Key Points

Question Was fan attendance at National Football League (NFL) games during the 2020-2021 season associated with subsequent spikes in COVID-19 cases in-county and in contiguous counties?

Findings In this cross-sectional study of NFL games attended by a total 1.3 million fans, the presence of large numbers of fans at NFL games was associated with increases in the incidence of COVID-19 cases both in the counties in which these venues were located and contiguous counties. Specifically, NFL games that had 20 000 fans in attendance had 2.23 times the rate of spikes in COVID-19, but NFL games with fewer than 5000 fans in attendance did not generate any spikes.

Meaning This analysis suggests that in-person attended games during the NFL’s 2020 season were associated with subsequent spikes in COVID-19 cases, and that the spikes were most prominent when attendance was over 20 000 persons.