High Risk Sports and COVID-19

Health Risk Communication

Orange County Department of Health,
Commissioner of Health: Dr. Irina Gelman, DPM, MPH, PhDc

I hope that this finds you and your family healthy and safe. At the Orange County Health Department, the protection of the public’s health is our fundamental goal. Governor Cuomo has announced that schools may allow high-risk sports and recreation activities as of February 1, 2021 if permitted by local health departments. This information is provided to you at this time in order for you to make an informed choice for your child regarding the participation in these activities as you know your child and their circumstances best. 

The local impact of the COVID-19 global pandemic as of January 27, 2021 has resulted in 31,137 confirmed cases as well as 674 deaths in Orange County to date. Of those cases, 46% have been in individuals 18-44 years of age, with the second largest number of confirmed cases in the 45-64 age group (32%). The prevalence of COVID-19 in our region is higher than the statewide average. Our County 7- day percent positivity rolling average is 7.9 and we are experiencing 273.3 cases per day on average as of January 27, 2021. The CDC “Indicators and thresholds for risk of introduction and transmission of COVID-19 in schools” is outlined in the document found at https://www.cdc.gov/coronavirus/2019-ncov/downloads/community/schools childcare/indicators-thresholds-table.pdf. 

In addition, we are finding that there are variant strains present in our Mid-Hudson Region and other counties in New York State. Globally, we are seeing reports of a disproportionate impact of the SARS COV-2 UK (B.1.1.7) variant in women and children. While Orange County is using every dose of vaccine given to us by the State, we are nowhere near achieving “herd immunity” with the current rate of vaccine allocation. 

Children and adolescents are at risk for acquisition of COVID-19 and serious illness or death among members of this age group has occurred here in New York State. Furthermore, vaccines are not yet approved for children or adolescents under the age of 16, and New York State has not yet permitted vaccination of children ages 16-18. Thus, vaccinations are not yet providing protection for students engaged in activities associated with a high risk for COVID-19 transmission. 

While children account for 2,165 cases or (6.9%) of the total cases, this virus is completely new and although some symptoms are common among those suffering from the illness, the complete list of symptoms, as well as long term complications remain unknown. In fact, some children seem to be at risk for developing more severe complications from COVID-19, such as multi 

system inflammatory syndrome in children (MIS-C), which is of great concern, especially for children who are medically fragile. For more information about MIS-C, please visit the following website: https://www.cdc.gov/coronavirus/2019-ncov/daily -life-coping/children/mis c.html. At present, it cannot be predicted who will become severely ill, although older people and those with underlying health conditions are at higher risk. The long-term effects of SARS CoV-2 are not known; even people with mild cases may experience long-term complications. Of additional concern is that the American Academy of Pediatrics noted that in the two- week period from 12/31/20-1/14/21, there was an 18% increase in child COVID-19 cases, and more American children contracted COVID-19 from 1/7/21-1/14/21 than any other week during the pandemic. 

Please understand that the State’s decision to permit higher-risk sports and recreation activities does not mean that health risk has been eliminated. In fact, as the recent study by the Journal of the American Medical Association found, while in-school transmission of COVID-19 was not found to be high, the resumption of in-person ath transmission. This increase was particularly evident in wrestling. This study concluded that: 

“Even though high school athletics are highly valued by many students and parents, indoor practice or competition and school-related social gatherings with limited adherence to physical distancing and other mitigation strategies could jeopardize the safe operation of in-person education. While there are likely many factors, the pressure to continue high school athletics during the pandemic might be driven at least in part by scholarship concerns, colleges and universities recruiting athletes for the 2021/2022 academic year should consider approaches that do not penalize students for interruptions to high school sports related to the pandemic to avoid incentivizing activities posing high risk for SARS-CoV-2 infection.” 

Please see the study for more information: https://jamanetwork.com/journals/jama/fullarticle/2775875.

Additionally, this article cites a recent CDC report regarding an outbreak of COVID-19 that resulted from a wrestling tournament. For more information regarding the CDC investigation, please see https://www.cdc.gov/mmwr/volumes/70/wr/mm 7004e4.htm 

As you are aware, any time people are gathered, there is a risk of exposure to COVID-19, which can lead to serious medical conditions and even death. Symptomatic and asymptomatic individuals can spread the virus and indoor, close contact practices and tournaments increase this risk. In the Spring of 2020, we witnessed the resumption of college sports activities which resulted in campus closings, conversion to remote learning, and increased community transmission. Masking, distancing, and other mitigation measures reduce, but do not eliminate risk. The American Academy of Pediatrics COVID-19 Interim Guidance: Return to Sports warns that masks cannot be worn for all activities and described medical clearance needed for student athletes who have contracted COVID-19 in the past. Please see: https://services.aap.org/en/pages/2019-novel-coronavirus-covid…ns/clinical-guidance/covid-19 interim-guidance-return-to-sports/ for more information regarding the recommendations. 

Additionally, there is a significant risk of transmission to those in the home of an infected 

The JAMA study also noted that, “Outbreaks among athletes participating in act sports can impact in-person learning for all students and increase risk for secondary in-school and community transmission with potentially severe outcomes, including death.” Part of the increased risk is because transmission can occur though cumulative brief interactions, such as those which occur during athletic activities, which has been confirmed by the CDC. In a study entitled, “Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9 – November 21, 2020”. In this study the CDC concluded that, COVID-19 transmission could occur following less that 15 minutes of cumulative interaction. For more information, see https://www.cdc.gov/mmwr/volumes/70/wr/mm 7004e2htm. 

Parents should understand that other social interactions which occur during organized activities, outside of an actual practice or competition, also increase risk of transmission among student athletes. These include, but are not limited to, interactions in locker rooms and buses. Many counties have had experience with positive athletes attending sports tournaments, which have resulted in additional athletes being isolated and quarantined, and exposure to others resulting in positive cases of COVID-19. 

Decisions made by parents and guardians today can help contribute to the safest possible in person operation of schools. These are difficult decisions and require a balancing of the public health best practices to limit the transmission of COVID-19 in the community and other societal factors. As we collectively learn more about this ongoing pandemic, new health information will be shared with you. With two vaccines now being distributed and more vaccine options anticipated for the near future, there is every reason to hope for a much safer environment for schools and school-related activities as time progresses. However, as noted, there are no SARS COV-2 vaccines that have been authorized for use in individuals under 16 years of age, at this time, 

Key items to consider before allowing your child to engage in higher-risk sports and recreation activities 

  • COVID-19 is still highly prevalent and variant strains have been found in the County 
  • Higher-risk sports and recreation activities increase the possibility of transmission of COVID-19 among students, their families, and their community
  • Studies of sport-related transmission show that the brief interactions which occur during these activities increase transmission risk, even if it is less than 15 minutes
  • Competitions and tournaments also increase the risk of spread through additional interactions like riding on team buses and interacting/congregating in locker rooms 

Please keep all of the foregoing in mind as you make the decision on whether or not to allow your child to participate in sports and recreation activities known to place them at a high risk for acquiring COVID-19. 

The Orange County Health Department takes the health and safety of our children very seriously, even more so during the worst public health crisis in a century. While infection rates are increasing daily, we need to proceed with caution and take every step possible in resuming in person activities safely and responsibly. 

Printable Version of Dr. Gelman’s Letter

Superintendent’s Consent for Winter High Risk Sports

As you are aware, New York State’s Re-opening Guidance for Sports and
Recreation activities categorizes sports/activities as lower risk, moderate risk, and higher risk. On January 22, 2021 Governor Cuomo announced that sports categorized as high risk sports (including wrestling, basketball, competitive cheer, etc.) will be permitted as of February 1, 2021 as permitted by the local health department.

On January 29, 2021 the Orange County Department of Health (OC DOH) issued its guidance on high risk school sports in Orange County. As part of the guidance school districts are required to do at a minimum the following:

 Provide Consent, either by the Board of Education or the Superintendent for specific sports and grades to play;
 Medical clearances for student athletes;
 Informed, written consent to an Orange County Code of Conduct approved by the Superintendent or Board of Education;
 Retention of the informed consent to be shared with OC DOH and or any other County the team participates, subject to request;
 Acknowledgement that high risk sports may be suspended if the local 7-day percent positivity rolling average exceeds the State average.
 Compliance with the current NYS Interim Guidance for Sports and Recreation available at
https://www.governor.ny.gov/sites/governor.ny.gov/files/atoms/files/SportsAndRecreationMasterGuidance.pdf
 Compliance with American Academy of Pediatrics guidance relative to the wearing of face coverings. See: https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/covid-19-interim-guidance-return-to-sports/
(as amended from time to time).
 Compliance with Best Practices as outlined in the New York Municipal Insurance Reciprocal Association (NYMIR) High Risk Sport Protocols for Counties.

As Superintendent of the Valley Central School District, I have reviewed the
guidance and the District has created District guidelines/protocols and sport
specific guidelines/protocols which meet the criteria outlined by the Orange County Department of Health.

Accordingly, as of February 1, 2021, in my role as Superintendent I permit the
Valley Central School District to participate in the following high risk sports at the interscholastic level and for students in the following grades:

Sport Levels of Competition: Grades

Girls Basketball Varsity, JV, Modified: 7-12
Boys Basketball Varsity, JV, Modified:  7-12
Wrestling Varsity, JV, Modified:  7-12
Competitive Cheerleading Varsity, JV: 9-12

Please be aware that students and the parents of students participating in interscholastic athletics for Valley Central teams will be required to complete an Acknowledgement and Assumption of Risk form for the District.

The safety of District students and employees is of utmost importance. If I deem that there is a change in the COVID-19 status or the ability of all involved in higher risk sports to comply with the protocols, I reserve the right to place a team or specific teams or the entire athletic department on pause or to cancel the winter sport season for high risk sports.