It’s a strange world that athletes are practicing in with COVID-19. Everyone from professional sports teams and athletes to children’s club sports have had to make some tough decisions weighing the risks due to COVID-19 versus the benefits of sports to a person’s physical and mental health.

Dr. Nicholas Slenker, an orthopedic and sports medicine surgeon with Coordinated Health, part of Lehigh Valley Health Network and works with the athletic department at Lafayette University, said the medical community has been working hand-in-hand with schools and universities to help them make athletic health plans and implement guidelines from the Centers for Disease Control and Prevention, the National Collegiate Athletic Association, Pennsylvania Interscholatic Athletic Association and the National High School Association.

“I feel passionately about sports,” he said. “The science is there that allows us to get the kids back in a safe way.”

The mainstays come down to three things:

1. Make sure plans are in place to protect the health and safety of the athletes;

2. Make participation in sports possible, even if it is just practices, and;

3. Be flexible and realize practices or games may have to be rescheduled or canceled.

“This is such a changing landscape,” he said. “What we decide right now is not necessarily set in stone.”

The motto of medicine

Slenker said keeping athletes healthy is the motto of sports medicine. To make that possible in the midst of a pandemic, practices and games are done a little differently. For instance, the players no longer use the locker rooms. Athletes come dressed for practice and leave that way.

“The locker room space is that close, confined space that worries us for virus transmission,” he said.

And the water station is no more. Instead, athletes are asked to bring at least 2 gallons of water with them to practice and games. They keep track of it and keep it separate from that of the other players.

“Dehydration has a big effect on sports injuries,” he said.

The changes also include:

• Coaches are conducting daily checks of athletes’ health and stressing the importance of washing hands regularly, wearing masks, and maintaining social distancing when not on the field, which is easier to do in noncontact sports.

• Coaches are putting the athletes in groups of eight to 10 people during practice. That way if an outbreak occurs, the number of people exposed is limited.

• No sharing of equipment. The athlete brings his or her equipment to practice and takes it back home. Items that have to be shared like a football get cleaned as often as possible.

• No busing of the teams. Transportation is provided by the athlete’s family. For that reason, the games are being scheduled between teams that are closer to each other.

• Game schedules could be different. For instance, if a school plays against another school two or three times in a season, then they might play all of their games against that school on the same day. That way, if the one of the teams has a breakout of COVID-19, then the games will have been played.

• And players who feel sick must stay home.

What to do if you are sick

If a player thinks he or she might have COVID-19, Slenker said the athlete should do a video visit with a physician or speak to one on the phone. The physician can write an order for a test to find out if he or she does have the virus.

“Along with social distancing, testing is critical,” he said.

Usually it takes a day or two to get the results back. The athlete should stay quarantined until the results come back.

The team does not have to quarantine if the results will be available in a day or two. It really hinges on the turnaround time of the tests, he said.

If the result is positive, then contact tracing has to be done. The guideline for contact tracing is “inside of 6 feet for more than 15 minutes.” In the case of team sports such as football, “most of them are going to have hit that threshold.” Quarantine is for two weeks.

Get the flu shot

Slenker recommends that all players get an influenza vaccine in order to help eliminate that illness as a cause of their symptoms.

“There are very few viruses that are as contagious as (COVID-19) is with asymptomatic people,” he said. “It makes controlling it a little bit trickier.”

Slenker went on to say, “You can be really asymptomatic for three to four days, and that’s almost when you’re most infectious, which is very different than in any other virus that we see.”

With influenza, most people feel ill when they are contagious, he said. That’s not always been the case with COVID-19.

“Especially for kids, there is a higher chance of them being asymptomatic,” he said. “We’re not quite sure why. They probably have a better immune system.”

A healthier immune system helps them fight off the virus and have less severe symptoms.

“Quick contract tracing is critical,” he said.

A rare side effect

One very rare side effect of infection is an ailment called myocarditis.

Slenker said it’s rare, but is a concern in the medical community because the long-term effects of COVID-19 are not known yet.

Myocarditis is an inflammation of the heart tissue. When it’s diagnosed, the athlete needs to rest until the heart tissue calms down. This means he or she might not be able to play the sport for a year.

“Sometimes that can be a risk as these athletes get out on the field and begin exerting themselves,” he said. “While it’s extremely rare, when it happens it can be devastating and sometimes takes the life of our athletes with sudden cardiac death.”

Slenker said they haven’t seen a case of myocarditis in this area.

When it does come up, a complete cardiac evaluation with an EKG is ordered. If a more serious condition is found, then further testing is ordered.

The medical community has not found a genetic factor or pre-existing conditions as components that could bring on the disease.

“Most of these are really out of the blue,” he said, but reiterated that the condition is rare.

Slenker said the best way to help athletes stay healthy is for the community to continue to do what they can to stay healthy.

“The virus is in our community and there are going to be positive cases. We’ll be able to beat this thing by being diligent,” he said. “If we’re smart in the community and we’re not having a big spread, then it’s going to allow the kids to play.”