The risks posed by indoor sports during the COVID-19 pandemic

Sports bind Whitney Childers’ family together. She and her husband, Sam Flickinger, see participation in formal and informal athletics as crucial for the development of their two children.

“I think like a lot of families in general, and a lot of families here in Utah, being outdoors, being active, and playing sports is huge,” Childers says. “We do it as a family; we support our kids doing it. Not only is it a great physical outlet, it’s good for them mentally as well.”

But the coronavirus pandemic’s winter surge, as it has with so many formerly routine aspects of daily life, has created cause for worry around youth sports. As the cold weather continues and practices and games remain indoors, the tension between safety and continued play becomes even more fraught.

Childers recalls a recent tournament that her 13-year-old son Kai’s basketball team — he plays for the Salt Lake Sonics — participated in. Despite offering assurances about careful mask use, social distancing, and sanitization policies, Childers says, the facilities were packed with people, many who had pulled down their masks or went maskless altogether. “As a club, as a team, you make a choice,” Childers says.

“We’re not going to participate in that again.”

In December 2020, the American Academy of Pediatrics released a report advising families on how to deal with youth sports during the colder months of the pandemic. The report advised diligent mask use — even during games, a standard few youth leagues hold to — and careful monitoring of children returning to play after recovering from COVID-19. Some medical experts applauded the report for recognizing the important role athletics play in some young people’s lives, in terms of social development, physical health and mental stimulation.

“When we talk about the risk of playing sports,” pediatric cardiologist Peter Dean told The New York Times, “we have to look at the risk of not playing sports,” Dr. Dean said.

As the pandemic spikes in many communities while temperatures drop, families now weigh those risks themselves. Vaccines have not yet been approved for children under age 16, due to a lack of data in studies with different age groups; those studies are expected to extend several months into 2021. Childers’ children have kept up their activities, but, she says, “Every week we reevaluate.”

Scott G Winterton, Deseret News

Risk and reward

“Any sport is, intrinsically, more dangerous if it’s conducted inside than if it’s conducted outside,” says Dr. Sankar Swaminathan, the chief of infectious diseases at the University of Utah. “If you’re outside, that’s a layer of protection, because the wind and the air circulation make it less likely that there’s going to be a concentration of particles around you.”

“Indoor sports bear a greater risk of transmission of SARS-CoV-2, and certain sports (eg. ice hockey) carry higher relative risk,” the AAP’s report noted. “The risks and benefits of indoor sports, in addition to the current community prevalence of COVID-19, should be carefully considered when making decisions about continuing or resuming indoor sports.”

COVID-19 tends not to be fatal to the population playing youth sports. According to the Centers for Disease Control and Prevention, 153 children between ages 5 and 18 hav died of the coronavirus as of Jan. 4, 0.1{066dbc63777e5ed549f406789d72fdeebd77a32711d57f7b38ff2b35c4ba2a42} of 250,208 deaths for which age data was available (of 250,183 deaths) in the U.S. The longer-term ramifications of contracting the illness, like so many aspects of the virus, remain unknown.

“Unfortunately, we do not know if there are any long-term effects on lung function for children after infection with COVID-19 because this is a new strain of virus,” says the University of Maryland Children’s Hospital website. “The good news is that children do seem to have milder symptoms than adults.”

“I can’t tell you if a person who gets an asymptomatic infection or a mildly symptomatic infection today is going to have a higher incidence of heart problems in 10 years,” Swaminathan said. “We just do not know.”

Still, staying away from teams and tournaments until the tide of the pandemic ebbs poses its own problems. The American Academy of Pediatrics report begins with a justification of returning to play: “Reengaging in sports activity with friends has both physical and psychological health benefits for children and adolescents. Participating in sports allows youth to improve their cardiovascular health, strength, body composition and overall fitness. Mentally, youth may experience benefits from the increased socialization with friends and coaches as well as from the return to a more structured routine.”

Difficult decisions

Victoria Jackson, a former collegiate and professional runner and sports history professor at Arizona State University, empathizes with the difficult decisions that parents of older grade-school and middle-school-aged children face. Replacing organized teams with family centric athletic activity, she says, is a viable option for parents of younger kids. But tweens have a strong desire for social outlets to go along with the need to burn energy.

“Middle-schoolers might resist or push back against that,” Jackson says of substituting outings such as family hiking trips for regular sports seasons. “The tween years make that challenging.”

Parents are left sorting through a messy and constantly shifting set of variables: the needs of their kids, the latest updates on spikes and hotspots, the willingness to make sacrifices in other areas of their lives to mitigate the risk of spread. It is a problem, like so many associated with the pandemic, that resists clear answers, even from leading experts. “Ultimately,” the AAP’s report says, “the decision falls on a parents/guardians to decide whether they will allow their children to participate in sports.”

John Gardner has four kids age 14 and younger, all of whom play sports: baseball, basketball, tennis, gymnastics, dance, cheerleading. He is passionate about the benefits belonging to teams affords his children.

“We’ve always been a competitive family,” Gardner says. “We enjoy the competition, we believe that the friendships you develop are important. They learn how to lose, they learn how to win, they learn how to work together as a team. It’s a big part of their lives.”

When leagues shut down during the early stretch of the pandemic, the Gardners turned to family games, playing tennis in the backyard and going to church gyms to practice basketball. “It wasn’t the same, but we found other outlets,” Gardner says.

But when leagues returned, the Gardner family made the decision quickly — the benefits of being back on teams, sharpening skills and developing strong social habits, outweighed the possibility of being infected with the virus. “We feel like they should be playing, and we can make it safe,” Gardner says.

Their family has made sacrifices, such as limiting how often the children can see their grandparents, in part due to sports participation. Gardner notes also that the notion that kids would otherwise be practicing perfect social distance, absent organized sports, is impractical.

“A controlled environment isn’t 100{066dbc63777e5ed549f406789d72fdeebd77a32711d57f7b38ff2b35c4ba2a42} safe, but it’s safer than these kids out just playing with their friends, which they’re doing already.”

Childers has multiple vantage points on the issue; in addition to deciding whether her kids can participate, she works as a board member for MetaSport, a youth soccer organization in Salt Lake City that Kai and his sister Jessie belong to. She notes that, while professional, college and even high school sports organizations tend to have exacting standards for playing during the pandemic, youth leagues have largely been left to fend for themselves, with parent volunteers doing what they can to help organize and regulate things.

There are communities that run counter to this pattern; Minnesota Gov. Tim Walz’s restrictions on youth sports, which paused all activity for weeks and have allowed practices but no games through early January, were met with a lawsuit from a parent group called Let Them Play MN.

In Salt Lake City, “What was the most difficult thing as a board member was trying to make sure that we provided an outlet, and a way for kids and families to still participate within the guidelines, while being very cautious and very safe,” Childers says. She notes with gratitude the carefulness of the particular organizations here kids are involved in: MetaSport, the Sonics, and the Children’s Dance Theater.

“I’m grateful these organizations have done such a good job,” she wrote in an email. “What you can’t always control is whether other clubs and teams you come in contact with are taking the same precautions.”

She describes a regimen of keeping up with the news and science in order to understand various risk factors and the latest learning regarding the pandemic. “You have to learn very quickly,” she says. “You have to follow the science, you have to follow the state guidelines.”

For now, Childers’ children remain in their respective leagues, and she can see the beneficial effects. “Being able to have any sort of interaction where you’re running, getting your heartbeat up, is huge,” she says.

Still, she continues to read, to study the data — to know that the decision to allow her kids to keep playing ultimately comes down to her and her husband. She is willing to pull them out if the situation demands it.

“I don’t want to fall into the trap of saying that if my kid doesn’t compete in a sport, then they’re going to just be have a really mentally hard time and they’re not going to be able to recover,” Childers says.

“There are creative ways that you can still be active: you can hike, you can still do lots of things safely outdoors, especially in our state.” But she knows there are some elements of team sports that can’t be replicated, and that mean so much to her children in a time when social interaction is rare. “You can tell when they come back from it: It just gives them a really big spark.”