Facilitating national football teams return to training and competition during the COVID-19 pandemic

Objectives Provide a robust framework to provide a safe environment for return to training and competition of the US national soccer teams following domestic and international travel. Methods US Soccer COVID-19 working group created a return to play manual for its national teams, prescribing discrete phases to return to training and competition. This was underpinned by strict health and safety and travel protocols for specific venues and persons. This was complemented by an aggressive testing cadence and isolation policies for delegations (players, internal and external support staff). Between September 2020 and April 2021, there were nine events for males and females at the youth, senior and Paralympic level, with international opponents hosted domestically. Results In total, 6590 point of care (POC) (n=1810) and PCR (n=4780) tests combined were run. Overall positivity rate for players and staff in male events of 0.10% (n=2) and 0.00% (n=0) for females were recorded. Staff positivity rate was 0.14% overall, and external vendors 0.10%. Total POC and PCR positives in male events (n=2) occurred either the day of arrival or the following day. Conclusion The implementation of strictly adhered to protocols and testing cadences yielded low positivity rates within team delegations. By comparison, initial league-wide COVID-19 testing in mid-2020 in other sports reported league-wide positivity rates of 2.9% (National Football League), 2.7% (Major League Soccer) and 5.3% (National Basketball Association). The English Premier League reported an increase in positivity rate in early 2021 from 1.22% to 1.74%. With the implementation of regimented protocols and stringent testing, it is possible to hold elite-level international sporting competitions involving long-haul travel while ensuring continued safety during a global pandemic.