Health experts weigh in on young athletes wearing masks in the heat.
High school sports teams in Western Pennsylvania have started returning to the field for workouts in preparation for seasons that may not ultimately occur, but in a country gripped by the COVID-19 pandemic, that rite of summer doesn’t look the way it so often has.
A quick glance at the faces of the players and coaches, or at least what’s visible of them, indicates as much.
Many of these workouts take place outdoors and involve conditioning drills in consistently warm temperatures, and coaches and trainers have had to be more cognizant than ever of the effect masks can have on young athletes in such a setting.
While the combination of masks and heat could be a concern for parents, experts say that with the proper precautions — adequate hydration, breaks from action and opportunities to take masks off entirely — any health risks posed by masks in athletics can be mitigated significantly.
“The issue with masking and the heat is an important health issue,” said Dr. Graham Snyder, medical director of infection prevention and hospital epidemiology at UPMC. “It’s a balance between how can we prevent transmission and at the same time watch the safety of our athletes. I think part of that answer is a sports medicine answer.
“How do we do things to ensure enough water breaks and enough pauses to activities for people to remain cool and, at the same time, do it safely in a way that prevents transmission? The requirement to wear masks is not necessarily incompatible with keeping people well while they’re participating in athletics.”
The effectiveness of masks in preventing the spread of the coronavirus that causes COVID-19 has been well-documented, from federal Centers for Disease Control and Prevention recommendations to numerous clinical and laboratory studies.
As sports have tried to return in various forms, from high school to professional, masks have played a pronounced role in those precautionary plans.
Among Gov. Tom Wolf’s guidelines for sports in Pennsylvania to restart was a requirement that coaches, athletes and spectators must wear face coverings unless they are outdoors and can consistently maintain at least 6 feet of space between them and others. Athletes, however, are not required to wear face coverings while actively engaged in workouts and competition, though they have to wear them when on the sidelines and any situation in which maintaining 6 feet of social distancing is not possible.
It’s a logical step, particularly in Allegheny County, where an average of 172 new coronavirus cases a day was posted from June 30 through July 9. There are, however, some concerns with the guidelines’ application, given the time of year.
From July 2-10, the high temperature in Pittsburgh was at or surpassed 90 degrees each day, creating uncomfortable conditions and increasing the likelihood of heat illness even without masks worn.
The CDC notes that people engaged in high-intensity activities “may not be able to wear a cloth face covering if it causes difficulty breathing.” The World Health Organization advises that people not wear masks when exercising “as masks may reduce the ability to breathe comfortably.”
As part of its return-to-play guidelines, UPMC recommends that for athletes, “the percentage of time without the mask should be limited to the active participation time.”
Health officials have cautioned individuals to be strategic with wearing masks outdoors, especially those with underlying health conditions that make them more susceptible to heat-related illness. As Dr. Matthew Levy of the Johns Hopkins University School of Medicine noted, studies have shown that wearing masks can “affect the amount of physiological stress on the body and raise the microclimate around the face.”
“It becomes a little bit more difficult because now you can’t disperse the heat through your lungs as much if you have a mask on because your breathing is tempered by what kind of mask you’re wearing,” said Dr. Edward Snell, a physician of orthopedic sports medicine at Allegheny Health Network. “Masks make it harder to maintain homeostasis of body temperature.”
There are other concerns when it comes to sports, as well. High school athletes have been away from their teams and organized training sessions since March. With gyms closed for much of that time, some coaches worry athletes may not be in the kind of physical shape they would have been otherwise, making preseason conditioning that much more grueling. Also young athletes with issues such as asthma and anemia have to be considered.
Group settings like team workouts complicate the ability to exercise without a mask, but there are remedies to many problems that may be posed. While N95 masks cling very tightly to one’s face, cloth masks have a looser fit that typically make it easier to breathe.
“Everything is out there,” Dr. Snell said. “There are so many things you can do. There are so many mask manufacturers. There’s really not a problem with [personal protective equipment] and getting the PPE that can address your certain situation.”
There are also initiatives that those overseeing the workouts can monitor and control. Dr. Snell recommends water breaks built in every 20 minutes if a team is working out for an hour or more. If a player is having trouble breathing and that problem is exacerbated by the mask, they should take it off if they are a sufficient distance away from others.
If the distancing standard can be maintained, masks aren’t even necessary for athletes as they exercise.
Several high schools in Allegheny County have temporarily halted football practices recently — Gateway, McKeesport, Central Catholic and North Allegheny among them — but for those continuing, increased attention has been placed on the well-being of its participants.
Pine-Richland coach Eric Kasperowicz said two or three athletic trainers are on site for every one of his team’s workouts, which began July 6. Rams players have worn masks during the majority of their sessions thus far, he said, but if someone feels they need a break or a chance to get water, they should take it.
“It’s just being up front with them,” Mr. Kasperowicz said. “This isn’t the 1940s, where you limit water breaks. If you need water or need a break, go do it. I think everybody is on the same page with that. It’s just open communication between coach and player that I think we have.”
The situation has been similar at Blackhawk, where coach Zack Hayward said he has been monitoring every detail in workouts, which have primarily consisted of conditioning and implementing game plans the first several weeks.
“These kids, they just want to go back to normal,” Mr. Hayward said. “They want to play football and they want to be kids. They don’t want to have to worry about all of this stuff. But as a coach, you have to look out for them. That’s the first thing on my mind every single day whenever I go to practice now. I want these kids to be healthy. I look after them just like they’re my own kids.”
For both those in the medical community and coaches, there have been complaints about masks in the heat, many of which revolve around a lack of comfort or cloth masks becoming soaked in sweat. Mr. Hayward said qualms from parents have been minimal, but those who have reached out have questioned why seemingly healthy kids have to wear masks.
As workouts continue and the feasibility of sports during a pandemic is evaluated, coaches acknowledge that they must remain observant and adaptable to change.
“You’ve got to take baby steps and work it back,” Mr. Kasperowicz said. “Hopefully, in a couple of weeks things change and we’re able to take the masks off full time. But who knows? This might be the new norm for a while.”