ABSTRACT
OBJECTIVES: To describe the incidence and transmission of SARS-CoV-2 infections in South African professional rugby union players in different phases of return-to-competition during a pandemic. DESIGN: Prospective cohort study. METHODS: Players reported their history of SARS-CoV-2 infection before/during a national competition, using an online questionnaire (physician verified). Three periods of return to training/competition after a nation-wide complete lockdown during a pandemic were studied: 1) non-contact training, 2) contact training, 3) competition. The total period was 184â¯days (20/07/2020-20/01/2021) including 45 matches. Outcomes were: 1) incidence of SARS-CoV-2 infection (I: per 1000 player days; 95%CI) in each period (calculated using a Poisson distribution), 2) player symptoms, 3) median days to return-to-training following SARS-CoV-2 infection, 4) method of transmission, and 5) percentage matches cancelled due to SARS-CoV-2 infections. RESULTS: 185 players had 42 physician verified positive SARS-CoV-2 infections (Iâ¯=â¯1.23; 95%CI: 0.86-1.61). Incidences during the three periods were: non-contact trainingâ¯=â¯0, contact training (Iâ¯=â¯1.04; 0.36-1.71; mostly forwards), and competition (Iâ¯=â¯1.54; 1.00-2.10). 83â¯% of the infected players were symptomatic and 52â¯% of the 42 positive players had systemic symptoms. Median return-to-training was 14â¯days. 22 (52â¯%) SARS-CoV-2 infections were rugby-related: 13 off-field (31â¯%), 9 on-field (21â¯%). 11â¯% of matches were cancelled due to SARS-CoV-2 infections. CONCLUSIONS: As contact in rugby was introduced back into the game following lockdowns there was an increasing incidence of SARS-CoV-2 infection. On-field rugby activities were responsible for 21â¯% of SARS-CoV-2 infections and 11â¯% of matches had to be cancelled, indicating the need for risk mitigation strategies.