Thousands of high school athletes across Pennsylvania await the decision as to whether their sports teams will return to fields and courts this fall amid the highly contagious coronavirus pandemic.
Pennsylvania Gov. Tom Wolf and Secretary of Health Rachel Levine have recommended high schools hold off on youth sports until Jan. 1 to reduce the risk of spreading the virus.
The Pennsylvania Interscholastic Athletic Association, the governing body of high school sports, wants to move ahead with fall sports. PIAA executive director Bob Lombardi is asking for Wolf’s support, arguing student-athletes are going to compete this fall regardless of whether the association is governing athletics.
At the college level, the Big Ten on Tuesday postponed the 2020 fall sports seasons, scrapping the Penn State football season among the perennial fall lineups. Other conferences, including the Pac-12 and Mid-American Conference, have followed suit. Still, three powerhouse conferences – the SEC, Big 12 and ACC – have signaled they will move ahead with the fall season.
All of this underscores the uncertainty amid high school sports conferences as to whether to postpone, delay or cancel the fall season.
The debate is playing out amid a growing consensus from medical experts that any decision to resume youth sports amid the coronavirus pandemic must be done with extreme caution. Still, doctors offer different perspectives on the question about sports at the scholastic level.
“Unfortunately, there is no clear answer to the decision to safely re-open sports activities for the entire Commonwealth just as there is no easy answer to re-open our schools or even our society,” said Dr. Trude Haecker, president of the Board of Directors of the PA Chapter of the American Academy of Pediatrics.
The organization supports school districts and counties making that decision in congruence with the decision of whether students should return to in-person classes, remote learning or a hybrid model.
Dr. William Keough, co-chair of the Advocacy Committee of the state chapter, underscores that cautionary advice and urges districts and parents to consider major league baseball, a multibillion dollar industry with state-of-the art medical resources that resumed play a few weeks ago, but now is scrambling to contain the spread of infection among its ranks.
“How do we expect to be able to keep students, coaches, trainers, EMTs, parents and the like safe when playing, particularly contact sports?” he said. “I just don’t see how we have community transmission rates low enough and that schools and sports leagues have enough point of care and rapid testing capabilities in place to be able to ensure that we can protect all of those involved.”
For Keough, the decision comes down to common sense.
“These schools do not have the resources to even be testing as much as they probably should for in-person instruction, which is the most important thing in a child’s life,” he said. “How can we say that if we can’t even test enough to open schools safely, we have enough testing and identification of cases to say it’s safe to have extra curricular activities?”
To be sure, children and young adults derive tremendous benefits from sports and physical activities, from social to emotional development to fitness and health. But when it comes to the coronavirus, the risks may just outweigh the benefits.
“Those activities are not meant to be activities that can wind up doing harm to the child,” Keough said. “As we say in medicine, above all else, do no harm. We have to ask ourselves can we really protect everybody involved, particularly when we have not done everything in our communities across the board to tamp down local transmission rates.”
The decision to resume play or scrap the season for many districts rests largely on community rate of contagion: In Pennsylvania, some school districts are located in counties that have virtually no coronavirus cases, while others find themselves amid persistent troubling percentages of cases.
Some school districts, such as those in Montgomery and Allegheny counties, which continue to have troubling rates of coronavirus cases, have decided to hold classes online, and along with that, they have scrapped the fall sports season .
Indeed, the disparate landscape in a state of more than 12 million underscores the many complexities at play in making the decision.
But sports does not happen in a vacuum and that makes geography an important factor. Sports teams routinely travel regionally and even across state lines, opening up the possibility of putting athletes and adult staff at risk of infection.
“These are the sorts of things we want to avoid, bringing kids together from different areas where there might be high disease in one area and low disease in another,” said Dr. Susan Coffin, a pediatric infectious disease specialist at Children’s Hospital of Philadelphia. “The longer we stay in proximity, the higher the rate of contagion. Closer and longer equal more likelihood to get infected and more likely to get more severe disease.”
An individual squad from a county or region with few COVID-19 cases could find itself faced with having to play a team located in a high disease area. Travel would be an especially important consideration amid the disparate rate of positive cases among states.
Still the decision to go forward with high school sports is based on a myriad of factors – both for parents and districts. Beyond the need to adhere to guidance from the Centers of Disease Control, adults must factor the type of sport activity, the closeness of contact and the length of time players are in close contact.
“As a sports pediatrician, I want kids to be physically active,” said Dr. Matthew Grady, a sports medicine pediatrician at the Children’s Hospital of Philadelphia. “We know that physical activity is good for kids. It’s good for their mental health. They actually perform better academically…and it’s better for physical attributes including less obesity and better bone density….But we are trying to figure out that balance of how we keep track of infection risks and how we keep kids active.”
Beyond the safety of athletes and adults involved in a sports season, medical experts urge school officials to weigh a myriad of other factors, from travel to the risks posed by high-contact sports versus low-contact ones; and even the environmental safety that comes into play when athletes use locker rooms and showers or even simply share equipment.
One overriding consideration in high school sports is the fact that outdoor activities appear to have lower risks of infection than prolonged indoor activities.
“It’s just a lot more space for people to spread out as well as the respiratory droplets to spread,” Coffin said.
Grady and Coffin advocate an idea that plays on a word integral to fighting the coronavirus: quaranteam.
The idea is to hold athletic teams to commit to now familiar principles on best practices to safeguard against transmission of the coronavirus within a team and across sports leagues.
“Everyone would agree that ‘I won’t come to practice if I have symptoms, and I’m going to keep the bubble of who I’m interacting with relatively small so I don’t accidentally bring the infection to the team and infect the team,’” Grady said. “We are relying on everyone getting together and making a pact with each other that they are going to do the best to limit infection.”
Still, the coronavirus has proven to be a tricky virus rendering infected people asymptomatic yet potentially infectious.
On top of that, the novel virus is now posing a new threat, which has further cast doubt on high school and college sports this fall.
COVID-19 has now been linked to the rare heart condition known as myocarditis, an inflammation of the heart muscle typically caused by a viral infection. The condition can potentially cause heart damage and sudden cardiac arrest.
Myocarditis seems to be fueling much of the pushback from among college conferences to proceed with the fall season.
The condition, known as MIS-C, causes inflammation of the heart, lungs, kidneys, brain, skin, eyes or gastrointestinal organs. Though it is a rare syndrome, the children who do have it can experience severe illness, requiring ventilators and life-saving measures.
“We can’t predict which individuals will get complications ahead of time,” Keough said. “There’s no test to predict which individuals are likely to get these complications with COVID-19. We just can’t predict that at all.”
Nationwide, approximately 500 young people have been afflicted with MIS-C. Approximately 97,000 children tested positive for the coronavirus last week. Keough suspects many more – who don’t have symptoms – are positive.
“If you are that one family and that is your child who has this complication, then it’s the most significant thing in the world,” he said.
Wolf has described his stance to postpone the sports season as a necessary precaution. In an interview with KDKA Radio in Pittsburgh Tuesday, Wolf said schools will make their own decisions but he thinks it’s safer to postpone sporting events for now.
“It’s just an open invitation to bring this contagious disease back to your local school district, which is going to interfere with the education process,” Wolf said on the radio show. “We have to be focused, laser-like, on getting out kids educated. And then the other good things that can happen as part of the education process, we ought to build that back as quickly as possible. But right now, I think the first priority is, let’s get back to school.”
Levine, who worked as a pediatrician, said she fully appreciates the benefits of sports. But she said postponing sports would help improve the chances for students to have more face-to-face instruction.
“Even though many of those sports are outside, many of the sports are going to involve a lot of personal contact, not only football but especially football, where social distancing is not going to be possible, even in soccer and many other sports,” Levine said at a news conference Monday on guidelines for schools.
For high school athletes, mandatory fall sports activities are suspended for two weeks, although teams can seek approval for voluntary workouts.
Some jurisdictions, such as the Philadelphia Public League, the governing body for public schools in Philadelphia, have already ruled on the decision. The league this week announced that no scholastic sports would be played this fall.
Grady advocates a gradual return to full capacity for teams, meaning rolling out sports that inherently have social distancing such as tennis and golf.
As infection rates drop, he said, as long as the team’s community practices social distancing and other hygiene practices, contact sports might be able to resume practice. He offered the idea that soccer teams, for instance, might keep players 6 feet apart and permit the passing of the ball only with the feet and not hands.
Eventually as infection rates drop, school districts could return to intrasquad scrimmages; or even hold basketball games outdoors.
“The tricky part is if we have a spike in infection in the area, we will have to go backwards and go from training where athletes are close together to where they are potentially training far apart,” Grady said. “The goal is to try to get kids as active as possible and make sure we don’t take necessary risks.”
For parents still on the fence as to whether or not to let their children play this fall, Keough issues a strong warning.
“We want them to have lifelong opportunities and to not have their ability to participate in the rest of their life cut short because of complications of this disease, which we can’t guarantee they will not contract, and we can’t predict or guarantee whether or not they will have severe complications from it,” he said.
High school sports carry profound milestones for a young person – but, says Keough, so does a healthy, long life.
“I would rather prefer that I can tell a parent that I want to preserve the ability of their child to have lifelong milestones and lifeline memories – 60, 70, 80 years worth of them – that are free from serious complications from this virus that is showing no sign of slowing down and everyday is showing us that it’s capable of causing severe complications in the young and old,” he said.
“I can’t in good conscience tell parents that it’s necessarily safe to send their children out to these activities when there are other ways for children to more safely have physical activity each day than necessarily participating in team and youth sports.”
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