Covid-19 And Sports Health

As an active sports medicine specialist, parent of two very active teenagers who play sports year-round, and living in an active community like Portland, Oregon, I am frequently asked about sports safety and when might see the return of sports, especially organized youth sports. Common questions I hear include:

“My teen is healthy, are they really at risk of Covid-19 related illness by playing sports?” 

“Why can’t we just screen kids for Covid-19 symptoms like fever and cough, and let them play if they’re healthy?”

“I can see why tackle football is dangerous with huddles and close contact, but what about other sports with more space between players?”

“Why can’t our kids practice and play outside with masks?”

“Not being active regularly in sport has made my teenager more moody than normal, what are they supposed to do with all that physical energy?”

With the cancellation of spring and much of summer school and sports activities to reduce the spread of Covid-19 and the pandemic related health risks, most Portland area student athletes have experienced significant disruptions to their mental and physical activity schedules. Many parents, coaches, teachers, and health experts are increasingly concerned about the short and long-term effects of Covid-19 on student athletes’ physical and mental health.

Around the country and around the world, the existing routines of school, sports, clubs, churches, and other social structures that have provided stability, developed skills, enhanced relationships, and provided a sense of purpose for student athletes (and adults) have been turned upside down. While many health officials and politicians are thoughtfully and carefully working to reduce impact of this pandemic on society and preserve life, the social distancing efforts are impacting student athletes, their families, and sports activities in unique and significant ways.

Currently, we know that children of all ages can get Covid-19. While children appear to be affected less commonly than adults, the majority of Covid-19 cases in student athletes appear to affect teens ages 10-18 years old. Children of racial and ethnic minority groups may also be at higher risk of Covid-19. Although there are severe cases in both children and adults and the symptoms of Covid-19 are similar in children and adults, the symptoms of Covid-19 tend to be overall milder with children in comparison to adults. The most frequent symptoms in children are fever and cough.

Parents have asked me about recent reports on studies showing most children who were infected with Covid-19 were infected by a household contact or that transmission of Covid-19 is uncommon outside the household. While those studies support that conclusion and could be extrapolated to support return to sports and school, they have to be interpreted cautiously because of how implementation of distancing efforts like closing schools, skewed the data. In Portland, OR and other areas where schools and businesses shut down, people wore masks, and stayed at home, the curve flattened and most Covid-19 infections during that period would’ve been household contacts.

Why Covid-19 seems to be less common and less severe in children than adults is still not clear. Some have suggested that children have a less intense immune response to the virus than adults. Other theories have pointed to lower viral loads in children and healthier blood vessels in children than adults. While healthy children typically experience less severe Covid-19 illness, children with certain underlying conditions such as congenital heart disease, neurologic conditions, and multiple medical conditions can be at higher risk for being hospitalized and possibly needing ventilator support.

As we head into the fall and many schools are planning to begin the school year with online education or a hybrid approach of part-time online and part-time face-to-face learning many students and parents are asking:

“Will we still practice sports after school?”

“Will fall sports happen or be moved to spring?”

“How will we know when it is safe to get back on the field?”

Several national organizations are trying to provide guidance and help with answering these questions. The American Academy of Pediatrics (AAP), The National Athletic Trainers Association (NATA), and the American Medical Society for Sports Medicine (AMSSM) are working together to provide guidance for athletes, parents, and coaches regarding optimizing sports participation safety during the Covid-19 pandemic. One area of guidance pertains to the use of cloth face coverings which have been shown to reduce the spread of the virus. These societies advise coaches, parents, officials, and athletes to wear face coverings when indoors, unable to maintain 6 feet of social distancing, arriving/departing the field, on the sidelines, in a dugout, or in a team meeting.

Additionally, these organizations recognize the importance of sports participation for mental and physical health in our student athletes and are working to provide guidance to help stratify risk of certain sports activity. In a Covid-19 guidance handout  provided by the AAP, NATA, and AMSSM, they suggest that sports allowing 6-8 feet of distancing between athletes are considered lower risk while those with close contact are considered higher risk. Outdoor sports are considered lower risk than indoor sports, teams playing within a local community are considered lower risk than those playing “travel” or outside of a community, small teams with cohort groups less than 10 are safer than larger groups, and sports with less than 15 minutes of contact are lower risk than those with more than 15 minutes of contact.

As we look forward to resuming school and sports activities, in order to stay safe, it is important to follow new safety rules and advice provided by local school and political leaders. If you are experiencing cough, fever, or other symptoms of illness like shortness of breath, stay home from school or sports and contact your physician. Other important safety habits to develop are washing hands frequently, wearing masks, maintaining physical distance, and using your own gear and water bottle.

Additionally, during games or practices, check in with your coach if you are not feeling well. Avoid spitting, blowing your nose without tissues, shaking hands, high-fives, and other congratulatory gestures during and after games. Lastly, wash your hands and clean your gear thoroughly after practice and games.

By adopting these measures and utilizing simple safety routines of washing hands, wearing masks, and social distancing, we can hope to open up schools and return student athletes back to sports and club activities in the near future. Choosing to follow the guidance of organizations like AAP, NATA, and AMSSM can positively affect the physical and mental health of student athletes by increasing their physical activity, reducing boredom, and helping them socially engage with friends and peers face-to-face, instead of via electronic devices.

—David Westerdahl, MD FAAFP RMSK

Sports Health Northwest