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Return to Sport Considerations for College & University Intercollegiate Athletics

We finally appear to be able to see the light ahead which represents the possibility of campuses reopening and a return to a new normal for athletics.

The American College Health Association has recently published some good guidance that applies to what you do. For this month I think it is very wise we consider these essential points

"Many colleges/universities have hundreds of students participating in intercollegiate (varsity) sports. The novel COVID-19 virus presents a high risk of transmission in athletic settings due to frequent physical contact, potential for aerosolization during exercise, fomites (shared towels, water bottles, athletic equipment, balls/pucks), and the potential physical effects of over-training and dehydration on disease resistance.

Student-athletes are first and foremost students. Athletics and sports medicine programs must ensure department policies, procedures, and communications regarding COVID-19 align with institutional, CDC, federal, state, tribal, territorial, or local public health guidelines and requirements.

In preparation for a partial or full resumption of intercollegiate athletics activities, including practice and competition, athletics and sports medicine programs should consider the following:

Creation of an Athletics COVID-19 Action Team: Team members could include:

  • Athletic director or designee.
  • Head athletic trainer or designee.
  • Head team physician or designee.
  • Coaching representative.
  • Strength and conditioning representative.
  • Student health services representative.
  • Counseling services representative.
  • Student athlete.
  • University crisis management/emergency preparedness representative.
  • Health care system (academic medical center or local health care system) representative.
  • Other potential ad hoc or advisory group representatives could include those from: recreation services, public health, facilities management, custodial services, compliance offices; equipment services; health promotion and well-being services, nutrition/dining services, housing, academics, human resources, campus safety, and athletic conference/governing bodies. 

Creation of an Athletics and Sports Medicine COVID- 19 Action Plan: This plan is a living document that is developed, reviewed, and updated by the Athletics COVID-19 Action Team and includes:

  • Pre-participation screening and evaluation of student athletes:
    • Consider addition of pre-participation questions regarding COVID-19 diagnosis, recent or current illness suggestive of COVID-19, exposure, current restrictions (isolation or quarantine), and/or current symptoms.
    • Carefully review each athlete for the presence of underlying health conditions that places the individual at higher risk for COVID-19.
    • Consider further evaluation of a student athlete based upon their questionnaire and recommendation of team physician or student health or primary care provider. Ensure onsite access to appropriate PPE in the event of a concerning student athlete questionnaire or screening.
    • Consider staggering pre-participation screening (rather than a single “mass screening event”), perhaps by team or by individual athlete appointments, to ensure physical distancing during waiting and examinations and allow cleaning of exam spaces between athletes.
    • Understand that scheduling changes could impact the immediate availability of individual athletes or teams upon return to campus.
    • At the time of publication of these guidelines, the question of COVID-19 testing of all intercollegiate athletes or other at-risk groups (noted on page 2) has not yet been settled. Given the current limitations of testing technology and interpretation of the results, it is clear that even a combination of testing for both infection (nucleic acid or antigen testing) and immunity (serologic or antibody testing) cannot provide a comprehensive picture of the safety of the student athlete "herd." There will also be questions about the need for repeated testing and how often. IHEs and athletics programs are advised to continue carefully monitoring the recommendations of CDC, public health authorities, and professional organizations moving forward.
  • Safe transition/acclimatization to athletic activity. Review adherence to NCAA governing body and sports medicine consensus recommendations for transition and acclimatization to activity following extended inactivity periods.
  • Guidelines developed in conjunction with the campus COVID-19 planning and response committee regarding:
    • Personal protective equipment (PPE) and training for athletic trainers and custodial staff, including donning and doffing procedures.
    • Adequate availability of recommended PPE.
    • Recommended approach to Basic Life Support (BLS), resuscitation, and automated external defibrillator (AED) use in a student athlete/staff/spectator/patient with possible COVID-19
  • An assessment of the potential for COVID-19 transmission in each sport (e.g., individual vs. team sports; contact vs. non-contact sports; major spectator vs. limited spectator sports). Consider a phased return to athletics participation based on potential risk of transmission in each sport. Areas for consideration should include:
    • Sport-related impediments to personal distancing, which is unavoidable in many sports (e.g., wrestling, football, soccer, basketball, and other contact sports) and less common in others (e.g., golf, individual swimming events with appropriately spaced lanes, singles tennis).
    • Ball transfer during practice and competition (e.g., volleyball, basketball, soccer, baseball/softball, etc.).
    • Needs and feasibility of appropriate cleaning and disinfection in shared apparatus sports (e.g., gymnastics).
    • The difficulty/feasibility of “policing physical distancing” among spectators, even in a very small crowd and whether it is a task that athletics staff are able/willing to undertake.
  • Physical distancing principles in athletics. Consider recommendations for physical distancing in:
    • Athletics training room and other sports medicine health care facilities.
    • Athletics locker rooms.
    • Strength and conditioning facilities (including weight rooms). Will need to evaluate the spacing of equipment and use of a “sanitation station” at each equipment/exercise site so that cleaning can take place between each athlete, either by staff or the user.
    • Team meeting rooms.
    • Athletics academic areas.
    • Athletics dining areas.
    • High volume communal areas in athletics facilities, including spectator areas (“the stands,” arenas, and stadiums).
  • Recommendations for virtual team activities (e.g., team meetings). Whenever possible, these virtual activities should include athletes, coaches, and staff currently separated due to high-risk conditions, illness, or travel restrictions.
  • Recommendations on use of personal face coverings (or surgical masks) in the athletics setting (including training rooms and sports medicine settings) that are consistent with CDC guidelines.
  • Recommendations for non-touch temperature check prior to practice, training, and competition.
  • Recommended steps in the transport, assessment, and testing of student athletes or staff with potential COVID-19 illness.
  • Isolation and quarantine guidelines for student athletes:
    • Guidelines should be consistent with campus and CDC guidelines and procedures (see Housing recommendations).
    • Many student athletes live together in groups (e.g., off-campus apartments and houses), which may present issues for isolation and quarantine of individuals and groups.
    • Include contingency plan for onset of illness and/or exposure during athletics-related travel and competition. 
  • CDC guidelines for disinfecting non-emergency vehicles in the event of transport of an individual with diagnosed COVID-19 or a person under investigation (PUI) (available athttps://www.cdc.gov/coronavirus/2019-ncov/community/organizations/disinfecting- transport-vehicles.html).
  • Implementation of an athletics “shared responsibility” infection prevention plan, including:
    • Individual personal conduct consistent with prevention guidelines.
    • Signage about prevention based on CDC, campus, and other recommendations.
    • Hand sanitation stations (soap and water or 60% alcohol-based rub/hand sanitizer).
    • Annual prevention education and training for student athletes and staff.
  • Guidelines for custodial services on appropriate techniques and PPE (as per CDC guidelines) for cleaning and disinfecting common, non-clinical spaces (available here).
  • Guidelines for both athletic trainers and custodial services on appropriate techniques and PPE (as per CDC guidelines) for cleaning and disinfecting training room and sports medicine health care spaces, including terminal cleaning (available here).
  • Travel considerations: sports medicine staff should follow federal, state, local, and institutional public health recommendations related to screening and testing of student athletes and staff following team, work-related, and individual travel.
    • Considerations include travel to community or international “hot spots” and sports involved (contact vs. non-contact sports, team vs. individual sports).
    • Sports medicine staff should provide guidance regarding whether the proposed travel is appropriate given the current stage of the pandemic, potential isolation and quarantine measures that could arise as a result of the travel, and additional screening that may be required as a result of the travel.
  • Contingency plans for illness, isolation, or quarantine of athletic trainers and other sports medicine staff. Consider minimum athletic trainer staffing levels for the safe continuation of team training and competition activities.

Provision of COVID-19 and infectious diseases education and training for athletics staff, including athletic trainers, coaches, strength and conditioning professionals, administration, facilities management, other departmental staff, and student athletes. The Athletics COVID-19 Action Team should recommend the timing (prior to return to campus) and continuing need throughout the academic year(s). The training should include:

  • Details of COVID-19 signs, symptoms, evaluation, testing, course of illness, and transmission.
  • Infection prevention and control concepts and procedures, including physical distancing, avoiding contact with ill individuals, and institutional screening procedures (if any).
  • Individual personal conduct and hygiene." 

Be safe and let us know how we can help you during this challenging time. 

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