 …