As we all wait anxiously to determine if we have truly “turned a corner“ with respect to COVID-19, and as the weather in many places around the world begins to entice people to leave the safety of their homes, our attention turns to outdoor sports and recreation. In the United States alone, there are an estimated 50 million children and teens (approximately 1 out of 3) itching to get back outside to join their friends and teammates on fields and courts around the country.
There are non-contact sports (most racquet sports and golf), collision sports (football, ice hockey, and rugby), concussion sports (martial arts, mixed-martial arts, and boxing), and contact sports (everything else), and organizers at every level are beginning to ask questions about what participation, officiating, and spectating in these sports will look like after the COVID-19 dust settles.
Here I will attempt to “tame the beast” that is youth sports AC-19 (After COVID–19) and offer food for thought regarding the many challenges that organizers, players, parents, and referees might face.
Presently the dilemmas, in general, facing all of us as we long to get back outside are: Insufficient testing capacity, lack of consistency across municipalities and states with respect to spread-mitigation, inadequate surveillance infrastructure to accurately trace contacts of infected individuals, and the absence of a viable and widely-distributable vaccine.
Why are we even talking about youth sports?
Youth sports are a staple within the community infrastructure, with over 30% of all youth under 15 participating in at least one organized sports activity. The fiscal impact on the sports industry in general and on communities specifically cannot be underestimated. Community sports offer another vehicle by which youth learn everything from teamwork and discipline to problem solving and leadership. The social benefits of youth sports include socialization of children and family bonding, while the health and fitness benefits of organized youth sports participation have long been well-documented within a population where growing numbers of children are being diagnosed with hypertension, diabetes, and obesity.
Typically the youth sports logistics flow begins with local or regional league organizers, and it flows downhill through team managers and coaches to the parents and players. Venues, times, uniform combinations, field set-up and take-down, payments for officials, and post-competition score-reporting are just some of the moving pieces that must work together smoothly to ensure that all the youth player has to do is simply show up and play.
Now logistics will include the added COVID-specific planning and burden of venue seating in the era of social-distancing, field set-up to ensure player distancing, equipment sharing between players and teams, in-game hydration, hygiene, and injury management. It is likely that distribution of in-game and halftime snacks will be eliminated, and bench-seating configurations will ensure safe social distancing practices. It is unclear whether players who are not on the field of play, coaches, and other game accessory personnel will be expected to wear masks, though it is entirely possible. Venue seating will be tricky and will undoubtedly now have to be tightly monitored and limited in many cases. Venue set-up will have to carefully mark and monitor “assigned” seating, and technology platforms are already entering the marketplace to allow for e-ticketing systems to ensure that safe seating capacity is maintained. Logistical plans will have to ensure that due diligence practices account for cleaning and disinfecting of all shared spaces (bathroom, port-a-potty, locker rooms), and snack bars will likely remain closed due to food handling and group gathering concerns.
Training, Apparatus & Equipment
The hallmark of youth sports is training. Although the game is at the heart of the excitement for players and spectators, many community-based sports programs have a training-to-competition ratio of 2.5-3.0:1, meaning that for every gathering to compete, there are 3 gatherings to train (practice). As we begin to re-shape the youth sports landscape within the context of a pathogen that we do not yet fully understand and with the looming shadow of the possibility of recurrent waves of case-surges, planners, participants, and parents will all share in the responsibility to keep the playing environment safe. In the wake of this first (and hopefully only) COVID-19 pandemic wave, players will likely be required to own and therefore be responsible for their own equipment. For many sports, this is easy and not cost-prohibitive, but for sports such as hockey, football, baseball, lacrosse, etc., the cost associated with the likely mandate may negatively impact the player pool. Parents and players may be required to document the cleaning and disinfecting of personal equipment, while organizations will have the same responsibility for shared equipment such as goalposts, benches, locker rooms, field-lining equipment, and other field-space preparation items.
COVID-19 has undoubtedly raised the level of awareness with respect to personal contact, and this is perhaps the most significant hurdle facing youth sports. With few exceptions, training without contact is suboptimal at-best, while in competitive contests, contact between players is unavoidable. In the absence of eliminating contact, the challenge will shift to optimizing the health of the participants–which for a disease that we still do not yet fully understand, is going to be tricky. Based on what we currently know, and in the absence of reliable and widely accessible infection and immunity testing, surveillance mechanisms will be critical.
League organizers will likely have to have in place a simple, consistent, and easily reportable method of documenting sick and febrile (people with fever) players and participants. The current pre-game routine of presenting game officials with line-up cards and verification of age and team assignment will now likely include a coach attestation as to the “wellness” of those rostered players. Additionally, parents will now have mandatory fever and illness responsibilities and reporting requirements as will coaches and referees. “Sick” players, coaches, and officials will be required to self-report and to stay away from teams and venues until “cleared” to return.
The excitement of youth sports extends beyond the players, as watching youth sports is an opportunity for family and extended family to gather, watch, and cheer. Venues range from small community park spaces to large tournament field complexes and stadium venues. In each venue, the seating of spectators will create yet another area of planning and surveillance. Since social-distancing appears that it is here to stay for the foreseeable future, the level of challenge related to spectator seating will be proportional to both the size of the venue and the size of the crowd.
Smaller venues will have to develop a mechanism to mark individual seating areas while field marshals will then be given the added responsibility of monitoring the seating configuration. Larger venues will require a similar process. We are already beginning to see technology platforms within the marketplace that allow for seating configurations to be “mapped” with each seat then linked to an e-ticket. Subsequently, acquiring the e-ticket not only assigns the seat to the spectator, but it also becomes an electronic attestation where the spectators affirms that they have been “well” and “fever free” for the 14 days prior to the ticketed event.
Team Dynamics, Gamesmanship & Sportsmanship
Youth sports offer children the opportunity to learn about the benefits of hard work and competition. Perhaps the two most significant lessons that adults teach and children learn center around the concepts of team and sportsmanship. Team training events often start and finish with communal team-spirit activity such as joining hands in the middle of a circle and collectively shouting the team name or some other unifying exclamation.
Throughout training and competition, teammates often celebrate one another with high-fives and fist or chest-bumps. Competitors often help each other up off the ground using hand contact, and players end matches with a sportsmanship display that also involves players contacting each other and their game referees. All of this contact-dependent sportsmanship will undoubtedly be eliminated from post-pandemic youth sports and likely replaced with non-contact shows of sportsmanship such as head-nodding, bowing, or the “Wakanda salute.” These points of contact framed important teaching moments that are essential in the development of the youth sports participant. League organizers will have to be as creative as they will need to be vigilant so as to safely continue to teach team unity and sportsmanship.
Surveillance & Self-Reporting
One of the largest logistical hurdles facing leaders at every level of public health and government is disease surveillance. This broad term includes real-time identification of new cases, following known cases of infection to resolution (recovery vs. death), and contact-tracing—which involves tracking down all of the individuals who were in contact with the infected individual.
The United States public health infrastructure continues to develop and train a workforce capable of this daunting task. Presently, a reliable widespread contact-tracing framework simply does not exist. It will be incumbent upon youth sports organizers, both for public health and safety reasons and as a means of liability mitigation, to have mechanisms in place to monitor players, parents, and other participants who might become ill after a training session or competitive event. This mechanism will have layers of reporting including notifying opponents and spectators as well as the mandatory reporting requirements of the jurisdiction where the event was held. These strategies will need to be able to meet the mandate while also maintaining confidentiality.
Burden, Due Diligence & Liability
The challenges facing youth sports in the weeks, months, and years to come will test the organization and the resolve of the players, parents, coaches, spectators, and organizers. Effective implementation will require a shared commitment to maintain safe and healthy spaces for all participants. COVID-19 has redrawn the landscape of how humans will gather together. But we have consistently demonstrated that we are nothing if not resilient and creative.
A wise and familiar proverb perhaps best captures our “now”; “Necessity is the mother of invention.” This proverb suggests that working together, we can continue to create opportunities for our children to enjoy sports participation at every level in a safe and exciting way. Due diligence and implementation of best practices will not only optimize the health and safety of playing spaces, but attention to these areas will also limit liability within the context of the dangerous and ever-changing public health minefield that is COVID-19.
Simple Recommendations For Safer Youth Sports
- Social distancing for all players not competing (on the bench)
- Social-distancing practices during training with respect to players’ personal equipment (backpacks, bags, water bottles, etc.)
- No unnecessary pre- or post-practice gatherings for team/parent meetings, etc.
- Self-reporting of illness and/or fever, with a clear and understandable return-to-play clearance mechanism
- No celebrations involving player-to-player, player-to-coach, or player-to-referee contact–contact such as high-fives, fist bumps, chest bumps, etc.
- Limit shared equipment (pads, helmets, etc.) with diligent sanitizing of essential shared-equipment (balls and other equipment)
- Social-distancing requirements for parents and other spectators
- Ready access to hand sanitizer for players, referees, and spectators
- No team snacks, concessions, or snack bars
- No shared water bottles, coolers, etc.
- Laundering and disinfecting all training and competition clothing and equipment after every use—including coaching items such as training vests.
- Reinforcing proper cough/sneeze hygiene as well as “soft” monitoring of face touching, nail biting, etc.
- Limiting training and competitive groups to 20 players or less if at all possible/feasible.
Christopher T. Conti, MD
Doctorpedia, Founding Medical Partner
Team Physician, United States Soccer Federation
Concussion Medicine Physician
United States Youth Soccer Association, Return-to-Play Committee Member