Back to the classroom: COVID-19 forces new guidelines for school sports programs

Participation will be extra challenging in high-contact sports such as football and basketball, says UCLA Health’s Dr. Annabelle de St. Maurice.

Feb. 27 was special for young athletes throughout Los Angeles County. That was the day elementary, middle and high school administrators were informed they could resume many of their sports activities, which had been shut down for months due to COVID-19.

As exciting as that is, though, doctors are advising coaches to be wise in how they govern their athletic programs as the pandemic lingers.

Annabelle de St. Maurice, MD, MPH, co-chief infection prevention officer for UCLA Health, said sports programs within Los Angeles County schools will have to make significant changes to keep the virus from spreading, particularly when it comes to high-contact sports such as football and basketball.

“Those sports are definitely more tough to monitor, particularly when they’re being played in competition. Obviously, you can’t recreate the NBA bubble for an elementary school,” said Dr. de St. Maurice, referring to the NBA’s strategy last season of having players from multiple teams share protected venues on and off court.

“So, I think they’re going to have to weigh the risk and benefits of having those sports and maybe move toward just having practices and drills rather than having team sports,” she said. “We’re still seeing a lot of transmissions, so until we have decreased numbers of cases we will need to take extra precautions.”

Los Angeles County elementary schools were allowed to reopen classrooms after the county reached a minimum daily COVID-19 case rate of 25 per 100,000 residents. Middle school and high school students can return to in-person classes once the case rate drops to seven per 100,000.

California youth sports programs are allowed to return sooner. Counties where the average daily case rate is less than 14 per 100,000 residents have been given a green light to resume basketball, football, ice hockey, lacrosse, rugby, rowing/crew, soccer and water polo.

Caution, however, remains critical.

“What you don’t want to happen is that we have all these safety measures in place inside the schools and classroom and then ruin the entire in-person school bit because we’re having basketball games and football games where people aren’t following the rules,” said Dr. de St. Maurice.

On March 4, the advocacy group Let Them Play CA announced it had reached a lawsuit settlement that will allow all indoor and outdoor youth sports to resume in California. Prior, only outdoor sports were approved. The California Department of Public Health will release guidelines with contingencies citing that sports programs can resume if they follow the same protocols as college and professional sports.

This means student-athletes will have weekly COVID-19 testing and must show negative tests results within 48 hours of a game. The new guidelines state that each player can have four family members in attendance at games and that spectators do not have to be tested to attend home games.

Last summer, the Centers of Disease Control and Prevention created and circulated detailed guidelines for youth sports programs. Coaches will now have the daunting task of making sure their players adhere to certain guidelines on the practice field and in competition.

“I think they should follow the CDC’s guidance for resuming sports safely,” Dr. de St. Maurice said. “They should continue to wear masks as much as possible, move all activities outdoors, particularly in California. That’s fairly easy. They should also continue to maintain physical distance when able to.”

The CDC’s “Considerations for Youth Sports Administrators” provides guidance for assessing risk, promoting behaviors to reduce the spread of COVID-19, mask wearing, respiratory etiquette, cleaning, disinfecting and directions for coaches, among other areas of safety.

The CDC suggests that coaches of close-contact sports such as football, wrestling and basketball focus more on individual skill-building activities rather than competition. Guidelines also advise those coaches to consider keeping their players in small groups and allowing the athletes to work with each other in stations, as opposed to mixing groups. The document also states that athletic activities that last longer pose a higher risk of spreading the virus, citing that being within six feet of someone who has COVID-19 for a cumulative total of at least 15 minutes in a 24-hour period greatly increases the risk of becoming sick and requires quarantine.

According to the CDC, people who have been fully vaccinated no longer need to quarantine if they come into contact with someone who has been exposed to COVID-19. This might lead some to think student-athletes would just have to get vaccinated and sports could return to normal. Dr. de St. Maurice, however, said there is still a long way to go.

“The vaccine isn’t yet available for high school students, but we expect that through clinical trials, more data will be coming out on children and adolescents,” she said. "We want more data for vaccinating those individuals, but I think that will take some time. Pfizer recently completed enrolling 12- to 17-year-olds, so they're still analyzing that data and Moderna and Johnson & Johnson are starting to enroll adolescents."

Despite the increased speed of a vaccine rollout, acceptance of the shot is not universal. Uncertainty about the vaccine is trickling down from the professional ranks to younger athletes.

“It's not surprising given the nature of medicine and some of the racist and systemic racist practices that medicine has a history of conducting,” explained Dr. de St. Maurice, about a lack of total vaccine acceptance among NBA players, for instance. “It’s not surprising that there’s distrust given the demographics of the NBA. However, I hope that what we can do is continue to have physicians, including myself, continue to reach out and address some of the questions in the population.”

One of the challenges for school sports programs, in particular, is getting everyone to understand the importance of the COVID-19 vaccine.

“The real hidden message and something we don’t talk enough about is the ‘long haulers,’ meaning if you get infected with COVID-19, you may not end up in the hospital, you may not die, but what can happen is that you can get a lot of symptoms following COVID-19 infection, such as brain fog or myocarditis, which is inflammation of the cardiac tissue,” said Dr. ee St. Maurice. “Getting the vaccine can prevent you from getting infected with the virus and in turn prevent long-term consequences which can make your life miserable and impair your athletic abilities.”

If you have questions about the vaccine, contact your primary care physician or visit the UCLA Health COVID-19 information hub.


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