Resumption of professional football league with spectators during the COVID-19 pandemic: The implementation of Bio-secure bubble protocol.

backgroundElite professional sports events involving mass gatherings carry a high risk of viral transmission during the coronavirus disease of 2019 (COVID-19) pandemic. We describe the potential impact of resuming professional football leagues involving international participants adhering to a strict

methodsWe conducted a descriptive cohort study involving football players, referees, match officials, local organizing committee (LOC) members, hotel and security staff working in close coordination, and over 10,000 spectators from the Asian Football Confederation (AFC) Champions League (East) and the final match. The study covered almost four weeks of the event (November 19 to December 19, 2020) under a robust

resultsA total of 12,250 RT-PCR tests involving 3158 individuals in the

conclusionsThis report shows a very low incidence rate of COVID-19 infections during mass gathering events at the international level. For the resumption of football with spectators, careful mitigation strategies should be considered to reduce the risk of transmission to a sufficiently safe level. This may require proper coordination and measures (i.e., physical distancing, testing, entry, and exit routes in the stadium, and seating arrangement inside the stadium with limited attendance). Based on this, during the ongoing COVID-19 pandemic, the supervised and controlled resumption of football matches with spectators can be done safely provided that a strict