Authors: Taylor N. Langon1, W. Cary Hill2, Mark B. Rogers1, Mike Goforth1, Robert I. MacCuspie2, Stefan M. Duma3, and Matthew S. Hull2,3
1Sports activities Medication Division, Virginia Tech, Blacksburg, VA, USA
2NanoSafe, Inc., Blacksburg, VA, USA
3Institute for Important Expertise and Utilized Science (ICTAS), Virginia Tech, Blacksburg, VA, USA
Matthew S. Hull, PhD
325 Stanger Road, Kelly Corridor Suite 410
Blacksburg VA, 24061
Taylor N. Langon, MS, LAT, ATC is analysis affiliate and concussion analysis coordinator within the Division of Sports activities Medication at Virginia Tech. Her major obligations embrace coordination of concussion analysis for Virginia Tech Athletics underneath the NCAA-DoD CARE Consortium.
W. Cary Hill, PhD is presently vp at NanoSafe, Inc. Cary’s areas of analysis curiosity embrace supplies science and engineering, nano-enabled human well being and security applied sciences and testing methods, and superior materials processing strategies.
Mark B. Rogers, DO, CAQSM, FAAFP, FAOASM, is the chief medical officer at Virginia Tech and an affiliate professor within the Departments of Household Medication and Osteopathic Medication, Self-discipline of Sports activities Medication on the Edward Through Faculty of Osteopathic Medication (VCOM). Mark oversees administration and supply of care to Virginia Tech scholar athletes.
Mike Goforth, MS, LAT, ATC, is affiliate athletics director for sports activities drugs at Virginia Tech. Mike oversees the healthcare wants of all student-athletes and organizes all trainers and medical doctors whereas supervising all different healthcare-related providers supplied at Virginia Tech.
Robert I. MacCuspie, PhD, is director of regulatory and testing providers at NanoSafe, Inc. Rob’s areas of analysis curiosity embrace nanotechnology and multifunctional supplies, accountable commercialization of superior applied sciences, and secure use of nano enabled merchandise.
Stefan M. Duma, PhD, is Harry C. Wyatt Professor, Biomedical Engineering and Mechanics, and Director, Institute for Important Expertise and Utilized Science (ICTAS) at Virginia Tech. Stefan’s areas of analysis curiosity embrace harm and affect biomechanics, and modern strategies for measuring the security of athletes, occupants, and customers.
Matthew S. Hull, PhD, is analysis scientist, Institute for Important Expertise and Utilized Science (ICTAS), at Virginia Tech, and president/founding father of NanoSafe, Inc. Matthew’s areas of analysis curiosity embrace functions and implications of converging applied sciences, environmental nanotechnology, and occupational well being and security.
American Soccer and COVID-19: decreasing on-field exposures to respiratory particles
American soccer poses distinctive challenges to defending the well being of athletes each on and off the sphere. Whereas off-field actions possible pose the best danger of COVID-19 transmission amongst members of the identical staff, on-field actions might pose transmission dangers from one staff to a different. The findings of this research recommend that, when utilized in well-ventilated out of doors environments, helmet modifications combining higher and decrease visors might assist scale back on-field respiratory transmission dangers with comparatively minimal results on athletic efficiency. These findings might supply sensible insights to staff physicians and athletic trainers as they search methods to guard athletes in opposition to on-field transmission of COVID-19 within the weeks and months forward.
Key Phrases: COVID-19, droplets, soccer, well being, helmets, infectious illness, danger, SARS-CoV-2, virus, visor
American soccer poses distinctive challenges to stopping COVID-19 transmission on the taking part in area. Masks utilization and social distancing are efficient measures for decreasing off-field transmission, however their use throughout play is impractical. Whereas off-field actions possible pose the best danger of illness transmission amongst members of the identical staff, on-field actions might pose transmission dangers from one staff to a different. As aggressive sports activities resume in the course of the ongoing pandemic, research are wanted to explain and validate the effectiveness of methods that not solely scale back on-field COVID-19 transmission dangers, however which can be extensively obtainable to athletes in any respect ranges, together with youth leagues. This research examines the suitability of sensible helmet modifications to reduce on-field transmission of COVID-19 throughout American soccer.
Because the onset of the COVID-19 pandemic, quite a lot of approaches have been deployed to guard athletes from SARS-CoV-2 with an emphasis on mitigating respiratory exposures, decreasing contact with high-touch surfaces, and minimizing high-risk social interactions. Approaches have various from full isolation of league personnel as demonstrated by the “bubble” strategy carried out by the Nationwide Basketball Affiliation (1), to the Nationwide Soccer League’s implementation of complete protocols detailing procedures and facility modifications designed to reduce dangers to athletes and workers (2). Procedural modifications have been complemented by the event of athletic gear designed to guard in opposition to SARS-CoV-2 exposures. Examples of such gear embrace the Mouthshield developed by the Nationwide Soccer League (NFL) and Oakley, which protects in opposition to the transmission of respiratory droplets whereas maximizing athlete consolation (3). On the collegiate stage, quite a lot of stories describe collaborations between Sports activities Medication workers and engineers to develop protecting gear (e.g., 4). Whereas quite a few methods have been described, their practicality and efficacy usually are not extensively reported. Additional, since most improvements in American soccer gear have centered on defending in opposition to accidents from affect (e.g., concussion), for instance (5,6), few testing strategies exist for evaluating the efficacy of protecting units designed to scale back on-field transmission of infectious illness. The work reported right here describes helmet and mouthguard modifications designed to scale back on-field transmission of SARS-CoV-2 and their efficacy in laboratory research with a simulated respiratory problem.
Helmets have been outfitted with modified visors or a mouthguard prototype and subjected to aerosol challenges to evaluate their capability to dam simulated respiratory droplets projected each outward (from contained in the helmet) and inward (from outdoors the helmet); the mouthguard modification was evaluated individually. Modifications investigated embrace 4 helmet-mounted visor configurations: 1.) no visor (i.e., no modification), 2.) higher visor solely, 3.) decrease visor solely, 4.) mixed decrease/higher visors, and 5.) a prototype mouthguard modified to loosely cowl the nostril and filter respired breath (Mouthshield) (Fig 1a). Emphasis was positioned on modifications that may be readily assembled from acquainted supplies obtainable by means of athletic gear distributors. Polycarbonate higher visors have been obtained from NIKE, Inc. (Beaverton, OR, USA) and mounted as supposed to the higher half of the helmet facemask. Decrease visors have been configured from the identical materials because the higher visors however have been rotated 180 levels and trimmed to suit the decrease half of the helmet facemask to enhance air flow and athlete consolation. Two mounting clips have been used for every configuration. The mouth protect innovation consists of a easy polymer-based meeting that converts a traditional American soccer mouthguard into an built-in face protect and low pressure-drop filter system. A extra full description of the Mouthshield innovation is offered elsewhere (7).
Particle Challenges and Measurement
A industrial airbrush (Photograph End Airbrush Firm, Greeneville, SC, USA) full of 2 mL of deionized water was used to generate aerosols consultant of exhaled breath. The air brush was administered for a period of 10 seconds per spray, a process that was replicated six occasions for every of the 4 helmet modifications and the Mouthshield. A TSI (Shoreview, MN, USA) Aerotrak 9306 optical particle counter (OPC) linked to sampling ports situated throughout the nostrils of a headform (Bepholan) was used to quantify the typical variety of particles measuring 0.3 to 25 mm in diameter throughout every 10 s spray. The positions of the airbrush and headform relative to the helmet-mounted visors and mouthpiece have been 30 cm aside and alternated between two completely different testing configurations: 1) containment of aerosols projected outward from contained in the helmet (Determine 1b,c) and a couple of) blockage of aerosols projected inward from outdoors the helmet (Determine 1d).
Notice. Abstract of helmet modifications, check setup and ensuing particle retention or blockage. A, 4 completely different helmet visor modifications have been assembled and investigated (m=Mouthshield not proven). B, Illustration of check setup used to guage outward retention of particles generated from throughout the helmet. C, Shut-up view of outward check setup exhibiting placement of the airbrush nozzle relative to the helmet facemask and distance separating the factors of particle technology and measurement. D, Illustration of check setup used to guage inward blockage of particles generated from outdoors the helmet.
Ensuing particles intently approximated dimension distributions and velocities reported within the literature for exhaled breath (8, 9). Combining higher and decrease visors decreased each outward and inward transmission of particles by >99% (by mass). Decrease visors have been more practical than higher visors at decreasing outward transmission of droplets, whereas both visor helped scale back inward transmission equally. Alone, higher visors, that are mounted above the mouth, supplied just about no retention of particles projected outward. All modifications have been more practical in opposition to particles of 1-25 mm diameter than the smallest particles measuring 0.3 to 1 mm.
No. (%) of particles (by mass), imply (SD), measuring 0.3 – 25 mm in diameter retained (in outward challenges) or blocked (in inward challenges) by every helmet modification relative to the optimistic management (no helmet).
(n = 6)
(n = 6)
(n = 6)
|Higher and Decrease
Visor (n = 6)
(n = 6)
|No. (%) Outward Particles Retained, imply (SD)||2.5 (13.3)||-3.8 (17.8)||99.9 (0.02)||99.9 (0.02)||99.8 (0.07)|
|No (%) Inward Particles Blocked, imply (SD)||12.9 (8.3)||88.8 (2.0)||86.1 (3.0)||99.8 (0.05)||97.7 (0.5)|
Whereas N95 respirators are preferable to faceshields for cover in opposition to COVID-19 transmission (10, 11), notably in poorly ventilated environments, they’re impractical for extended use throughout high-intensity athletic actions. Helmet-mounted visors successfully decreased the transmission of aerosol droplets measuring 0.3 to 25 mm and handed testing beneficial by the Nationwide Working Committee on Requirements for Athletic Tools (NOCSAE) (12). Nationwide Collegiate Athletic Affiliation (NCAA) athletes wore the modified helmets throughout aggressive common season play. Athletes reported that trimming the decrease visors improved consolation, however the visor’s placement can prohibit removing and reinsertion of mouthguards. Fogging of the decrease visor decreased downward visibility, however visually signifies the visor’s efficacy in opposition to outward projection of respiratory droplets. When utilized in well-ventilated out of doors environments, helmet modifications combining higher and decrease visors might assist scale back on-field respiratory transmission dangers with comparatively minimal results on athletic efficiency.
Helmet modifications combining higher and decrease visors decreased each outward and inward transmission of particles measuring 0.3 to 25 mm by >99% (by mass), suggesting that their use might assist scale back on-field transmission of COVID-19 by way of respiratory droplets with comparatively minimal results on athletic efficiency. When used with no decrease visor, higher visors, that are mounted above the mouth, supplied just about no retention of particles projected outward.
APPLICATIONS IN SPORT
The bodily calls for of athletic competitors, notably American soccer, pose distinctive challenges to defending athletes from COVID-19 exposures throughout play. Coaches, athletic trainers, and sports activities physicians have developed strong methods to guard athletes off the sphere, however choices for on-field safety stay restricted. The analysis herein proposed easy helmet modifications and a mouthpiece-mounted face protect that demonstrably decreased each the outward projection and inward penetration of simulated respiratory droplets in managed laboratory research. The interventions handed testing beneficial by the NOCSAE and have been worn throughout aggressive common season play by NCAA athletes. Whereas these interventions can’t supply the identical stage of safety as fitted masks and respirators, they could assist scale back the dangers of on-field transmission of illness by way of respiratory droplets in in any other case well-ventilated out of doors environments.
- Salazar, J.W., & Katz, M.H. (2021). COVID-19 classes from the nationwide basketball affiliation bubble—can persistently SARS-CoV-2–optimistic people transmit an infection to others? JAMA Inner Medication, 181(7), 967.
- DeFilippo Mack, C., Osterholm, M., Wasserman, E.B., Petruski-Ivleva, N., Anderson, D.J., Myers, E., Singh, N., Walton, P., Solomon, G., Hostler, C., Mancell, J., Sills, A. (2021). Optimizing SARS-CoV-2 surveillance in the US: insights from the Nationwide Soccer League occupational well being program. Annals of Inner Medication, On-line forward of print.
- The Related Press. NFL, Oakley provide you with face shields to guard gamers. Retrieved 26 Jul 2021 from: https://www.nf.com/news/nfl-oakley-come-up-with-face-shields-to-protect-players.
- Fetty, N. Engineers modify soccer helmet to scale back the unfold of COVID-19. Retrieved 26 Jul 2021 from: https://news.engineering.iastate.edu/2020/08/10/engineers-modify-football-helmet-to-reduce-the-spread-of-covid-19/.
- Breedlove, Okay.M., Breedlove, E.L., Bowman, T.G., Arruda, E.M., & Nauman, E.A. (2018). The impact of soccer helmet facemasks on affect habits throughout linear drop checks. Journal of Biomechanics, 79(5): 227-231.
- Rush, G.A., Rush, G.A., III, Sbravati, N., Prabhu, R., Williams, L.N., DuBien, J.L., Horstemeyer, M.F. (2017). Comparability of shell-facemask responses in American soccer helmets throughout NOCSAE drop checks. Sports activities Engineering, 20: 199-211.
- Hull, M.S., & Duma, S.M. (2020). Mouthpiece-mounted Face Protect. Mental Property disclosure VTIP 21-029 submitted to Virginia Tech Mental Properties July 2020. Retrieved 17 Feb 2021 from: https://vt.edu/content/dam/link_vt_edu/vtip/toa-docs/toa-21-029.pdf.
- Wei, J., & Li Y. (2017). Human cough as a two-stage jet and its function in particle transport. PloS One, 12(1), 1-15.
- Yang, S., Lee, G.W., Chen, C.M., Wu, C.C., & Yu, Okay.P. (2007). The dimensions and focus of droplets generated by coughing in human topics. Journal of Aerosol Medication, 20(4): 484-494.
- Verma, S., Dhanak, M., & Frankenfield, J. (2020). Visualizing droplet dispersal for face shields and masks with exhalation valves. Physics of Fluids. 32(091701):1-8.
- Facilities for Illness Management and Prevention (CDC). Concerns for sporting masks. Retrieved 10 Oct 2020 from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover-guidance.html.
- NOCSAE: Normal Efficiency Specification for Newly Manufactured Soccer Helmets Overland, KS, Nationwide Working Committee on Requirements for Athletic Tools. Retrieved 10 Oct 2020 from: https://nocsae.org/standard/standard-performance-specification-for-newly-manufactured-football-helmets-3/.