Dr. Susannah Briskin plans to let her 15-year-old daughter play indoor basketball under the following conditions: No locker rooms. Masking and distancing rules must be strictly followed. And when she gets home, the teenager immediately showers and puts her clothes in the wash.
As a co-author of the Covid-19 interim guidelines on youth sports, released by the American Academy of Pediatrics, Dr. Briskin has thought deeply about the safety of indoor sports during the pandemic. For her own kids, the benefits of exercise and seeing friends outweigh the Covid-19 risks, provided the right precautions are in place.
But not all parents feel that way. Sebastian Andion, a team manager for his 11-year-old son’s soccer team in Montgomery County, Md., is one of more than 300 parents who filled out a survey saying they weren’t comfortable moving soccer indoors for the winter season. The ventilation systems at the local indoor gyms didn’t give him confidence and enclosed areas just felt too risky, he said.
As the weather cools and youth sports move increasingly indoors, many parents are grappling with new questions about safety. With daily coronavirus cases in the United States averaging over 150,000 in the past week, this has a new urgency. .
Experts agree that the probability of coronavirus transmission is lower outside, where wind disperses viral particles. Less clear are the risks in large gyms, indoor arenas and other indoor spaces.
While guidelines from both the Centers for Disease Control and Prevention and the American Academy of Pediatrics say the risk of transmission is greater indoors, neither has taken a hard position on indoor sports, though Dr. Briskin said the academy analyzes new data and research every 30 days to determine if any new findings should guide its recommendations.
Recent outbreaks linked to indoor hockey in New England could serve as a precautionary tale. In Massachusetts, all ice hockey and ice skating rinks were ordered to close in October, following an outbreak of nearly 110 coronavirus cases (they have since reopened with stricter rules). This came after a similar move by New Hampshire last month, after 158 positive cases over a two-month period were linked to the sport.
It’s unclear whether the virus was transmitted during the game itself or on the sidelines, locker rooms or related social gatherings, said Dr. Briskin, who is also a pediatric sports medicine specialist at Rainbow Babies & Children’s Hospital in Cleveland.
So much depends on the sport itself. Close contact and physical exertion put hockey and basketball in a higher risk category, but masks during practice and games can provide some protection. It’s easier to distance in swim lanes, but you can’t mask in the water.
So what should parents keep in mind as they’re weighing these decisions?
Parents should consider multiple factors, including the facility’s size and ventilation (big and well ventilated is best), the amount of physical contact in the sport and whether players are required — or able — to wear masks, said Dr. Susan Huang, medical director for epidemiology and infection prevention at the University of California, Irvine School of Medicine.
“The mask, the hand hygiene, the distance,” Dr. Huang said. That is “the trio that you really have to think about.”
Whether to mask during play is often up to the teams. In some sports, it’s difficult. On the balance beam or uneven bars in gymnastics, for example, masks can slip and impair visibility, Dr. Briskin said.
But whenever possible, as much as possible, kids should wear masks when playing indoors, Dr. Huang said.
“That mask,” she said, “is one of the most protective things you can do. And children are very, very adaptable.” While masks are not required for her 13-year-old son’s cross-country team, he wears a special running mask whenever he’s near other runners.
Parents should be sure that masks for sports fit snugly, feel comfortable and, importantly, have multiple layers, said Mark Cameron, an associate professor at the Case Western Reserve University School of Medicine and an emerging infectious disease researcher.
“With exercise, you’re exhaling a lot of moisture, and a single-layer mask of any type will soon get damp and saturate,” Dr. Cameron said. “At that point, it’s not trapping the virus anymore.”
Beware single-layer bandannas or lightweight neck gaiters, and avoid anything with a vent or a valve, which protects only the wearer.
Dr. Peter Chin-Hong, a professor of medicine and infectious disease specialist at the University of California, San Francisco, advises against the N95 mask for exercise and said, “It’s suffocating, it’s tough to wear for long periods of time, and it smells weird.”
Whatever you use, have a couple extra available for when they get wet from breathing or sweat. Travis Woodruff, a coach for the Potomac Soccer Association in Potomac, Md., said that at first, his soccer players complained about masking during practice, but they’ve learned to adapt.
“Masks are part of our uniforms now, just like shin guards. They put it on and they’re ready to play.”
Coaches and trainers are getting creative about adapting practice to maximize safety. At the Sender One Climbing facility in Santa Ana, Calif., where Dr. Huang’s 16-year-old daughter is a competitive climber, all athletes are now required to use liquid climbing chalk mixed with at least 70 percent ethanol, in an effort to keep hands — and handholds — virus-free. Masks are mandated, temperatures are checked at the door and arrows on the floor keep foot traffic moving in one direction.
Since the Potomac Soccer Association canceled all indoor play because of coronavirus concerns, Woodruff and Andion are committed to training their players outdoors all winter, weather permitting, and they’re both strict about enforcing safety measures. Woodruff uses cones to set up a personal distancing grid during water breaks, and he films every soccer practice to cut back on the number of parents attending. Andion sets up socially distanced camping chairs for the kids, which he wipes down with Lysol between use.
Parents should ask if shared equipment, like balls and mats, are being regularly cleaned, as they’re a potential source of contamination, said Dr. Christine Salvatore, chief of pediatric infectious diseases at NewYork-Presbyterian Komansky Children’s Hospital. “Use your own towels, your own water bottles and don’t share,” she said.
One of the greatest dangers, Dr. Huang said, might be snacks and water breaks.
She suggested removing food tables from training altogether, so team members are never tempted to congregate. Consider individual energy bars that are easy for players to eat while distancing.
The C.D.C. guidelines state that the risk goes up with exposure to another team, with travel for away games especially dangerous.
It was a mask mandate, along with widely available hand sanitizer and strict social distancing rules, that helped Dr. Huang feel comfortable sending her daughter back to her climbing gym when it reopened.
But there was another critical factor: She needed assurance that her daughter would be personally responsible for her own safety. So the two sat down and played out different scenarios. For example: If your closest friend is standing two feet from you and not wearing a mask, what do you say? Do you feel comfortable saying something?
In this regard, age plays an important role. “If they’re really little, the onus is on the team and the coach,” she said. “As they get older, choice becomes a part of the equation.”
A recent survey by the Aspen Institute found that parents said their children have played sports an average of six and a half hours less per week during the pandemic. Only about half expected their kids to resume their pre-pandemic sports at the same level when restrictions are lifted.
When weighing the risks of opting out of sports, parents should consider what kids might lose: physical fitness and skill development, but also stress relief and social connection, Dr. Briskin said. In her own practice, she’s seen more stress fractures and overuse injuries from kids returning to teams after stay-at-home orders were lifted. The reason could be a loss of flexibility and strength or a lack of impact activity during quarantine, followed by a sudden return to practice.
However, she said, the social component of sports “may help them bridge over the isolation they may be experiencing during the pandemic.”
Still, if you’re doing a close-contact indoor sport, and you have someone in your life who is immunocompromised or otherwise high-risk, “the risk easily crosses the unacceptable barrier,” Dr. Huang said.
Her own kids, for example, are not seeing their grandparents, other than in Zoom calls and occasional waves from a distance. This is a significant change for the family, who recently moved across the country to be closer to the grandparents and saw them nearly every week before the pandemic.
“I won’t take that risk, because it’s just not worth it. Once they incur risk through sports or school, they incur it for the family.”
Jenny Marder is a senior science writer for NASA and a freelance journalist. She was formerly digital managing editor for the PBS NewsHour.