Doctors Weigh in on Safety of Youth Sports During the Coronavirus Pandemic

From its beginnings, sport has been defined by close human proximity. The earliest wrestling matches have evolved into competitions with limited physical contact, like golf or tennis, while others such as basketball and soccer remain intimate and can therefore present risk during the current COVID-19 pandemic.

SI engaged in separate conversations with Dr. Chris Koutures, a pediatric and sports medicine specialist in Anaheim Hills, Calif. who has worked with USA Volleyball, US Figure Skating and numerous collegiate programs (and has three children, ages 16, 13 and 13), and Dr. Edward Cheng, a pulmonary critical care physician in Los Angeles (and the father of a 5- and 7-year-old), to clarify what’s safe and what isn’t, particularly for young athletes.

The following has been edited for length and clarity.

SI: Baseball seems relatively safe, right? Opponents rarely touch each other.

DR. KOUTURES: There is limited contact, but it depends on how often you change baseballs. In youth baseball, it’s not as often. College baseball goes through several baseballs each game. The biggest risk is probably celebrations – handshakes, high fives and hugs. Or in the dugout where kids are touching for their bags or equipment. Today’s kids don’t share helmets or bats as often [as previous generations]. … Overall, I’d worry about the transmission rate at lower-level games where they recycle baseballs, as opposed to the higher levels.

SI: Basketball seems riskier, with multiple players touching the ball, competing and breathing in close proximity, lots of physical contact …

DR. KOUTURES: And there’s one ball, and you usually don’t switch it out that often. I’d recommend wiping it down. And in basketball, there are timeouts – contact with bench players and the coach with his whiteboard. And there’s also the intimacy of a gym, with spectators and potentially lots of people in a small, confined area. That’s what I’d be worried about, along with the layup line before practice, before the game, using multiple balls.

DR. CHENG: Baseball is more spread out. With basketball and volleyball, it’s important to avoid congregating in close indoor quarters. That’s why medical centers are setting up coronavirus tents outside. At my hospital, we have outdoor mobile tents. If a patient has cough or fever, instead of bringing them into clinic they are directed to this outdoor tent. We don’t want to bring people into an enclosed environment where they can cough and aerosolize the virus to people nearby.

SI: Is it true that young people are more resistant to coronavirus?

DR. CHENG: Yes, initial studies have shown that kids are more resistant to coronavirus … and if they actually do get it, their symptoms are more mild. For parents who are worried about kids going to the park and playing, the risks are low. But with team sports there is closer contact. I coach my son’s basketball team – they just canceled the rest of our season. I just got a note from [American Youth Soccer Organization] canceling all games and practices this weekend. That’s reasonable. Proper social distancing at this point is important.

SI: And healthy young people can carry the virus without showing symptoms, yes?

DR. CHENG: Most people with the virus will have symptoms at some point. If you don’t have symptoms at all, then you likely don’t have it. The issue is that two-week window where you won’t have symptoms but you are contagious and infecting people – and of course you don’t know when that two-week period is. Case in point, Rudy Gobert, he was joking around, giving the impression that this was being blown out of proportion, touching the microphones, then he starts to feel sick. Well at that point he had already been shedding virus for two weeks … he might have given it to Donovan Mitchell, and who knows who else. That’s really the game changer, the asymptomatic transmission period. When that became a reality – that you’re not just infectious when you have symptoms – I think that’s why this thing is spreading.

SI: You mentioned soccer. Of course, hands aren’t supposed to touch the ball except on a throw-in, but even so, is the ball “cleaned” by the grass as it rolls around during play?

DR. KOUTURES: I don’t think we have enough info about that. I’d worry about my goalies. He or she is wearing gloves, but what do they like to do when they’re bored? Lick their gloves. Then they pick up the ball and punt it. But the biggest touch-point would be throw-ins, no doubt.

DR. CHENG: Most organized team activities are being postponed. But being outdoors is preferred compared to having a playdate at home in close quarters. This weekend, I’m not working so I plan to take the kids to [the local school field] to kick the ball around, shoot hoops, ride bikes …

DR. KOUTURES: There’s nothing wrong with getting your soccer ball and going out and passing and staying a couple meters away from each other, just to keep moving. Maybe switch out the ball if you need to. Wash your hands. Definitely no sharing of equipment or water bottles. Going for a run with friends while keeping our social distance -- these are all reasonable things.

SI: What about ice hockey?

DR. KOUTURES: Hockey is interesting because most players wear face shields or face masks. Microbes can collect there. And there are mouthpieces and mouth guards. If it falls out, do I pick it up? Most hockey facilities offer a small locker room to change. I’d suggest everyone go to a different area and change by themselves. We should always think about how many people we have in a small area.

SI: Your thoughts on water sports? Swimming, water polo …

DR. KOUTURES: My daughter just finished water polo. They get pretty close to each other … I would think there is greater risk of aerosol transmission as opposed to swimming, because there is a player right on top of you, breathing on you. Does chlorine do anything? Again, I don’t have that information in front of me.

[EDITOR’S NOTE: The Center for Disease Control [CDC] calls chlorine and pH balance a “disinfection team” that works as “the first defense against germs that can make swimmers sick.” The proper amount of chlorine can kill e. coli bacteria in less than a minute, while the Hepatitis-A virus takes longer – approximately 16 minutes.]

SI: Staying physically active can help us resist infection, correct?

DR. KOUTURES: Yes, we want to encourage age-appropriate sport activity for kids. For their physical health but also their emotional well-being. We’re going through unprecedented times. If kids are told, ‘There’s no school, no sports, we’re basically gonna pull everything,’ that may not be the best thing. If we can get ‘em outside and moving, while trying to make it as safe as possible and minimize risk, the benefits will outweigh the risks. I worry about us saying, ‘Just go inside and do nothing.’

DR. CHENG: That said, if you’ve been identified as exposed to the virus and the L.A. County Department of Public Health is telling you to self-quarantine, you have to do it. We want to avoid a situation like Italy where there is a big public outbreak because of a lack of proper social distancing. Isolating yourself for two weeks is not gonna make a huge difference in a child’s overall health. Now, for those not in self-quarantine, the risk of going to the park and shooting hoops or riding bikes – the risk of them contracting something at the park is extremely, extremely low. … I strongly support showing an abundance of caution, but at the same time tempering that and avoiding mass hysteria.