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Q&A Transcript from AHAA Webinar (Aug. 10, 2021)

The following is a transcript of the Q&A section of the webinar entitled Athletics in the Era of COVID-19 - Vaccine and Return to Fall Sports Updates. The questions and answers are posted as they were originally entered and are listed in the order that they were answered.

When will we need to stop quarantining for a positive test?
Fully immunized people do not have to quarantine following a positive test. Those with a positive test will still need to isolate for a minimum of 10 days. Early evidence in some of our USOC data, shows that immunized people may clear the infection faster and we may be able to isolate for a shorter time.

 

Travel to and from games are by Vans and or Buses what do you recommend for team travel
If 100% of those in the van/bus are vaccinated then I think the masking, social distancing can be relaxed. Some organizations have gone with a number of 85%. What we have learned is that most of the infections in sports don't happen during play, but during socialization (travel, meals, meetings, hanging out.)

 

Should you get the vaccine if you have health issues?

It would depend on your health issues and if you had a contraindication to receiving the vaccine. The only true contraindication is an allergic reaction to a first dose or to any components of the vaccine. So, I would recommend the vaccine for most people.

 

Knowing that myocarditis is unlikely either way, is there any data on lower risk of myocarditis for those vaccines? Any other non-URI benefits of getting the vaccine?

We don't have any data per se, but those who get the vaccine are much less likely to get severe covid disease. We have learned that those patients with moderate to severe symptoms (prolonged fever, oxygen need, hospitalization) are those that are more likely to get myocarditis. So it would seem that immunizations should lower the risk of myocarditis.

 

What are your thoughts on the studies that state natural immunity after getting COVID is 6x stronger than the vaccines?

The data supports that the vaccinations have a much longer immunity versus natural infection.

 

What about immunity from natural infection? We are seeing global studies showing strong, lasting immunity from natural infection, yet the CDC seems to be ignoring it.

Yes. There have been several studies that show that natural immunity can last for 90 to 150 to maybe even 180 days. Vaccine immunity is "durable" meaning it is expected to last for a much longer period.

 

Can you address the need for someone who has been previously infected and recovered from COVID-19 to get vaccinated? Are there other concerns with the vaccine in someone with “natural immunity”?

What we know about natural infection is that protection lasts from 90-180 days and the vaccination will last longer than infection. Immunization also decreases the transmissibility from those that may test positive.

 

If an athlete has ever tested positive for covid, should they receive a post covid clearance for continued participation?

The schema has changed based on the severity of disease. Those with mild or asymptomatic disease should follow a graduated return to exercise protocol. (BJSM has an excellent model) - if they have exercise intolerance during the RTP process, they may need further testing. Those with moderate or severe disease (prolonged fever, O2 need, hospitalization) should get medical/cardiac clearance prior to return to play.

 

Athletes and stakeholders with an autoimmune condition may have vaccine hesitancy. Potential complications of the vaccine with my personal condition, G6PD deficiency, was of concern to me, so I consulted my GP and am now fully vaccinated after the relevant information on G6PD deficiency and the safety of the Covid19 vaccine was presented: https://www.youtube.com/watch?v=WUaEB3TQhaA

Thank you for that response. I agree that educating young people and those with medical conditions is the key.

 

How can you mention the potential risk of long-term issues for individuals that get infected with COVID without mentioning the potential risk of long-term issues from the vaccines?

We don't know the long term risk from the vaccines yet, but in our short stint with covid, we have seen many complications (and death) from infection. In athletes, we have seen long covid in even asymptomatic athletes that have limited their ability to return to sport.

 

While the NCAA has stated that based on data collected during 2020-21, that transmission as a result of playing sport is very rare. How much more concerned should we be in Fall of 2021 with regard to spread during intercollegiate sport with the Delta Variant being significantly more transmissible?

I think the risk of transmission with the delta variance is higher, which is another big reason for more athletes to get vaccinated. However, the short term episodic exposure during practice and play has not been a significant source of infection. We will still need to keep social distancing, masking, hand washing, staying home if sick or symptomatic, etc.)

 

If you are vaccinated or unvaccinated is there still an amount of time you should wait before getting tested if you have been exposed or are symptomatic?

If you are immunized there is no need to get tested after exposure, unless symptomatic. If not immunized and exposed, the patient should quarantine and per the CDC could consider testing at day 7 and if negative could come out of quarantine. However, whether immunized or not, people with symptoms should get tested.

 

I've heard (not sure what news site) that regular covid testing required by a school or by work (as opposed to by a health provider) will likely not be covered by insurance companies. Do you have any insight on this? If it is accurate or not?

I have not heard that yet, but as of yet, most covid testing has been free or covered.

 

For intramural and social sport programs, should we mandate vaccinations for our participant-facing employees?

I think for safety, strongly recommending vaccinations increases safety. If not against the laws of my state or community, I would mandate. Colleges require many other immunizations to prevent transmission of infectious disease, this should be no different.

 

Is there a time that the vaccination will last? Meaning, does our vaccinated student-athletes (the population) need a booster or another dose at some point in their career?

There is evidence that protection levels do degrade over time. The data suggests that boosters are likely going to be needed for immunocompromised and highest risk group first. I do think that given Covid is not going to complete go away there will need to be boosters at some point. Will it be yearly? every two years? This is not fully clear yet.

 

With Delta seeming to resolve more quickly - will CDC change quarantine guidelines?

That is possible, we still don't have enough data yet, but the evidence from Israel shows this may be possible.

 

Should there be an emphasis on testing referees if they are unvaccinated in outdoor sports if unmasked? Indoor sports such as basketball if unmasked?

Depends on the closeness of the referees to the athlete and if the referee can be masked. It would be safest to emphasize testing on referees who are unvaccinated, knowing that a negative test would reduce any potential transmissibility. But if testing can't be done, masking of the ref and use of an electronic whistle can be used.

Why are some specific populations hesitant on getting the vaccination?

I think it is secondary to lack of clear educational messaging or due to cultural hesitancy to vaccinations or distrust of the healthcare system. Also, the vaccine has become politicized, which has contributed.

 

Thanks. Yet the CDC has been stuck on 90 days since last winter. Also, I understand there were several shortcomings with the study out of Kentucky that Dr. Swartzberg cited? Why hasn't the CDC acknowledged the other foreign studies that show opposite results?

The CDC is still remaining conservative in their approach, because it is safer for large populations.

 

What is the response, in a language students can understand, when they share that their family members are encouraging them to stay unvaccinated? We are in a very rural, conservation, "non believing" location.

I would focus on the safety of the vaccine, the decrease in the likelihood of significant disease and reduced transmission.
But would agree that this needs to be in language that is understandable and culturally acceptable.

 

Can you please explain more detail on early outpatient treatment for a COVID-19 case and how has that changed with the Delta variant?

there’s really not a difference in the treatments of different variants. one of the monoclonal antibody therapies (bamlanivumab, by Lilly) was taken off the market because its become less active to delta and other strains, but in general the treatments are the same, and limited only to people who are at high risk. But drug development is progressing, with outpatient antivirals, especially molnupiravir, which I’m hopeful for as an outpatient intervention. But still months away

 

With collegiate athletic travel returning to a more normal level across the board. From a public health perspective, are there any strategies for testing patients who develop symptoms while traveling. Antigen vs PCR? Non-charter flight trips seem to pose a risk to public health

A symptomatic individual should absolutely be tested. A symptomatic person with a negative antigen test should still have a PCR test. As the FAA still requires masking the risk is lower than it would be without masks.

 

The NCAA does not recommend masks during practice/competition whether the athlete is vaccinated or unvaccinated. Is this safe?

Again, what we have learned so far is that most transmission happens in social settings less in the sport environment. What we currently know about Delta, this is still the expectation.

 

What are your thoughts on youth sports and those not eligible for the vaccine?

I think that this is a difficult question for sport in those that are not able to get vaccinated. I would focus on masking, distancing and other hygiene when possible (travel, meetings, meals) also having as many of those who are able to get vaccinated, vaccinated will reduce the overall risk of infection from adults and teens to the younger population.

 

Are you seeing more reinfected individuals or vaccine break through cases?

I have seen more unvaccinated cases by far. then reinfections of those who are not vaccinated after infection. I have had zero in people who have gotten the vaccine after infection.

 

Is there COVID data coming out of the Olympics? If so, how is it applicable to college athletics?

There was data collection, which may be made available. I hope it gets released and hope that it allows us to learn more about transmissibility in the current time.

 

Is there any upcoming recommendation to limit travel for athletic participation within a region as seen in Canada with health region restrictions? If you do not know of a recommendation at this time, do you foresee regional limitations for essential travel in the future with the Delta variant which would limit or cancel opportunities for travel to athletic events?

I would hope that we see an uptick in vaccination and a drop in the number of cases that would limit this. But, if the delta variant surges, there may need to be a regression to mask mandates and travel restrictions.

 

So we are surging back up in cases but we are also increasing in the number of people vaccinated correct? So is the vaccination helping or is it the mask and distancing that was decreasing the number of cases post February?

Both are effective. Vaccinated people are less likely to get infected and if infected are less likely to transmit disease, so a combination of both factors is beneficial.

 

Sorry, I know this is somewhat of a repeat, but I just want to be sure. What is the thought about relaxing distancing/masking guidelines when a team is fully vaccinated. We are interested in using that as a incentive in order to get a higher vaccination percentage.

I think if the unit in which the athlete interacts is 100% vaccinated, then restrictions could be relaxed. For safety, however, masking during travel and meetings would continue to keep the risk low.

 

Return to play recommendations and testing for athlete’s with significant symptoms/hospitalization and lingering symptoms post-Covid infection. I.E. chest pain, decreased respiratory capacity

https://www.amssm.org/Content/pdf-files/COVID19/NCAA_COVID-19_30-APR-2021.pdfI Is an excellent resource developed by sports medicine and sports cardiology doctors.

 

What is the reinfection rate with Delta?

Sadly we don’t know perfectly - there are certainly reinfections occurring, but how common they are compared to previous strains is not yet clear. It also depends on when you were previously infected, as neutralizing antibodies certainly wane over time. eg: I’d be less confident about protection the first infection was over a year ago

 

Do you have a few physical (or linked) resources that are easy to be academically digested by the athletic population that helps to debunk and streamline the information supporting vaccination? There is SO MUCH terrible info out there on social media and the like to combat vaccination that finding succinct resources to send out for review is difficult yet important.

USCAH does have this information. We can post in the AHAA area or send to you directly.

 

When do we think that vaccination will be available to those under 12 years of age?

The trials continue as we speak - there’s more illness, so they’re likely to prove their efficacy quicker, although Pfizer was asked to include more people in light of the myocarditis question, so we’re probably a few months away at least

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