• Is Returning to Sports Irresponsible?

    During this time of the year we typically are busy preparing for fall sports and getting athletes ready to return to competition. I'd love to be planning which University of Florida football game to attend and completing hundreds of pre-participation physicals for our local high school athletes and at-risk youth to get back to their sport and sports community safely.

    female soccer players and coach

    I'm not the only one eager for normalcy when it comes to sports. I'm looking forward to a distraction from the "new normal" we are all living in, but are we really ready and able to kick off the fall season safely?

    Sports and COVID-19

    During the COVID-19 pandemic, primary care and sports medicine physicians have had to plan (and adapt plans) rapidly as things change, sometimes on a daily basis. When the NBA suspended its season back in early March it shocked the sports world. The ATP Tour, college football, PGA, Boston Marathon, NASCAR, NFL and MLB all followed suit by placing their events and seasons on hold. The Olympics were postponed, and athletic competitions came to a screeching halt. Sports, as we knew it, took a collective time out.

    The slow restart of professional sports has been haphazard and chaotic, with dozens of MLB games postponed. Nearly 20 members of the Miami Marlins tested positive with COVID-19 within the first two weeks of their season opener. The St. Louis Cardinals were sidelined for two weeks after 17 players and staff tested positive. 

    Conversely, the NBA's "bubble" approach has been remarkably effective at staving off the spread, with no players testing positive for COVID-19 for more than a month. Players underwent testing beginning the week of June 23 before arriving to The ESPN Wide World of Sports Complex in Orlando, Fla. They were required to quarantine up to 48 hours until two negative COVID-19 tests were confirmed. Players are tested regularly and required to adhere to strict protocols, including wearing masks in common areas unless they are eating or doing physical activity. Guests are extremely limited and are required to quarantine for a week. The NHL has used similar protocols with success.

    Early on, this seems to be an effective strategy for professional sports. However, the resources and protocols needed to make this approach effective are not practical at the college and high school level.

    South Korea returned to sports in April with strict health and safety protocols. A country that was impacted early in the pandemic has been able to slow the outbreak with lockdowns, aggressive contact tracing and testing. South Korea has now entered into a phased reopening planned by health officials who are limiting access by fans, who will be screened, required to sit apart and wear masks. In addition, no food will be allowed in stadiums, and fans are discouraged from excessive shouting, singing and cheering. It's a far cry from the sport spectating we're used to.

    Here in the United States, there are no fans at MLB and NBA games. Recorded cheers and boos fill the air, and the projected faces of virtual fans appear in the stands. What a change to the environment and culture of sports. I'm still wrapping my head around it.

    What a Safe Return Could Look Like

    We are unsure about the long-term implications of this virus. A recent study in JAMA Cardiology found 60% to 70% of adults who recovered from COVID-19 had cardiac complications. Myocarditis has been reported in young, healthy patients with mild illness. Some colleges and sports organizations are beginning to require echocardiograms before athletes can return to sports after recovering from COVID-19.

    Health advisory boards have presented recommendations to local and state athletic boards about what safe return to play at the high school level might look like: screening questions, temperature checks, contact tracing, postponing fall sports (particularly football and volleyball), limiting group gatherings and universal masking when social distancing is not possible.

    I live in Florida, where our cases and positivity rate continue to be high. I would love to see a safe return to school prioritized and executed before we even consider returning to team sports. I also know how important exercise is for our physical and mental health, but is the risk worth the reward?

    With these competing interests, mandating mask wearing is one of the simplest things we can do to protect each other and ourselves, but the right decision is not always the most popular. Regardless of whether fall sports are canceled, played or postponed, some people will be unhappy. Sports governing bodies can't please everyone, but can society as a whole protect more people until we know more about the spread, treatment and long-term effects of COVID-19?

    To control this virus, we need to depend on the social responsibility, self-discipline and self-control of others, and so far I have not been convinced we as a society are able to take on this challenge.

    I personally love watching and playing team sports. For me, nothing can replace the feeling of camaraderie, community, connection, competitive edge and confidence that athletics brings. Going on a run by myself is just not the same. Exercising in isolation is certainly not the same as the team-building of group exercise classes or intramural sports. Sports bring people together, help bridge the racial and social inequalities in this world and offer powerful, inspiring stories of hope, perseverance and success. Sports bring us together socially, while giving us a sense of purpose, community and order. Although we crave it, cheer for it and celebrate it, the environment in which we would usually find joy in it has greatly changed.

    I'm hopeful we will return to the sidelines and fields soon, once it is safe to do so.

    Kristina DeMatas, D.O., is a family and sports medicine physician in Jacksonville, Fla. She is the founder of sportydoctor.com where she shares rehabilitation tips, home treatments and more.


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