by Dr. Dev Mishra

As we work through the current COVID-19 surge, with hopes for a vaccine in the near future, it’s instructive to dig deeper into how individuals become infected with the coronavirus and how to decrease risk. In the world of sports we’ve seen multiple NFL players infected, and even in Formula 1 three drivers have tested positive. We can be certain that Lewis Hamilton didn’t get the virus by driving himself in his vehicle.

So what’s going on? While it’s impossible to be 100% certain of the risk factors a common thread is emerging. The virus appears to be spread through aerosol particles in the breath, and inhaled by someone else. The higher risk is not on an outdoor field of play, it’s indoors at a team meeting in a small room or at a meal with others. The meal, the car ride, the shared hotel room, and the whiteboard session are likely risker than the game itself.

Infection During Outdoor Events With Spacing Is Low Risk But Not Impossible

According to the CDC (Centers for Disease Control and Prevention), “Infections occur mainly through exposure to respiratory droplets when a person is in close contact with someone who has COVID-19.

Respiratory droplets cause infection when they are inhaled or deposited on mucous membranes, such as those that line the inside of the nose and mouth.”

The data available so far show that outdoor activities involving adequate spacing of individuals and movement of the participants is a low-risk activity. Multiple published medical reports have failed to show a virus transmission pathway from two individuals exercising outdoors with appropriate safety spacing. That doesn’t mean it’s impossible but given that it hasn’t yet been documented it’s likely a very small risk.

The NFL does not disclose the specific way in which players are infected, but we can have some inferences about risk from the safety pathways the NFL puts in place. For example, play on the field continues but all indoor activities are strictly controlled. No mask indoors, no play (ask a Denver Bronco quarterback about that rule ...) There are regulations on the number of individuals who can gather at one time indoors depending on the space available.

“We still see no evidence of on-field transmission from football-related activities,” Dr. Allen Sills, the NFL’s chief medical officer, said recently.

Higher Risk From Indoor Activity In Poorly Ventilated Spaces

As far as we currently know, the bigger risk is from indoor activity in smaller spaces with inadequate ventilation. There was until recently a huge uptick in youth sports activity in the Phoenix area, with the argument that youth sports benefits outweigh the small risk of getting the virus through outdoor sports.

Debate on many sides of this issue becomes heated quickly but think for a moment what goes on apart from the interactions on the outdoor field of play. For example, you might travel in a car with folks outside your immediate family, you might share a hotel room, you might sit in proximity in a meeting room, you might get carry-out food and eat together in the hotel room ...

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Please follow the precautions set in place by your national governing organization for your sport and the CDC. I have a feeling the data will continue to prove the risk is not the outdoor sport itself. The pregame meal held behind closed doors is the bigger risk.


• Risk of coronavirus transmission from outdoor activities in which the participants are moving and spaced at least 6 feet apart appears to be very low.

• The risk is higher in activities held in relation to a sports event, such as a shared car ride or hotel room, and meals shared within an indoor space with poor ventilation.