Coronavirus in Context: Youth Sports: Managing the Risk of COVID-19

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You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. A couple days ago, we talked about going back to the gym, whether or not it was safe. Today, I want to talk about youth sports.

Can your kid go back, you know, and play baseball or soccer? To help provide insight into what one can and cannot do, I've asked Dr. Deverick Anderson, he's Professor of Medicine at Duke, to join us. Dr. Anderson, thanks for taking time to talk today.

Thanks. It's my pleasure to be here.

Let's start off with some type of risk assessment if we can, in terms of what sports for kids are less risky and which ones might be a bit more risky. Can you help rank them for parents?

Right. I think you can certainly think of-- use some of the same general principles we're using elsewhere. And the notion of the closer you are together, the more contact you have with others, then the higher the risk. And so I think you can definitely parse out individual sports like tennis and golf as prob-- being quite safe as-- as sports that you can participate in.

Then moving all the way to the other end of the spectrum, perhaps, would be things like, you know, rugby and football, where there is just such a significant amount of contact, and maybe even a large number of-- of people on a team. So in between there, I think you would have baseball is a potentially low risk, because of just essentially throwing the ball back and forth as opposed to frequent kind of close contact.

And in soccer, somewhere in the middle. Where obviously not touching the ball with our hands necessarily, but more likely to have more contact with individuals while you're on the field. And basketball is probably at about the same range as well in the middle, compared to some of the individual sports or some of the very, very high contact sports.

Does age matter? Does that come into play when you're deciding whether or not your kids can return to sports?

It's certainly an important question to ask. And, you know, there have been-- there's been a lot of discussion about the impact of this virus on children. Certainly we know that children can have infection from coronavirus, of course.

But in the big picture, they do seem to be less frequently impacted than adults who may try and play sports. Within children, you know, 18 years or younger, there's not a very large distinction between, you know, teenagers versus school age children as far as risks. And so I don't know that there's anything specific, uh, to recommend regarding age if you fall into that kind of, you know, children's group.

What about wearing masks? Say baseball. Should they be wearing masks when they're playing baseball?

Yeah. It's the same idea that, you know, in general, if we can use some of the principles that we're trying to use elsewhere in society, distancing, masking, frequent hand washing, then it's worth the attempt to-- to do so. And I think this is where some of the difficulties in following those types of recommendations really will come into play.

Six feet distance. That's going to be hard.

Six feet for sure, uh, will definitely be hard. And I would imagine that if, for some sports, when you get into a high exertion, exercising, sweat, then wearing face masks will be very difficult to-- to do effectively.

So what do you recommend? Bottom line on masks.

Well, I think that if you can find opportunities to-- to wear it and can wear it without risk of sweat, then it's worth a try. However, I think more likely the scenario would be that we have our masks on as much elsewhere as we can. Arriving to the field early, activities on the field.

But when the exertion of the game, of the practice actually begins, then it seems unlikely that we would be able to wear masks in that. However, as soon as we're done, let's try and put those masks right back on and get right back into those recommendations we're following with other places in society.

Now, what about surfaces? The CDC put out additional guidance a few weeks ago that transmission on surfaces is not as likely. Still possible, but it's more the respiratory transmission. But then we hear about, you know, making sure you, you know, wash baseballs, you know, carefully.

We heard someone talk about, in tennis, that you should put your, you know, initials on your tennis ball and only use your tennis ball. Is that-- is that practical? Is there a science behind it? What should we do about those surfaces in sports?

Certainly another one of those good topics where there are going to be some differences in how well we can achieve some of the routine practices we'd like to achieve in sports versus in other settings. Because, again, basketball or baseball is a good example where you are literally are throwing something from one person to another, and handling it in each place.

And so obviously, there will not be any way to disinfect a-- a surface like that before it moves from one person to the next. Um, and so I think, you know, then it becomes the,well, will how do you just kind of get it a little bit lower, a little bit lower. And then perhaps you can think of more balls during practice periods.

Additional use of bats, for example, in baseball where, you know, again, how practical it can be in certain settings will be difficult. But, you know, thinking of the ideal at least, if everybody had their own bat and everybody had their own glove, the that's just, you know, one or two fewer things that you may be passing back and forth between each other.

In general, you know, it remains important that, while it is true, CDC helped kind of clarify where the emphasis should be, droplet transmission, but we still do want to pay close attention to surface disinfection whenever we can. And so, uh, there may be other places, like the bench, for example, where we can think more about effective use of disinfectants in that setting as opposed to the actual ball that's being used in the-- in the sporting event.

Now, I mentioned you're at Duke. It's hard to mention Duke and not talk about basketball. So what's going to happen with college sports like basketball?

Right. It's a great question. Um, you know, a lot of the professional levels are really investing in high amounts of testing, at high cost as well, as you might imagine. And it's just not clear that that same strategy is going to be something that, you know, colleges can routinely pull off.

Now, again, testing at all-- even at the highest level, testing is not the only thing. So this is where you have to think of these additional strategies, and the college environment as a good one. Where you think of ways of screening people as they come in and out of campus. You think of ways of checking for symptoms. You think of really pushing hard on some of these social distancing and mask wearing measures.

And, you know, in the end, what we will have to do as a society is decide, if there is clear increased risk with these sports, is it an acceptable risk? And for parents of children, or college kids, and college athletics, and even professional ranks, for that matter, individuals are going to have to decide if what we know will be at least a little bit of an increased risk, is worth it to them. For many, it will be. And I'm sure for some, that it will not be.

You've been a consultant to the National Football League, and you've worked with Task Force in terms of how do we bring football back. What-- what were the discussions that you were having in terms of where was the main focus?

So I think, again, with those groups, and this has been true with discussions with folks at Duke as well, it really is multiple layers. How many layers can we put in place where none of them is perfect, uh, but with a Swiss cheese model? Can we put them all together where there's no hole that ends up aligning, and-- and therefore have as good of protection as we can?

But those layers include things like testing, uh, things like changing the environment so that you have better capabilities for social distancing. Really messaging the importance of hygiene and the use of facemasks outside of those very specific periods where you just won't be able to in athletic events.

And really, again, really putting all of these kind of on top of one another as an attempt to say, OK, we-- we acknowledge there is increased risk, but we have all of these strategies to try and keep it as low as it can possibly be.

Is it safer if people train and practice outside?

Yes. There is value in being outside when it comes to, you know, risks related to this virus' transmission. I think it has to do with a combination of even things like sunlight, uh, and effective air flow, most importantly.

And the more airflow, the better. It's abundant outside. If you're inside, that's where you start to have those concerns. If many people get together in a small room, that is really one of the most high risk scenarios that we know of right now.

Well, you know, as we've talked about high risk and-- and population density, I'm going to put you a little on the spot, if I may. When do you expect to see fans in stadiums for professional sports?

Yeah. That is putting me on the spot for sure. I'm not sure of anyone that has the answer at this point. Now, that said, I do believe that there have already been people that are trying to figure it out, and trying to think of innovative ways, uh, to get fans back in the stands. It's such an important part of the-- of the experience of sports.

I think it will when it happens. And again, maybe it could happen as early as this fall in outdoor arenas in particular. But it will look very different. I think key strategy number one in that environment will be numbers reduction, and starting small, and then seeing how it progresses.

And so it will appear that it will be-- you know, perhaps it would appear that there is a scattered audience, uh, throughout the stadium, as opposed to everybody, uh, right on top of each other, as we're used to seeing.

What are you most concerned about in terms of infection when it comes to youth sports?

Well, certainly even before coronavirus, we know of various types of infections that can be spread in-- in youth sports. And those are still on the table. We can't, of course, completely discount those. But things like hand, foot, and mouth disease, and viral infection, and, um, herpes, and, you know, wrestling, for example.

And then staph aureus or MRSA, uh, M-R-S-A, is another one of those that comes up. Now, the good news there is that all of these measures we're thinking about as far as preventing the spread of coronavirus actually will be helpful for almost all of those other types of infections as well. And so, you know, we're in this-- in this setting where we're trying to find as many silver linings in this storm that we're dealing with right now. And perhaps that's a silver lining as it's related to-- to youth sports.

Well, that's a good point to end on. And I want to thank you, Dr. Anderson, for taking time today to provide your insights.

It was my pleasure. Thank you.

And thank you for watching Coronavirus in Context.