After a Covid-19 Semester, College Doctors Reflect on Sports

Weighing the risks and benefits of participating in sports against the larger public health factors.

My latest column, about the American Academy of Pediatrics’ new guidance on youth sports in the time of Covid, drew two very different sets of parental responses. The guidance emphasizes the importance of wearing face coverings, and also the importance of making sure that any young athletes who have had Covid infections — even asymptomatic infections — are checked out medically before they return, gradually, to full activity.

Some readers were shocked and horrified that youth sports and college sports are going on at all, even with face coverings; to some parents, that is the very definition of unnecessary risk, with players, coaching staff, perhaps parents and even spectators congregating, with the possibility of close physical contact and heavy breathing. Others were shocked and horrified at the idea of asking athletes to wear face coverings during exercise.

Those are not equivalent reactions, or at least not from my point of view. To weigh and measure the risks of participating in athletics, or to think about how to modify the normal athletic schedule to reduce infections are aspects of thinking sensibly around public health risks and benefits. That’s very different from refusing to acknowledge the increasing body of evidence that face coverings protect everyone — the wearer and the wearer’s contacts, and are safe during exercise.

It’s been a semester like no other, and I asked some people who have been taking care of the health of college athletes what they’ve learned and what they’ll be taking forward into the unknown territory of the winter and the spring.

A New York Times analysis released Friday found that more than 6,600 college athletes, coaches and staff members had tested positive for the coronavirus, and there have been reports of spectators behaving in risky ways.

To many people, intercollegiate competition, with attendant travel risks, by definition brings up highly problematic issues of university priorities, and the risks that students are asked to take.

“It’s not reasonable to ask adolescents and young adults to take on additional risks for the enjoyment of spectators and the financial gain of their universities,” said Dr. Adam Ratner, the director of pediatric infectious diseases at New York University School of Medicine and Hassenfeld Children’s Hospital at N.Y.U. Langone Health.

There are places where athletes have been exempt from campus shutdowns, he said: “Everyone is used to there being a different set of rules for athletic programs at universities,” and it’s particularly troubling to see that playing out in a pandemic.

What happens with a college’s sports program has to be seen as part of the larger question of what happens with campus life — whether the dorms are open, whether classes are happening, and whether there is an effective plan in place for limiting exposures and testing for infections.

While some conferences — the Ivy League, for example — have canceled their seasons, there are places that have kept their sports programs going even though they decided it was too dangerous to teach in the classroom, said Marc Edelman, a professor of law at Baruch College who consults on sports-related legal issues, and was the lead author on an article on college sports in the time of Covid in the Michigan State Law Review.

Basketball season, which will be indoors, will be even more dangerous than football season from the point of view of infections, he said.

“These schools have reached the conclusion, right or wrong, that because of the risks of the virus, students should be at home with their families, studying on Zoom,” Mr. Edelman said. “But they’re willing to take a small number of students, who are disproportionately minorities, and fly them back and forth across the country to compete in sporting events indoors because it’s revenue-generating. Ethically, that’s appalling, and logically it doesn’t make sense.”

Other colleges and universities, which do have students on campus and in the classroom, have modified their athletic seasons and the rules they expect their athletes to follow, amid changing information about the virus and its effects, different sports with different degrees of potential exposure, and a changing social landscape.

Dr. Peter Dean, a pediatric cardiologist who is the team cardiologist for University of Virginia athletes, noted, for example, that at the beginning of the epidemic, as it became clear that Covid infection could cause inflammation of the heart in adults, no one in pediatric cardiology knew what the implications were for children and adolescents. Now, cardiologists are much more focused on checking out those athletes who have had moderate or severe Covid infection, or who have persistent symptoms such as chest pain, fatigue or palpitations. “What we’re doing now seems to be working to protect athletes’ hearts,” said Dr. Dean, who sits on the American College of Cardiology sports and exercise leadership committee; so far, there have not been reports of unexpected cardiac events on the athletic field.

Dr. Dean said that in his experience, the students involved in fall sports had been particularly careful to follow the rules about reducing possible Covid exposure. “The fall sport athletes have something to lose, they’re being safe, not going to parties,” he said. “They want to play,” and they know that if they test positive, they can’t.

His colleague Dr. James Nataro, the chairman of pediatrics at the University of Virginia, who is a pediatric infectious diseases expert who studies emerging infections, said that the university, which had students on campus and held in-person classes in the fall, generally did well. “Against almost every prediction, the students complied, the students were just wonderful,” he said.

The school is part of the Atlantic Coast Conference, which modified its schedule to include more in-conference games, Dr. Nataro said, and spectators were kept to a minimum. Still, he said, it was clear, watching football games, that “there were lots of opportunities for transmission,” and some of the good results may have been a matter of luck. And though he himself loves football, he said, he worries about “the lesson it sends if people turn on the TV and watch all these guys without masks standing next to each other — that image isn’t lost.”

Some of the schools that canceled or curtailed their sports seasons were those that do not generate significant revenue from televised games.

Dr. Thomas McLarney, the medical director of Davison Health Center at Wesleyan University, which is a Division III school, said that for fall sports that involve close contact — football, lacrosse, soccer — the teams practiced and worked on their skills, but they did not play against other teams and “did not scrimmage even with themselves.”

In sports like tennis, where strict distancing is possible, he said, there was some opportunity for Wesleyan’s athletes to play — sometimes wearing masks while playing outside. For swimmers, the locker room was taken out of the equation; students changed in their dorm rooms, and then dried off as best they could when they got out of the pool, before going back to their rooms to change back (it helped that it was a relatively warm fall).

“I thought our plan was very good,” Dr. McLarney said, but of course, the plan was only good if the students followed it. “Our students were extremely compliant, I give these folks so much credit,” he said, adding that he was annoyed to come home and turn on the evening news, only to see stories about students taking risks.

Student athletes, Dr. McLarney said, “were hungry for being with other athletes, and we felt we could provide that to some extent — they would rather be out mixing with other teams, but they understood, it’s a pandemic.” Wesleyan is a member of the New England Small College Athletic Coalition, which made the decision in October to cancel winter sports as well, because of pandemic concerns.

“It’s hard,” Dr. Dean said. “We didn’t learn about this in medical school.”

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