EURO 2020: Hosting a Major Football Tournament During a Global Pandemic – The UK Perspective

FEATURE / STEPHEN BOYCE & MIKE PATTERSON

Following the declaration of the covid 19 global pandemic the UEFA European Championships due to be held in the summer of 2020 were postponed by a year to 2021. These championships were to be different. Instead of one large country or two smaller countries co-hosting the event, UEFA had awarded the tournament to eleven cities across Europe. The idea was to provide an opportunity for smaller nations to host part of a major football tournament that would otherwise not have the resources to do, bringing live matches to a larger fan base. The semi-finals and finals were to be held at Wembley stadium in London.

The logistics of organising a transcontinental tournament would be challenging in normal circumstances, however, the addition of covid measures increased these difficulties significantly. International travel, government restrictions and public health legislation varied across European countries, and even within sovereign states.

The governance of the tournament consisted of an overall CMO in charge of the tournament appointed by UEFA, with a CMO appointed for each host city. Following the introduction of covid travel restrictions, the CMO’s could not meet in person, with meetings coordinated by the UEFA medical department via video conference. I was appointed the CMO for the Glasgow and Mike Patterson the CMO for London. Despite Scotland and England being part of the UK on the global stage, Scotland has its owned devolved government. Covid restrictions and public health guidance was different between Scotland and England. This led to significant problems in planning for the tournament, for UEFA, the national teams, and both UK CMO’s.

Glasgow

Four matches were scheduled to take place at Hampden Park, Glasgow; three group matches and a last 16 knockout match. UEFA have a list of medical regulations required for hosting a tournament. This involves the stadium (players and crowd), training venues, team hotels, referees, VIPs, staff, and major incidents. The Glasgow medical plan had been prepared by Dr John Maclean in 2018/2019. Due to the Scotland national team qualifying for the tournament, he stepped down as CMO to concentrate on his role as national team doctor and I took over the CMO role in January 2021 at the height of covid, with Scotland under significant government restrictions. A comprehensive medical plan for all aspects of the tournament at Glasgow now required the addition of covid mitigation measures.

Covid restrictions in Scotland were different to England throughout the pandemic. The differences in each nation’s public health approach reflected epidemiology, public health strategy, and the complex political landscape between UK central and devolved governments. All of this needed to be presented in a unified way to the national participants and UEFA by the UK CMOs. UEFA asked for guarantees that the tournament would take place in June 2021. The Scottish Government could not provide these guarantees and it wasn’t clear if the tournament would take place in Glasgow. Two host cities, Dublin, and Bilbao had their matches moved to alternative venues as the respective governments could not provide these assurances. After many meetings with the Scottish Government, public health authorities and the local organising committee (LOC), the Scottish Government finally agreed at the end of March 2021 that the tournament would take place. The number of fans allowed inside the stadium and covid mitigation procedures had still to be agreed.

At this time covid public health restrictions were different in Scotland and England. These encompassed the following:

• Entry requirements into the country regarding PCR testing, previous covid infection and the use of lateral flow tests • Definition of a close contact • Isolation time for positive cases and close contacts • Social distancing • Face mask wearing • The public were subject to different rules regarding households’ gathering, the opening of shops, restaurants, hotels and licenced premises.

The national teams scheduled to be based in Scotland were Croatia, Czech Republic, and Scotland. Croatia planned on a base in St. Andrews, the Czech Republic in Edinburgh. Scotland, qualifying later via the delayed play-offs route, had chosen the North of England as their training base. These national teams would also travel to England to play one group match at Wembley.

Explaining the difference in covid restrictions to representatives of national teams at the site visits caused confusion. Despite being resident in one country, the UK, they would be required to adhere to a different set of covid rules at their base camp in Scotland, compared to the hotel base prior to their match at Wembley. Concerns were raised about the rigidity of covid testing and restrictions in Scotland, with the main contentious point around the definition of a “close contact”. Players and staff would be tested every 72 hours. A close contact was defined as “within 2 metres for more than 15 mins” in Scotland. Isolation was a legal requirement in Scotland. The national teams concluded they would require a minimum of six buses to travel to training and matches to avoid having players potentially being considered a “close contact” of any positive case. England had different regulations including exemptions and “research” options in elite sport. I was asked a valid question that I couldn’t answer; “why is the Scottish national team staying in England and not their own country?” . Despite intensive discussion with public health authorities, I could not achieve exemptions from these rules for the “national team bubbles”. After discussion with UEFA, Croatia, and the Czech Republic, it was agreed these nations would remain in their own countries and travel to Scotland for matches. This way they would be subject to their own national public health legislation. They would travel 48 hours before the match having performed PCR testing in their own country and leave immediately after the match to travel directly home. The team services department had worked for several years arranging tournament logistics for the national teams, e.g., hotels, training venues, transport, to have this work no longer needed.

The tournament took place with only 20% of fan capacity at Hampden Park, Glasgow due to covid social distancing rules. National teams travelled in and out of Glasgow airport, turning travel operations into a less than 48 hour trip to the UK with the constant fear of delays and extra testing. No testing of the teams occurred in Scotland, only the LOC staff. In the end this actually worked well, removing the logistical difficulties of medical staffing for training venues and hotels, requiring only the 48 hour period of stay in Glasgow to be covered.

London

Wembley Stadium hosted eight matches in the tournament, including both semi-finals and the final. One match scheduled for Dublin prior to the pandemic increased the originally planned seven events. The Football Association (England) has staff in employed roles that include delivery of medical care in tournaments; including stadium clinical care, venue medical operations, team medical liaison and an over-arching CMO role. Having recently delivered the U17 EUROs and Champions League Final, and with an established stadium medical team already part of The FA staff, we were able to up-scale our normal operations to deliver the required UEFA medical requirements.

Having already designed a detailed medical strategy, we started planning how this would be implemented in the COVID-19 pandemic. A major component of our planning was developing strategies to meet the healthcare needs of the high volume of personnel, both playing and otherwise participating in the delivery of the tournament, in London. A combination of strict travel restrictions and quarantine for everyone but players and technical staff, and the last-minute decision by participating teams to remain in basecamps at home and fly in for less than 48 hours, led to the overall healthcare burden of the tournament reducing enormously, so the majority of our planning was focused on the implementation of COVID-19 rules. The only remaining national authority we were to host was the Scottish national team; the strong links and excellent working relationship we already had in place with our healthcare professional colleagues made what could have been a difficult situation relatively straightforward, even in complex and contentious case management. From the period leading up to the tournament, and throughout its delivery, we would be in almost constant contact with one another and our UEFA CMO colleague.

As far as delivery on the ground, all the FA tournament medical team had worked as frontline staff in London during the pandemic. They had then gone on to work with the team delivering football matches from behind closed doors to matches with limited spectator numbers at Wembley and other venues. We relied heavily on this experience and our close links with UK government and local public health authorities.

A major difference between the experience in London and our colleagues in Glasgow was the increasing spectator attendance at Wembley due to our participation in the UK Government’s Event Research Project (ERP). This allowed us and other event providers to participate in developing new protocols to manage the safe return of the public to sports and cultural events. Wembley was the only major stadium participating, and in conjunction with our events delivery team, the local authorities, and the associated government departments, we developed novel crowd management models and ventilation systems to augment social distancing guidelines and implemented a system that integrated mass testing and vaccination certification into our normal ticketing and stadium access protocols. This project allowed us to escalate the spectators attending Wembley through processes tested prior to the tournament at our traditional end-of-season cup finals, and include a tapering up of spectator numbers through the tournament, with 25% capacity for the group stage and first R16 games, 50% capacity for the next R16 game and 65% capacity for the semi-finals and 100% capacity for the final at 88,000.

During the tournament we worked with public health colleagues in central UK government, local authority and regional health protection teams. When notified of COVID19 cases pre-ordained protocols were used to ensure ongoing safety in the affected cohorts, gather information for the identification of close contacts to support the public health authorities, and advise affected individuals to ensure compliance with law. We co-ordinated additional testing with laboratory partners alongside stringent regular PCR testing protocols that were required for participation in the tournament. COVID19 case management was the daily reality of running the tournament, and the case management

system was used for a whole range of staff and participants, from Fan Zone volunteers, venue security staff, broadcasters, to national governing body staff and players.

One significant difference in the COVID19 case management experience between London and Glasgow was the participation of the London medical team in a Public Health England research study into the utilisation of regular testing and monitoring of elite sports individuals who had been allocated low risk close contact status from a COVID19 case. This allowed us to adopt daily medical assessments with rapid antigen testing (at that time an emerging technology), to safely allow continued participation in the competition. This was only available to key, mission critical personnel and players, who were living within the managed risk environment “bubbles”. This allowed a number of games to continue without major last minute disruption and did not lead to any adverse cases.

Conclusions

Both CMO’s kept in close contact throughout the preparation and competition phase. We endeavoured to provide one answer where possible, but were both subject to the rules and regulations set by the Scottish and UK governments. It is easy to understand why UEFA and national teams expected the UK to operate under one set of rules, but the covid pandemic demonstrated the differences in approach of the four home nations and within English regions. For UEFA, rules were different in other countries too with full stadium attendances in Budapest compared to 20% capacity in Glasgow.

What lessons could be learned away from politics? In a sporting event of this size taking place in the UK during a pandemic, more opportunity should have been provided for public health authorities to play a prominent role in the organisation of tournament covid rules, communicating directly with each other and not via intermediaries, namely the CMO’s, who are not public health specialists. We were appreciative of the assistance and support that we received from individual personnel within our public health authorities, who provided a practical common sense approach tailored to sport when needed, supporting us in our CMO roles. Irrespective of pandemics, a public health medicine specialist would be a valuable addition to the senior medical team involved in major tournament planning, with protected time provided by the employing authorities to this role.

The constant changes in the political landscape across Europe and within the UK regarding the hosting of the event was frustrating. Of course it was extremely difficult to plan forwards at the height of a pandemic with pressing health matters prioritised over a football tournament. However, the bureaucracy of decision-making needs streamlined. These events involve multi-agency partnership working but require timeous accountability in the final decisionmaking process to allow complex infrastructure organisation to proceed.

Acknowledgements

We would like to thank our respective medical teams, public health personnel and the UEFA medical team, for their help and assistance in ensuring the delivery of an excellent football tournament despite the numerous challenges we all faced.

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