The new competitive advantage: Stay healthy!
Damion Martins, MD, recently masked up and sat down for his second Community Conversation. As the medical director of Sports Medicine at Atlantic Health System, and the team physician and director of Internal Medicine for the New York Jets, as well as medical advisor to the New Jersey Interscholastic Athletic Association (NJSIAA), he has a lot of thoughts about the successful return to sports in the 2020-21 academic year.
With children and young adults across the state of New Jersey returning to school, Dr. Martins discussed the many positive impacts of athletics, the need to look to primary sources (such as the NJSIAA) for information and updates related to COVID-19, and how to return to team sports and athletics safely.
The perils of pulling athletes out of athletics
A fact that Dr. Martins expects will surprise many people is the dramatic toll felt by athletes who are suddenly unable to participate in their sport, or to properly train.
A recent study by the NCAA found that 25-30% of their student athletes met the clinical criteria for depression or general anxiety.
In May, the University of Wisconsin published data showing that 70% of high school athletes reported symptoms of depression. Even worse, these athletes were 3.5 times more likely to experience symptoms of severe depression after the lockdown of 2020 began.
“In every decision we make in life,” Dr. Martins says, “there is a risk-benefit analysis.” But when he looks at the downside of not exercising – especially for these young athletes – the benefits outweigh the risks. Children ages 5 to 18 “are least likely to get the virus. They’re the least likely to get sick from the virus. And they’re the least likely to die from the virus.”
Which isn’t to say that children can’t get COVID-19 or suffer dire consequences. “But,” says Dr. Martins, “when you look at the risk-benefit analysis, it’s clear there are significant benefits to returning to sports in a safe environment.”
As a member of the NJSIAA task force that provided recommendations for a safe return to play, Dr. Martins knows firsthand the lengths the New Jersey Department of Health went to in order to ensure everyone’s safety.
“The health and safety of the athletes came first,” Dr. Martins explains. “Second came the understanding that re-engaging these student athletes was important for their emotional and mental well-being, as well as the physical benefits of exercise.”
With those guiding principles, the task force studied the science behind COVID-19 transmission, including what other states had done and their successes and failures, as well as New Jersey’s success in driving transmission rates down.
The fall sports season will look different in how athletes practice and train, and even in the focus on championships. Nevertheless, Dr. Martins is hopeful for a successful athletic year, with no major outbreaks, as long as schools work to follow the guidelines.
Data-driven guidelines
Club sports in New Jersey have been ongoing since late June. More than good news for the 100,000 athletes who participated, it also provided an opportunity for the NJSIAA to study their successes.
With no major outbreaks reported in that population, Dr. Martins finds reassurance about the plans for the coming fall season of school sports.“I think the big take-home message,” Dr. Martins says, “is that outdoor fall sports are okay.” To acclimate students to the new COVID-aware school environment, there will be a two-week hiatus between the return to school and sports. “But, after that, most outdoor fall sports (cross country, field hockey, football, soccer, and girls’ tennis) are scheduled to begin practice on Monday, September 14.”
A common question about physical activity in the era of COVID-19 is how to wear masks while training.
Dr. Martins explains that many teams have elected to wear masks during warm-ups, calisthenics, and team discussions. “But once you they hit a moderate level of activity, they pull their mask down,” to help them breathe and train better.
One thing Dr. Martins stresses – both to the professional players he helps coach, as well as the high school athletes in his own home – is the competitive advantage gained by being socially responsible and staying healthy. “Washing your hands, wearing your mask, keeping a safe distance, not going to parties … there’s a competitive advantage for behaving yourself here … because if you bring this virus into your training room, into your team, you’re not going to win games.”
The heavier challenges of indoor athletics
Data shows that COVID-19 spreads primarily through respiratory droplets between people, which makes outdoor sports safer than indoor sports. Outdoor air is naturally circulated, dispersing respiratory droplets. Sunlight is known to kill other viruses, and may have an effect on SARS-CoV-2 – though that’s still being studied. And there’s plenty of space for athletes and some spectators to physically distance whenever possible.
Indoor sports, in contrast, are more challenging. Air has to be circulated and filtered. Space for both athletes and spectators has to be made. Practice for high school winter sports in New Jersey are slated to begin December 3 – though Dr. Martins stresses that this date is fluid, and may change as necessity demands.
Due to many variables – including the safety of the athletes and spectators, uncertainty about air quality and filtration and the spread of the virus, and limitations on indoor capacity – fall indoor sports (girls’ volleyball and gymnastics) will be moved to Season 3. Practices are scheduled to begin on February 16, 2021.
Deconditioning, heart health, and risk factors
One challenge many athletes face as they return to sports is re-conditioning. Having been forced away from their sports and gyms for months, the risk of injury in returning athletes is high. Athletes who used to run 25 miles a week, and were then sidelined for three months, can’t expect to operate at the same level right out of the gate.
“You’re going to get hurt doing that,” Dr. Martins cautions.
Aside from the risks faced by deconditioned athletes is the danger of myocarditis – inflammation of the heart, a topic Dr. Martins recently discussed in a Community Conversation with Matthew Martinez, MD, director of Atlantic Health System Sports Cardiology at Morristown Medical Center. Myocarditis, says Dr. Martins, is “one of the common causes of sudden cardiac death in young athletes.”
Myocarditis is known to be caused by viruses such as influenza, H1N1, parvo and mononucleosis. In general, people with acute viral illnesses are 1-5% more likely to develop inflammation of the heart.
It’s unknown the exact relation between COVID-19 and myocarditis. “We just don’t have that data yet,” says Dr. Martins. Which is why the NJSIAA task force was adamant about adding related questions and recommendations to the health history questionnaire when getting a student’s sports physical.For any athlete getting back into exercise, “If you experience shortness of breath or feel like you’re more fatigued than usual,” says Dr. Martins, “it’s essential that you see your physician and be sure you don’t have COVID-19 or any evidence of myocarditis.”
For athletes with asthma, wearing a mask becomes an additional barrier to getting a good breath, which further complicates athletics.Parents with children who have asthma and other risk factors should talk to their pediatrician or sports medicine doctor about whether or not athletics are the right decision for that athlete this year.
Adhere strictly to guidelines – but be open to change
Two ideas that Dr. Martins returns to again and again are the needs to stick to the guidelines (wear a mask, physically distance, wash your hands) and to stay flexible.
“All the plans created by the NJSIAA are made to pivot programs to a different season, based on the numbers. So, what we tell you today may be very different if, come October, the positivity rate is 8 or 10%.”
Already, the schedule for indoor fall sports has shifted to a third season beginning in early February. If, after returning to practice and competitions, people start getting sick at unexpected rates – either because of something happening on the field or because of changes in the larger community – plans for other sports will have to be adjusted, as well.
The NJSIAA, Dr. Martins stresses, “has worked very, very hard on contingency plans.”
New Jersey has seen its new cases plummet from more than 4,000/day through parts of April, to less than 500/day for most of June, July, and August. “The numbers are very positive,” says Dr. Martins. “We’re very confident this is going to work. That being said, everyone on the committee is well aware that we need to watch these numbers and see what happens.”
Another adjustment for athletes and fans alike will be a shift away from playoffs and championships, with a greater focus on fitness, social engagement, and participation. As quoted by the NJSIAA, Denis Nelson, director at River Dell Regional High School, adds, “From a competition perspective, the COVID-19 pandemic has had a substantial but different impact on every school district. As a result, the playing field won’t be level this year, so it’s only fair not to crown statewide champions.”
The new competitive advantage: Stay healthy!
“I really do believe,” Dr. Martins says in closing, “that the benefits of exercise on an emotional and social level – as well as to the physical immune system – are tremendous. I implore the kids, coaches, and staff to do all the things we’ve outlined – temperature screenings, questionnaires, hand washing and sanitizing, wearing face masks … If they do this, I really believe they’ll have a competitive advantage, and they’re going to pull this season off.”