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COVID-19 and youth sports: Is it safe to play?

young bog running to first base at a softball game

As communities, schools and workplaces slowly start to reopen, many are welcoming back another time-honored tradition – the return to sports. With the opportunity to let kids back on the field also comes many questions from families. Most importantly: Is it safe for kids to play sports during the COVID-19 pandemic?

“It really comes down to your family’s risk tolerance,” explains Valerie Scott, MD, family medicine provider at Roper St. Francis Physician Partners Primary Care. “We know this virus is spread by close human contact, and that defines sports. But, we also think kids with COVID-19 tend to have more mild symptoms or be asymptomatic.”

“To be honest, the jury is still out on long term consequences of COVID-19,” Dr. Scott continues. “The big one that worries me more than any is potential heart damage.”

Dr. Scott recommends families sit down and consider what they are comfortable with. “Most children are going to do fine if they get sick,” she says. “But, there are still risks. That’s why if we have them return to play, we have to do it in the most scientific way possible.”

That includes parents learning about the risks associated with COVID-19 in children, and the steps sports leagues and coaches are taking to protect children and prevent the spread of the virus.

Keeping athletes safe on and off the field

Roper St. Francis Healthcare certified athletic trainers are in many high schools across Charleston County and see firsthand how schools are helping athletes return to play.

“Charleston County has done extensive research on how they can best keep athletes safe. It’s amazing what they’ve implemented in such a short time,” Dr. Scott shares.

That includes protocols such as:

  • Keeping opposing teams and fans separate to reduce the risk of spreading virus between communities
  • Requiring masks for coaches, staff and fans (and athletes when not in play)
  • Regularly disinfecting shared surfaces
  • Graduated return-to-play guidelines when athletes do become sick

“We’re so used to thinking ‘Oh, they feel well, they can play again.’ But that may not be the best approach with this virus,” explains Dr. Scott. “Making sure athletes are healthy keeps them safe and reduces the risk of spreading the virus to teammates, coaches and their families.”  

“Athletes, families and coaches may not like the quarantine timeline for players who do get COVID-19, but it’s a critical step. Quarantine reduces community spread and it ensures we have the time to catch any potential issue,” she continues.

For Dr. Scott, that includes cardiac damage.

Myocarditis and athletes

Recent findings suggest that individuals recovering from even a mild case of COVID-19 are at risk of developing myocraditis. Myocarditis is when the middle layer of the heart wall becomes inflamed. It can lead to heart damage, abnormal heartbeat and sudden death.

A small study, published in JAMA Cardiology , performed cardiac imaging tests on 28 athletes who recovered from COVID-19. Imaging showed that four athletes had myocarditis. The study also found eight additional athletes had signs of prior myocardial injury.

“Research is just starting to look at the connection between COVID-19 and myocarditis. There is a lot we don’t know,” Dr. Scott admits. “It may be that there is a zero-point-one percent or a three percent risk of myocarditis. The risk may be low, but it’s still a risk. Parents should stay informed so they can make the decision that is best for their children.”

Myocarditis is particularly troubling for athletes because it is the most common cause of sudden heart failure. Monitoring for symptoms and diagnostic testing may help identify myocarditis, but there are not yet any specific recommendations for COVID-19 patients.

“If it were my child, I would have them get an EKG or echo before they got back to sports, and I’d want to be sure athletic trainers had an AED on the sidelines of games,” Dr. Scott says.

An electrocardiogram (EKG) can identify an abnormal heartbeat, which may increase the risk of sudden heart failure. An echocardiogram takes pictures of the heart and can also identify inflammation or trouble with how blood moves through the heart. These tests are important to diagnose myocarditis so athletes can properly recover from the condition.

An automated external defibrillator (AED) is a portable device that may be able to shock the heart back into rhythm if it suddenly stops. Dr. Scott underscores these are important for any sport – even when it’s not a global pandemic.

“If your child has a rhythm disturbance, CPR is nice, but an AED will save their life,” Dr. Scott says.

Making a choice that’s best for your family

Dr. Scott understands the confusion and even frustration families and athletes are feeling.

“Our knowledge base is constantly changing,” she says. “Making a decision about playing sports is not cut and dry. Juniors and seniors in high school often have a lot riding on their seasons. It really comes down to what’s best for your family and your athletes.”

For Dr. Scott, that includes weighing your child’s risks of developing complications and reviewing the protocols schools and teams have to reduce the spread of COVID-19.

But, most importantly, it includes following those guidelines. “You don’t want to base a return-to-play decision on whether or not there is a tournament coming up. You also can’t keep your child or the community healthy by not following the guidelines yourself.”

Dr. Scott encourages parents to model healthy behavior at games, including properly wearing a mask, maintaining physical distance and respecting team protocols. Being supportive shows your child that it’s important to follow the rules and helps them feel comfortable letting you know if they aren’t feeling well.

“There’s often pressure on athletes to tough things out,” says Dr. Scott. “We just can’t do that anymore. Athletes need to let their parents and coaches know if they aren’t feeling well, even if it’s just mild symptoms. If an athlete has a fever, cough, sore throat or another symptom, then get them tested.”

Talk to your child’s doctor

If you’re not sure what’s best for your family, talk to your child’s primary care provider. They can identify any health conditions that may put your youth athlete at risk of complications from COVID-19 and ensure they start the season with a clean bill of health.

Find a primary care provider near you.

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