To Play Or Not to Play: Advice For Implementing Athletics In The COVID-19 Era

As the school year begins again, high schools across the country have more to decide than simply whether to physically open their doors or resume online learning (or both). They are also faced with questions regarding how to handle issues that were never a concern before. For example, to play or not to play – sports, that is. Some may argue that risking student health in the name of sports is simply not worth it. But athletics are key to mental and physical health, and if implemented safely, may help students regain some sense of normalcy when much else is still in flux.

Guidance From The NFHS SMAC

In late July, the National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee (SMAC) released guidance for opening up high school athletics and activities. The Committee notes that it is crucial to the physical and mental well-being of high schoolers to return to physical activity and athletic competition. It endorses the idea of students returning to such activity wherever it can be done safely, regardless of the fact that there will “likely be variation in what sports and activities are allowed to be played and held.” In other words, schools should feel free to start small.

For example, the Committee identifies “lower risk” sports as those that can be done with social distancing or individually with no sharing of equipment or the ability to clean the equipment between use by athletes. These include individual running events, throwing events, individual swimming, golf, weightlifting, sideline cheer, and cross country running (with staggered starts).

“Moderate risk” sports involve close, sustained contact but with protective equipment in place that may reduce the likelihood of respiratory particle transmission between participants, or intermittent close contact, group sports, or sports that use equipment that cannot be cleaned between participants. These include basketball, volleyball*, baseball*, softball*, soccer, field hockey, tennis*, swimming relays, pole vault*, high jump*, and long jump*. Those sports marked with an asterisk could be considered “lower risk” with the appropriate cleaning of equipment and use of masks by participants.

Finally, “higher risk” sports are defined as those that involve close, sustained contact between participants, lack of significant protective barriers, and high probability that respiratory particles will be transmitted between participants. They include wrestling, football, competitive cheer, and dance.

Points of Emphasis

The Committee has provided several points of emphasis for schools to keep in mind when implementing its recommendations.

Face Coverings

The Committee advises schools to look to their state and local health departments for guidance when making decisions regarding face coverings. However, among other things, it generally recommends that:

• cloth face coverings, rather than “medical grade” masks, are acceptable;
• cloth face coverings should be worn by students during Phases 1 and 2 as outlined below (exceptions include swimming, distance running, or other high intensity aerobic activity) as well as during Phase 3 when not engaged in vigorous activity (such as while on the bench); and
• coaches, officials, and other contest personnel may wear cloth face coverings at all times during Phases 1 through 3.

Policies

The Committee notes it is likely that schools may have periodic closures and teams may need to isolate for two to three weeks while in season. Thus, it recommends state associations develop policies regarding practice and/or competition during such closures, the cancellations of contests during the regular season, and parameters for the cancellation or premature ending to post-season events and competitions. Having such policies in place avoids rushed decisions and prepares athletes and coaches for smoother transitions.

Travel

Due to the uncertainty of which phase will be attained at the beginning of a particular season or maintained during a season, schools should aim to schedule contests requiring less travel. This will also reduce time spent in buses or vans.

How to Stay Safe: Phases 1-3

Schools’ decision on which athletics to allow, if any, should depend on their ability to carry out the below guidance to keep students (as well as coaches, trainers, and similar contest personnel) safe. The following chart shows the development of the Committee’s main categories of concern throughout three phases.

	Phase 1	Phase 2	Phase 3
Pre-Workout Screening	Coaches/students should be screened for signs/symptoms prior to a workout, including a temperature check and screening questions; any person with positive symptoms should not take part in workouts and should contact a healthcare professional	Coaches/students should be screened for signs/symptoms prior to a workout, including a temperature check and screening questions; any person with positive symptoms should not take part in workouts and should contact a healthcare professional	Any person who has had a fever or cold symptoms in the last 24 hours should not be allowed to participate in workouts and should contact a healthcare professional
Maximum number of individuals gathering inside	10	10	50
Maximum number of individuals gathering outside	10	50	50
Locker Rooms	Cannot be used	Can be used with six feet between individuals	Can be used with three to six feet between individuals
Level of Risk	No competitions, practices only	“Lower risk” sports practices and competitions may resume; modified practices may begin for “moderate risk” sports	“Moderate risk” practices and competitions may begin; modified practices may begin for “higher risk” sports
Equipment Cleaning	Equipment should be cleaned after each use	Equipment should be cleaned intermittently	Equipment such as bats, batting helmets, and catchers’ gear should be cleaned between each use; other equipment should be worn only by one individual
Shared Equipment	None	No shared towels, clothing, or shoes	No shared towels, clothing, or shoes
Weight Lifting	Free weight exercises requiring spotters cannot be conducted while honoring social distancing; safety measures must be strictly enforced in the weight room	Maximum lifts should be limited, and power cages should be used for squats and bench presses; spotters should stand at each end of the bar	Maximum lifts should be limited, and power cages should be used for squats and bench presses; spotters should stand at each end of the bar
Hydration	Students shall bring their own water bottle; water stations should not be used	Students shall bring their own water bottle; water stations should not be used	Students shall bring their own water bottle; water stations may be used but must be cleaned after every practice/contest

In all Phases, the following practices should be followed:

• Facilities Cleaning: Top priorities include: (1) creating and implementing adequate cleaning schedules for facilities; (2) wiping down and sanitizing hard surfaces within a facility prior to individuals entering the facility; (3) ensuring individuals wash their hands for at least 20 seconds with warm water and soap before participating in workouts; (4) ensuring hand sanitizer is plentiful and available as individuals move from place to place; (5) thoroughly wiping down weight equipment before and after each use; (6) ensuring appropriate clothing/shoes are worn in the weight room to minimize sweat from transmitting onto equipment/surfaces; (7) covering any equipment with exposed foam; and (8) encouraging students to shower and wash their workout clothing immediately upon returning home.
• Physical Activity and Athletic Equipment: Students should wear their own workout clothing, and individual clothing/towels should be washed and cleaned after every workout.

Additionally, in Phases 1 and 2, workouts should be conducted in “pods” of students with the same five to 10 students always working out together. This will ensure limited exposure if someone develops an infection. Smaller pods can be utilized for weight training. The Committee advises a minimum distance of six feet between individuals at all times. If this is not possible indoors, the pod must be decreased until proper social distancing can occur.

Let’s Look To The Pros

Professional sports teams have allowed players to restart – or begin – their seasons. Perhaps schools can look to them for guidance on what works and what doesn’t. Let’s first examine the status quo – standard practices and games with COVID-19 appropriate protections.

For example, Major League Baseball (MLB) began its season in July, but after just three games, 14 members of the Miami Marlins tested positive for COVID-19, forcing them to cancel their home opener and calling the entire MLB season in question. To be clear, the MLB wasn’t careless. There were no fans or on-site media, lockers were socially separated, athletes were not permitted to loiter in locker rooms before or after games, umpires wore a health mask under their normal mask, and pitchers did not share the same rosin bag (a canvas bag filled with rosin powder used by pitchers to improve their grip on the ball and keep their hands dry). Yet the virus still struck. The league increased its COVID-19 related precautions and has been able to proceed with its regular season with relatively few positive test results after that initial scare.

An alternative approach employed by pro basketball, soccer, and hockey leagues is the “bubble,” wherein teams reside, practice, and play closed off from the larger community, contained in either Orlando (basketball and soccer) or Edmonton (Alberta, Canada) and Toronto (Ontario, Canada) (hockey). There have been amazing preliminary results.

In early August, the NBA announced that for the third straight week, none of the 343 basketball players who were tested for COVID-19 returned confirmed positive tests, and the NHL announced it had zero positive COVID-19 test results since its teams reported to its bubbles. In addition, Major League Soccer played in a bubble in July and August and announced that all 884 players tested negative for the virus after an initial hiccup that caused several teams with infected players to drop out of the tournament

Schools may want to consider following suit. The question applies to schools offering physical and distance learning: should schools separate those involved in contact sports from the school, allowing them to practice and play as a cohort but forcing them to distance learn in order to decrease the likelihood of the spread of infection? Simply put, a bubble seems safer than the status quo, and schools with the ability to implement one ought to seriously consider doing so.

However, it’s not so simple. Schools have countless issues to consider that professional sports leagues did not. For example, many high school students have siblings who attend or parents who work at their school (or any school). If schools separate the student-athlete into a cohort during the season, how should they treat the sibling and parent-employee? Must the sibling distance learn for the season? Does the parent need to work remotely? This may be especially troubling if the parent works as a teacher, where their success may depend on interaction with students. Should siblings and parents of student-athletes playing different sports (low risk; moderate risk; high risk) be treated differently? None of these questions come up in the professional bubble context, but they are serious considerations for schools. And, unfortunately, there are no easy answers.

Conclusion

As schools begin to reopen, they will face serious questions regarding athletics, but if they follow these measures – from screening to cleaning – they set themselves up for the best chance of success. Students will benefit from safely executed programming, both physically and mentally, and if these measures are implemented, they can feel safe practicing and competing and regain a sense of normalcy. Schools able to successfully implement a “bubble” approach may further protect the health of such students and see even more positive results.

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