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Youth ice hockey COVID-19 protocols and prevention of sport-related transmission
  1. Allison Krug1,
  2. Richard Appleby2,
  3. Robert Pizzini2,
  4. Tracy Beth Høeg3,4
  1. 1Artemis Biomedical Communications LLC, Virginia Beach, Virginia, USA
  2. 2Hampton Roads Youth Hockey Association, Virginia Beach, Virginia, USA
  3. 3Department of Physical Medicine & Rehabilitation, University of California-Davis, Sacramento, California, USA
  4. 4Northern California Orthopaedic Associates, Grass Valley, California, USA
  1. Correspondence to Allison Krug, Artemis Biomedical Communications LLC, Virginia Beach, VA 23456, USA; akrug{at}


Objectives This observational study evaluated the impact of return-to-play protocols to prevent transmission of SARS-CoV-2 in a youth ice hockey programme in Virginia Beach, Virginia.

Methods Following an outbreak of SARS-CoV-2 in November 2020, a COVID-19 Response Team evaluated the epidemiological data to identify transmission dynamics and develop enhanced protocols to prevent transmission. During the subsequent 18-week study period, incident cases were investigated to identify the likely transmission source; testing, quarantine and isolation recommendations were provided to families in accordance with Centers for Disease Control and Prevention guidelines.

Results Simple but stringent protocols were implemented among 148 youth ice hockey players ages 6–18. Players were required to arrive at the rink in full gear; locker rooms were closed, building entry was limited to one parent per player, and masks were required at all times except for players on the ice. Following implementation of the enhanced protocols, more than 500 practices and games were completed with at least 15 858 athlete-hours of exposure and no within-programme COVID-19 transmission was detected despite high community incidence and sporadic household exposures.

Conclusion This study suggests indoor youth sports can operate safely with appropriate protocols in place, even within communities of high COVID-19 transmission, even when athletes are not yet vaccinated or wearing masks during play. Transmission appears to be more likely in congested indoor areas involving adults than on the ice during play. Protocols should be developed in collaboration with programme participants. Strong collaboration in the interest of youth sports can motivate adoption of protocols which prevent within-team transmission.

  • COVID-19
  • ice hockey
  • indoor
  • public health
  • infection

Data availability statement

Data are available on reasonable request. De-identified data are available upon reasonable request from the corresponding author.

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Data availability statement

Data are available on reasonable request. De-identified data are available upon reasonable request from the corresponding author.

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  • Twitter @AlliKrug, @tracybethhoeg

  • Contributors AK, MPH, conducted the contact tracing, provided quarantine and isolation recommendations, provided protocol recommendations, conducted the epidemiological analysis, and wrote the manuscript; RA collected and stored the data; RP provided recommendations for the protocol development; TBH provided epidemiological guidance regarding the data analysis, protocol recommendations, and manuscript development. AK, MPH, is the guarantor and affirms that the manuscript is an honest, accurate and transparent account of the study being reported; no important aspects of the study have been omitted; and any discrepancies from the study have been explained. All authors took responsibility for the work.

  • 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 All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare: no support from any organisation for the submitted work. The authors have no financial relationships with any organisations that might have an interest in the submitted work in the previous three years except RA, who is the President of the not-for-profit Hampton Roads Youth Hockey Association described in this report. AK, MPH, is a parent of two youth ice hockey players and served as the volunteer epidemiologist on the COVID-19 Response Team during this study period. RP is the Fundraising Chair for the Hampton Roads Youth Hockey Association and one of the high school coaches.

  • 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.