Doctors warn of COVID transmission risks in contact sports

The Connecticut high school sports season begins Oct. 1, and the new landscape includes COVID-19 protocols, masks, regionoal pods, abbreviated schedules, and few, if any, spectators in the stands.

The Connecticut Interscholastic Athletic Conference’s decisions for fall sports, including the cancellation of football, have been based on recommendations from the state Department of Public Health and sports medicine doctors.

Speaking with infectious disease doctors about high school students and sports, one common thread comes through: In the year of COVID-19, the biggest obstacle facing contact sports is contact.

“Contact sports are inherently in-your-face,” said Dr. Sten Vermund, dean of the

Yale School of Health and a pediatrician and infectious disease epidemiologist. “You’re spitting on each other, you’re grunting at each other, you’re shouting at each other — it’s the perfect venue to transmit from an asymptomatic player to a susceptible individual, and you could transmit it to multiple people.”

There is a perception that teenagers and children are less

susceptible to the effects of the virus. But that is not the case, according to Alvin Tran, assistant professor in the Department of Health Administration and Policy at the University of New Haven.

“Children and teens are at risk for COVID-19,” said Tran. “While most cases of COVID-19 among those under 18 years are generally mild or asymptomatic, children and teens are still at risk for severe COVID-19.”

Dr. Paul Nee, an infectious disease expert at Danbury and New Milford hospitals in the Nuvance Health system, pointed out that the documented numbers could be on the short side.

“According to the state of Connecticut, over 2,000 people between the ages of 10-20 have tested positive for COVID-19,” Nee said. “This may be an underestimation as teenagers may have mild symptoms and may have not sought out treatment.”

Combining sports with a highly-contagious virus such as COVID-19 is difficult because of the contact inherent to athletics.

Teammates are often in close proximity to each other on the field, on the sidelines, in locker rooms and on bus trips during away games, and there’s also contact with opposing players, which is frequent in a sport such as football.

The emotionally charged debate surrounding that sport seemingly concluded Sept. 16, when the CIAC, the governing body for high school sports in Connecticut, announced the cancellation of the 11-on-11 football season, citing the DPH’s recommendations and discussions with the Connecticut Association of Public School Superintendents.

“It was made clear to the CIAC that its members are not public health experts and, as such, on the matter of playing football, CAPSS would defer to the appropriate state and local public health authorities,” read the CIAC’s statement.

The data

The numbers on the Centers for Disease Control and Prevention’s COVID Data Tracker indicate that kids ages 5 through 17 who contract the virus have a mortality rate of less than 0.1 percent.

The age group data represents only information from geographic areas that contributed data on race/ethnicity, and thus the data is not “generalizable to the entire U.S. population.”

As of Tuesday, the CDC’s tracker includes age group data for 4,877,706 cases, with 324,128 cases, or 6.6 percent, from ages 5 through 17. According to the CDC's website, the United States has surpassed 200,000 total deaths, of which 143,429 are included on the data tracker, with 55 deaths in the 5-17 age group.

Connecticut’s COVID-19 summary includes 2,846 cases in the 10-19 age group, which is 5.1 percent of the state’s total, and one death.

Both the CDC and Connecticut trackers show that the mortality rate increases with age.

On Tuesday, Gov. Ned Lamont tweeted that, the day prior, the state had administered 12,044 tests and 136 came back positive for a positivity rate of 1.1 percent. That rate has ticked upward from below 1 percent in recent weeks, a trend Lamont has said was troubling, but is still lower than many states.

Long-term effects

While the mortality rate is low for children and teenagers, there are potential long-term health problems, such as scarring in the lungs and inflammation of the heart, even in young adults.

Boston Red Sox pitcher Eduardo Rodriguez, 27, battled severe COVID-19 early in the summer, eventually recovering and was even cleared to play. His season ended when he was diagnosed with myocarditis, an inflammation of the heart suspected to have been caused by his bout with COVID-19.

For adolescents, the risk of severe COVID-19 is again relatively low, but is still a concern.

“Right now, health experts believe that children and adolescents may appear to be less at risk for severe COVID-19, but that doesn’t mean the coast is clear,” Tran said. “There is still a risk and children and teens have been hospitalized for severe COVID-19 symptoms. Should a high school age student become infected with the virus and develop COVID-19, it’s very hard to predict what the long-term impact of that infection will be after recovery.”

Gauging the lasting effects is difficult, as medical professionals are still learning about the virus and there is no true long-term data to guide them.

“However, there are many cases of adults who recover from COVID-19 and who end up with cardiac damage, which is very concerning,” Tran said.

Going home

The danger of COVID-19 isn’t limited to the effect on the individual who contracts the virus. An infected person could be asymptomatic, but will still be able to pass the virus on to others they come in contact with.

Vermund said the “one good thing” about the virus is that it doesn’t attack younger people as substantially as it does their elders, but the main concern is that they could pass it on to more vulnerable individuals.

“These kids are in touch with their loved ones, their grandparents, their teachers, staff members, and sometimes even parents who are over the age of 60 and who have an underlying medical condition,” Vermund said. “To start this wildfire all over again just doesn’t seem to make sense to me.

“We’re worried as much about the grandmothers and grandfathers in the crowd, and the teachers, because the children are not likely to get seriously ill.”

It’s also important for people to look outside of their own home environments, as the virus links everyone.

“If you don’t happen to have a vulnerable person in your household, the fact that (your kid) gets infected may not be a big deal,” Vermund said. “But if (he) infects anybody else, like another football player, then that person goes home and that person has grandmother or granddad at home, or somebody in their sphere of influence, who is vulnerable.”

Sports in the year of COVID

The biggest issue facing athletics when it comes to COVID-19 is contact. Teammates are often in close proximity to each other both on the field and off, and many sports involve contact with opposing players.

Both Tran and Nee said the COVID-19 risk varies based on the sport, with an emphasis on how much contact there is between athletes, and for how long they are in close proximity.

Football, a high risk sport according to the National Federation of High Schools (NFHS), features contact on every play, and many teams have large rosters.

“High-contact sports such as football and wrestling have the greatest risk because they involve players being in close proximity with each other, often for long periods of time,” Tran said.

“Right now, health officials recommend people, including teens, practice physical distancing and maintain at least six feet from each other. This will help lower their risk of infection.”

“Football likely has the greatest risk given the time on the field as well as the close contact with opposing players,” Nee said, adding that it’s not necessarily the field of play which will lead to the spread of the virus.

“One thing with sports is (we) often think of transmission occurring on the field of play. But one must remember it can occur on one team’s sideline or in the locker room,” Nee said.

Nee pointed out that steps can be taken to mitigate the spread of the virus, such as wearing masks.

For volleyball, which is considered a moderate-risk sport by the NFHS, masks have been added to the CIAC protocols, meeting one of the Connecticut Department of Health’s recommendations to reduce the risk for the indoor sport.

“Sports like volleyball fall under a lower risk category than football as there is generally more physical distance and less sustained contact between players, but the risk still exists” Tran said.

Masks, Tran said, would help limit the transmission of the virus through respiratory droplets released by yelling, talking or coughing. Players are spaced further apart in a typical volleyball match, with low or no contact, and that distancing would also help mitigate the spread.

“Wearing masks properly will most likely reduce the spread of the virus,” Tran said. “However, I would still recommend that coaches have a discussion with the players on social distancing. Volleyball is one of those sports where players generally are positioned at a certain distance from one another. This makes social distancing possible as long as players are communicating with each other in the arena, especially when going for an attack or block.”

Cross country falls into the lowest risk category for sports, although there still is risk when there are large groups of runners. The CIAC will limit meets to 50 runners and says in its guidelines six feet should separate each team at the starting line.

“While possible, sustaining physical distance from each runner can be a challenge,” Tran said. “I would say among football, indoor volleyball and cross country, cross country and track are safer bets as long as participating athletes are able to maintain enough distance from one another.”

Vermund suggested putting contact sports on the shelf for a month or two and focus on building skills, which would both help kids grow as athletes, while also keeping them, and their friends and families, safe.

“We are now one of the most disciplined states in the country, having been the third worst rate of COVID in the country in April,” Vermund said. “Now we’re one of the five to 10 best and we have one of the lowest rates. We have this wonderful opportunity to reopen our state .... (but) we’re going to reopen it to avoid the kind of surge that we’ve seen in Texas, Arizona, Georgia, and North Dakota. We’ve been through that.

“We’ve been through the horror story of April.”