July 26, 2020

COVID-19 and Sports Medicine Trends Today

Due to the changing landscape of the sporting world today, we felt it would be useful to try and put together a list of states in the U.S. and where they stand on starting school and fall athletics. This is a controversial topic with valid points made for delaying or restarting sporting activities. As you know, states and the NCAA canceled winter sports championships and the spring sports and championships. We are going to try and make a comprehensive list as of now that may change or get moved depending on the next few weeks or few months.

There are guidelines available for strategies or help with re-opening available here. This does include strategies for youth sports, NCAA, National Federation of State High School Associations (NFHS) and the USOPC. Most sports medicine provide services to high school athletics or NCAA athletics and this will be the main focus.

List of States

Alabama – Announcement by high school athletic board on July 22 that they will follow guidelines and begin football games starting August 20-21. Football practices are schedules to start July 27.

Alaska – The ASAA will proceed with fall sports but coaches must have approval of their school district. All activities need to be in accordance with local and state health mandates.

Arizona – The AIA is delaying fall athletics after the school year start was pushed back to August 17. An announcement on June 29 stated there would be no athletics until in-person teaching is done. The earliest in-person instruction would fall in line with the start of the school year August 17. Further announcements regarding fall sports expected in the next few weeks.

Arkansas – The AAA released a statement on July 7 stating sports will continue as planned. Limited practices have been ongoing since June 1. Board meeting for AAA on August 2.

California – The CIF moved back fall and winter seasons to start in January 2021. There are ten sections of the CIF and each will make its own start and end dates. The Southern Section will begin its football season Dec. 14. However, there is some differences between the sections in California. The Northern section announced July 20 that it will attempt to start the fall season on time as long as there is local health department clearance. This may make them ineligible for the state championships. The situation there is developing.

Colorado – The CHSAA are letting local school districts make decisions on fall sports with oversight. The board is awaiting official recommendations from the state on accommodations and changes, but the most recent announcement on July 15 is to start high school fall sports on time.

Connecticut – The CIAC moved into a phase that allows summer conditioning in groups of 5-10 and up to three times per week. Fall practices are scheduled to start with football on August 17 and all other sports August 27. The first day of competition is September 10 and reports from July 22 were positive.

Delaware – The DIAA announced approval to begin workouts on July 6 with approval of local districts. A poll on July 14 showed many board members for the state preferred a delayed and condensed season, but more info should be available the next 1-2 weeks.

District of Columbia – A DCSAA announcement on July 16 postponed all fall activities and sports until January 2021. The winter practices will start December 14 and competition is to start January 4. The fall seasons will now be spring sports with practices starting February 1 and competition starting February 22.

Florida – The FHSAA approved a proposal on July 20 to begin fall season sports on time. Practices will begin July 27, but district, local and school governments need to approve. The metropolitan areas will likely have a delay or condensed season. Eight football games need to be played to qualify for state playoffs. Competitions are scheduled on August 20 in some parts of the state.

Georgia – The GHSA announced on July 20 a postponement for the football season by two weeks. Competition is to start on September 4 and this will also push back playoffs by the same margin. All other fall sports will start on time.

Hawaii – The HHSAA announced moving the “no-contact” period further to at least August 18. There will be no “instructional or developmental sport specific activity allowed between high school coaches and student-athletes” until this time. The earliest competition will begin will be August 31.

Idaho – The IHSAA announced on July 16 plans to proceed with the start of fall sports as scheduled. Sporting events plan to return to full practices August 10. There will be measures taken and recommendations including “no high fives or fist bumps.”

Illinois – The IHSA was in phase 2 of 4 in returning to fall sports. Coaches were permitted with local district approval to have 20 contact days from June 30 to August 9. This plan was altered 4 days after implementation and all participants were to wear masks. This was then delayed indefinitely the week of July 13 due partially due public pushback, disagreement among governing boards and a lawsuit. All future decisions on fall sports will be discussed at the board meeting on July 29.

Indiana – The IHSAA announced fall workouts to be allowed on July 6 with limitations of 15 hours per week. No locker rooms and no contact allowed. As of July 20, the school year and athletics were pushed back 2 weeks with the earliest contact date being August 17. This will likely push back or cause the first two weeks to be canceled.

Iowa – The IHSA announced on July 17 plans to begin fall sports as scheduled with practices starting August 10.

Kansas – The Kanas Governor’s executive order has delayed the start of school until after Labor Day, meaning fall sports will potentially be pushed back until at least then. The Kansas Board of Education voted to reject this order on July 22. Proposals to move forward with fall sports with restrictions starting on August 17 were made and discussed. More will be available in the coming weeks with a KHSAA meeting on July 27.

Kentucky – Groups up to 50 were allowed for fall conditioning as long as these were divided into groups of ten and with a coach. Football, soccer and volleyball were not allowed to conduct game-like situations. Recent quotes from the KHSAA have indicated possibly leaving the decision up to local districts or governments, but the plans are to continue with fall sports. New guidelines expected on July 26 with golf having a potential start date of August 1.

Louisiana – LHSAA has a four phase return plan. Proposals to move into phase 3 for fall sports and practices will not occur before August 7. A statement by LHSAA on July 22 stated there will be fall sports barring any setbacks. Potential football games will start September 4.

Maine – The MPA pushed back the start of practices from August 17 to September 8 and earliest competition will occur on September 18. The Maine Department of Education plans to release a color coded map for return to school on July 31 and decisions for fall sports may depend on the return to school.

Maryland – The MPSSAA announces an ongoing plan forward and no contact practices have occurred since June 11. The MIAA and IAAM announced a delay from the August 12 plans and no practices will be allowed until September 1. Announcements are expected weekly. Montgomery County, the largest county in Maryland, announced a cancellation of all fall and winter sports.

Massachusetts – The MIAA announced on July 21 a delay of the sports until September 14. This is delayed from the initial start dates of August 21 for football and August 24 for other sports.

Michigan – The MHSAA announced on July 17 the fall sports will begin as traditionally scheduled. Football practices will start August 10 and other fall sports on August 12. There are backup plans in place in case of setbacks.

Minnesota – The MSHSL announced fall teams are scheduled to start on August 17, but decisions are pending. A board meeting on August 4 will decide on delaying the start of the season.

Mississippi – The MHSAA announced on July 14 a delay to the season by two weeks with all fall sports besides football starting on August 10 and competition starting August 24. Football practices start on August 17 and games are scheduled for September 4.

Missouri – The MSHSAA announced moving forward with fall sports and starting practices on August 10. St. Louis county did move back to groups of ten and there are schools that announced online schooling in the fall. These schools will not be eligible for competition.

Montana – The MHSA announced summer rules were in effect until July 31 and will proceed with fall sports and competition will begin August 27.

Nebraska – The NSAA announced on July 20 are proceeding with fall sports as scheduled. Practices officially begin August 10.

Nevada – The NIAA announced on July 24 that fall sports are being pushed back to February 2021. Football practice is now set to begin on February 13 and all other fall sports being pushed back to February 20. At this time, it is anticipated that there will not be State Tournaments for the 2020-21 school year. Winter sports practices will start January 2 and competition will start January 15. Each season will be reduced to six competitive weeks.

New Hampshire – The NHIAA phase 3 guidelines are expected to be announced the week of July 26. No definitive plan to play or delay the season have been made but initial reports have been optimistic a fall season will occur.

New Jersey – The NJSIAA announced on July 10 the fall season will begin on October 1. The season will be shortened to six games (from 10).

New Mexico – The NIAA announced on July 23 that fall sports will be postponed with practices starting in February and competitions starting on March 5. The winter sports will start the season practices January 2 and competitions on January 15. Each season will be shortened to six competitive weeks. No state tournaments are scheduled.

New York – The NYSPHSAA announced on July 16 that the fall sports will be delayed around one month as of now with a start date of September 21. Regional and state championships are canceled as of now. More decisions will be made in the coming weeks and the fall season sports may be postponed.

North Carolina – The NCHSAA announced the fall sports are delayed for public schools and the tentative start will be September 1. The NCISSA (private schools) announced the season practices will begin on August 10 and competition on August 31, as long as the state moves into phase 3 of reopening.

North Dakota – The NDHSAA announced on July 16 to proceed with fall sports as scheduled. Sport practices will be different with soccer starting August 3 and other sports starting August 10 or 17.

Ohio – The OHSAA announced that practices for fall season can begin on August 1 and competition is set to start August 24. Mitigation strategies were announced on July 22.

Oklahoma – The OSSAA announced plans to start the fall season as previously scheduled with practices starting August 14.

Oregon – The OSAA announced practices will start on time August 17, but competition will be pushed from August 27 to September 23. This prior announcement is currently in question and all contact sports are currently on hold. A meeting will occur the week of August 3 to discuss further.

Pennsylvania – The PIAA announced on July 15 that high school sports will continue as scheduled unless otherwise directed by the state. Football practices are scheduled to start August 10 and the remaining sports on August 17. A meeting is scheduled to discuss further plans July 29.

Rhode Island – The RIIL announced that fall sports practices will resume the third week of August and competition will begin September 4.

South Carolina – The SCHSL announced on July 15 that practices will begin August 17, delaying this more than two weeks from its original date. A shortened football season of seven games will start September 11. Other fall sports will have a shortened playoff schedule.

South Dakota – The SDHSAA announced continuing the fall season as scheduled with football practices starting August 3 for smaller schools and August 10 for larger schools. Guidelines were proposed for mitigation on July 22.

Tennessee – The TSSAA announced July 22 a plan that gives the state governing body flexibility on a week to week basis depending on developments of the coronavirus. An executive order was made that would allow practices to start after August 29 and competition to start September 18. Meetings this week at TSSAA are trying to make football and other sports exempt from the order and start on either August 3 or August 10.

Texas – The UIL announced on July 21 fall sports for the two largest classes 5A and 6A are delayed 5 weeks, with practices starting September 7 and competition starting September 24-26. There will be playoffs for these teams. The smaller classes, 1A-4A, will continue as scheduled with practices starting August 3 and competition starting August 27-29. The TAPPS (private schools) delayed the season and will work on a similar time frame as the larger schools with practices starting September 8 and competition starting September 28.

Utah – The USHSAA announced on July 9 to proceed with fall sports as scheduled. Local school districts will be overseen by the USHSAA and changes may be made through the next couple months if needed.

Vermont – Fall sports are delayed and will not begin until there is in-person educational instruction. School is currently delayed in Vermont until late August or early September. Petitions have been presented to start sports on August 10 due to summer sports still being allowed.

Virginia – The VHSL announced the fall sports will be delayed and football will be postponed until the spring. Further decisions will be made on July 27 on whether to play low-contact sports in the fall, switch fall and spring seasons or delay all sports until winter.

Washington – The WIAA announced on July 21 will start higher contact fall sports football, soccer, volleyball in early March. Cross-country, slow pitch softball, swimming, gold and tennis will continue as scheduled in the fall. Four seasons were made instead of three and baseball, fastpitch softball, boys soccer, and track and field will start in late April and go until June 27.

West Virginia – The WVSSA announced on July 10 that the high school seasons will be delayed one week and practices will start September 3. Schools were delayed until September 8.

Wisconsin – The WIAA announced on July 23 that lower contact sports golf, tennis, cross country and swimming will start on August 17. Football, volleyball and soccer will start on September 8.

Wyoming – The WHSAA announced previously that they will be deferring to individual school districts to comprise their own plans for resuming high school sports and activities. The state is going through non contact sports this past week and competitions may begin on August 28. A contingency plan is in place if needed to start the season October 16.

The NCAA has a general set of guidelines and strategies in place to attempt to contain or stop the spread of COVID-19. The recommendations include daily self-health checks, appropriate use of face coverings and social distancing, testing strategies for all athletics activities including pre-season, regular season and postseason. Testing and results within 72 hours of competition in high risk contact risk sports and compliance with public health standards set by their local communities. Each conference has different approaches and I will try and cover just the Power 5 here.

ACC

The ACC announced fall “olympic” sports have been postponed until September 1. For football, the Chick Fil-a kickoff games are still in question and they expect further details in “late July.” For football, the following games have been canceled: Purdue at Boston College; Holy Cross at Boston College; Elon at Duke; Miami at Michigan State; Syracuse at Rutgers, Colgate at Syracuse; Penn State at Virginia Tech. The following games have been postponed: Delaware at North Carolina State; James Madison at North Carolina; Richmond at Pittsburgh; Villanova at Wake Forest.

Big-12

Along with the ACC, the Big-12 announced a decision on football and fall sports likely in “late July.” For football, the following games are canceled: Iowa State at Iowa; Oregon State at Oklahoma State; TCU at California; Texas Tech at Arizona; Maryland at West Virginia. The following games are postponed: New Hampshire at Kansas; Prairie View A&M at TCU; Alcorn State at Texas Tech.

Big Ten

The Big Ten announced all the league’s members will play conference opponents only in the fall. This is for all fall sports including football. The following games have been canceled: Illinois State at Illinois; UConn at Illinois; Bowling Green State at Illinois; Western Kentucky at Indiana; Ball State at Indiana; Indiana at UConn; UNI at Iowa; Iowa State at Iowa; Northern Illinois at Iowa; Towson at Maryland; Northern Illinois at Maryland; Maryland at West Virginia; Michigan at Washington; Ball State at Michigan; Arkansas State at Michigan; Michigan State at BYU; Toledo at Michigan State; Miami at Michigan State; FAU at Minnesota; Tennessee Tech at Minnesota; Minnesota at BYU; Central Michigan at Nebraska; South Dakota State at Nebraska; Cincinnati at Nebraska; Bowling Green State at Ohio State; Ohio State at Oregon; Buffalo at Ohio State; Kent State at Penn State; Penn State at Virginia Tech; San Jose State at Penn State; Memphis at Purdue; Air Force at Purdue; Purdue at Boston College; Monmouth at Rutgers; Syracuse at Rutgers; Rutgers at Temple; Southern Illinois at Wisconsin; Appalachian State at Wisconsin; Notre Dame at Wisconsin.

Pac 12

Pac-12 CEO Group announced that the fall season for several Pac-12 sports, including football, men’s and women’s soccer and women’s volleyball, would schedule conference-only games. The following games are canceled: Northern Arizona at Arizona State; Arizona State at UNLV; BYU at Arizona State; Hawaii at Arizona; Portland State at Arizona; Arizona at Texas Tech; California at UNLV; TCU at California; Cal Poly at California; Colorado at Colorado State; Fresno State at Colorado; Colorado at Texas A&M; North Dakota State at Oregon; Ohio State at Oregon; Hawaii at Oregon; Oregon State at Oklahoma State; Colorado State at Oregon State; Portland State at Oregon State; William and Mary at Stanford; Stanford at Notre Dame; BYU at Stanford; New Mexico State at UCLA; UCLA at Hawaii at UCLA; UCLA at San Diego State; USC vs Alabama (in Arlington, Texas); New Mexico at USC; Notre Dame at USC; BYU at Utah; Montana State at Utah; Utah at Wyoming; Michigan at Washington; Sacramento State at Washington; Utah State at Washington; Washington State at Utah State; Houston at Washington State; Idaho at Washington State.

SEC

No decisions have been made regarding the SEC football season, but the conference announced that it will postpone the start of volleyball, soccer and cross country competition through at least Aug. 31. The decisions regarding football are expected in “late July.” The following games have been canceled: Alabama vs USC (in Arlington, Texas); Colorado at Texas A&M. The following games have been postponed: Alcorn State at Auburn; Alabama A&M at Mississippi State.
A joint statement from the NFHS and AMSSM was released on July 9 and available here [1]. The recommendations include a questionnaire that is similar to many screening questions for healthcare facilities. If an athlete had a prior confirmed diagnosis of COVID-19, it is recommended that this person be cleared by a healthcare professional. History should be taken to assess severity of prior symptoms and if there are any ongoing symptoms. It is recommended that any student-athlete that had severe illness or was hospitalized undergo a cardiac consultation and possibly a pulmonary consultation depending on symptoms. Residual or ongoing symptoms also need to be addressed similarly before clearance. Student-athletes with underlying conditions (asthma, diabetes, obesity, chronic kidney disease) should also be evaluated by a physician or healthcare provider if they are returning to sports. Further information on COVID-19 and sports can be found here.
FIGURE 1. QUESTIONNAIRE FOR COVID-19 SCREENING
With new infections, schools may or may not have a tracking tool available. A task team (may include parents, ATCs, teachers, other staff) may be formed to screen, report and track new infections. Student-athletes that are ill should not participate and should undergo an evaluation by a healthcare professional. If a positive test is confirmed, the patient should be quarantined for 10-14 days from diagnosis and exercise is not recommended during this time and potentially 7 days afterwards. After symptom resolution, the student-athlete should undergo an additional evaluation. They should be off of all medications and may enter into a graded return to play. Emergency Action Plans should be rehearsed before the season with special precautions and changed or updated to accommodate for COVID-19. You can learn more about the EAP here.
FIGURE 2. BJSM GRADUATED RETURN TO PLAY GUIDELINES.
There will also be many changes for spectators, student-athletes and coaches. Most schools and districts will likely have precautions in place to try to limit the spread of COVID-19. There may be a capacity limit for some and other changes made for crowds to try to increase distance between spectators. Locker rooms may try similar and may even be off limits. Masks will likely be required at most sporting events. Some athletes may also be asked to wear a mask when not actively engaged in activity and in close quarter activities such as dugouts. Hand hygiene and respiratory etiquette should be discussed and signs and reminders may be posted in locker rooms and around the venues. The staff and maintenance employees will also likely have to spend more time and effort to ensure they sanitize and promote a clean environment. Teams and staff need to be prepared if staff or coaches need to miss time. The CDC provides many details for strategies and educational posters here.
There will also be a large amount of questions and concerns as the school year approaches. Many concerns have already been brought up locally with our community here. For student-athletes, there will certainly be disappointment by players and coaches if the season has been shortened or delayed. We all know as health care providers that sports have many benefits beyond the physical aspect. Some may be at a higher risk and have increased concern about playing. Each will likely have to make difficult decisions in regard to this. Others have voiced concern with scholarships and many student-athletes depend particularly on the fall season to showcase their talents for schools and scouts. Many student-athletes also have concern about being asymptomatic and possibly putting parents, grandparents or others around them more at risk. Some student-athletes may not answer questions appropriately or be dishonest when reporting symptoms due to fear of being held out. As providers, we understand that many players try to avoid the ATCs, physicians or do not voice their injuries or illness due to fear of missing time or being held out. Coaches and officials are more likely to have underlying conditions due to age and will likely be at more risk. Some areas may not have the testing readily available.
I have also read about districts voicing concern about a statewide approach. We already saw a difference in California in the northern and southern areas having a difference of start dates due to the northern states being less affected by COVID-19. There are counties in Pennsylvania that have less than 10 total cases and zero deaths. This is in comparison to another county that has nearly 30,000 cases and more than 1,600 deaths. There is sometimes a great variance in how areas of the state are affected due to the nature and spread of the virus.
Some variance will also exist in the comfort level of healthcare providers, similar with teachers. Providers will likely have a variance of comfort level depending on the area they live in, their personal age and possible comorbidities, the comorbidities and risks of their family or others that they have frequent contact with, among other concerns. This is also difficult because there can potentially be an increase in injuries due to deconditioning. Some may also feel they do not have much more risk involved if they are already in an office setting. These are all valid questions and concerns and there will likely not be a uniform solution for everyone.
In conclusion, guidelines and schedules will inevitably change. This will be a very different season for all sports for everyone involved and everyone will likely have to continue making adjustments. Local guidelines and state guidelines may change if there is a spike or group of cases in particular areas and entire states may also change because of these also. Everyone will have to participate in a team effort to try and move forward with fall and winter sports and communication will be as important as ever.

REFERENCES

1. Drezner, J. A., Heinz, W. M., Asif, I. M., Batten, C. G., Fields, K. B., Raukar, N. P., … Walter, K. D. (2020). Cardiopulmonary Considerations for High School Student-Athletes During the COVID-19 Pandemic: NFHS-AMSSM Guidance Statement. Sports Health.
2. Elliott N, Martin R, Heron N, et al. Infographic. Graduated return to play guidance following COVID-19 infection. British Journal of Sports Medicine Published Online First: 22 June 2020. doi: 10.1136/bjsports-2020-102637

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