General Guidance for the Operation of Interscholastic, Youth and other Amateur Sport Activities

during the COVID-19 Pandemic Fall/Winter 2020

 

Executive Summary

In the interest of primary prevention of COVID-19 disease, the Connecticut Department of Public Health is offering revised guidance for the continued operation of sports activities for private, municipal, and interscholastic youth and adult sports leagues. This revision is offered given the general expectation of an increase in the number of infections across our state during the fall and winter months, the anticipation that schools and workplaces will bring individuals back together in larger numbers, that colder weather will force more activities indoors, the shift in age distribution of COVID-19 cases in CT to youth and young adults, and the persistently high level of disease transmission in most areas of the United States. The guidance is based on the recognition that by their nature of play certain sports are more likely to promote exposure to the virus that causes COVID-19 (SARS-CoV-2) through respiratory droplets and subsequently amplify community transmission. Sports organizations should evaluate these risks when making a determination whether or not to suspend or continue activities in the Fall and winter, and should inform players and parents of the risks as appropriate.

Risk Categorization for Various Sports

In developing this guidance, DPH has considered guidance for risk categorization of various sports published by the National Federation of State High School Associations (NFHS) Sports Medicine Advisory Committee[1], to categorize individual and team sports and the various activities common to all sports according to their differential risk for the spread of COVID-19 among teammates, between teams, and in the wider community. Table 1 lists the current risk categorizations defined by NFHS, with applicable individual sports identified for each category.

In assigning risk categories, NFHS considered the fact that direct person-to-person spread via respiratory droplets is the most likely route of transmission for COVID-19, the factors associated with the generation of respiratory droplets and the dynamics of their travel between individuals, and the specific aspects of normal play that require close contact or lend themselves to the implementation of mitigation strategies.  In the case of NFHS, the categorical decisions made by their Sports Medicine Advisory Committee were made with deference to guidance provided by the United States Olympic & Paralympic Committee.[2]

 

Table 1:  Risk Categorizations with Associated Sports, National Federation of State High School Associations, Sports Medicine Advisory Committee, May 2020

HIGHER RISK

 

Sports that involve close, sustained contact between participants, lack of significant protective barriers, and high probability that respiratory particles will be transmitted between participants.

Wrestling

11-on-11 Football

Boys Lacrosse

Competitive Cheer

Dance

MODERATE RISK

 

Sports that involve close, sustained contact, but with protective equipment in place that may reduce the likelihood of respiratory particle transmission between participants OR intermittent close contact OR group sports OR sports that use equipment that can’t be cleaned between participants.

 

Basketball

Volleyball*

Baseball*

Softball*

Soccer

Water polo

Gymnastics*

Ice hockey

Field hockey

Tennis*

Swimming relays*

Pole vault*

High jump*

Long jump*

Girls lacrosse

Rowing/Crew (with two or more rowers in shell)

7-on-7 football

*Could potentially be considered “Lower Risk” with appropriate cleaning of equipment, use of masks by participants, moving activities outdoors, and/or other appropriate mitigation strategies

LOWER RISK

 

Sports that can be done with social distancing or individually with no sharing of equipment or the ability to clean the equipment between use by competitors.

Individual running events

Throwing events (javelin, shot put, discus)

Running (staggered starts)

Individual swimming

Golf

Weightlifting

Alpine skiing/ snowboarding

Sideline cheer

Rowing/Crew (single sculling)

 

Cross country

 

 

Risk Categorization for Various Athletic Activities

In addition to categorical risks applied to specific sports, similar risks can be applied to the types of progressive activities that are generally similar across sports.  Sport-related activities can generally be divided into the following groupings (listed in order of risk):

Tier 1:  Individual one-to-one training, Small group aerobic conditioning, Small group sport-specific non-contact skill development drills

Tier 2:  Team practices, Intra-squad scrimmages

Tier 3:  Interscholastic or in-state contests, meets, or tournaments

Tier 4:  Interscholastic or other contests between teams from different states

As with the risk assignment of sports, assigning risk to athletic activity-types requires attention to the size of the group participating in the activity, the ability of participants to utilize general public health prevention strategies (distancing, mask wearing, hand hygiene), the ability of coaches or other supervisors to control and ensure compliance from participants, the environment in which the activity is taking place, and the dynamics of contact and potential respiratory droplet spread involved with each activity. 

The ability to operationalize and ensure compliance with appropriate mitigation strategies in a way that does not introduce additional safety risks or unintended consequences to health are other important factors that should be considered and applied to decision-making for various sports, in consultation with sports medicine professionals.  Some of these mitigation strategies include (but are not limited to):

  • Moving indoor activities outdoors and keeping individuals in small cohorts
  • Increasing and maintaining the distance between participants
  • Implementing rule changes that reduce the number, frequency, duration, and/or exertional level of person-to-person physical contact
  • Limiting the sharing of equipment without appropriate cleaning and disinfection
  • Adding face covering masks that completely cover the nose and mouth to the required equipment for players and coaches

 

 

Table 2:  Recommendations for the Operation of Interscholastic, Club, and Recreational and Other Amateur Sports Activities 

 

CT State Current Sports Risk Categories (from Table 1)

Activities

Lower Risk Sports

Moderate Risk Sports

Higher Risk Sports

Indoor*

Outdoor

Indoor*

Outdoor

Indoor*

Outdoor

Tier 1

Small group conditioning and non-contact drills

Recommend allowing

Recommend allowing

Recommend allowing

Recommend allowing

Recommend allowing

Recommend allowing

Tier 2

Team practices, intra-squad scrimmage

Recommend allowing

Recommend allowing

Recommend allowing if appropriate modifications are feasible

Recommend allowing

Not recommended

Not recommended

Tier 3

In-state contests meets and tournaments

Recommend allowing

Recommend allowing

Recommend allowing if appropriate modifications are feasible

Recommend allowing

Not recommended

Not recommended

Tier 4

Out-of-state competitions with states on the CT Travel Advisory List

Not recommended

Not recommended

Not recommended

Not recommended

Not recommended

Not recommended

* In all cases, indoor activities should be limited to group sizes of 10 or less with appropriate mitigation strategies for indoor settings in place (face coverings if practical and safe, 6 ft or more distancing, etc.)

Based on the risk categorizations for individual sports and activities above and the status of community COVID-19 infection rates in our state, DPH does not believe that it is necessary to abandon all athletic activities at this time.  However, we do recommend the following for the 2020 fall and winter seasons: 

  • Athletic club organizers should develop specific written protocols for strategies to be utilized during practices and contests, provide those written protocols to the appropriate local health department and participant families, and educate coaches and families about the COVID-19 risks associated with athletic activities and the need for strict compliance with protocols
  • Athletic club organizers should keep rosters of participants for all practices and games with appropriate contact information and make that information available to health officials as needed for contact tracing
  • Tier 4 activities (i.e. competition across state lines) should be suspended and reconsidered for the spring season
  • Sports defined as Lower Risk should be allowed to continue activities, up to and including in-state competition (Tier 3)
  • Sports defined as Moderate Risk should be allowed to continue activities outdoors, up to and including in-state competition (Tier 3)
  • Sports defined as Moderate Risk should be allowed to continue activities indoors, up to and including small group conditioning/skill building (Tier 1), provided routine public health protocols for indoor activities (e.g. face coverings, social distancing, cohorting, hygiene procedures) are in place.Tier 2 and 3 activities should be suspended and reconsidered for the spring season unless additional safe and effective strategies can be developed and implemented, in consultation with sports medicine advisors, to significantly mitigate the spread of respiratory droplet emissions among participants.
  • Sports defined as Higher Risk should be allowed to continue activities, up to and including small group conditioning/skill building (Tier 1), provided routine public health protocols for indoor activities (e.g. face coverings, social distancing, cohorting, hygiene procedures) are in place if those activities are occurring indoors.Tier 2 and 3 activities should be suspended and reconsidered for the spring season unless additional safe and effective strategies can be developed and implemented, in consultation with sports medicine advisors, to significantly mitigate the spread of respiratory droplet emissions among participants.

 

There are real and significant benefits of athletic activity for physical and mental health and well-being for both children and adults. However, DPH does agree with NFHS and other governing bodies that not all sports are equal in their risk for their potential to spread infectious respiratory droplets, and therefore certain sports and activities have more potential to be conducive to the spread of COVID-19 infections in our communities.  This, coupled with recent changes in the data trends for COVID-19 infections, our understanding of the dynamics and the role of asymptomatic drivers of spread in our communities, and our continuing experiences both within our state and nationwide with outbreak events all point to the need for a continued cautious approach to organized athletic activities.