key: cord-0817806-v668jgzs
authors: Nishino, Tomofumi; Obara, Kazuhiro; Nishida, Yusuke; Yamaguchi, Hiroshi; Hayashi, Mitsutoshi; Yamazaki, Masashi
title: Large-scale international volleyball competition in “bubble” under the COVID-19 pandemic
date: 2021-12-18
journal: Asia Pac J Sports Med Arthrosc Rehabil Technol
DOI: 10.1016/j.asmart.2021.12.001
sha: d7a4bc5e70d3400a4806ef3a2a3143fafe85bbfb
doc_id: 817806
cord_uid: v668jgzs

nan

Coronavirus disease 2019 (COVID-19) was first identified in China in December 2019, 5 causing a cluster of respiratory diseases. 1 This new virus rapidly spread around the world, and 6 the World Health Organization declared a pandemic in March 2020. 2 The global crisis 7 affected all life aspects, including sports. Major national and international sporting events 8 were affected, including the Tokyo Olympic Games, which were postponed until the summer 9 of 2021. The "bubble" method of cutting off contact between the athletes and the outside 10 world is one solution to stop the spread of COVID-19. 3 We report herein our experience with 11 a large-scale international volleyball competition using the bubble method. Sixteen teams of both men and women played a single round-robin system over five weeks, 18 and the top six teams then competed in a five-day final round to determine the final ranking. 19

In 2020, VNL was canceled owing to the COVID-19 pandemic. In 2021, the VNL was held in 20

Rimini, Italy, where all teams, officials, and staff were enclosed in a bubble without spectators. 21 A total of 572 volleyball players played 248 matches. More than 1,000 people, including 22 players, teams, and competition management staff, participated. The women's and men's 23 competitions were held from May 25 to June 25, and from May 28 to June 27, respectively. 24

The men's and women's teams alternated games and practices for three days each at the same 25 venue, but basically there was no contact between them. In addition, more than 100 television 26 production teams were included in the bubble. 27

Hygiene management system 28 Sanitation practices were governed by guidelines issued by the competition task force 29 (VNL 2021-COVID-19 VOLLEYBALL SAFETY GUIDELINES; https://www.fivb.com/-30 /media/volleyball/regulations%20and%20 forms/vnl%202021%20-%20covid-31

19%20volleyball%20safety%20guidelines.pdf?la=en&hash=FBDEA253CC1BA3F84AD277 32 4423E688A4). Basic hygiene management included wearing masks, maintaining social 33 distancing, frequent hand washing and disinfection, and air purification through ventilation, 34 as shown in Figure 1 . Only non-woven masks were allowed, not including cloth or urethane 35 masks. Masks were required to be worn at all times, even during games, except for players 36 and head coaches. No one was allowed to leave the bubble, except for transport to the hotel 37 and activity venues, which was allowed only by designated means of transportation (mainly 38 buses), and going out for other reasons was not allowed. In the designated hotel, only trips 39 to the private beach for relaxation were allowed. Each team was assigned a specific time to 40 take their meals. Although buffet style, all meals were served by the restaurant staff. In the 41 hotel, we tried to avoid contact with other teams as much as possible, including in the 42 elevators. The person-in-charge was required to send a daily health report of the entire team 43 to the task force platform. 44

As shown in Table 1 , all participants were required to take a PCR test and a negative result 46 before leaving the respective countries. Upon arrival, the participants were taken directly to 47 the hotel where they were staying and were not allowed to enter the bubble until another PCR 48 test was conducted at the hotel, with a negative result. During the competition, antigen 49 qualitative tests were conducted at the venue every four days. Participants had to wait in the 50 waiting area for about 10 minutes, and were allowed to enter the venue once the negative 51 results were confirmed. If the test result was positive or uncertain, the PCR test would be 52 conducted immediately in another room. After the competition, PCR tests were also 53 conducted at the venue before leaving for home, and if the results were negative, a certificate 54 J o u r n a l P r e -p r o o f was issued and we left for home. In addition to the regular tests, if there were any symptoms 55 related to COVID-19, it was agreed that the task force would conduct tests as needed. 56

Composition of our team 57

The Japanese team consisted of 27 men and 27 women (17 players each), including one team 58 doctor. Except for the team doctor, the 53 team members were unvaccinated. Three male 59 players and one female player had a previous COVID-19 infection. 60

We investigated the infection status of the Japanese team in the bubble and the results of the 61 overall examination to verify the effectiveness of the bubble method. 62 63 RESULTS 64

In the Japanese team, there were a few fever cases among the male members (Table 2 ). In the 65 women's team, there were no cases of fever or symptoms suggestive of COVID-19. In the 66 men's team, three staff members had temperatures of ≥ 37.5°. All of them were additionally 67 tested for antigens or PCR by the task force, and diagnosed as acute gastroenteritis, pyogenic 68 tonsillitis, and acute upper respiratory infection, respectively. One staff member diagnosed 69 with pyogenic tonsillitis had tonsillitis with white moss, and was treated with 5 days of 70 antimicrobial treatment for suspected streptococcal infection. Six players had fever. The fever 71 broke within a day except for the first one. All of them had a sore throat, without no evidence 72 J o u r n a l P r e -p r o o f of tonsillitis. The first patient had a fever that broke within two days, and a sore throat that 73 persisted for several days. In both cases, additional antigen or PCR tests were performed using 74 the task force, and all were negative. An acute upper respiratory tract infection caused by a 75 non-coronavirus was diagnosed due to sequential morbidity. 76

In the competition, 2,250 PCR tests and 7,920 antigen tests were performed in 38 days. The 77 only positive case was that of a bus driver who drove a team from the hotel to the training site 78 and back. Immediately after the test results returned, the bus driver was released from the 79 bubble and quarantined, and the players and staff of the team underwent additional tests, all 80 of which returned negative results. Since it was before the competition, there was no direct 81 impact on the team's ability to compete or hold the competition. great precedent for future sports bubbles. 3 The bubble method has also been adopted in the 97 World Cup in football, and was effective in controlling infection. 6 For this competition, the 98 FIVB worked with local public health authorities to conduct a risk assessment in line with the 99 WHO best practices. As a result, stringent measures were taken to minimize the health risks 100 to athletes and staff. These data provide a direct benefit in that COVID-19 transmission can 101 be minimized or reduced to zero if large international competitions are held safely and 102 appropriate risk mitigation factors are implemented. In addition, the number of personnel 103 within the bubble group is minimized and operational integrity is maintained. This study is 104 one of the rare reports of COVID-19 transmission among convention staff in the field using 105 the bubble concept, which combines regular testing, hygiene measures, physical distancing, 106 and daily symptom reporting. All participants in the competition were tested negative by PCR 107 prior to travel to the host country and again upon arrival. One local staff member tested 108 positive, and the source was determined to be non-external. Therefore, we were able to limit 109 the risk of transmission within an individual bubble, which is a significant phenomenon for 110 an indoor competition. 111

Description of our team's fever 112

The symptoms of one player and six other players were similar, except for two staff members 113 who developed fever on days 2 and 3. There were no cases of persistent high fever or specific 114 symptoms, such as ageusia, and from the infectiousness of the cases, we thought it was very 115 likely that the upper respiratory tract infection was caused by a non-coronavirus. Although 116 general hygiene precautions were followed, it proved to be very difficult to avoid droplet 117 infection, especially among players who played and practiced without masks. 

Clinical features of patients infected with 2019 novel 138 coronavirus in Wuhan, China

An ounce of prevention: Coronavirus (COVID-19) and mass gatherings

Utilizing the National Basketball Association's COVID-19 142 restart "bubble" to uncover the impact of travel and circadian disruption on athletic 143 performance

All persons who have made substantial contributions to the work reported in the manuscript (e.g., technical help, writing and editing assistance, general support), but who do not meet the criteria for authorship, are named in the Acknowledgements and have given us their written permission to be named. If we have not included an Acknowledgements in our manuscript, then that indicates that we have not received substantial contributions from nonauthors.J o u r n a l P r e -p r o o f

T. Nishino K. Obara 

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