Returning to Sports After Having COVID-19

Review the guidelines on returning to youth sports during the COVID-19 pandemic.

While many of us are simply concerned about kids returning to school, there is an added concerned for other parents, whose kids play sports and have already had COVID-19.

Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.
Many kids are returning to playing sports as they return to school during the COVID-19 pandemic.

When can they go back to playing sports?

Returning to Sports During the COVID-19 Pandemic

What are the issues with returning to sports during the COVID-19 pandemic?

Well obviously, there is the issue of a lot of kids getting together during practice and games and the risk that they could get each other sick.

“Sports that require frequent closeness between players may make it more difficult to maintain social distancing, compared to sports where players are not close to each other.”

COVID-19 and Considerations for Youth Sports

There is another issue though.

If kids have been inactive for a long time because we have been worried about them getting together and playing sports, then they might be out of shape and not ready to jump back in at their usual high level of activity.

“Implement a two-week ramp-up period for conditioning—aerobic, interval and strength training to decrease risk of injury—without scrimmages or games.”

Return to Youth Sports after COVID-19 Shutdown: Reference Guides

A graduated return to play program will be necessary until their conditioning improves again.

Returning to Sports After Having COVID-19

But what if your child has already had COVID-19?

When can they start playing sports again?

“Returning to sports participation after a COVID infection will be a significant question posed to pediatric providers in the coming months”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Wait, weren’t you aware that returning to sports after having COVID-19 was an issue?

Well, it is…

“Most pediatric patients will be able to be easily cleared for participation without extensive cardiac testing, but pediatric providers should ensure patients have fully recovered and have no evidence of myocardial injury.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Or at should at least be something to think about.

“The question of returning to sports is significant because of the propensity for COVID-19 to cause cardiac damage and myocarditis. While the incidence of myocarditis is lower in the pediatric population compared to the adult population, myocarditis is known to be a cause of sudden death during exercise in the young athletic populations.”

Returning To Play After Coronavirus Infection: Pediatric Cardiologists’ Perspective

Fortunately, kids often have mild or asymptomatic infections when they get COVID-19 and shouldn’t be at risk for heart problems. Even if these kids don’t need further testing, they should likely wait at least 14 days until their symptoms resolved (or after they tested positive if asymptomatic) before playing sports again.

Experts do recommend that older kids, over age 12 years who had more moderate symptoms, especially prolonged fevers or who required bed rest, have an ECG before doing high intensity, competitive sports or physical activity.

Those kids who had severe symptoms, especially if they were hospitalized, should see a pediatric cardiologist and follow the myocarditis return to play guidelines, which include an ECG, echocardiogram, and exercise restrictions, etc.

And all will likely need a graduated return to play program once they are ready to play sports again, as deconditioning will be an issue after weeks or months of being inactive, with further evaluation if they develop chest pain, an abnormal heart rate or rhythm, or fainting during exercise, etc.

More on Playing Sports and COVID-19

Going Back to School During the COVID-19 Pandemic

What does going back to school during the CO pandemic look like?

For most parents, the ongoing COVID-19 pandemic has complicated their plans to send their kids back to school.

Going Back to School During the COVID-19 Pandemic

We can likely all agree that if it could be made safe for kids, teachers, and other support staff in schools, then kids should go back to school.

So what’s the problem?

Depending on where you live, the size of your school, and the number of cases, etc., it may not be possible to make schools that safe. After all, how much social distancing can you do in a classroom full of kids? And will kids, especially younger kids, really wear a face covering all day?

Sending Your Kids Back to School

On the other hand, if your community is doing a good job of keeping COVID-19 case counts down, then maybe it is safe, or at least, safe enough, to send most kids back to school.

Online or virtual schooling will be a safer option for higher risk kids.
Online or virtual schooling will be a safer option for higher risk kids. Fill out and review the CDC’s Back to School Decision Making Tool with your pediatrician if you aren’t sure what to do about school.

Going back to school might be a good option for:

  • kids who are healthy, without any high risk medical conditions, like diabetes or poorly controlled asthma
  • kids who have no high risk contacts at home, keeping in mind that in addition to having a chronic medical problem, the risk increases with age, especially once you reach age 65 years.
  • kids who have an IEP or get any kind of services or therapy at school that you can’t get at home
  • kids who did poorly with online school last spring
  • kids who are eager to go back to school

Most importantly, going back to school might be a good option for your kids if you are confident that your school has a good plan to keep your child and everyone else in the school safe.

Do they have a plan to cohort kids together, so that every kid in the school isn’t mixing with each other? What is their plan if someone gets sick? What is their plan if a lot of kids get sick?

It is also important to remember that virtual school isn’t a good option for everyone. Having a safe school to go to will be important for those kids who don’t have a parent or caregiver at home to help them with school or because they don’t have a reliable internet connection, etc.

Going to the School Nurse During the COVID-19 Pandemic

If your kids do go back to in-person school, what happens if they get sick?

“Immediately separate staff and children with COVID-19 symptoms (such as fever, cough, or shortness of breath) at school. Individuals who are sick should go home or to a healthcare facility depending on how severe their symptoms are, and follow CDC guidance for caring for oneself and others who are sick.”

Operating Schools During COVID-19

Should they go see the school nurse, if your school is fortunate enough to have one?

“School nurses are essential healthcare providers in the community working on the frontlines of the COVID-19 pandemic in schools.”

Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

In addition to the problem with a bunch of contagious kids in the school nurse’s office, it is easy to see that it will difficult, if not impossible, for health care professionals at school to easily know if a sick child has COVID-19, strep throat, a cold, or the flu, etc.

“The overlap between COVID-19 symptoms with other common illnesses means that many people with symptoms of COVID-19 may actually be ill with something else. This is even more likely in young children, who typically have multiple viral illnesses each year.”

Screening K-12 Students for Symptoms of COVID-19: Limitations and Considerations

There is also the fact that a child who goes to the nurse’s office with a cough, runny nose, or headache, etc., might not have a contagious disease at all, as these symptoms can also be caused by asthma, allergies, and migraines.

“Remember that schools are not expected to screen students or staff to identify cases of COVID-19. If a school has cases of COVID-19, local health officials will help identify those individuals and will follow up on next steps.”

Considerations for School Nurses Regarding Care of Students and Staff that Become Ill at School or Arrive Sick

Fortunately, there are plans in place to deal with all of these scenarios.

Still, everyone should understand that most “sick kids,” whatever they have, will likely be sent home from school, just in case they have COVID-19. While that might sound drastic, the risk of getting others sick if they did have COVID-19 is too great.

“Actively encourage employees and students who are sick or who have recently had close contact with a person with COVID-19 to stay home.”

Operating Schools During COVID-19

So how do these plans work?

Back to School COVID-19 Sick Policies

While each state and school district seems to have their own back to school sick policy, in general, what to do should likely depend on the child’s symptoms, the possibility of an alternative diagnosis for the symptoms, potential for exposure to someone with COVID-19, the amount of community spread in the area, and COVID-19 test results, etc.

The Minnesota COVID-19 decision tree is for people in schools, youth, and child care programs who are experiencing symptoms consistent with COVID-19.
The Minnesota COVID-19 decision tree is for people in schools, youth, and child care programs who are experiencing symptoms consistent with COVID-19.

If one thing isn’t clear in all of these guidelines, it is to your pediatrician – we typically won’t be able to simply say that your sick child doesn’t have COVID-19 and can go back to school.

“A doctor’s note or negative test should not be required to return to school. Some tests can yield false negatives if taken too soon, and individuals with confirmed COVID-19 can continue to test positive after the infectious period has passed. Antigen tests currently are not as reliable in determining a true negative.”

Decision Tree Tool for School Nurses

Fortunately, many of the guidelines seem to understand this and don’t require a doctor’s note when kids have very mild symptoms.

“If the person is sent home, they can return to the school or program 24 hours after the symptom has improved.”

COVID-19 Decision Tree for People in Schools, Youth, and Child Care Programs

They aren’t perfect, but hopefully we can use these guidelines to help balance keeping those kids who might have COVID-19 out of school, perhaps learning virtually, while those kids who don’t remain at their desks.

More on Back to School

COVID-19 Registry List

To get answers as quickly as possible, researchers and health care providers have created COVID-19 registries that cover everything from asthma and diabetes to pregnancy and pulmonary embolism.

Since COVID-19 is truly a novel disease, we continue to look for answers about how to best treat our patients who are getting sick.

Fever and cough are the most common symptoms in this COVID-19 pediatric registry.
Fever and cough are the most common symptoms in this COVID-19 pediatric registry.

And to get those answers as quickly as possible, researchers and health care providers have created COVID-19 registries that cover everything from asthma and diabetes to pregnancy and pulmonary embolism.

COVID-19 Registry List

Not surprisingly, there is a COVID-19 registry to cover just about every aspect of this new disease.

The results from these registries will hopefully help us come up with better COVID-19 treatment protocols and answer some very important questions, such as whether or not SARS-CoV-2 truly is triggering new cases of type 1 diabetes and why some people have lingering symptoms.

More on COVID-19