University of São Paulo: Covid-19 incidence in São Paulo soccer surpasses the highest in the world, according to study

A study conducted at USP reveals that the incidence of infection by the new coronavirus among athletes from the São Paulo Football Federation during the 2020 season was 11.7% – an index equivalent to that of health professionals working at the forefront of the fight against pandemic.

To reach this number, the authors retrospectively analyzed almost 30 thousand RT-PCR tests applied to 4,269 athletes over eight tournaments, six of which were male (Copa Paulista, U-23, U-20 and the three divisions of the Paulista Championship) and two women (Campeonato Paulista and U-17). In all, 501 tests confirmed the presence of SARS-CoV-2. Also, 2,231 tests performed on members of the support teams (health professionals, technical commission, managers, wardrobes, etc.) were also analyzed, and 161 were positive, that is, 7%.

“It is an attack rate that is much higher than that observed in other countries. In the Danish football league, for example, there were four positive results among 748 athletes tested [0.5%]. In the Bundesliga [of Germany], there were eight cases among 1,702 players [0.6%]. Even in Qatar, where there is a moderate risk of community transmission, the number was lower than ours: 24 positive out of 549 evaluated [4%]. Compared to other recorded cases, therefore, our players became infected between three and 24 times more, ”says Bruno Gualano, professor at the Faculty of Medicine (FM-USP) and research coordinator to Agência FAPESP.

In the article, which is still in the process of peer review, the authors claim that the numbers are probably underestimated. The group had access to the laboratory database commissioned by the São Paulo Football Federation to test the athletes. However, players from teams that competed in national tournaments had the option of taking the tests in laboratories commissioned by the Brazilian Football Confederation (CBF). These results, therefore, were not included in the analysis.

In any case, data from São Paulo indicate that the virus affected the men and women evaluated equally. When comparing the results of athletes and staff members, it is noted that the attack rate was higher in the first group. However, severe cases were more frequent in the second group, which has a higher average age and more heterogeneous health conditions.

“This is a data that worries. The few serious cases – among them one that evolved to death – were recorded among the members of the staff. Although our data indicate that athletes tend to develop only mild symptoms or even be asymptomatic, they can act as a vector of transmission to the community. In general, they are individuals with a very active social life ”, says Gualano.

The researcher points out that the policy that provides for the screening of contacts has never been implemented in Brazil and, therefore, it is not possible to measure the impact of secondary infections caused by players in their homes or social circles.

Where is the risk
Due to the social distance measures implemented in the State of São Paulo in March 2020, football matches were temporarily suspended and resumed on June 14. To minimize the risk of transmission of COVID-19, the Medical Committee of the São Paulo Football Federation created a protocol that provides for frequent testing of athletes and support teams, isolation of infected people, screening of contacts (within the sports environment) and a series of hygiene measures.

“The cases appeared every time there was an escape from the protocol,” says Moisés Cohen, president of the Medical Committee. “It is a controlled environment, where risks are monitored and minimized, as far as possible, carrying out tests every two or three days. For those who leave [the concentration] and return the tests are daily. We have also implemented contact tracking in case of positive RT-PCR and all protective precautions, such as PPE [personal protective equipment] and alcohol gel ”, he explains.

According to Gualano, in fact the risk of transmitting the virus during matches has been shown to be small. But there are other factors that compromise the effectiveness of the protocol, which the professor at FM-USP considers technically appropriate.

“It would work if it was applied in Denmark or Germany. There is a great deal of common sense in the athletes, who are instructed to go home from the Training Center and maintain social distance and non-pharmacological measures of protection during their hours of rest. But here in Brazil a good portion does not follow these rules and does not suffer any kind of punishment. In addition, you travel a lot to play the matches. The smaller teams go by bus, eat in restaurants and are probably more exposed than the elite players. Our social inequality also permeates football, ”says Gualano.

The study shows that some teams were much more affected. One of them even registered 36 positive cases, 31 in a single month. Seven teams had more than 20 confirmed cases and 19 registered 10 or more cases. For Cohen, all outbreaks are consequences of breaking the protocol.

Gualano sees with great concern the fact that the Paulista Championship was resumed in the city of Volta Redonda in Rio de Janeiro two weeks after the games were suspended in the State of São Paulo, on March 11, in view of the upsurge of the pandemic and the emergence of viral variants more aggressive.

“As long as the transmission of COVID-19 is not mitigated, any sector that reopens represents a high risk of contagion. The only safe alternative would be to completely isolate football in a bubble, as the NBA [National Basketball Association, United States] did, at a cost of $ 170 million. It either closes or isolates ”, defends the professor at FM-USP.

The research was carried out under the coalition Sport-COVID-19, formed by researchers from Hospital das Clínicas (FM-USP), Hospital Israelita Albert Einstein, Hospital do Coração (HCor), Complexo Hospitalar de Niterói, Federal University of São Paulo ( Unifesp), Dante Pazzanese Institute of Cardiology and High Performance Sports Center, with the support of the São Paulo Football Federation. The consortium aims to monitor the possible long-term consequences of COVID-19 on football players and other elite athletes.

In addition to Gualano and Cohen, two FAPESP doctoral fellows sign the article: Ana Jéssica Pinto and Ítalo Ribeiro Lemes.

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