01/26/21- Reminders about Sports and Sport-Activity Return to Play

January 26, 2021 Athletic Department Blog Updates

In the past couple of weeks, there have been several questions regarding the COVID-19 Return to Play protocol. There have been no changes to the protocol since it was adopted early part of the fall prior to the start of play, but the questions coming in lately indicate the need for a refresher.

Rather than detail the policy again in this post, both the required and recommended elements can be reviewed on the KHSAA website at https://bit.ly/2SQDOxm 

Below are listed various questions that have been presented and the appropriate responses. This information will be updated as necessary as either additional inquiries occur, or further data or recommendations are issued.

What is the difference between isolation and quarantine?

• Isolation separates sick people with a contagious disease from people who are not sick. (dealing with the person who has tested positive)
• Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick. (people determined to have been around someone who has tested positive long enough to require separation from them).

What is the return to play protocol?

• The protocol is a series of stages for any participant who is involved with any KHSAA sport or sport-activity with a detailed example on page 4 of the document at https://bit.ly/2SQDOxm.
• The protocol includes a CDC directed isolation period (mindful that isolation only refers to someone who has tested positive), which has remained constant at 10 days following day 1 as defined.
• Then there is a recommended interim period of four (4) days for evaluation by a physician, primarily motivated by concerns about myocarditis.
• After that, there is a six-day gradual return to play followed by a return to competition on the next day if there is no other compelling factor to prevent such return.

Who recommends this type of protocol to the KHSAA?

• The KHSAA has for more than forty years partnered with the Kentucky Medical Association for the best advice on health and safety aspects related to sports, whether it be policy directives or recommendations.
• This group has a committee within their organization designed to review the medical aspects of sports and recommend those policies that are in the best interest of the health and welfare of the student-athletes participating in high school and middle school athletics.
• In addition, the National Federation of High Schools, of which the KHSAA is a member, has a Sports Medicine Committee for recommendations and advice on the health and safety of student-athletes.

What is myocarditis?

• Myocarditis is usually caused by a viral infection.
• A severe case can weaken the heart, which can lead to heart failure, abnormal heartbeat, and sudden death.
• Symptoms include chest pain, abnormal heartbeat, and shortness of breath.
• Treatment may include medication to regulate the heartbeat and improve heart function.
• In rare but severe cases, a device may be needed to help the heart function.
• A good summary can be found online at https://www.healthstream.com/resources/blog/blog/2020/10/20/what-is-myocarditis-and-how-is-it-linked-to-covid-19.

How is myocarditis related to the coronavirus?

• In early research in both other countries and in the United States, there was thought of an increased occurrence of myocarditis in persons who exerted while playing sports and other activities following a case of COVID-19.
• According to that early research, “COVID-19 can cause myocarditis, a condition marked by inflammation of the heart muscle.  Symptoms often include chest pain, abnormal heartbeat (arrhythmia) and shortness of breath. And if left untreated, it can cause permanent damage to your heart muscle and lead to serious health concerns.”
• This relationship remains under study including several published articles from a variety of researchers.
• Again, review is ongoing.

Does this policy relate to the possibility of myocarditis?

• Absolutely, when faced with decisions about athletic participation and potential risks, having a practical and step-wise approach to post-infection students was a mitigation step that allowed for continued participation following this period, favoring that over the elimination of competition.

What periods are required?

• Student-athletes competing for KHSAA member schools who test positive for the virus are required to fully meet CDC requirements for isolation (currently 10-days after the day of the positive test or symptom onset).
• Student-athletes competing for KHSAA member schools who test positive for the virus are required to go through the six-day step-wise return to play protocol. It is recommended that this return to play protocol be in conjunction with a supervising physician.

What periods or aspects are recommended?

• The interim period is a recommendation by the KHSAA to ensure that there is an appropriate time for evaluation by a physician. This evaluation could focus on cardiology or any other aspect in conjunction with the primary care physician.
• It is recommended that the return to play form is signed by a physician and submitted to the school upon return.
• If this specific form is used, it is to be signed by a physician (MD or DO). Other written forms are certainly acceptable depending upon the local district policy, even to the extent of its use by other providers.

Is a student required to see a physician?

If the specific recommended form is used, it is signed by a doctor as it was designed by and for doctors (MD or DO). But that form is not required, and the local district can choose whatever written verification is desired by the district.

Does this policy apply to asymptomatic individuals?

• Yes

Does this policy apply to non-contact sports or sport-activities?

• Yes

How long is the maximum time a student would miss if the entire protocol is used?

• Absent further symptoms, if a school required both the required and recommended portions of the protocol, the student should be able to participate on the 22nd day. But that is only if both the required and recommended parts of the protocol are being used.

What is the minimum time a student would miss if only the required protocol is used?

• The CDC isolation period of ten-days (along with the release by the local health department) and the six-day gradual return to play is what is required, so the 17th day would be the minimum.
• The optional periods are at the discretion of the local school.

Didn’t the CDC change the quarantine period, and did that change the policy?

• The CDC did in fact change the quarantine period. But keep in mind this policy relates to isolation, not quarantine. So that change from 14-days to 10-days for quarantine did not impact this policy.

Why did the protocol change?

There has been no change in the protocol since sports resumed. The Association has consistently advocated for play in sports this year, but this important health and safety step is vital until more research is completed, and certainly, a better alternative than ceasing play until all facts are known