# Risk factors associated with COVID-19 infection among Chinese elite athletes during overseas training and competitions: a large-scale cross-sectional survey

## TL;DR

This study identifies risk factors for COVID-19 among Chinese athletes and staff during overseas training and competitions, highlighting the need for better prevention strategies.

## Contribution

The study provides novel insights into infection risk factors specific to elite athletes and support staff during international events.

## Key findings

- Athletes had the highest infection rate (37.9%) compared to other roles.
- Participating in both overseas training and competitions increased infection risk significantly.
- Inadequate ventilation and inconsistent mask use were significant risk factors.

## Abstract

To analyze COVID-19 infection incidence and risk factors among Chinese national team members during overseas training and competitions (April–October 2022) to inform prevention for international events.

A nationwide cross-sectional survey used electronic questionnaires distributed to 69 national teams. A total of 1,020 valid questionnaires were included for analysis, covering athletes, coaches, medical staff, team leaders, and other support personnel. The χ2 test was used to analyse the relationships between infection rates and variables, including individual factors, travel modes, accommodation conditions, and protective behaviors.

The overall infection rate was 35.5%. Infection rates differed significantly across occupational groups: athletes had the highest rate (37.9%), followed by coaches (29.8%) and team leaders (21.7%). Personnel who participated in both overseas training and competitions presented a significantly higher infection rate (47.9%) than did those who only participated in competitions (19.0%) (p < 0.001). Individuals vaccinated with 2 doses had the highest infection rate (48.6%), whereas those receiving ≥4 doses had the lowest infection rate (22.4%). χ2 analysis revealed significant risk factors for infection: sharing accommodation floors with foreign personnel, inadequate room ventilation, irregular room disinfection during training periods, taking nondirect flights, and inconsistent mask wearing.

Infection risk among national team members abroad clustered by role, assignment type, and behaviors. Elevated risk was linked to intensive training schedules, suboptimal implementation of prevention protocols, and frequent contact with foreign personnel. Multifaceted interventions—source control, rigorous process management, and strict adherence to personal protective measures—should be strengthened to reduce infection risk.