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NFHS Guidance Keys State Association Plans for Restarting High School Sports

By Nate Perry on August 26, 2020 hst Print

“Well, now what?”

As state associations placed indefinite holds on winter and spring athletic events back in March, that was – and in some cases still is – the question weighing heavily on the minds of high school student-athletes, administrators, coaches, parents and fans. Many held out hope that some sort of abbreviated spring sports season would eventually get underway, but the subsequent spike in cases and deaths brought on by the virus’ easily transmittable nature snuffed out those feelings of optimism.

It had become clear the delay would last much longer than originally thought and a formidable set of obstacles stood firmly in the way of a restart. If the almost eight million high school athletes around the country were going to get back to the action, it was going to require a sound game plan.

Recognizing its pivotal advisory role, the NFHS Sports Medicine Advisory Committee (SMAC) – a 15-member advisory committee composed of medical doctors, certified athletic trainers, high school coaches and officials, research specialists and state high school association executives – acted quickly to gather and analyze available data. On May 19, the committee released the fruits of its labor, a 16-page document titled “Guidance for Opening Up High School Athletics and Activities.”

In creating the guidance document, the committee considered that there would likely be differences in what sports and activities were allowed to be played and held relative to the severity of the virus’ impact in various parts of the country. Along those lines, the document described a staged approach to re-opening high school sports and other activities, similar to the phases of “opening up” that were applied to restaurants, fitness centers and other areas of society.

State associations were provided with a possible sport breakdown for higher risk, moderate risk and lower risk, with the basis for the breakdown tied to the potential exposure to respiratory droplets. As an example, the interaction of participants in higher-risk sports such as football and wrestling presented more of a concern for transmission of the virus than lower-risk sports like individual running events and golf.

Finally, the committee suggested state high school associations consult with their state and local health departments for determining the appropriate dates for implementing a phased-in approach within their respective states.

“We believe this guidance document to be a tremendous resource for our member state associations as they move forward with determining the timetables for re-opening sports and activities,” said Dr. Karissa Niehoff, NFHS executive director. “The NFHS Sports Medicine Advisory Committee utilized recommendations from the Centers for Disease Control and Prevention, as well as some return-to-play considerations by the United States Olympic & Paralympic Committee in formulating this guidance document for re-opening athletics and other activities in our nation’s schools.”

As leading medical experts uncovered more details on the virus, fears began to arise regarding a possible link to cardiovascular issues. In response to these concerns, the NFHS joined with the American Medical Society for Sports Medicine to co-author a set of guidelines for coaches, administrators and team personnel to use in assessing student health.

In addition to assembling a COVID-19 questionnaire for students to complete prior to engaging in fall athletic activities, the task force comprised of representatives from both organizations compiled the following recommendations:

  • Student-athletes with a prior confirmed COVID-19 diagnosis should undergo an evaluation by their medical provider. Written medical clearance is recommended prior to participation.
  • Student-athletes who had mild COVID-19 symptoms that were managed at home should be seen by their medical provider for any persisting symptoms. An electrocardiogram (ECG) may be considered prior to sports participation.
  • Student-athletes who were hospitalized with severe illness from COVID-19 have a higher risk for heart or lung complications. A comprehensive cardiac evaluation is recommended in consultation with a cardiology specialist.
  • Student-athletes with ongoing symptoms from diagnosed COVID-19 illness require a comprehensive evaluation to exclude heart and lung disorders that carry a risk of arrhythmia, respiratory compromise, sudden cardiac arrest (SCA) or sudden death. These individuals should not return to sports until medically cleared by a physician.
  • In addition, student-athletes should be evaluated by their medical provider if they have had close contact with family members with confirmed COVID-19 cases, if they have underlying medical conditions that place them at a higher risk of COVID-19 or if they had previous symptoms suggestive of COVID-19.

Additionally, the task force suggested that schools develop a daily tracking tool to ensure that student-athletes are self-monitoring and have not developed COVID-19 symptoms, develop a well-rehearsed emergency action plan for every sport and at every venue, and discourage students from attending school, practices or competitions if they feel ill.

“This document was the result of an outstanding collaborative effort between the NFHS and the AMSSM, with the goal of helping to safely return student-athletes affected by COVID-19 to sports activities,” said Bill Heinz, M.D., former chair of the NFHS Sports Medicine Advisory Committee and co-chair of the NFHS-AMSSM task force. “With so much unknown about the illness and its long-term effects, we called on nationally and internationally known experts to help develop guidelines for safe return to play that can be used by athletic administrators, coaches, team physicians and athletic trainers.”

Having already circulated general COVID-19-related guidance for state associations, the NFHS turned its attention to the sport-specific level. Components that elevated the risk of virus transmission were identified within each of the 17 sports overseen by the NFHS, along with corresponding alteration suggestions for risk reduction.

Under the title “Rules Considerations,” NFHS rules committees devised mitigation strategies for baseball, basketball, competitive cheer (spirit), cross country, field hockey, football, girls gymnastics, ice hockey, boys lacrosse, girls lacrosse, soccer, softball, swimming and diving, track and field, volleyball, water polo and wrestling.

While basic modifications were made to all sports (e.g., sanitizing all scorers’ tables, common areas and shared equipment; prohibiting handshakes and limiting attendance), other sports included proposed changes that were as significant as they were unique.

For example, one of the considerations for basketball was to eliminate the iconic “jump ball” at the beginning of the game. Instead, the visiting team would be given the ball to start the contest, with alternating possessions being awarded for each successive jump ball.

Another eye-catching proposal came with the list of boys lacrosse suggestions. To reduce the amount of exposure players have to one another, it is recommended that quarters be shortened from 12 minutes to 10, which could have significant effects on in-game coaching strategies and substitution philosophies.

Along with oversight from their respective state governments and state departments of health, state associations have since used the guidance and considerations issued by the NFHS to craft their own plans for returning to play and to evaluate the possibilities of further delays.

At this time, 37 states and the District of Columbia (DC) have modified their 2020-21 athletics calendars in some way. These modifications range from very minor adjustments such as Alaska moving first contest dates for fall sports from August 14 to August 20, all the way up to Maryland’s postponement of all athletic competitions through the end of the first school semester.

Some states – Delaware, Illinois, New Mexico and Michigan, to name a few – have moved at least one traditional fall sport to the spring season. Other states will likely follow the same path as Arizona, Florida, Louisiana and South Carolina, which are some of the states that have formally decided to keep football in the fall but play a syncopated schedule.

There isn’t a single state plan in the country that stands out more than that of Vermont. Student-athletes in The Green Mountain State will participate in 7-on-7 touch football this fall and will have to navigate an intriguing set of challenges surrounding mandated outdoor volleyball matches.

Outside of those noted above, there are 10 additional state associations – those in California, Colorado, DC, Hawaii, Minnesota, Nevada, North Carolina, Oregon, Virginia and Washington – that will not play football this fall (17 total).

As of August 21, the 14 states that plan to move forward with an unaltered athletics calendar are Alabama, Arkansas, Idaho, Indiana, Kansas, Missouri, Montana, Nebraska, North Dakota, Oklahoma, South Dakota, Tennessee, Utah and Wyoming, although there are individual schools in some of these states that have delayed or postponed some activities.

A countrywide snapshot reveals there are still far more questions than answers when it comes to a full-scale re-opening of high school sports in the United States. One thing that can be stated confidently, however, is that the NFHS is committed to its mission of providing leadership for the administration of education-based high school athletics and other activities. And it will be steadfast in that commitment until – and long after – a sense of normalcy is restored.