This past year has brought a lot of disappointment and frustration to young athletes and their families. Many organizations made difficult decisions to pull or postpone sports seasons. Others continued practices and competitions. Decisions often were quickly reversed as the pandemic ebbed, then regained momentum.
We asked Kristina M. Wilson, MD, MPH, who has served as medical director for several Arizona high schools, to weigh in on changes the pandemic has required of young athletes and their families. Wilson recently was appointed chair of the sports medicine advisory committee of the Arizona Interscholastic Association, where earlier this spring she led the committee in the development and drafting of the AIA return-to-sport guidelines.
Dr. Wilson is a pediatric primary care sports medicine physician at Phoenix Children’s Hospital, where she serves as medical director for adolescent and pediatric sports medicine and sports physical therapy. She is also co-director of the pediatric Brain Injury and Concussion program at Barrow Neurological Institute at Phoenix Children’s Hospital.
And as the mother of two athletic school-age children, she can relate to the concerns and challenges of returning to school — and athletics — safely.
Is it safe for children and teens to be participating in team sports at this point in the pandemic? If not now, when and under what conditions?
It will not ever be “safe” to participate in team sports while there is still high community transmission of COVID-19 and less than 70 percent of the community has either had the disease or has received the vaccine so we achieve a protective environment called “herd immunity.”
The challenge right now is to define when it is “safer” for youth sports to resume. This is particularly important to help balance another epidemic threatening our youth: a significant increase in depression, anxiety, and suicides. Physical activity is a healthy coping mechanism for children and teens, as is face-to-face socialization with peers. So the more important question is how to return to sports in a safer manner during a pandemic.
First, it is important to make these decisions based on scientific data. The state of Arizona has defined three metrics to guide return-to-school decisions. These metrics include the number of cases per 100,000 individuals, the percent positivity, and the number of hospital visits for COVID-like illnesses in the region. These metrics have benchmarks established by the CDC, which defines levels of community spread. The same metrics should guide return-to-play decisions.
The CDC defines minimal community transmission as less than 10 per 100,000 cases, and less than 5 percent of both percent positivity and hospitalizations for COVID-like illness. In a community defined as having minimal community transmission, adjustments to mitigation strategies could be allowed in order to allow athletics to resume. Some of these might include allowing contact among players from different households and without masks, which is necessary in many team sports.
Currently, the state of Arizona is in a level of substantial community transmission (defined as more than 100/100,000 cases, and greater than 10 percent of both percent positivity and COVID-like illness). At these rates, we must be vigilant about enforcing all mitigation measures to decrease the rate of spread of COVID-19:
- Staying home when not feeling well
- Getting tested when you have COVID-like symptoms
- Maintaining 6 feet of distance between you and non-household contacts
- Wearing a mask at all times when in public, including outdoor events where other non-household contacts are present
- Not sharing athletic equipment with other teammates
- Keeping groups in small cohorts of 10 or less
- Limiting groups to outside activities
- Not traveling outside of your local community
- Conducting practices virtually
Team sports should not be conducted during times of substantial community transmission unless all mitigation measures are implemented and enforced. As the level of community spread decreases, sports should resume in a controlled manner based on the current level of community spread.
Are some sports less risky in terms of possible COVID exposure than others?
Absolutely! Any sport where participation of the athlete is possible with mitigation measures in place is safer than a sport that cannot be played with most or all mitigation measures in place. Participation in an outdoor individual sport, such as cross country or golf, with your own equipment, is safer than participating in an indoor close-contact sport such as wrestling. It is important to emphasize that mitigation means reducing the risk of spread, not preventing the spread of the illness.
What about fans? Should parents and other family members or friends be attending youth sports competitions?
The parents or legal guardians of athletes are most at risk for severe illness. At current levels of severe community spread, it is in the best interest of the community to have no spectators at competitions. A limited number of spectators could be permitted only if there are designated seating areas that keep them a minimum of 6 feet from other spectators, officials, athletes, and athletic staff. They should wear masks the entire time they are at the event — including outdoor events.
What are recommended masking protocols for our youngest athletes?
While we remain at levels of severe or moderate community spread of COVID-19, all athletes 3 years and older should wear masks. There is data to support that mask wearing even during moderate to vigorous physical activity does not pose a significant risk to a young, healthy athlete. In addition, there is data to show that athlete-to-athlete transmission of COVID-19 is decreased when athletes wear masks for all team activities. The NFL, whose players underwent frequent COVID-19, started requiring masks during practice midway through the season based on the significant reduction in cases of COVID-19 they witnessed when teams practiced in masks.
How can parents of younger athletes keep their children active/fit while organized sports are on hiatus?
Right now, enjoy the cooler weather. There are lots of opportunities for riding bikes, hiking, or even going up north and skiing or snowshoeing. Play soccer with your kids or dribble and pass a basketball with them. Pick up a ball and glove and play catch. Get creative and create an obstacle course in your backyard, or go on a nature walk around your neighborhood.
One of my favorite things for my own kids is our “get moving jar,” which has cards they draw listing activities we can do right then for 30 seconds to 2 minutes — such as 20 jumping jacks or 10 push-ups. This is a great way to wake up your kids when they have been sitting at their computers all day.