A COVID-19 Outbreak After One Recreational Hockey Game, Florida, 2020

On June 16, 2020, two recreational ice hockey teams played an evening game at a rink in the Tampa Bay, Florida, area. Each team had 11 players — usually six on the ice and five on the bench — all men aged 19 to 53. Within five days, 15 people, 14 of the 22 players and a rink staff member, had COVID-19 symptoms, and 13 of them tested positive for SARS-CoV-2.

The outbreak

On June 19 the Florida Department of Health learned of a team A player who had developed fever, cough, sore throat and headache on June 17, the day after the game, and later tested positive. Investigators found that between June 18 and 21, two to five days after the game:

• 8 of the other 10 team A players fell ill;
• 5 of the 11 team B players fell ill;
• 1 rink staff member fell ill.

Leaving out the first patient, 13 of 21 players (62%) became sick. Of the 15 cases, 11 were confirmed by PCR, 2 by antigen tests, and 2 were not tested. Symptoms included fever, muscle aches, cough, sore throat, headache and loss of taste or smell. Players without symptoms didn't get tested. Neither on-ice referee got sick, and the game's single spectator stayed well and was not tested. The players had no other shared exposures in the week before the game.

COVID-19 cases linked to the hockey game, by date of symptom onset, Florida, June 2020. CDC, MMWR.

Why a hockey rink

Hockey involves hard exertion and deep, heavy breathing, and players move from the ice to the bench while still breathing hard. In this game:

• face protection varied — metal cages, plastic half-shields covering the eyes and upper nose, or none — and no one wore a cloth mask in the locker rooms or on the ice;
• the 60-minute game kept players frequently within 6 feet of one another, inside boards and plexiglass about 10 feet (3 m) high around a standard 200-by-85-foot rink;
• each team spent about 20 minutes in its own locker room before and after the game.

With a median incubation period of 4–5 days (range 2–14), investigators believe the first patient spread the virus while he had not yet developed symptoms, though more than one player may have been infectious. More of his own teammates fell ill, perhaps because of extra time together in the locker room and on the bench. An Italian study found that heavy exercise with mouth breathing can produce high rates of virus emission.

Lessons

Indoor sports with close contact and heavy breathing can set the stage for superspreader events — one person infecting many — which can drive explosive growth early in an outbreak and keep it going later, especially when the virus is circulating in the community. This game was small; hockey games can involve up to 20 players per team and many spectators. At the time, few reports had described spread at particular sports, beyond a choir practice, meat processing plants, fitness dance classes in South Korea (57 infected) and a squash facility in Slovenia (5 infected).

The health department gave isolation and quarantine advice to everyone at the rink during the game and advised the rink's management on COVID-19 risk and control. Because players without symptoms were not tested, some infections may have been missed.

Sources

• Atrubin D, Wiese M, Bohinc B. "An Outbreak of COVID-19 Associated with a Recreational Hockey Game — Florida, June 2020." MMWR 69(41). CDC.