In the last two weeks, most Texas high school football teams have started full practices or expanded conditioning workouts in preparation for the upcoming season.
Meanwhile, the coronavirus pandemic has continued to spread throughout Texas and the U.S., causing public health and economic crises while presenting decisions for parents about how to approach their kids’ education and participation in extracurricular activities.
As professional leagues’ successful resumptions have come on quarantined campuses and some major NCAA conferences have postponed the season, the UIL has held firm on its plan to execute the 2020 football calendar in full.
Teams Class 4A and below started practice Aug. 3 and will open the football season Aug. 27-29. Class 6A and 5A teams can currently hold conditioning and skill-specific sessions before full practices begin Sept. 7 and football games kick off in late September.
In recent interviews with four Texas doctors, The Dallas Morning News asked for their perspectives on the viability of those plans, the conundrums families face and the long-term outlook for resuming youth sports amid the pandemic.
Should parents allow their kids to play football this fall?
Each expert was hesitant about the current pandemic climate in Texas and the potential for increased spread through unessential activities.
Dr. Nikhil Bhayani, an infectious disease/epidemiology physician advisor for Texas Health, has a son who played high school freshman basketball last winter. Given the uncertainty about resuming in-person schooling, Bhayani said he’d likely prohibit his son from playing this season, should he want to try out again.
As the parent of two former soccer players, Dr. Steven Singleton, a sports medicine physician with Texas Health, would consider the same.
If his sons had contracted COVID-19 through school or sports, Singleton — also the head team orthopedic surgeon for TCU athletics — said he’d be most concerned about familial spread to him, and then potentially to his patients, and to their grandparents.
While experts agree older populations are at higher risk for COVID-19 complications, research has shown teenagers and young adults have a similar likelihood to contract and spread the virus.
Potential long-term health effects remain unknown.
In a late July study from the Center for Disease Control and Prevention, researchers found one in five previously healthy young adults (ages 18-34) have persistent symptoms 14 to 21 days after infection.
In a Journal of American Medical Association study of 100 patients recently recovered from COVID-19, cardiovascular system imaging showed “cardiac involvement” in 78 patients and “ongoing myocardial inflammation” in 60 patients, all of whom had no pre-existing conditions.
The journal concluded the need “for ongoing investigation of the long-term cardiovascular consequences of COVID-19.”
Doctors noted the possibility of high school players who contract COVID-19 having future athletic opportunities — perhaps college scholarships and professional goals — compromised by medical issues.
According to a report by The Athletic, the Big Ten, which on Tuesday postponed its fall sports season, is aware of at least 10 players who have myocarditis, a rare heart condition linked to people who have had COVID-19.
“It’s not just a respiratory virus that you get over and there’s no consequences,” said Dr. Jill Weatherhead, an assistant professor of tropical medicine and infectious diseases at Baylor College of Medicine in Houston. “We really don’t know and that needs to be a consideration when thinking about if it’s the right time to be starting large group activities.”
What are the biggest concerns high school football presents?
The National Federation of State High School Associations labeled football as the highest risk activity among UIL fall sports.
Doctors say close, on-field contact for extended periods — with and against linemen and in pile-ups after tackles, for example — and large teams and support staffs will increase the likelihood of spreading the coronavirus.
That games occur outdoors is an advantage, they said, but non-game scenarios also present issues.
Most football team meetings and weight room sessions happen in close proximity indoors. Practices, especially in inclement weather, can also occur in fieldhouses, which often have poor ventilation when doors or bays are closed.
While the NBA, WNBA, NHL and professional soccer leagues have modeled successful return-to-play protocol with daily testing and centralized, fan-free campuses, the environments aren’t applicable to the high school level, where financial resources are thinner, access to testing is limited and players are minors.
“In the high school setting, you have athletes interacting with students of all grade levels and coming from home and with their families,” Singleton said. “The virus can get propagated very easily.”
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What developments would make you more comfortable with participation?
Experts recommend parents and administrators use community spread rates to guide decisions.
In attempting to reopen businesses, most states have emphasized a decrease in positivity rate, the number of daily positive tests compared to total tests administered, across consecutive weeks.
Texas on Tuesday reported a 24.2% positivity rate for its seven-day rolling average of COVID-19 cases. The data marked an increase by double-digit percentage points since late July. Gov. Greg Abbott has said a positivity rate above 10% was cause for concern.
Some doctors suggest an even broader look when considering high school football.
“If I’m going to send my kid out there,” Bhayani said, “I would probably want to see ... the decline in number of cases over the last 30 days.”
If areas meet that criteria, experts said, it’s important teams and schools maintain the same prevention standards that helped achieve the decline, ensuring control isn’t temporary.
That likely will mean wearing masks, adhering to social distancing guidelines and maintaining proper sanitizing and hygiene practices — even though traditional seasons haven’t required such details.
Weatherhead also recommended administrators set a benchmark for what constitutes outbreaks and community concern, canceling sports if it’s surpassed.
“I just want people to realize that that does not mean you can take off your mask and go back to your normal lives,” Bhayani said, “because we will see an increase in cases, and it will make things a lot harder.”
In the meantime, Dr. Diana Cervantes, director of the Master in Public Health epidemiology program at the University of North Texas, said coaches should explain to their players the importance of safe behaviors outside practices and games.
“Sports is a very social thing,” Cervantes said. “Every decision you make is going to affect the whole team, and that’s not just on the field. It’s off the field.”
What about other fall sports?
Aside from football, volleyball presents the biggest risk, according to NFHS guidelines, given players’ close proximity on a smaller court, frequent shouting and the indoor setting.
Cross country, with staggered race starts, and team tennis appear more viable, experts said, because of their smaller sizes and natural individual, distanced participation. Traveling and competition against other schools — from different areas of the state that have experienced different levels of pandemic concern — is a risk for all four UIL fall sports.
The doctors said all sports are safer for the community, however, if schools prohibit spectators.
Current UIL guidelines allow attendance at 50% capacity, and most, if not all, schools plan to allow fans.
But congregation — especially indoors at volleyball matches — and potential lack of enforcement for crowd size and separation prompt concern. Major U.S. professional leagues that have resumed competition have done so without spectators.
“Kids want to play. Parents want them to play. It’s good for both physical and mental health,” Weatherhead said. “The sooner we can get these kids back playing, the better, but we need to do it in a safe and healthy way that protects both the players and the staff and also the greater community.”
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