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Team Sport Risk Exposure Framework-2 (TS-REF-2) to identify sports activities and contacts at increased SARS-CoV-2 transmission risk during the COVID-19 pandemic
  1. Ben Jones1,2,3,4,5,
  2. Gemma Phillips1,2,6,
  3. Clive Beggs1,
  4. James Calder7,8,
  5. Matthew Cross9,10,
  6. Neil Pearce11,
  7. Clint Readhead4,12,
  8. Jenifer Smith13,
  9. Keith A Stokes10,14,
  10. Simon Kemp11,14
  1. 1 Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University - Headingley Campus, Leeds, UK
  2. 2 England Performance Unit, Rugby Football League, Leeds, UK
  3. 3 Leeds Rhinos Rugby League club, Leeds, UK
  4. 4 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
  5. 5 School of Science and Technology, University of New England, Armidale, New South Wales, Australia
  6. 6 Hull Kingston Rovers, Hull, UK
  7. 7 Fortius Clinic, London, UK
  8. 8 Department of Bioengineering, Imperial College London, London, UK
  9. 9 Premiership Rugby, London, UK
  10. 10 Department for Health, University of Bath, Bath, UK
  11. 11 London School of Hygiene & Tropical Medicine, London, UK
  12. 12 South Africa Rugby Union, Cape Town, South Africa
  13. 13 Public Health England, London, UK
  14. 14 Rugby Football Union, Twickenham, UK
  1. Correspondence to Professor Ben Jones, Carnegie Applied Rugby Research (CARR) centre, Leeds Beckett University - Headingley Campus, Leeds, West Yorkshire, UK; B.Jones{at}

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The Team Sports Risk Exposure Framework (TS-REF) was developed in July 2020 by experts in sports medicine, virology, sports science and public health to facilitate the safe return of sport during the COVID-19 pandemic.1 The TS-REF was developed at the time when the outdoor transmission risk of SARS-CoV-2 during sport was unknown. The TS-REF has been adopted by Public Health England and the UK Government (Department for Digital, Culture, Media and Sport), for use within both elite and community sports,2 to both determine the risk of SARS-CoV-2 transmission during specific sporting activities (eg, rugby tackle),1 and to identify and isolate increased risk contacts during sport.3 The TS-REF classified increased risk contacts as player-to-player interactions within 1 m, directly face to face, for 3 or more seconds’.1

Increased risk contacts as defined in the TS-REF were studied in rugby league, following interactions with eight infectious players across four matches.3 Increased risk contacts were monitored for 14-days during their isolation period and serially tested for SARS-CoV-2. Of the 28 identified increased risk contacts from the matches, only one player subsequently tested positive for SARS-CoV-2, which was linked to an internal club outbreak and believed unrelated to training activities. Another study in professional soccer observed similar findings,4 collectively suggesting the risk of outdoor transmission during sports appears lower than first thought.3 4 Consequently, the TS-REF may require players to unnecessarily isolate who are not at an increased risk of infection. Our aim was to update the TS-REF based on our evolving understanding of SARS-CoV-2 transmission during sports.

Team Sport Risk Exposure Framework 2

SARS-CoV-2 can be transmitted by both exhaled large ‘ballistic’ respiratory (>100 …

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  • Twitter @23benjones, @drkeithstokes, @drsimonkemp

  • Contributors BJ, GP, KAS and SK conceptualised the initial TS-REF framework. BJ and GP conceptualised the initial draft of the TS-REF-2. BJ, GP, MC, KAS and SK developed and finalised the TS-REF-2 framework, and developed online supplemental table 1. CB, BJ and GP developed online supplemental table 2. BJ and GP drafted the manuscript. CB, JC, MC, NP, CR, JS, KAS and SK provided reviews and editing of the manuscript. All authors critically reviewed and edited the manuscript prior to submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests BJ and GP are employed in a consultancy capacity by the Rugby Football League. KAS and SK are employed by the Rugby Football Union. MC is employed by Premiership Rugby. CR is employed by South Africa Rugby Union. GP, JC and JS are employed by Public Health England.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.