Covid and Youth and High School Sports in 2021

By Ken Reed

People need to move to be healthy, physically and mentally. This includes children, especially in an era in which childhood obesity and related health problems are increasingly becoming a concern. Moreover, when children and teenagers are forced to remain isolated and inactive they have much higher rates of anxiety and depression.

Youth sports, at the recreational, club and high school levels, represent a great way for young people to stay active on a regular basis. Unfortunately, during a global pandemic, conducting youth and high school sports is also an individual and community health risk because large numbers of kids, parents, grandparents, coaches, officials and administrators typically gather at these sporting events.

And therein lies the dilemma for state and county public health departments, along with youth and high school sports associations, as they attempt to weigh the plusses and minuses of resuming athletic competition.

On Dec. 24, Arizona set a single-day high of 4,226 Covid hospitalizations, a surge health officials say was caused in part by a large number of unregulated youth sports tournaments in the area.

“We have several outbreaks that we have associated with club sports and clubs sporting events,” said Marcy Flanagan, executive director of Maricopa County Public Health.

Will Humble, executive director of the Arizona Public Health Association said it’s not so much the athletes, but parents who are the concern as they gather closely on the sidelines and in the stands, too often disregarding mask guidelines.

“The vast majority of the parents are completely ignoring the masks,” said Humble, “and it showed up all autumn in the contact tracing not just in high school, but club sports. It caused tons of spread. And there’s no governing body to control.”

Most of the sporting events in question in Arizona were held outside. Indoor sports bring even bigger challenges as the Covid-19 virus lingers in the air inside, not dissipating as quickly as it does outdoors.

Despite the ongoing pandemic, and case studies such as Arizona’s, some states have decided to move ahead with indoor sports as the calendar turns to 2021. For example, as of January 1, New Jersey has lifted its ban on indoor youth sports.

“We recognize that any continuance of the pause would likely mean that many sports’ seasons would have to be scrapped entirely,” said New Jersey Governor Phil Murphy. “We do not wish to see that happen. We know that sports are important for both the physical and mental wellness for our youth and our other residents.”

True indeed.

Perhaps the best — albeit not perfect — solution is to allow youth and high school sports for the participants but ban parents and other fans from attending. That’s an excruciating possibility for parents and grandparents who love watching their kids and grandkids compete. But it might come down to that undesirable option or no indoor youth and high school sports at all. Based on the Arizona experience, having indoor sports with parents and grandparents crowded together on the sidelines and in stands, could be disastrous in terms of the spread of Covid.

Here’s another issue: If the decision is made to move forward and play indoor sports, is it better for young participants in indoor sports like basketball to wear a mask while playing or not. The Centers for Disease Control and Prevention (CDC) guidelines (updated as of 12/31/20) are a little contradictory on this issue. Here’s one guideline:

Wear a mask if feasible, especially when it is difficult to stay less than 6 feet apart from other people and especially indoors, for example in close contact sports such as basketball.

However, the CDC also has this guideline:

Limit high-intensity sports when indoors. People who are engaged in high-intensity activities, like running, may not be able to wear a mask if it causes difficulty breathing.

Well, playing basketball while wearing a mask certainly causes difficulty breathing. Have any of these CDC folks ever played basketball? I don’t know about others but I can certainly say unequivocally that when I played basketball I often had a LOT of trouble breathing while running up and down the floor during a competitive game or high intensity practice, and that was without a mask on.

To add to the confusion, the CDC also says that wearing a mask is not a substitute for social distancing and that participants should still maintain 6 feet of distance between them. Can you imagine athletic administrators trying to tell basketball coaches about that CDC guideline? There won’t be many (read: zero) basketball coaches implementing a team defense in which their players can’t be within six feet of players on the opposing team. Social distancing and playing basketball simply don’t go together.

Besides the basic discomfort of wearing a mask while sweating and breathing hard, are there other potential health issues associated with wearing a mask during highly intense physical activity?

Dr. Matthew Rothbard, an athletic trainer who teaches athletic training at Southern Connecticut State University (SCSU), feels it is safe to wear a mask but that it will “negatively impact high intensity performance” due to restricted air flow to the lungs.

“That is called ventilation. It restricts air flow. It’s kind of like a chain reaction,” said Rothbard. “The second thing that happens is it decreases the body’s ability to transport and use oxygen. That in turn decreases the amount of oxygen in the blood and that’s called oxygen saturation.”

As a result, coaches will need to substitute frequently if players are required to play with masks on.

What about excessive carbon dioxide (CO2) intake due to wearing a mask during intense exercise? Are athletes at risk of experiencing dizziness, headaches, hypoxia (deficiency in oxygen reaching tissues) or hypercapnia (excessive CO2 in the bloodsteam)?

Bill Lunn, a professor in the Department of Health and Movement Sciences at SCSU says he would love to conduct tests with athletes wearing masks. However, the lab at his university is not currently conducting any studies due to the risk of exposure to Covid-19.

“If we were to test them, we could determine airflow through the mask at varying exercise intensities, and also could measure carbon dioxide output and oxygen uptake while wearing the mask,” said Lunn.

We notice pro and college basketball players aren’t wearing masks during televised games, do high school and youth players really need to?

“It depends upon a lot of factors,” according to David Soma, a pediatric sports medicine doctor at the Mayo Clinic.

“What type of mask you’re wearing, is it an N95, a medical mask? Is it a cloth mask? Is it one of those Dri-Fit masks? They all probably have different degrees of oxygen and CO2 movement through the fabric. And how much you’re exercising also plays a role.”

Well, that doesn’t clear up much.

Soma acknowledges it’s a complex issue. He’s only aware of two studies on masks and athletes, and both have been very controlled. Both also involved people on bikes or treadmills, so they didn’t mimic sports like basketball or volleyball.

One of those studies showed a slight increase in carbon dioxide retention at an intense level of exercise. The other study showed mild changes in oxygen uptake.

“Neither of which would be dramatically significant in the study,” he said. “But the hard part in the study is it’s not basketball, these are artificial, treadmills and bikes. It’s not the same as playing football, basketball, volleyball.”

When asked about carbon dioxide (CO2) dangers from wearing a mask, a CDC representative said the CO2 will slowly build up in the mask over time. However, the level of CO2 likely to build up in the mask is mostly tolerable to people. People might get a headache but would most likely not suffer the symptoms observed at much higher levels of CO2. It is unlikely wearing a mask will cause hypercapnia in the bloodstream. (It’s important to note that when answering this question, the CDC rep was talking about the general population, not young athletes competing in intense sports like basketball.)

Each sport is different and has different risk factors that need to be considered when deciding whether to require masks during competition.

“It’s almost an impossible question to answer in every sport,” said Soma.

And so sports administrators and state and county public health officials around the country are left with trying to make educated guesses.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, is now telling us we could approach herd immunity by fall and a return to normality by the end of 2021.

If we’re waiting for normality to return before resuming youth and high school sports, we’d have to cancel winter, spring, summer and fall sports. Given the negative impact on the physical and mental health of youth and high school athletes from a sports shutdown, that doesn’t seem to be a rational option.

Here’s the challenge: When it comes to the wellbeing of our young people, we can’t just focus on Covid. We also have to consider the negative impact of physical inactivity on our youth. And also the negative impact of young people being socially isolated from their peers.

Since the 1980s, the obesity rate has doubled among children between two and 11 and quadrupled in teens 12 to 19. Those are pre-Covid stats. Things have gotten worse since the coronavirus hit our shores. There has been nearly a 50% drop in physical activity among U.S. children from the start of the pandemic, according to a survey done in September by The Aspen Institute. That spike in physical inactivity has already resulted in negative health implications.

In addition to physical issues, many kids are struggling mentally and emotionally without sports. A survey of high school athletes conducted by the University of Wisconsin in July found 68% were experiencing feelings of anxiety and depression at levels that typically require medical intervention. That figure is nearly 37% higher than what was found in pre-Covid surveys.

“The results are both striking and concerning,” said Dr. Claudia Reardon, associate professor of psychiatry at Wisconsin’s School of Medicine and Public Health.

So, while the country gradually becomes vaccinated against Covid, it seems rational that youth and high school sports return in as smart a manner as possible in 2021. Now, of course, people will disagree about what constitutes “smart,” and “smart” might change from month to month, but that’s what we’re left with in dealing with a broad set of risks in this situation.

Given what we know about the negative impacts — physically and mentally — of taking sports away from youth and high school athletes for an extended period of time, keeping our kids waiting on the sidelines until normalcy returns — which, according to Fauci, night not be for another year — is simply not a reasonable option.

— Ken Reed, Sports Policy Director, League of Fans