There are more than 40,000 municipalities in the U.S., some of which host hundreds of youth sports games and practices on any given day. Given the obvious challenges of preventing the spread of COVID-19 in settings where spectators gather, bodies collide and shared balls and other equipment are just part of the sport, the Centers for Disease Control and Prevention recommends no organized sports or activities for now. The goal: No more biological bombs.
Still, some providers and even states want to bring back youth sports within two weeks, even as the U.S. Olympic and Paralympic Olympic Committee came out this week urging caution and Little League Baseball on Thursday cancelled its 2020 World Series and regional tournaments for this summer.
Keri King, CEO of travel tournament organizer Triple Crown Sports, said he heard of a Texas baseball team planning to practice at a private field this weekend in split-squads despite the state order that only four people can play at one time.
New Aspen Institute resource to help people of all ages assess risk in a variety of common sport and recreational activities
“People won’t even tell me the teams because it’s pushing the limit, even in Texas,” King said. “People in Dallas don’t care about the Olympic guidelines. They’re going to do what they’re going to do. (I say) let’s just get through this pain now and take our medicine as an industry, but here we go, a guy is practicing this weekend. It’s nuts.”
In Alabama, a group of lawmakers and business leaders who advise Governor Kay Ivey has issued a report recommending youth sports operations resume as soon as May 11. The group, which included Lieutenant Governor Will Ainsworth, laid out recommendations about how they think sports can responsibly come back, with many more details still needed.
One thing is certain: There are families and coaches who are eager to play, said Michael Beck, a travel baseball tournament state director in Alabama for the United States Specialty Sports Association.
“I think there’s a minimal chance (of spreading the virus when) outside in wide open space, and I think the sunlight and humidity, with what I’m hearing on TV, it kills this stuff fast,” Beck said. “I’m not saying you can’t catch it there. I’ll take my chances outside in a 25-acre complex. … I think all of us are willing to wait until it’s safe and Gov. Ivey will be the one to make that call.”
Ivey is waiting, having announced Tuesday the gradual reopening of beaches, retail stores and most businesses. Schools remain closed and non-work gatherings of 10 or more people are prohibited, meaning youth sports are on hold.
Ready or not, America is gradually reopening. When and how community sports joins in is a topic that will play out in the coming weeks and months, shaped by what local and state authorities allow and what leading sport and public health bodies recommend.
USOPC’s phased return model
On Wednesday, the U.S. Olympic and Paralympic Committee (USOPC) issued the first national guidelines to help sport organizations “return to play” – a phrase you’ll hear a lot in the foreseeable future. A medical review board offered recommendations on returning to training and returning to event planning, both of which suggest it will take considerable time to play organized sports again the way we once did.
The guidelines by the USOPC, whose charter from Congress includes a responsibility to coordinate amateur sports activity, are directed primarily at athletes engaged in the Olympic movement and the affiliated, sport-specific national governing bodies of sports whose reach covers millions of athletes, coaches and administrators. But the USOPC noted that the document could be used as a resource for organizations outside the Olympic family.
The USOPC recommends five return to training phases based on local public health requirements:
Phase 1: This occurs when shelter in place is required (where a lot of America currently resides). Individual trainings should only occur in the athlete’s home using his or her own equipment. Coaching should only occur virtually.
Phase 2: This happens when a community lifts shelter in place requirements but continues to prohibit group activities and public training facilities remain closed. Some states are now entering this phase. No coaches or other athletes should be present during individual training. These sessions occur at home or outside while maintaining social distancing and using personal equipment.
Phase 3: This occurs when group activities of less than 10 people are allowed. The USOPC’s group training criteria include: no signs or symptoms of COVID-19 in the past 14 days; live in a training location for 14 days prior to starting group training; and no close contact with anyone who is sick within the previous 14 days. Additionally, the USOPC says two negative COVID-19 tests separated by 24 hours or serology tests demonstrating prior infection but no current infection could be alternatives to return to group training, if the science and testing allow this.
In this phase, participants should use their own equipment and avoid touching each other with their hands. If a ball is being used, make sure only one player is using a specific region of the court and/or basket at a time. The court in that area needs to be cleaned before another player uses the ball in that space to prevent indirect transmission from the ball.
Phase 4: This is when health authorities allow public training facilities to open with no limitations on the group size. Activities with direct contact (such as wrestling) or indirect contact (such as high jump pit and basketball) can resume. Personal protective equipment, such as masks and gloves, are recommended in each of the first four phases.
Phase 5: This is the end game when a vaccine gets developed, which may be in 12 to 18 months, at the earliest. “Until COVID-19 is either eradicated, a vaccine is developed, or a cure is found, there is no way of completely eliminating the risk of fatal infection,” the USOPC said. “This should always be in the forefront of your mind when designing your return to training program.”
Some sports will be harder to bring back responsibly than others. The USOPC lists wrestling, boxing, judo, karate, taekwondo and rugby as examples of high-risk sports for transmission between participants (there’s no mention of football since it’s not an Olympic sport). Moderate-risk sports include basketball, volleyball, baseball, soccer, gymnastics, hockey and tennis. Low-risk sports include golf, skateboarding, skiing and snowboarding.
The travel sports industry, in particular, may be resistant to the USOPC guidelines. “I think what they produced really assists all decisionmakers. But I didn’t come away with anything but a set of guidelines for professional athletes,” said King, the Triple Crown Sports CEO. “Youth sports and Olympic sports are not the same rigor and looked at differently.”
Travel sports will be harder to bring back
The formats for competition also matter. Given the hazards of bringing strangers together in close contact, games among members of the same community offer less risk of spreading the virus than games that import players from other counties or states, potentially areas that are hotspots for the virus. Local youth sports will likely more easily return than the travel team industry, said Emory University epidemiologist Zachary Binney, who studies sports injuries and player health.
“Pro sports without fans is easiest to return because of the sheer resources involved and the fact these are adults you can sequester in an area and minimize the chances of bringing the infection back,” Binney said. “College is the hardest because it has to take place in the context of a college, which means it has to be open. You still need to not have fans and modify travel schedules. Youth is in the middle because they don’t have the resources, but they can be highly localized, so it’s relatively easy to return if you’re in an area that has suppressed the virus.”
Some cities and states will recover sooner than others. A recent American Enterprise Institute report written by five doctors, including former Food and Drug Administration Commissioner Scott Gottlieb, offered key milestones for when to reopen local economies:
Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care.
A state needs to be able to at least test everyone who has symptoms.
A state is able to conduct monitoring of confirmed cases and contacts.
There must be a sustained reduction of cases for at least 14 days.
Testing in local communities is vital
Thirty-one states did not conduct enough COVID-19 testing between April 20-26 to even consider starting to relax stay-at-home orders after May 1, according to an analysis by Harvard University researchers and STAT.
Some states, such as Washington, Texas, Alaska and Montana, are currently doing enough daily testing or very close to what they need. In Montana, American Legion baseball practices started this week with split-squad sessions. The season could begin May 22 with a limit of 50 people in attendance. The American Legion Regional and World Series were previously cancelled nationally but that did not impact individual states’ league play.
New York is able to test a little over 20,000 patients per day and would need to test a minimum of 130,544 patients daily to reopen its economy by May 1. New Jersey, Massachusetts, Illinois, Michigan, Connecticut and Colorado are also far behind.
Josh Krusewski, executive director of the Connecticut Junior Soccer Association, said January 2021 is the earliest he envisions organized soccer training returning to his state – much less a game environment.
“Let’s call it what it is – the spring is already gone and the summer is probably already gone,” Krusewski said. “I just think there are too many boxes to be checked for the fall to even get off the ground. Rec departments and municipalities are all going to have their own return to play plans. They’re not going to release any fields until they’re ready to go.”
Theoretically, Binney said, a league in Washington could open sooner because the state has done a good job suppressing the pandemic.
“If you try to open a league now in New Jersey, it could be disastrous,” he said. “How much can you rely on youth sports coaches to really enforce social distancing and infection control best practices? How close are spectators sitting in the stands? There’s definitely some substantial risk, especially in areas where there are a lot of cases floating around.”
The Harvard study found that the most worrisome states are those that are slowly reopening businesses and public spaces despite having thousands of COVID-19 cases. Georgia has been averaging 4,000 tests per day and needs to do 9,600 to 10,000 tests daily. Florida will need 16,000 tests per day and is averaging just above 10,000. Both states are gradually reopening and serve as huge hotbeds for youth sports, especially travel baseball this time of year.
Risk-benefit analysis to play
There are certainly many benefits to kids playing sports. After all, the CDC still recommends kids receive at least 60 minutes of physical activity each day. But what’s a minimally acceptable risk to bring back youth sports given what we know now about how the virus can spread?
“That’s really, really hard, and it’s a highly personal decision and judgment,” Binney said. “It probably has to be a family-specific decision and you should be clearing any plan with local public health officials about whether you’re creating an unacceptable risk for the broader community. It’s all a risk-benefit analysis and there are no easy answers.”
Dr. Andrew Stolbach, an emergency physician and faculty member at Johns Hopkins University School of Medicine, said youth sports should be one of the last elements of life to return.
“I wouldn’t recommend opening youth team practices, and certainly not youth competitions with spectators, until we have demonstrated that we have the virus under control,” said Stolbach, who is a youth wrestling coach. “We shouldn’t even open schools until a given area has demonstrated that cases are decreasing and hospitals can offer tests and treatment to all who need those services. Youth sports should be a lower priority than schools, because they present most of the same risks without all of the same societal benefits.”
The challenge for local public health officials to sign off on sports returning will be lack of funding to conduct contact tracing, so determinations will probably happen on a case by case basis, said Dr. Maria Elena Bottazzi, co-director of the Texas Children’s Hospital Center for Vaccine Development.
“It may depend on the type of sport, the location – is it a big urban setting or a rural setting or in between? – and the audience of who will be watching,” Bottazzi said. “Ultimately, do we have enough money and people to do contact tracing and have good technology for surveillance?”
Bottazzi suggested one possibility is keeping sports teams hyperlocal, at least initially. Communities could create leagues only with players who live in close proximity, so there’s relative health knowledge about where a network of kids come from.
If schools reopen in the fall, Binney suggested they could form multiple teams within their educational setting because kids will have already been in contact with each other. Think intramural sports. Theoretically, the risk could be lowered of spreading the virus.
Be prepared to start and stop
The pressure for sports to return will be intense in some states. “You can feel all of this building in May,” said King, the Triple Crown Sports CEO. “It’s going to be the wild west over the next month. It’s not right. We’re not ready for this as an industry.”
No matter when leagues return, medical experts stress they must have a plan in place on what to do if just one coach, athlete, official or spectator tests positive for COVID-19. Do you shut everything down? For how long?
“There has to be a recording system about how to try to contain it by acting fast,” Bottazzi said. “The last thing you want is to create panic after you finally go back to having these sports events and you have this setback. Then you lose the trust too if you don’t have a plan.”
In Alabama, Dr. Larry Lemak, a longtime medical official associated with several professional sports organizations, is thinking through these questions. He’s leading an advisory group that is crafting return to play guidelines in Alabama.
“We’re going to try to play soon, and sometimes we’ll be successful and sometimes we’ll have to stop,” Lemak said. “Like anything in our society, I think we’re going to have to have the courage to say, ‘It’s not working, let’s back off.’”
Who’s responsible for what?
Beck, the youth travel baseball organizer in Alabama, has time on his hands to consider what a return might look like. He is unemployed with no income. He says he has tried for seven weeks to sign up for unemployment benefits, only to continue being sent more documents to fill out.
“It’s almost like they forgot about this industry,” Beck said. “My business bills come through every month, just like everybody else’s. I don’t know if I can cover it. My wife and I have a $2,400 stimulus check. We don’t have anything other than that.”
Beck said that his financial situation will not pressure him to stage tournaments before they’re safe, even as many travel coaches ask when they can play again. “It’s safety first,” he said. “I’ve had friends I know who have had (the virus), really good people. I’m a germophobe.”
What might future baseball tournaments look like? Beck has ideas.
Eliminate bleacher seating and spread parents out at least six feet apart down the right field and left field lines. Grandparents would be encouraged to stay home. Younger kids couldn’t play on playground equipment.
Spectators at the complex would be limited to only those with a child playing in the game. Eight teams could play on four fields in 90-minute games, with the next teams and set of parents waiting in their cars. Pre-game warmups at open field spaces and batting cages wouldn’t be allowed.
Require umpires, coaches and players to wear masks, at least in the dugout and possibly in the infield. “Breathing is a big deal,” Beck said. “Some kids have asthma. Some kids may be claustrophobic. I simulated (wearing a mask) the other day and after 30 minutes I was ready to leave.” (Bottazi, the infectious disease expert, said that masks probably make sense on the field, at least initially.)
Sanitize the baseball with a disinfectant between half innings. Every pitch involves at least two kids touching the ball.
Limit restroom use to one person at a time and no concession sales, as recommended by the state of Alabama task force. “One of the biggest hurdles is there’s no incentive for the parks to open if they can’t make money off concessions,” Beck said. “Money drives the world. We’re looking at ways to share revenue. You can stand in line at Walmart, but you can’t stand six feet apart in a concession line? I don’t get that.”
Robin Schultz, whose grandson plays travel baseball out of Hoover, Alabama, isn’t sure it’s best for kids to return to sports yet. “Who’s responsible for what?” Schultz asked. “That’s where it gets to be difficult.”
One idea from Lemak: Use emergency medical technicians and paramedics to monitor public health at youth sports events. About five years ago, Lemak started a “sports responder” course to assist in emergency sports situations when athletic trainers are unavailable, which is often. The program went dormant and is now being restarted.
“The real challenge with this program, as with any innovation, is how do you get acceptance, adoption and implementation of something new and not part of conventional practices?” Lemak said.
Even as medical experts preach caution, the clock is ticking for the youth sports industry on how to safely return. Ready or not, some teams will be playing soon.
Do you have a topic that you would like Project Play to explore in future COVID-19 youth sports coverage? Email Jon Solomon at jon.solomon@aspeninstitute.org.
