Parents, coaches and athletes recently held rallies throughout California to pressure policymakers to permit high school sports to start.
Football coaches across the state have formed their own lobbying group.
And two Orange County private schools were warned about sanctions after playing a football game this month although all Southern California counties are in the purple, or most restrictive, tier in the state’s reopening system.
The debate to reopen California high school sports amid the COVID-19 pandemic has placed physicians in the middle of inflamed passions as they balance how to help shape policy that placates families while keeping communities safe.
“It’s pretty vicious,” said Dr. Nirav Pandya, director of the Sports Medicine Center for Young Athletes at the UCSF Benioff Children’s Hospital in Oakland. Taking “youth sports away has increased parental anxiety to push for sports.”
Proponents of playing make fervent arguments citing the low case rates and death rates for kids 17-years-old and younger. They also say temporarily stopping sports has taken a toll on the mental health of children, a thesis supported by recent psychological studies.
Those who disagree point to the overall U.S. death rate that has passed 400,000, or about the population of New Orleans.
Reviewing the national landscape highlights the complexities. The for-play advocates are justifiably frustrated because 33 states already have had high school football seasons whereas all California sports have been on hold since mid-March.
Pandya said the biggest factor in getting kids back on the field is determining how bad COVID is in the community.
“Right now in California, it is really bad,” he said. “Before we go down the route of talking about how and ways and tiers, we have to do a better job of getting this under control.”
Pandya’s perspective is augmented by a stressed health system dealing with rising cases, new variants of COVID-19 and the slow rollout of the vaccine.
Yet, the California Interscholastic Federation that oversees the state’s 1,606 high schools has advocated playing all sports in the restrictive red and purple tiers. The states that participated in athletics in the fall and winter had much less restrictive reopening standards, said Brian Seymour, CIF associate executive director.
In California, four to seven cases a day per 100,000 people places counties in the red tier.
“We would still be operating in the most restrictive tier nationwide,” said Seymour, who oversees the CIF’s medical advisory committee. But he also understands the complexities in the country’s most populous state: “California is not one-size-fits-all for anything. That’s what they are dealing with.”
Ultimately, state and local public health officers control when California high school sports begin this academic year. And they are not budging from current guidelines.
The sports that would be allowed to hold competitions in the purple tier once California’s stay-at-home order is lifted are cross-country, golf, swimming and diving, tennis and track and field. Executives from the North Coast and Central Coast sections that cover much of the Bay Area recently approved plans to allow purple tier sports to begin as early as Monday if officials rescind the shelter-in-place order.
Football will not be allowed until counties fall into the lower-risk orange level whereas basketball will be approved only in the safest yellow tier.
It is difficult to guess when the state’s 58 counties will return to the orange and yellow levels, physicians said.
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Only 0.1% of Americans from ages 5 to 17 have died from the SARS-CoV-2 virus, which causes COVID-19, the Centers for Disease Control and Prevention reports. The case rate for this age group is 9%.
The low transmission rates have left many parents wondering why their kids cannot participate in high school sports. Serra High football coach Patrick Walsh last month launched a statewide initiative to lobby health officials to relax some of the restrictions. Last week, the coaches sent Gov. Gavin Newsom an open letter urging the state to reconsider its policy.
However, the basic data does not offer a complete picture.
According to the CDC, the true incidence of infection in children is unknown because of a lack of widespread testing. The CDC also said evidence suggests that as many as half of pediatric infections might be asymptomatic so kids could unwittingly bring the virus home to infect family members.
As a member of the North Carolina High School Athletic Association’s Sports Medicine Advisory Committee, Dr. Kevin Burroughs has researched on-field transmission rates to help determine when it is safe to return to play.
Burroughs said he could not find peer-reviewed data to help inform the committee’s recommendations. Haphazard reporting methods reduce the accuracy, he said.
But Burroughs, co-chief of primary care sports medicine at Atrium Health Musculoskeletal Institute in Charlotte, said he found no evidence that the games were superspreader events.
Georgia, like California, has one of the highest case rates in the country. Unlike California, Georgia recently completed its high school football season.
“It did not cause the massive outbreaks we were worried about,” Burroughs said.
“We felt because we could not find data where there is widespread transmission at the sports level we went ahead to allow it.”
The football season for North Carolina’s public schools is scheduled from Feb. 26-April 9, according to the association’s website. The state’s private schools played in the fall and held state championships on Nov. 20.
California’s high school sports leaders drew the same conclusion as Burroughs in looking at how well other states fared during their seasons. But Seymour said they cannot rely on anecdotal reports.
Pandya, a UC San Francisco orthopedic surgeon, said holding youth contact sports goes against the medical guidelines recommended to help stop transmission of the coronavirus: mixing different households, being fewer than six feet apart for more than 15 minutes and not wearing masks. He described it as a setup for transmission.
Questions also have been raised about how California high schools can safely return to play when professional and college sports have experienced transmission of the disease despite their sophisticated testing and strict protocols.
Colleges such as Cal, San Jose State and Stanford created “bubble” environments for the players while testing everyone involved in the program multiple times per week. The colleges also have dedicated people to handle contract tracing and ensure everyone follows state and county protocols.
High schools cannot mimic any of that, Seymour said. A majority of schools do not have athletic trainers. Yet, CIF officials have lobbied the California Department of Public Health to allow contact sports in the red tier.
Seymour said playing under the supervision of high school coaches is the best way to ensure safety for kids.
Former U.S. Surgeon General Richard Carmona said it is important to encourage social contact even when it is not prudent to hold competitions.
“We need to socialize and do things other than shelter-in-place,” Carmona said.
But Pandya said he worries about how little physicians know about the possible long-term effects of the disease. Carmona, professor of public health at the University of Arizona where he helped craft the school’s COVID-19 plan, described the situation as a war.
“There are things that we have to do that are inconvenient to prevent the spread of the disease,” he said.
Playing high school football at the moment might be one of the casualties.
