Is it safe to play football? Lacrosse? Hockey? Organize a cross-country race? These are the kinds of questions that schools and others are facing even as COVID-19 case counts rise across the country this fall.

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In an effort to provide education and direction, a team of sports medicine physicians in The Permanente Medical Group, which serves Kaiser Permanente members in Northern California, has released guidance for youth, high school, and collegiate athletes to help them return to sports as safely as possible during the COVID-19 pandemic.

The “COVID-19: Return to Sports Playbook” provides information about exercise and the immune system. Drawing on the expertise of infectious disease doctors and other specialists in The Permanente Medical Group, the authors cover the symptoms of COVID-19 and how it spreads as well as hand hygiene and infection prevention. The playbook also contains recommendations for healthy food choices, sleep, mental health considerations and coping mechanisms. Additionally, the playbook provides sports-specific guidance as the world works through a safe return to activities.  

“We really take ownership of the athlete and our members as human beings so that if you're an athlete, we're concerned about your sleep, nutrition, training and injury prevention, as well as pressing public health needs,” said Susan M. Joy, MD, who led development of the playbook and co-directs the Kaiser Permanente Sports Medicine Center in Sacramento. The Permanente Medical Group is an AMA Health System Program Partner.

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The playbook addresses “not just when can you be more than six feet apart or not in sports, but what else student-athletes and active individuals should do during a pandemic to get through it and maybe come through stronger on the other side,” said Dr. Joy.

“The playbook is directed to the athletes, coaches, parents, schools and it's really very broad,” said Richard S. Isaacs, MD, CEO and executive director of The Permanente Medical Group. “The main goal is to help people get back into fitness and to do it in a safe way.”

“When you talk about returning to sports, it gets challenging because you're putting everything in the produce aisle into one basket and trying to call it something,” said Dr. Joy. “You have to realize it may not be fair that cross country can go before something like football in some markets, but certain sports have better inherent protections in this type of scenario.”

“This is such a tough thing because there are different risks associated with different sports,” she said.

Watch this episode of the “AMA COVID-19 Update” about the challenges that kids face going back to school, including sports.

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Even if a patient doesn’t participate in organized sports, the playbook helps with “building the cardiovascular reserve and building the muscles to prevent injury with activity,” said Dr. Isaacs. “Some of our elderly population could benefit from building muscles in the lower extremities to improve balance and avoid falls.

“In general, the book may be helpful for people who are weekend warriors or want to get back into sports. It’s really about seasonal conditioning,” he said.

“Having good, solid advice about nutrition, mental health, injury prevention and recovery should just be a natural part of what we do in sports,” said Dr. Joy. It is important to “give athletes who are our patients better tools to understand how important all these other things are than just practice, practice, practice, and play hard and win.”

For example, “there are steps you can take if you're struggling with your mental health,” she said. “We hope that some of these will be enduring and can be adapted after the pandemic to still serve as really good guidance for athletes, parents, coaches and anyone else who's looking for those types of resources.”

While it may be hard for a physician to tell a parent yes or no because of pressure from a sporting organization, physicians can arm parents with the tools to understand whether physical distancing, handwashing and other preventive measures are properly followed.

“It’s important for physicians to be the home base of the good information that parents can get in terms of assessing risk of sports and helping them to understand what’s going on locally in their communities,” said Dr. Joy.

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