Jonna Lorenz

Football is a numbers game. The same could be said for the deadly COVID-19. Counties that hosted professional and college football games with limited in-person attendance during the COVID-19 pandemic didn’t see a substantial increase in COVID-19 cases, according to investigators with Massachusetts General Hospital.

, analyzed US counties that hosted NFL and NCAA football games to estimate the association between games with limited in-person attendance and spread of COVID-19.

A total of 528 games (101 NFL and 427 NCAA) were included in the study, which also included a matched control group with 361 counties similar in size and COVID-19 restrictions that did not host a game on the corresponding day. For NFL games, attendance ranged from 6,000 to 13,797, with a median of 9,949. NCAA attendance wasn’t available.

“We surmise that the NFL and NCAA policies regarding limited in-person attendance, mask use, and social and physical distancing measures in stadiums was not associated with substantially higher community spread of COVID-19,” the authors, led by Asmae Toumi, BS, of Massachusetts General Hospital, wrote. “Additionally, an important number of NFL and NCAA football stadiums are outdoors or have a retractable roof, which could have had an impact on mitigating spread.”

On game day, the median daily new COVID-19 cases in counties that hosted football games was 26.14 cases per 100,000 residents compared with 24.11 cases per 100,000 residents for counties in the control group. The change in number of cases within 14 days after game day ranged from -5.17 to 4.72 cases per 100,000 residents, with a mean of 1.21.

“Our study provides evidence suggesting that in-person attendance of football games with social distancing and mask use could be resumed in the 2021 to 2022 season,” the authors wrote. “However, it is worth noting that newly emerging variants of SARS-CoV-2 have less predictable implications at this point and might lead to more disruptive interruptions in the future.”

Limitations of the study included that attendance was considered as a binary variable since in-person attendance wasn’t available for NCAA games. The study also didn’t control for other large events or the possibility of spillover to adjacent counties.

“Studies such as that by Toumi et al, which add to our understanding of the virus and its transmission, are essential for providing decision-makers with the information needed to design and enact policies that align with evidence and protect people in the community,” Michael A. Rubin, MD, PhD, MS, of the Salt Lake City Health Care System and the University of Utah School of Medicine, said in an 

. “More like it are needed as the United States and other countries confront the mounting political and societal pressure of regaining a sense of normalcy that comes with returning our large and beloved sports arenas to full—and full-throated—capacity.”

The US Food and Drug Administration’s full approval of the Pfizer-BioNTech COVID-19 vaccine granted on August 23 also could boost events. Former FDA Commissioner Mark McClellan, MD, PhD, said that he expects more vaccine requirements at venues such as indoor dining, sports and entertainment venues. McClellan is the Robert J. Margolis Professor of Business, Medicine, and Policy, and founding Director of the 

Sports venues have been areas of concern during the pandemic, with some worrying games could become super spreader events. A study from West Virginia University 

 found that US cities saw influenza mortality rates increase between 5% and 24% during the professional football, basketball, hockey, and baseball seasons.

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, might also become the nexus of an examination into health care disparities that the coronavirus uncovered. Nursing homes with Black residents had a greater number of COVID-19 infections and deaths during the pandemic than those without Black residents, a new study from Columbia University School of Nursing found.

Journal of American Medical Directors Association

, included data from 11,587 nursing homes in the United States that reported data to the US Centers for Disease Control and Prevention during the pandemic.

“COVID created a crisis in nursing homes, that’s for sure. I think everybody has heard that over the past year, and it’s worse for minorities,” Pat Stone, PhD, director of the Center for Health Policy at Columbia University School of Nursing told Contagion. “It exacerbated health disparities. That’s the biggest takeaway.”

Among nursing homes included in the study, 3639 (31.4%) had no Black residents, under 20% of residents were Black in 1020 (8.8%), Black residents accounted for 20% to 49.9% of residents in 1586 (13.7%), 50% or more residents were Black in 681 (5.9%) nursing homes, and race was not reported for 4661 (40.2%) nursing homes.

COVID-19 infections were 13.6 percentage points higher in nursing homes with 50% or more Black residents, and deaths were 3.5 percentage points higher.

Stone attributed the disparities to structural racism, saying that nursing homes that have a high percentage of Black residents have fewer resources, poor staffing, worse infection control processes and a higher dependence on Medicaid with fewer patients on Medicare.

“We need to fight for these vulnerable people that are living in nursing homes and provide the best care,” Stone said. “We need advocacy because we need to have some changes in policies.”

The study found that disparities were greatest in rural settings and that nursing homes with the highest proportion of Black residents were more likely to be for-profit organizations, report staffing shortages, have the highest percentage (about 75%) of residents on Medicaid, have lower RN and aide hours per resident.

Other factors included that nursing homes with a large proportion of Black residents were located in communities with a scarcity of resources such as transportation and health services and with low socioeconomic indicators such as education and income along with mistrust in the healthcare system.

The study authors call for investments in infrastructure, social services, health care, education and housing in Black communities and an increase in Medicaid reimbursement to nursing homes. But even before the reinforcements arrive, nursing home care can be improved for a relatively small investment, as 

 on how one long-term care facility managed to hold off COVID-19.

Stone said she will continue to research infection prevention and control measures, such as having a certified infection preventionist on staff in nursing homes, which has been associated with improved resident outcomes. Ann Marie Pettis, RN, BSN, CIC, FAPIC, the president of the Association for Professionals in Infection Control and Epidemiology, 

 last June that states should mandate that a fulltime infection preventionist be assigned to every long-term care facility, something that states don’t currently mandate. In addition, the sad fact is that, despite billions more allocated for nursing homes, the facilities are 

For her part, Stone plans to continue her research on the impact of health disparities on infection prevention and control measures.

“This is really changing the landscape of infection prevention and control, which needed to be done. But we don’t know how that’s going to look a year from now and we don’t know how that will look for nursing homes that serve minorities,” Stone said. “Will they be able to make these changes as well as other nursing homes? So, that’s where my research is going next.”

Racial disparities in COVID-19 infection and mortality rates have been a topic of ongoing research during the pandemic. A 

 found that social and environmental factors have a greater impact on disparities than biological or genetic differences.

 that evaluated COVID-19 health disparities underscored the long history of inequities throughout history and around the globe.

Jonna Lorenz is a freelance journalist with more than 20 years of experience. Her background is in business and health care news, including reporting, editing and research for newspapers and websites.

Investigators with Columbia University School of Nursing found that COVID-19 infections were 13.6 percentage points higher in nursing homes with 50% or more Black residents, and deaths were 3.5 percentage points higher, compared with nursing homes with no Black residents.

Jonna Lorenz

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Sparsely Attended Football Games Do Not Spread COVID-19

Health Care Disparities Uncovered in Nursing Homes