HS sports during COVID-19: A Colorado doctor explains challenge coaches, athletes are facing

Posted at 3:06 PM, Feb 01, 2021

DENVER — While educators have been faced with the challenge of teaching kids during a pandemic, coaches and athletic directors are dealing with another hurdle: How can sports safely carry on?

We talked with Dr. Aaron Provance, medical director of the sports medicine center at Children's Hospital Colorado, about the challenges of high school and youth sports during COVID-19 and some of the issues that doctors and coaches are dealing with.

Watch our conversation with Dr. Provance above, and read our full interview here:

Denver7: What is the main challenge that you've noticed over the last year with children getting back into sports while also being cautious?

Provance: I'd say that we're attempting to achieve a balance here. And it's really between mitigating the spread and risk of COVID-19, through physical distancing, and proper hygiene. And then also balancing that with the importance of sports and exercise and promoting health, mental health, physical health, and also cognitive development.

We know that the CDC and many of our medical societies recommend that we have physical activity for both children and adolescents up to 60 minutes a day, and adults as well, for 30 minutes a day. But on the flip side of that, we've also seen that we've had increased risk of depression anxiety during the COVID-19 months and almost a year now.

Denver7: We know children do not have the same impact from COVID-19 that older adults may have. But what are some either lingering health issues that are that you've seen either here in Colorado, or just kind of monitoring these issues in general, across the country? What are a couple concerns regarding children getting COVID-19 and recovering from it?

Provance: I would say the more concerning, or most concerning, health condition that we see with athletes getting back to sports would be myocarditis. And this is an inflammation of the heart muscle, or muscles, that can lead to abnormal function, whether that be the pumping effects of the heart, or even the electrical system of the heart can be affected.

(Read more about myocarditis from the Mayo Clinic)

And that can lead, of course, to issues with electrical conductivity, which can lead to a arrhythmias and other things that can happen with sports.

So what we're recommending is if the athletes have symptoms for longer than three days, then we recommend that they see their primary care physician for this. And all these infections really should be managed by their primary care physician. Their primary care doctor may recommend that they have an EKG done of their heart to see if there's any signs or symptoms of myocarditis. And for those athletes that are having more of a moderate or severe illness or have to be hospitalized, they may even have to have cardiac workup.

But this is, again, all dependent on what the primary care physician sees and how they want to manage the patient.

We're also seeing some different things throughout the throughout the country where we're having athletes with blood clots in unusual places throughout the body, what we think is associated with COVID-19 infection that can be in the lower extremity. Some change in it changes in vascularity, or how the blood flows through the toes, and other areas of the body.

Denver7: CHSAA had a high school football season that was a success, but not without its hurdles and challenges. What are the challenges specific to indoor sports like basketball, volleyball -- compared to outdoor, which has seemed to be a safer setting with COVID-19? But now you get to kids in gyms and more confined spaces, what are the issues that come up with that?

Provance: I think that's a really important topic to discuss today. And we know that transmission of COVID-19 in indoor spaces is higher than outdoor spaces. So the recommendations for those sports being played and participated indoors is different.

For the majority of those indoor sports, it is recommended that face covering be worn at all times, whether that be practice or competition. But I would say there are certain sports where that doesn't always apply. So I want to mention three different situations where that may not apply.

So for swimming and diving, for example, you know, if you had a face covering on if you got wet, you wouldn't be able to breathe very well. So for swimming and diving, the athletes will need to take off their face covering.

Of course, there are some sports where choking hazard could be a risk and the risk outweighs the benefits of wearing a face mask. One of those sports would be wrestling.

And then another sport that I'd want to mention where a face covering could impede the vision with some of our athletes is gymnastics and cheerleading, where these athletes are in the air and if that face covering then goes up over their eyes, they may not be able to spot the landing. And that could be a situation where we can have a high risk and have a much more serious injury.

Denver7: Is it hard to sometimes get everyone on board with wearing a face covering while they're in competition? How is it difficult to get them to take that extra precaution even though it could be inconvenient?

Provance: That is has been a challenge. We have a weekly meeting here at Children's where we talk about those challenges and how we can improve how well our athletes are wearing their face mask. And the coaches are on board and they help us out quite a bit. Athletic directors can also be a big piece of that support for us to make sure their athletes are wearing their face covering at all times. So yeah, it has been a challenge for sure.

Denver7: And if a child tests positive COVID-19 during their sports season, they're obviously going to be quarantined, based off the district's guidelines. But as far as returning back to competition and returning to practice, what is your guideline that you're telling CHSAA and telling schools when you advise them?

Provance: There are a lot of things that the schools and CHSAA are doing to help decrease the spread of COVID-19. And of course, the schools are following those guidelines, but really our local health departments are the vital pieces here for making decisions, whether that be on low versus high risk exposures, whether the athlete needs to quarantine, and for what duration they need to quarantine.

And then if a patient is infected, or has a positive test, how long that isolation period needs to be before they go back to sport. And then, of course, going to their primary care physician to let them know that they've had COVID infection and have the primary care physician doing a full examination of their heart, lungs, and really their whole body to make sure that they really are ready to go back.

Now if they had symptoms for longer than three days, we recommend that they go through a return-to-play process or protocol, where they gradually continue to increase their level of physical activity to look for signs and symptoms of exercise intolerance or troubles that may be arising from myocarditis or some other kind of condition.