Sports safety and COVID-19

Gradually, team sports are reemerging in the U.S., on hesitant terms. Professional leagues have been isolated in bubbles, tournaments have been reshuffled, and stadiums are sparsely filled, if at all. In spite of COVID-19 and its uncertainties, American sports culture persists.

Risk levels for the virus vary by sport, though certain conditions—outdoor locations, low contact—can ensure more safety. Beyond that, much depends on decisive leadership from coaches and managers, setting an example from the top to take health precautions seriously.

Such leaders "need to be a messenger for public health," says Tara Kirk Sell, a senior scholar with the Johns Hopkins Center for Health Security, in a recent episode of the Public Health on Call podcast.

Sell is also an assistant professor of environmental health and engineering and an Olympic silver medalist for the 400 medley relay at Athens in 2004. In this podcast episode from the Johns Hopkins Bloomberg School of Public Health, she touches on major questions of sports safety during the COVID-19 era, such as which activities may be riskier than others, how youth sports leagues and pro teams are trying to stay safe, and factors added from off-the-field traditions like tailgating. Listen or read the full transcript of the Sept. 22 episode below.

So we're going to talk today about sports and COVID-19, and I want a little fun fact here. You actually were an Olympic silver medalist in swimming. Is that right?

Yep, that's true.

So you have some COVID-19 knowledge and some real genuine sports knowledge here.

Yep. COVID-19 and sports is the specialty area of only a few people.

Excellent. Excellent. So we have a lot of questions about safety. And so I'd like to start maybe with the youngest among us. And for example, my son is a high school cross-country runner, and he's facing a canceled season. Feels to me like running is safe, but I'm curious to hear your thoughts on that and could he be running safely?

Well, so I hesitate to say anything is completely safe because we know that there are always risks, tail-end risks, the rare events. And so with anything, something could happen. But I think, for the most part, younger people especially, the sport of cross-country is already a socially distanced thing.

It's outdoors, and people are doing things on their own. So I would say that that's a lower risk activity and that he could probably be doing that. And also, there are so many other health benefits for being an active person.

And I want to talk about that. So what are the safest sports for kids and possibly the least safe sports at this moment?

Yeah, so I thought about this in the past and have gone through the Olympic sports list, and tried to think, OK, how would I rank everything? But in general, I try to think through what's the venue—is it indoors, is it outdoors—what's the level of contact and for how long is the contact we're having, and how many people are we having together. And so I think, OK, things like cross-country, things like swimming, tennis, those types of individual sports or if there's not too much contact going on, these are sports that I think are generally lower risk.

And then you go up a level, and you might say, OK we have contact—we might have more contact or more close proximity, but it's outside. So baseball—I might even put football in here because even though they have contact, they're not in contact for that long. But then, even riskier than that, I would say things like wrestling are highest on the list, possibly basketball might be up there.

This has really struck a lot of people, the lack of sports that we've been having. And so I'm curious, in your mind, why do we care so much about sports as a society? And why is it so important for us to see at least some sports happening again?

Yeah, this is a tough question because you could think, well, we don't need sports like we do food and water and air. Why do we actually need to do this? And I think it's different for everyone. But back to when I was a swimmer, sometimes you think, Why does this even matter? Why am I even spending my time doing it? And I think that a lot of people really need to either watch or be part of something that people are striving for, something larger and something that's hard to do. And that is really something exciting to see, and it's helpful in taking us out of ourselves and bringing us together as a society. I think that that's important.

But I also think that goes within the list of things that are critical for us and that are our priorities. If we think about youth sports, and we think about activity, I think that's incredibly important because we have, also, an obesity epidemic at the same time. So trying to think through how to do things safely, I think, is important for us going forward. We're not going to have an immediate vaccine. We need to think through how we're going to do things in a sustainable way, the things that really are important to us.

It makes me think, What factors beyond contact on the field should we be concerned about with regard to COVID-19?

So I think some of these things are how often we're having athletes in close proximity, how long that close proximity lasts, how efficient the ventilation system is. These types of things are really important. But I also think that beyond just thinking about what's happening in the field, it's really important to include what's happening off the field. I think that while the sport itself might be fairly low risk, partying every Friday night is not low risk. And so I think that we need to think about, well, these are also social gatherings, and it's important for our teens and our kids and young people to get together. But I think that we need to have a culture of safety.

Coaches and teammates need to be part of that to say, well, we could get together to do our sport, which is really important, but that doesn't mean that we're all safe together and that we can go and party at so-and-so's house every weekend or something. This is where, I think, we're having a lot of problems, these uncontrolled events that are happening in people's houses. And that's, I think, more of a problem than actually what's happening on the field, though the two are connected because that's a social network there.

And I guess also people in the stands—because this makes me think of college football. So some colleges have canceled their seasons, but some are still going to play football. I just spoke to the mayor of Tuscaloosa, Alabama, who told me that about 18,000 fans will be in the stands when they host their first home game next month. So even though the stadium holds 100,000 people, this still feels like a lot of people and the COVID risk. What do you think?

Right. Well, so 18,000 is a lot of people, and you worry about bringing that number of people together. Now, if you're in an outdoor stadium, you're seated 6 feet apart, OK, the stands don't seem to me like the biggest risk. But to me among the other things that are involved with a big event like that is tailgating. Are we lining up close together to get into the bathrooms? Are people taking off their masks in close proximity to drink or to eat their food? Are we having house parties or gathering at a bar around these events? Those are the things that I worry about. Also buses and joint transportation.

So it's not necessarily having people in those stands, specifically, but all the other things that come around these events. And that's why I really think the colleges, the sports teams, all the people who are actually doing these and trying to put these on, there's a critical component here that they also need to be a messenger for public health and highlight how important it is for people to stay safe, wear their masks, do these things that help reduce transmission rates in the community, which makes it then more possible to be able to hold an event, do your sport, and those types of things. So it needs to be a partnership.

We each have a role to play. Also, I think of all the screaming that goes on in the stands, and we know that screaming can send the particles further and things like that.

That's definitely a risk. Like I said earlier, nothing is zero risk, so it is possible that all the yelling in the stands could cause some sorts of transmission.

So which would you say maybe is safer then, youth sports or more pro sports? Is there a difference?

It's really hard to say because there's so many different factors that go into this.

With youth sports, there are fewer safeguards. Younger people, especially kids under 10, are less likely to have serious disease and significant transmission, or are at least less likely to get the disease. I think transmission might still be a little bit up in the air right now.

But the other thing, though, when you think about pro sports is that they have doctors on call. They're spending a lot of money to consultants to think through the best technologies and the best ways that they can prevent COVID from [affecting] their team because this is big money. And so I think that's one advantage that they have over recreational teams.

It's true that they have all these doctors on call, but then if you remember just the beginning of baseball season, they kept having to cancel games because people were getting sick. And so in baseball, you barely even have to talk to each other.

Right. Right. Well, with baseball, I think one of the biggest problems was that they were taking some precautions, but they were totally forgetting about other issues, like having a team meeting or getting the team together in an indoor space. That can be a problem. And for a while, I think, there was a thought that you could do a fake bubble, and that would be good enough.

And so I think that if you're going to do something other than what the NBA and NHL have done, then you need to really be testing frequently, and you have to have people take it seriously. Your players and your team need to take it seriously because there are real consequences if you get an outbreak going on your team. And I think maybe people didn't take it seriously. And I can't really say what was going on in people's heads, but it has been better since people have started to say, Oh wait, it really matters that we comply with the rules, and those rules are put in place for a good reason.

Well, also, we've seen with some of the baseball players and actually some other sports that people who have gotten sick have gotten really sick. I mean, they've gotten heart issues that may not go away.

Right. I mean, even the fittest among us can have those bad outcomes. And so I think that it's important to realize these types of things and provide these lessons to the public as well.

I was watching some of the Ravens game over the weekend, and these guys are breathing on top of each other in the huddles—they're all close. I mean, that's key to this game, and as a public health person, it was making me crazy that they're going to get each other sick. I think it's a new reality for all of us to try to balance.

Right. I think it is really tough. I do know that the Ravens players and staff are getting tested all the time. And so as testing opens up and it's more available to everyone, I think that that's going to really help people be able to make the right choices and be out of circulation, basically, before they have the chance to spread it too far. But yeah, there are risks.

There are risks that people are going to undertake when they do these types of activities. And I think that we need to make a judgment on what risks are worth it to both us and society. And those judgments are different for each person. And so I think it's just something that people need to think through.

And I guess as a parent, you want to see sports being played, let your kids get out of the house and run around and just be kids again because they've been locked up for so long.

Right. I mean, I have kids myself, and I'm always thinking through, OK, what other risks and benefits are we balancing here? And in some cases, I think it's hard for people to realize, but we don't live a zero-risk life. And so we have to just decide what's worth it.

In some cases, it may not be worth it to do that one event where you think that you're going to have a chance of a lot of exposure. But if you think maybe there's an event that's more well planned and that people are working hard to keep things safe, and it has a lot of benefits to you, then maybe it's something you do. I think at the end of the day, it's about balancing those risks and deciding what's appropriate.

Public Health on Call is produced by Joshua Sharfstein, Lindsay Smith Rogers, Stephanie Desmon, and Lymari Morales. Audio production by Spencer Greer, Niall Owen McCusker, Cian Oatts, and Matthew Martin, with support from Chip Hickey. Distribution by Nick Moran.