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Int J Sports Med 2021; 42(05): 407-418
DOI: 10.1055/a-1342-8071
Review

The Potential for Airborne Transmission of SARS-CoV-2 in Sport: A Cricket Case Study

Rory England
1   Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
,
Nicholas Peirce
2   Department of Sport Science & Medicine, England and Wales Cricket Board, Loughborough, United Kingdom of Great Britain and Northern Ireland
,
Thamindu Wedatilake
2   Department of Sport Science & Medicine, England and Wales Cricket Board, Loughborough, United Kingdom of Great Britain and Northern Ireland
,
Joseph Torresi
3   Department of Microbiology and Immunology, The University of Melbourne, Melbourne, Australia
,
Simon Kemp
4   Medical Services Director, Rugby Football Union, Twickenham, United Kingdom of Great Britain and Northern Ireland
5   Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom of Great Britain and Northern Ireland
,
Malcolm Cook
6   School of Architecture, Building and Civil Engineering, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
,
Sean Mitchell
1   Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
,
Andy Harland
1   Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Loughborough, United Kingdom of Great Britain and Northern Ireland
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Abstract

A review of risk factors affecting airborne transmission of SARS-CoV-2 was synthesised into an ‘easy-to-apply’ visual framework. Using this framework, video footage from two cricket matches were visually analysed, one pre-COVID-19 pandemic and one ‘COVID-19 aware’ game in early 2020. The number of opportunities for one participant to be exposed to biological secretions belonging to another participant was recorded as an exposure, as was the estimated severity of exposure as defined from literature. Events were rated based upon distance between subjects, relative orientation of the subjects, droplet generating activity performed (e. g., talking) and event duration. In analysis we reviewed each risk category independently and the compound effect of an exposure i. e., the product of the scores across all categories. With the application of generic, non-cricket specific, social distancing recommendations and general COVID-19 awareness, the number of exposures per 100 balls was reduced by 70%. More impressive was the decrease in the most severe compound ratings (those with two or more categories scored with the highest severity) which was 98% and the reduction in exposures with a proximity <1 m, 96%. Analysis of the factors effecting transmission risk indicated that cricket was likely to present a low risk, although this conclusion was somewhat arbitrary omitting a comparison with a non-cricketing activity.

Key words

COVID-19 - coronavirus - sport - risk of airborne transmission - risk factors


Publication History

Received: 12 October 2020

Accepted: 14 December 2020

Article published online:
28 January 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Rice SG, Small EW, McCambridge TM. et al. Medical conditions affecting sports participation. Pediatrics 2008; 121: 841-848
    CrossrefPubMedGoogle Scholar
  • 2 Tellier R, Li Y, Cowling BJ. et al. Recognition of aerosol transmission of infectious agents: A commentary. BMC Infect Dis 2019; 19: 1-9
    CrossrefPubMedGoogle Scholar
  • 3 England R, Peirce N, Torresi J. et al. The Potential for Transmission of Coronaviruses via Sports Equipment; a Cricket Case Study. Int J Sports Med 2020; under review
  • 4 Chu DK, Akl EA, Duda S. et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet 2020; 395: 1973-1987
    CrossrefPubMedGoogle Scholar
  • 5 To KKW, Tsang OTY, Chik-Yan Yip C. et al. Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis 2020; 841-843
    CrossrefPubMedGoogle Scholar
  • 6 To KKW, Tsang OTY, Leung WS. et al. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: An observational cohort study. Lancet Infect Dis 2020; 20: 565-574
    CrossrefPubMedGoogle Scholar
  • 7 Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020; 109: 102433
    CrossrefPubMedGoogle Scholar
  • 8 Peeri NC, Shrestha N, Rahman MS. et al. The SARS, MERS and novel coronavirus (COVID-19) epidemics, the newest and biggest global health threats: What lessons have we learned?. Int J Epidemiol 2020; 49: 717-726
    CrossrefPubMedGoogle Scholar
  • 9 Otter JA, Donskey C, Yezli S. et al. Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: The possible role of dry surface contamination. J Hosp Infect 2016; 92: 235-250
    CrossrefPubMedGoogle Scholar
  • 10 Ding Y, He L, Zhang Q. et al. Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: Implications for pathogenesis virus transmission pathways. J Pathol 2004; 203: 622-630
    CrossrefPubMedGoogle Scholar
  • 11 Chan KH, Peiris JSM, Lam SY. et al. The effects of temperature and relative humidity on the viability of the SARS coronavirus. Adv Virol 2011; 2011: 734690
    PubMedGoogle Scholar
  • 12 Kampf G, Todt D, Pfaender S. et al. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020; 104: 246-251
    CrossrefPubMedGoogle Scholar
  • 13 Ong SWX, Tan YK, Chia PY. et al. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from a Symptomatic Patient. JAMA 2020; 323: 1610-1612
    CrossrefPubMedGoogle Scholar
  • 14 Peiris JSM, Chu CM, Cheng VCC. et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: A prospective study. Lancet 2003; 361: 1767-1772
    CrossrefPubMedGoogle Scholar
  • 15 Van Doremalen N, Bushmaker T, Morris DH. et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567
    CrossrefPubMedGoogle Scholar
  • 16 Xu H, Zhong L, Deng J. et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020; 12: 8
    CrossrefPubMedGoogle Scholar
  • 17 Lan J, Ge J, Yu J. et al. Structure of the SARS-CoV-2 spike receptor-Binding domain bound to the ACE2 receptor. Nature 2020; 581: 215-220
    Google Scholar
  • 18 Tang JW, Li Y, Eames I. et al. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect 2006; 64: 100-114
    CrossrefPubMedGoogle Scholar
  • 19 Teunis PFM, Brienen N, Kretzschmar MEE. High infectivity and pathogenicity of influenza A virus via aerosol and droplet transmission. Epidemics 2010; 2: 215-222
    CrossrefPubMedGoogle Scholar
  • 20 Chen W, Zhang N, Wei J. et al. Short-range airborne route dominates exposure of respiratory infection during close contact. Build Environ 2020; 176: 106859
    CrossrefPubMedGoogle Scholar
  • 21 Lednicky JA, Lauzardo M, Hugh Fan Z et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. medRxiv 2020; 2020.08.03.20167395
  • 22 Liu L, Li Y, Nielsen PV. et al. Short-range airborne transmission of expiratory droplets between two people. Indoor Air 2017; 27: 452-462
    CrossrefPubMedGoogle Scholar
  • 23 Watanabe T, Bartrand TA, Weir MH. et al. Development of a dose-response model for SARS coronavirus. Risk Anal 2010; 30: 1129-1138
    CrossrefPubMedGoogle Scholar
  • 24 Morgenstern J Aerosols, Droplets, and Airborne Spread: Everything you could possibly want to know. First10EM 2020; Im Internet: https://first10em.com/aerosols-droplets-and-airborne-spread/
  • 25 SAGE - Enviromental Modeling Group. Environmental Influence on Transmission. 2020; Im Internet: https://www.gov.uk/government/publications/environmental-influence-on-transmission-of-covid-19-28-april-2020
  • 26 Pantelic J, Tham KW, Licina D. Effectiveness of a personalized ventilation system in reducing personal exposure against directly released simulated cough droplets. Indoor Air 2015; 25: 683-693
    CrossrefPubMedGoogle Scholar
  • 27 Scales DC, Green K, Chan AK. et al. Illness in intensive care staff after brief exposure to severe acute respiratory syndrome. Emerg Infect Dis 2003; 9: 1205-1210
    CrossrefPubMedGoogle Scholar
  • 28 Noakes CJ, Andrew Sleigh P. Mathematical models for assessing the role of airflow on the risk of airborne infection in hospital wards. J R Soc Interface 2009; 6: 791-800
    CrossrefPubMedGoogle Scholar
  • 29 Judson SD, Munster VJ. Nosocomial transmission of emerging viruses via aerosol-generating medical procedures. Viruses 2019; 11: 940-952
    CrossrefPubMedGoogle Scholar
  • 30 Fiegel J, Clarke R, Edwards DA. Airborne infectious disease and the suppression of pulmonary bioaerosols. Drug Discov Today 2006; 11: 51-57
    CrossrefPubMedGoogle Scholar
  • 31 Morawska L. Droplet fate in indoor environments, or can we prevent the spread of infection?. Indoor Air 2006; 16: 335-347
    CrossrefPubMedGoogle Scholar
  • 32 Chen C, Zhao B. Some questions on dispersion of human exhaled droplets in ventilation room: Answers from numerical investigation. Indoor Air 2010; 20: 95-111
    CrossrefPubMedGoogle Scholar
  • 33 Bahl P, Doolan C, de Silva C. et al. Airborne or droplet precautions for health workers treating COVID-19?. J Infect Dis 2020; jiaa189
    CrossrefPubMedGoogle Scholar
  • 34 Sun W, Ji J. Transport of droplets expelled by coughing in ventilated rooms. Indoor Built Environ 2007; 16: 493-504
    CrossrefPubMedGoogle Scholar
  • 35 Tellier R. Aerosol transmission of influenza A virus: A review of new studies. J R Soc Interface 2009; 6: 783-790
    CrossrefPubMedGoogle Scholar
  • 36 Xie X, Li Y, Chwang ATY. et al. How far droplets can move in indoor environments. Indoor Air 2007; 17: 211-2256
    CrossrefPubMedGoogle Scholar
  • 37 Jayaweera M, Perera H, Gunawardana B. et al. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. Environ Res 2020; 188: 109819
    CrossrefPubMedGoogle Scholar
  • 38 Seto WH, Tsang D, Yung RWH. et al. Effectiveness of precautions against droplets and contact in prevention of nosocomial transmission of severe acute respiratory syndrome (SARS). Lancet 2003; 361: 1519-1520
    CrossrefPubMedGoogle Scholar
  • 39 Zhang R, Li Y, Zhang AL. et al. Identifying airborne transmission as the dominant route for the spread of COVID-19. P Natl Acad Sci USA 2020; 14857-14863
    CrossrefPubMedGoogle Scholar
  • 40 Schulman JL, Kilbourne ED. Airborne transmission of influenza virus infection in mice. Nature 1962; 195: 1129-1130
    CrossrefPubMedGoogle Scholar
  • 41 Nicas M, Nazaroff WW, Hubbard A. Toward understanding the risk of secondary airborne infection: Emission of respirable pathogens. J Occup Environ Hyg 2005; 2: 143-154
    CrossrefPubMedGoogle Scholar
  • 42 Morgenstern J Aerosol Generating Procedures. First10EM 2020; Im Internet: https://first10em.com/aerosol-generating-procedures/
  • 43 Liu L, Wei J, Li Y. et al. Evaporation and dispersion of respiratory droplets from coughing. Indoor Air 2017; 27: 179-190
    CrossrefPubMedGoogle Scholar
  • 44 Papineni RS, Rosenthal FS. The size distribution of droplets in the exhaled breath of healthy human subjects. J Aerosol Med 1997; 10: 105-116
    CrossrefPubMedGoogle Scholar
  • 45 Xie X, Li Y, Sun H. et al. Exhaled droplets due to talking and coughing. J R Soc Interface 2009; 6: 703-714
    PubMedGoogle Scholar
  • 46 Fairchild CI, Stampfer JF. Particle concentration in exhaled breath. Am Ind Hyg Assoc J 1987; 48: 948-949
    CrossrefPubMedGoogle Scholar
  • 47 Morawska L, Johnson GR, Ristovski ZD. et al. Size distribution and sites of origin of droplets expelled from the human respiratory tract during expiratory activities. J Aerosol Sci 2009; 40: 256-269
    CrossrefPubMedGoogle Scholar
  • 48 Bake B, Larsson P, Ljungkvist G. et al. Exhaled particles and small airways. Respir Res 2019; 20: 8
    CrossrefPubMedGoogle Scholar
  • 49 Hallett S, Toro F, Ashurst J V. Physiology, Tidal Volume. Treasure Island (FL): StatPearls Publishing; 2020
  • 50 Hough A. Physiotherapy in Respiratory Care: An Evidence-based Approach to Respiratory and Cardiac Management. Nelson Thornes, 2001
  • 51 Caretti DM, Pullen PV, Premo LA. et al. Reliability of respiratory inductive plethysmography for measuring tidal volume during exercise. Am Ind Hyg Assoc J 1994; 55: 918-923
    CrossrefPubMedGoogle Scholar
  • 52 Gupta JK, Lin C-H, Chen Q. Characterizing exhaled airflow from breathing and talking. Indoor Air 2010; 20: 31-39
    CrossrefPubMedGoogle Scholar
  • 53 Gupta JK, Lin C-H, Chen Q. Flow dynamics and characterization of a cough. Indoor Air 2009; 19: 517-525
    CrossrefPubMedGoogle Scholar
  • 54 Mahajan RP, Singh P, Murty GE. et al. Relationship between expired lung volume, peak flow rate and peak velocity time during a voluntary cough manoeuvre. Br J Anaesth 1994; 72: 298-301
    CrossrefPubMedGoogle Scholar
  • 55 Nicolò A, Massaroni C, Passfield L. Respiratory frequency during exercise: The neglected physiological measure. Front Physiol 2017; 8: 922
    CrossrefPubMedGoogle Scholar
  • 56 Donaldson AE, Walker NK, Lamont IL. et al. Characterising the dynamics of expirated bloodstain pattern formation using high-speed digital video imaging. Int J Legal Med 2011; 125: 757-762
    CrossrefPubMedGoogle Scholar
  • 57 Geoghegan PH, Laffra AM, Hoogendorp NK. et al. Experimental measurement of breath exit velocity and expirated bloodstain patterns produced under different exhalation mechanisms. Int J Legal Med 2017; 131: 1193-1201
    CrossrefPubMedGoogle Scholar
  • 58 Edwards DA, Man JC, Brand P. et al. Inhaling to mitigate exhaled bioaerosols. Proc Natl Acad Sci USA 2004; 101: 17383-17388
    CrossrefPubMedGoogle Scholar
  • 59 Atkinson J, Chartier Y, Jensen P. et al. Natural Ventilation for Infection Control in Health-Care Settings. WHO Publ; 2009
    Google Scholar
  • 60 Jennison M. Atomizing of mouth and nose secretions into the air as revealed by high-speed photography. Aerobiology 1942; 106-128
    PubMedGoogle Scholar
  • 61 Zhu SW, Kato S, Yang JH. Study on transport characteristics of saliva droplets produced by coughing in a calm indoor environment. Build Environ 2006; 41: 1691-1702
    CrossrefPubMedGoogle Scholar
  • 62 Bourouiba L, Dehandschoewercker E, Bush JWM. Violent expiratory events: On coughing and sneezing. J Fluid Mech 2014; 745: 537-563
    CrossrefPubMedGoogle Scholar
  • 63 Bourouiba L. A sneeze. N Engl J Med 2016; 375: e15
    CrossrefPubMedGoogle Scholar
  • 64 Lee J, Yoo D, Ryu S. et al. Quantity, size distribution, and characteristics of cough-generated aerosol produced by patients with an upper respiratory tract infection. Aerosol Air Qual Res 2019; 19: 840-853
    CrossrefPubMedGoogle Scholar
  • 65 Loh NHW, Tan Y, Taculod J. et al. The impact of high-flow nasal cannula (HFNC) on coughing distance: implications on its use during the novel coronavirus disease outbreak. Can J Anesth 2020; 67: 893-894
    CrossrefPubMedGoogle Scholar
  • 66 Wei J, Li Y. Human cough as a two-stage jet and its role in particle transport. PLoS One 2017; 12: e0169235
    CrossrefPubMedGoogle Scholar
  • 67 Parienta D, Morawska L, Johnson GR. et al. Theoretical analysis of the motion and evaporation of exhaled respiratory droplets of mixed composition. J Aerosol Sci 2011; 42: 1-10
    CrossrefPubMedGoogle Scholar
  • 68 Wei J, Li Y. Enhanced spread of expiratory droplets by turbulence in a cough jet. Build Environ 2015; 93: 86-96
    CrossrefPubMedGoogle Scholar
  • 69 Zhang H, Li D, Xie L. et al. Documentary research of human respiratory droplet characteristics. Procedia Eng 2015; 121: 1365-1374
    CrossrefPubMedGoogle Scholar
  • 70 Wells WF. On air-borne infection: Study II. Droplets and droplet nuclei. Am J Epidemiol 1934; 20: 611-618
    CrossrefPubMedGoogle Scholar
  • 71 Morawska L, Milton D. It is time to address airborne transmission of coronavirus disease 2019 (COVID-19). Clin Infect Dis 2020; 71: 2311-2313
    PubMedGoogle Scholar
  • 72 Harriss D, Macsween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
    Article in Thieme ConnectPubMedGoogle Scholar