SARS-CoV-2 infection in South African professional rugby players

After the cessation of sport worldwide and complete lockdown in South Africa due to the COVID-19
pandemic in 2020, sports federations developed varying regulations and introduced gradual return to
training and competition. There is limited data on the incidence and transmission of SARS-CoV-2 in
different sporting populations, including team sports, as they returned to full competition.

Rugby Union is a particularly difficult sport to mitigate the risk of SARS-CoV-2 transmission, owing to the
collision and physical contact nature of the sport, particularly during tackles, lineouts, loose ruck / mauls
and scrum phases of play. In these phases, both physical contact and high rates of ventilation increase
the risk of aerosol transmission. A study, recently published by researchers at the UP Sport, Exercise
Medicine and Lifestyle Institute (SEMLI), aimed to describe the incidence of SARS-CoV-2 infections in
professional rugby players as they return to competition during a pandemic. Researchers also compared
the pattern of infections in the rugby players to that of the general population, determined possible
mechanisms of SARS-CoV-2 transmission and reported symptoms and days to return-to-training in SARS-
CoV-2 infected players.

They found that the incidence of SARS-CoV-2 infections was higher in the contact and competition
phases compared to the noncontact phase. Overall incidence of SARS-CoV-2 infections over the 184
days was 1.23 per 1000 player days. The pattern of infections in rugby players was similar to those
reported in the general population. Rugby-related activities were responsible for 52 % of infections, with
training contributing the most. Eight out of nine on-field infections occurred in players in the forward
position and 11 % of matches were cancelled due to SARS-CoV-2 infections. Most (83.3 %) players were
symptomatic and 52 % of the players reported systemic symptoms. The median return-to-training days
in SARS-CoV-2 positive players was 14 days.

There are some practical implications to this research: A pandemic of this nature necessitates
practitioners to prepare for about 1 in 5 rugby players contracting SARS-CoV-2. Due to the contact
nature of rugby union there is a high risk for transmission, thus risk mitigation strategies should be
reviewed and adjusted. During on-field activities, forwards were most commonly infected (most likely
due to the scrum situation), and therefore there is a need to further investigate risk mitigation strategies
for these players and their activities.

Reference for this summary:
N. Sewry, M. Schwellnus, C. Readhead, et al., The incidence and transmission of SARS-CoV-2 infection in
South African professional rugby players …, Journal of Science and Medicine in Sport,
https://doi.org/10.1016/j.jsams.2022.06.004