The Effect of NFL and NCAA Football Games on the Spread of COVID-19 in the United States: An Empirical Analysis

Abstract

ABSTRACTImportanceIn 2020 and early 2021, the National Football League (NFL) and National Collegiate Athletic Association (NCAA) had opted to host games in stadiums across the country. The in-person attendance of games has varied with time and from county to county. There is currently no evidence on whether limited in-person attendance of games has caused a substantial increase in coronavirus disease 2019 (COVID-19) cases.ObjectiveTo assess whether NFL and NCAA football games with limited in-person attendance have contributed to a substantial increase in COVID-19 cases in the counties they were held.DesignIn this time-series cross-sectional study, we matched every county hosting game(s) with in-person attendance (treated) in 2020 and 2021 with a county that has an identical game history for up to 14 days (control). We employed a standard matching method to further refine this matched set so that the treated and matched control counties have similar population size, non-pharmaceutical intervention(s) in place, and COVID-19 trends. We assessed the effect of hosting games with in-person attendance using a difference-in-difference estimator.SettingU.S. counties.ParticipantsU.S. counties hosting NFL and/or NCAA games.ExposureHosting NFL and/or NCAA games.Main outcomes and measuresEstimating the impact of NFL and NCAA games with in-person attendance on new, reported COVID-19 cases per 100,000 residents at the county-level up to 14 days post-game.ResultsThe matching algorithm returned 361 matching sets of counties. The effect of in-person attendance at NFL and NCAA games on community COVID-19 spread is not significant as it did not surpass 5 new daily cases of COVID-19 per 100,000 residents on average.Conclusions and relevanceThis time-series, cross-sectional matching study with a difference-in-differences design did not find an increase in COVID-19 cases per 100,000 residents in the counties where NFL and NCAA games were held with in-person attendance. Our study suggests that NFL and NCAA football games hosted with limited in-person attendance do not cause a significant increase in local COVID-19 cases.Key pointsQuestionDid NFL and NCAA football games with limited in-person attendance cause a substantia increase in coronavirus disease 2019 (COVID-19) cases in the U.S. counties where the games were held?FindingsThis time-series, cross-sectional study of U.S. counties with NFL and NCAA football games used matching and difference-in-differences design to estimate the effect of games with limited in-person attendance on county-level COVID-19 spread. Our study does not find an increase in county-level COVID-19 cases per 100,000 residents due to NFL and NCAA football games held with limited in-person attendance.MeaningThis study suggests that NFL and NCAA games held with limited in-person attendance do not cause an increase in COVID-19 cases in the counties they are held.