The NCAA organized its 2021 March Madness tournament using a layered set of mitigation strategies. Informed by CDC guidelines, recommendations from its medical advisory council, local public health agencies, and host venues, the NCAA developed and implemented a comprehensive plan that involves a controlled environment, regular screenings, social distancing, and masks for all. those involved in the tournament. The controlled environment required players, coaches, NCAA officials, and support staff to remain in designated, regulated areas (including housing areas, transportation, and basketball courts) that adhered to mitigation protocols, including rigorous cleaning regimens. Teams could not leave the environment once they arrived at the tournament, and mitigation protocols dictated entry and exit from the environment, especially multiple negative tests prior to entry.
The protocols were developed in late 2020 with final approval from the Marion County Department of Public Health, the jurisdiction responsible for the main tournament site, on February 1, 2021, when final capacity (25%) was determined for fanatics according to local epidemiology. of SARS-CoV-2. This retrospective cohort study was approved by the Indiana University (IU) Institutional Review Board and followed the Strengthening Reporting of Observational Studies in Epidemiology for Cohort Studies guidelines.
Testing, social distancing and masking
The NCAA categorized people into tiers based on its COVID-19 Guidance on multiple teams in the same location. derived from DiFiori et al.  Level 1 involved people for whom physical distancing and face coverings were not used, including athletes, coaches, medical staff, trainers and officials. People in Level 2 came into close contact with people in Level 1, but generally kept physical distance and wore face coverings. This included bus drivers, NCAA administrative staff, and event security. Level 3 individuals provided event services, but did not come into close contact with Level 1 individuals. These individuals included housekeeping, catering, and media. Represented Tier 4 fans admitted to the venue but restricted from interacting with Tier 1 people. For example, parents of players were not allowed to have any in-person contact during the tournament.
Table 1 details the mitigation strategies observed during the tournament. Tier 1 individuals were required to test negative for seven consecutive days before arriving in Indianapolis. These people were isolated upon arrival until they tested negative for the SARS-CoV-2 virus twice. Level 2 individuals were tested upon arrival and quarantined until a single negative result was obtained. All persons were expected to observe universal masking and social distancing throughout the tournament.
All Tier 1 individuals were housed in Marion County, Indiana, within the controlled environment. Tournament buses transported level 1 individuals to the venues. Tier 1 individuals were not permitted to enter any facilities outside of the tournament venues, and buses returned to designated hotels in Indianapolis after the competition. Each team was housed on a separate floor of a designated hotel, and training and practice venues were staggered and cleaned between uses, limiting interaction and exposure when not in competition. Players were socially distanced when on transport. Within teams, people can interact at meals, practices, workouts, games, and on your hotel floor. When not practicing or competing, individuals observed universal masking.
Indiana University Health, the largest health system in the state with a state-of-the-art clinical laboratory and academic medical center in downtown Indianapolis, was responsible for screening and testing individuals at Levels 1 and 2 on a daily basis. All individuals Level 1 patients received a self-administered anterior nasopharyngeal (NP) swab and observed daily. Specimens were pooled for analysis into small (north= 5) batches and run 6–8 h after collection. If any specimen were to test positive, then all samples in the pool would be tested individually. If the confirmatory test was positive, the individual was presumed positive and placed in isolation. If the individual was asymptomatic, a second test was performed to confirm active infection. If the second test was negative, a third test was performed. The individual remained isolated until the second and third tests could be analyzed to confirm the negative status. People confirmed positive were excluded from the remainder of the tournament and sent home for the remainder of their quarantine period.
Laboratory diagnoses were performed using IU Health RT-PCR Emergency Use Authorization assays for viral RNA on the Roche cobas® 8800 System or the Roche cobas® Liat® PCR System. The above NP swabs were placed in individual tubes prior to testing. Most tests were performed on the Roche cobas® 8800 System. If a screening test was positive, a second test was performed on the Roche cobas® Liat® PCR System. The cobas® SARS-CoV-2 Test performed on the cobas® 8800 System is a single-well, dual-target assay, which includes specific detection of SARS-CoV-2 and detection of pan-sarbecoviruses for the subgenus sarbecovirus family that includes SARS-CoV-2. The test detects the genetic signature (RNA) of the SARS-CoV-2 virus in nasal, nasopharyngeal, and oropharyngeal swab samples.
Individuals at least two weeks after infection and within 90 days of the first known date of infection were excluded from the daily testing regimen. Anyone with a documented positive SARS-CoV-2 infection after December 5, 2020 has been waived from pre-arrival testing requirements.
Our data includes longitudinal laboratory tests collected before and during the NCAA tournament for all participating players, staff, and vendors (eg, bus drivers). Previous infection history and immunization records were documented by team certificates completed by university health officials, including team physicians. These records were linked to laboratory data using name and date of birth. Of 2,738 people tested on the site, 2,660 (97.2%) matched the attestation records. People were grouped into their respective levels based on NCAA designations. The data also included the results of genotyping performed by IU Health for each positive PCR result.
Descriptive statistics (counts and proportions) were calculated for (1) partially vaccinated persons (1 dose of an mRNA vaccine), (2) fully vaccinated persons (2 doses of an mRNA vaccine or 1 dose of Ad26.COV2 vaccine). S) and (3) individuals who reported an active infection within 90 days (December 8, 2020 or later) of the start of the Tournament. Analyzes were performed using R version 4.0 (R Core Team).