A DOCTOR, A TRAINER AND AN ATHLETIC DIRECTOR
Excerpts from interviews with industry leaders on the virus and #ReturnToPlay
(Photo Credit: Emory Healthcare)
Inflow vs. outflow. Welcome to the life of a reporter In The Year Of The Virus.
There are some weeks when the outflow (writing/emailing articles) matches or exceeds the inflow. This week, I’ve spent more time managing all of the inflow—news, interviews reacting to the news, reading lawsuit filings, talking to lawyers who can explain lawsuit filings—than expediting outflow.
On the class action lawsuit against the Illinois High School Association, I did a podcast interview Wednesday with one of the parents suing the IHSA, Dave Ruggles.
You can listen to the interview here.
Bottom line, there is a lot going on in the #ReturnToPlay and #ReturnToLearn movements, two areas I’ve been hyper-focused on this newsletter.
So as I disseminate the information in real time, and work on future articles, I wanted to send along highlights of conversations I had Wednesday with a medical doctor in Kansas, a high school athletic director in Indiana and the head trainer for Athletico.
First, Dr. David Smith a medical director of youth sports medicine in the University of Kansas Health System. He answered some burning questions about the virus and athletics and how they are working through things in Kansas.
Next is Mike Overturf, who is the director of training at Athletico. He talks about the labeling of risk around sports, as the Illinois Department of Health and the Governor’s office have controversially done, and the potential injury risk for athletes playing in condensed seasons and moving from outdoors to indoors and vice-versa.
The last interview is with Chris Enyeart, the Athletic Director at Lake Central High School in Indiana. He shared how their high school, located in St. John, IN, has played a full schedule of events and has even had a sell out football game (with a virus-adjusted threshold). They are embracing risk rather than cower from it.
Read on from these experts in sports medicine, physical therapy and athletic administration. The stuff from Dr. Smith is especially good.
The words spoken by the interviewees are below the subheads.
DR. DAVID SMITH
OPENING UP YOUTH SPORTS
I said from the beginning it is very possibly to open youth sports. the problem will be maintaining youth sports. Can we stay open? If we have the guidelines in place they are very good guidelines to mitigate risk. You cannot control human behavior. As I watch sports open and ride my bike along a trail that is next to some baseball fields it was like some people were totally oblivious that we have a pandemic. How hard is it really to space yourself out on a baseball field? You can distance, you can wear masks. I did observe coaches with masks on and the kids were not and we asked them to stay out of the dugout and they were in the dugout. So you ask yourself, there are all these good things going on to reduce the risk. The problem is, who is out there policing (human behavior) and asking them to follow these guidelines?
HOW TO MINIMIZE SPREAD OF THE VIRUS
The cases we saw were from being contracted outside the playing field. A friend would go home and get together with friends in the evening have a big get together and all of a sudden we had 12 or 13 cases at one school all contracted from outside the playing field. My encouragement to coaches and athletic directors and parents and school districts is it’s like a game plan. You go into an athletic event with a game plan. That game plan should start with number one, let’s do everything we can to reduce risk so that we can continue sports.
WHAT KANSAS DECIDED TO DO WITH FALL SPORTS
We got through the summer which I called our laboratory experiment. Now we are at fall sports and schools had to decide if they are going to open or not. Our high school athletic association decided to open sports and had an alternative plan but it was an option not mandatory. There was a 50 percent opt in in order for that to happen but the schools didn’t want it. They wanted sports. A lot of that was the mental health aspect of it. We look at the physical aspect of COVID, the heart, the lungs, even the brain now with some reports coming out. There is data. But we don’t seem to paying as much attention to the mental health aspects as we do the physical. A lot of that is we had metal health aspects pre-COVID. We are dealing with those and it was horrible to see, suicide rates going up, depression and anxiety going up and COVID hit. Then we shut down all of these youth activities and what did we expect? The hypothesis is, anxiety, depression, problems go up. And sure enough we have data to support it.
HOW THINGS HAVE BEEN GOING
Fall sports have started. We are into it. We’ve had some schools that have had to shut down and be in quarantine for a bit because of cases and alternate schedules. It’s a moving target every day with the multiple high schools and middle schools we are dealing with. A high school may have a cancellation, so you try and add a school to the schedule. But they are playing. I cover a sideline and I watch the behavior. Well, half the kids are doing well, half the kids are doing poorly. Half the coaches are doing well, half the coaches are doing poorly. I mentioned that to the athletic director of the school where I was standing on the sideline and I told him, ‘look, I’m not here to police. I’m not here to get your school in trouble.’ I just tried to point out examples. Why can’t we control this? Why can’t we make that game plan number one as we want to play sports and we are going to have that plan to do it safely. Now we will move forward and winter sports is the big one and they will come out with announcements next week.
LABELING SPORTS HIGH RISK, MEDIUM RISK AND LOW RISK
I’ve been asked this multiple times for months. I’m not inclined to categorize sports. The National High School Sports Federation has put together some guidelines. We have a local pediatric hospital that has put together guidelines listing these sports. And I can look at those and I can argue against. How in the world can you do cheerleading? Pretty easy. Don’t do stunting. Spread them six feet apart and put a mask on them. How hard is that to do? I watched the cheerleading squad of the local game and one of the athletes was up in a corner staying far away as she couldn’t wear a mask as she struggles with asthma. So the squad put her in a corner. She’s still cheering and the rest of the squad was six feet apart, all had masks on. They did get together closer than six feet but they kept their masks on. So why should cheerleading be considered high risk? Same with dance. Spread out a routine a little bit, spread them apart. Band? They are blowing into horns and you keep them spread out a little bit. Why is football a higher risk than basketball? I watch basketball they are face to face, guard to guard, in the lane, probably sweating and spitting into each other. I can’t make football higher risk sport? So I’ve shied away from categorizing. I could take every sport, and figure out a way to reduce the risk. I can’t eliminate the risk, but I can reduce it.
ANECDOTE-DRIVEN NARRATIVES VS REAL SCIENCE
We still don’t know all those answers. One question is the virus aerosolized or is it respiratory droplets? Droplets are bigger particles than aerosolization and I saw a common study where someone commented, ‘if you can smell a BBQ grill across the park that’s how far this virus potentially could go’ and I was like, huh? That’s a smell, it doesn’t mean the particle is entering your respiratory system. But when you hear anecdotes, anecdotes are fine but that’s not how we practice medicine nor is that science. Anecdotal evidence we pay attention to as they can create a hypothesis to then study. Going back to the masks. I’m a proponent of masks as much as you can as it reduces the risk. As soon as you sweat, basically the air you are ventilating in wets the inside of that mask and the efficacy of that mask goes down tremendously. So theoretically, on a hot day with someone masking up, if they are playing sports they better be changing that mask frequently and every time they change it, they better wash their hands before they touch it and then once they take it off make sure they put it back on and keep their hands away from their face. People are not masking how we mask in the hospitals or in our clinics. The wet mask is something to pay attention to. If your medical experts are working with the governor, they should know that research. They should be able to give that information to the governor. That’s very, very important.
ATHLETICO TRAINER DAVE OVERTURF
LABELING SPORTS LOW RISK, MEDIUM RISK, HIGH RISK
My personal assumption on this is it was a little narrowly focused, saying OK where does the contact ability come in and that’s what categorizes each of those sports. The example of cheerleading is good example. There are ways to mitigate that contact and proximity to each other to enable the sport to continue. I have a son that plays soccer and is participating in the soccer contact days. They wear masks the entire time. Soccer they are supposed to stay six feet apart and in basketball they do that as well as they can but understanding that basketball is not supposed to preclude being able to play defense when you are not six feet apart. So it’s finding ways to mitigate the risk as best as possible and putting controls in place so when something does occur and there is a positive case how can we quickly shut that down so there is not a further spread.
IMPACT OF MOVING SPORTS SEASONS AROUND AS ILLINOIS IS DOING
There is a lot to be seen with that. Today, there are a number of facilities that are very nice. They are no longer playing on the hard ground or grass fields they are on turf fields. There haven’t been studies done that have shown, ‘OK grass field at 30 degrees versus turf field indoors, does that change any inherent risk?’ For me, it’s an awareness leading up to it. In Illinois we have these 20 contact days that are fantastic and we’ll go through a period for two months where we’ll have contact for our traditional fall or winter sports. So when they come in, what is their level of conditioning, what is their level of preparedness similar to coming into August. Is a kid doing their strength training and engaging in conditioning as opposed to just playing video games and expecting to come in and be ready day one. For me, it’s an awareness and it won’t change how we manage it. We’ll manage the injuries as they come but it will be interesting if there is any correlation with a change in season or an increase in soft tissue injuries versus more strongly acute ACL tears. You are seeing the NFL come out with some thoughts and there needs to be more studies to take place around injuries but I think that is where the learning that will come with this and being able to sit down and study.
LAKE CENTRAL ATHLETIC DIRECTOR CHRIS ENYEART
ON RETURNING TO PLAY
We started first day of official practice on August 3rd. We have had to not miss any games here. We shut down for two days at the summer and we had two positive cases and luckily we had cameras in the area and could do all of our contact tracing and it was a small group. We were keeping them in smaller groups and with volleyball keeping the numbers down as they were inside. We had four kids with that positive case and we’ve been going strong every since.
ALLOWING PARENTS TO CHOOSE, OPT IN OR OPT OUT
There is no right or wrong answer here. People ask ‘what should we do?’ and we tell them there is no right or wrong answer. I’m not going to tell people what is right for their family and act like a professional and tell you if you should get tested or whether you should play a sport or not. If you feel it is in the best interest of your family or for your child then do so and do what you have to do. We had a few kids who opted out but we had record numbers of participation this year in tryouts in all sports. A lot of that comes back to the spring and the toll that that took, the mental health aspect of what that did to the kids and our youth when something they are working for is taken away. It was the right call as there are too many unknowns. We are glad we are not doing that this fall. We have lost no games and continue to have our protocols and mask up and have a plan for all of our facilities.
HOW THEY ARE PLAYING FOOTBALL
We completely rebuilt how we usually do a student section and the band. We rebuilt it so we can maximize and get as many people there that want to participate. We had one sell out game. The stadium is built for 4,000 and a sell out this year is 1,500 we almost reached that with another opponent and everyone was properly social distanced. It’s everybody do your part. That is the message to our parents and coaches and kids. It’s not just what you are going to do here at practice. We can manage that. When you leave our program that’s where we are seeing it. People were worried about how high school sports was going to be this hotbed and it would spread throughout the community. And that just hasn’t happened here at Lake Central.