1. Introduction
COVID-19 has afflicted the world since the beginning of 2020. The virus SARS-CoV-2 causes this infection. The presentation of this infection varies a lot from no presentation to severe infection and mortality (1). Because of this disease's rapidly spreading nature, on 20 March 2020, the WHO (World Health Organization) has declared COVID-19 a pandemic (2, 3). One year after the pandemic's announcement, many countries have started emergent vaccination against this virus. The pandemic is not controlled yet, and the new variants of the virus are rapidly spreading. The total number of infected individuals reaches 111 million people, leading to 6.24 million deaths worldwide in February 20212.
All kinds of human gatherings, including sports activities, were highly affected by this pandemic, and the world of football was not left untouched. To reduce the virus's person-to-person transmission rate, health authorities and the government applied limitations to all activities and lockdowns (4). As a result, all football matches and team training worldwide were suspended for a limited period until a reducing infection risk was recognized (5, 6).
Although the desire to resume the competitions promptly was rushing among players, clubs, and even the fans, a big challenge was facing the world of football: first to resume the training and matches within suitable safety precautions to ensure the health of players, staff, and officials. Finally, many countries restarted their leagues, but none let the spectators back in as there was no established protocol to keep them safe. After the vaccination speed-up and better person-to-person control of virus spread, the English premier league and Chinese super league allowed a limited number of fans to attend the matches in stadiums. After the successful experience of resuming football matches and tournaments following tight restrictions in keeping the players, staff, and organizers safe, it is time to let the spectators back in the stadiums and establish the needed guidelines.
This commentary will highlight the most important aspects and issues that need to be addressed if the football federation and associations decide to let the spectators back into the stadiums. It should be emphasized that these points should constantly be considered along with the local ministry of health guidelines and local authority guidelines for resuming football matches and training.
The following documents were used as a guide for writing down this commentary: (1) UEFA Minimum Health Hygiene Requirements for the Return of Spectators and UEFA Return to Play Protocol during COVID (7); (2) Basic principles and guidelines for developing concepts for allowing spectators back into stadiums in Bundesliga (8); (3) AFC match operations protocol during the COVID-19 pandemic (9); (4) Stadium sector guidance for Scottish professional football and Scottish professional rugby – Operational Guide (COVID-19) Checklist and Summary (10); (5) EFL (England Football League) match day operations guideline stage three return to socially distanced competitions (11); (6) CDC guideline on How to mitigate COVID-19 transmission in densely populated areas globally (12); (7) FIFA, Football-specific risk assessment tool (13); (8) World Health Organization, guidance for the use of the WHO mass gatherings sports: addendum risk assessment tools in the context of COVID-19 (14); (9) World Health Organization, considerations for sports federations/sports event organizers when planning mass gatherings in the context of COVID-19: interim guidance (15).
2. Basic Principles
We should keep in mind that it is impossible to assure a completely risk-free environment for all spectators, and all these points are to minimize the risk of infection. As the aerosols of this virus will get diluted more quickly in open spaces, an indoor stadium is not recommended to host the spectators unless an efficient air conditioning system is allocated for each hosting area. Meanwhile, as the other less significant transmission route is droplet or contact, disinfecting the surfaces and keeping enough distance between individuals are necessary. These principles could be considered by all local and international authorities and organizers responsible for resuming a football match or tournament. No symptomatic individual must be allowed to enter the stadium. Anybody entering the stadium must have a temperature lower than 37.5 centigrade, which is checked by non-contact thermometers.
3. Risk Assessment of the Pandemic Level
There are two risk assessment tools to be considered before deciding on resuming football matches with spectators. One is a tool published by FIFA based on the WHO Mass Gathering Sports Addendum Risk Assessment tools in the context of COVID-19. The WHO mass gathering risk assessment tool will define the risk from very high to be considered by the organizers. The next tool is to measure the pandemic level. If the pandemic level is high (≥ 35 new infections per week per 100,000 inhabitants), no spectators should be allowed in stadiums. Based on moderate and low pandemic levels, it can be decided to allow a specific percentage from 30 to 50% of spectators back in the stadiums.
4. Stadium Requirements and Infrastructures
General hygiene measures as per international and national regulations must be followed. All areas in the stadium accessible by the spectators must be disinfected before, during, and after each match. The areas with more traffic like bathrooms may need more sessions of disinfection. Alcohol-based sanitizers must be placed through the stadium and area accessible by spectators, especially at the entering and exit points. All spectators are required to wear a mask at all times, and they should be advised to sanitize their hands regularly.
For better air circulation, those stadiums which do not have a covering roof can host spectators during the pandemic. If a stadium consists of both roofed and unroofed areas, only the unroofed area for spectators must be used. The entering and exit ways for spectators must be separated from the teams and officials, while one-way paths must be used to avoid crowds and gatherings.
All individuals entering the stadium must have a body temperature lower than 37.5. In order to avoid crowding during the entrance and leaving the stadium, a queuing concept and design must be applied. The paths must be signed, and the individuals must enter the stadium based on a pre-defined schedule.
No food and beverage sharing must be allowed between spectators. Spectators must be allowed to use only their food and beverage. Sealed and pre-packed food and beverages can be sold inside the stadium if needed, following general hygiene matters.
Each stadium must allocate a specific air-conditioned room to keep symptomatic spectators before they are referred to hospitals.
There must be assigned COVID control officers for spectators to help them follow the guidelines and refer them in case of any problem.
5. Ticketing, Seat Allocation, and Capacity Determination
Only online ticketing must be considered during the pandemic, and paper tickets must be avoided. All seats must be numbered, and all spectators must have an allocated seat. Having standing spectators who do not have an assigned location and can quickly move between areas should not be considered safe during the pandemic. Each assigned seat must be separated from the next assigned seat by at least 1.5 meters of distance, and the unassigned seat must be marked. Two empty unassigned seats in each row between assigned seats and one empty row of seats between each row with assigned seats can provide a minimum distance.
Based on the pandemic level and risk assessment, 30 to 50% of stadium capacity is decided. The capacity determination must be based on the working and active capacity of the stadium. If any area cannot be used, the capacity must be reduced based on the remaining active capacity.
All ticket holders should enter the stadium based on a prescheduled timing which must be mentioned on their tickets. They must accept the local health authorities' guidelines to enter the stadium. Those high-risk individuals must not be allowed to buy tickets. Any individual with a valid ticket must avoid coming to the stadium in case of being symptomatic.
6. Education
The organizer must consider an educational structural plan for the spectators. This education must start when an individual buys an online ticket to read and agree to follow the general hygiene requirements. Educational signs and boards must be in place to entry and host areas to increase spectators' attention. Meanwhile, the TV boards located in the stadiums can play short educational videos for the spectators before the match and during halftime. All individuals entering the stadiums must cover their nose and mouth with a proper mask. The mask should be worn throughout the stay inside the stadium, besides when entering and leaving the stadium.
7. Spectators’ Travel
All individuals must be encouraged to use their private transport to the stadium. Preparing enough parking lots and help to ease this process is recommended. In case of using public transport, all hygiene measures must be followed by all spectators and the public transport must be used at half capacity.
