>> Hello, and thank you for joining us. My name is Sarah Yacoub, and I'd like to welcome
you to the CDC Partner Update Call on COVID 19. This call serves as a way for CDC to share
weekly updates on the COVID 19 situation, and our latest resources and guidance, especially for our private
sector and other partners. Our topic of focus today is on the
considerations that sports programs can keep in mind as they are thinking about scaling
up operations in the time of COVID 19.
This includes questions that are relevant
to athletes, coaches and staff at all levels of play, from children to adults, as
well as amateurs to professionals. We also plan to cover information relevant to
those managing sports venues, such as stadiums, and to those hosting large events. This call is not intended for media. Media can correct their questions
to media@cdc.gov. This call will be recorded and later posted on
the CDC COVID 19 website, as well as on YouTube. Before we begin, I'd like
to remind all participants that the CDC website has the latest information,
guidance, and communication resources. There are over 1,500 documents providing
information and guidance for individuals, businesses, and the public on this website. Since we last facilitated on Monday
partnership call, some examples of resources that have posted include resuming business
toolkit, COVID 19 employer information for office buildings, interim
guidance for mass transit operations, what construction workers
need to know about COVID 19, and interim guidelines for
COVID 19 antibody testing. Today, our plan is to hear general updates from
our response leadership, followed by comments and considerations for sports programs. We'll then have ample time for Q&A.
Speaking of Q&A, thank you to those
who sent questions in advance. We tend to take those questions and
tea them up in preparation for today. And I'll also be keeping an eye on
the Q&A box, so please feel welcome. If you've got any questions that come
to mind, to take advantage of that box. There will be no content slides during our
speakers' remarks, or for the Q&A session. So, what you see on your screen right now
will remain for the duration of the time. However, there will be a transcript that
provides all of the remarks that are made that will be posted both online
and onto our YouTube account. I'm pleased to be joined today by
three CDC experts; Dr.
Grant Baldwin, Dr. Jill Daugherty, and Dr. Ken Mead. Dr. Grant Baldwin is the Co Lead for
CDC's COVID 19 Community Intervention and At Risk Task Force. Dr. Baldwin is also the Director of the Division
of Overdose Prevention at the National Center for Injury Prevention and Control at CDC. Dr. Jill Daugherty, a Subject Matter
Expert for the CDC Sports Guidance. She's an epidemiologist, currently serving
on the COVID 19 Community Guidance Team. And Dr. Ken Mead is a Senior Research Engineer
on CDC's COVID 19 Worker Safety and Health Team. He is also Chief of the Engineering and Physical
Hazards Branch of the National Institute for Occupational Safety and
Health, also known to some as NIOSH. I'd like to now turn it over to
Dr. Baldwin for some updates. >> Great. Thank you, Sarah [phonetic]. As she said, my name is Grant Baldwin. I co lead our Community Intervention
and At Risk Task Force. So, in my life outside of
work, I am a huge sports fan. My wife, son and I regularly attend a
variety of professional, collegiate, and minor league sporting events
here in the Metro Atlanta area.
And prior to the pandemic, I would
say we were at at least a game a week. I'm also an athlete. I compete as a master's level racer
on a cycling team here in the area. I share this with you to let you know how
to important sports and athletics are to me. I understand the power of sports to bring
people together and the draw of competition. I also know the economic engine they provide. So, in this call today, we will touch
on considerations for sports, both in, both for attending a sporting
event as a spectator, or participating in event
as a player or staff member. The same precautions and protections
largely apply at all levels of sport, with some variability, of course. Across America, states and localities
are experiencing different stages of the COVID 19 pandemic. With this backdrop, many states and
local officials are moving gradually and strategically towards
reopening their communities. At CDC, we are working to provide guidance
and tools to assist state and local partners and other stakeholders in making
decisions about establishing and adjusting mitigation strategies
to protect the public's health.
Community mitigation involves actions
that people and communities can take to slow the spread of respiratory viruses like
SARS CoV 2, the virus that causes COVID 19. Mitigation actions are designed to protect all
individuals, especially those at greatest risk of severe illness; while also minimizing
any negative impact of these strategies. All of the considerations we are about to share
are aimed at helping us more safely co exist with COVID 19 until a vaccine or
therapeutic drug is widely available. Decisions about the level of mitigation
required should be guided by the extent of disease transmission within
a community, demographic, and other community characteristics, and by
public health and healthcare system capacity. State, local, tribal, and territorial
officials really are best position to help inform these decisions, while
also addressing the economic, social, and secondary health consequences of COVID 19. Decisions and strategies about how to operate
are implemented at the state, local, territorial and tribal levels, because
every locale is different. And individual jurisdictions have the authority and the local awareness to
protect their communities.
CDC's community mitigation guidance
gives sectors and communities choices, while at the same time calling out inherent
risks associated with those choices. The bottom line is that the more people
an individual interacts with at an event, whether as an athlete, coach, staff member,
or spectator, and the longer that interaction, the higher the risk of COVID 19 spread. It's important to recognize that the underlying
and ongoing levels of COVID 19 transmission in a community will influence the rest too. Additionally, successful community
mitigation involves stacking best practices with several layers of actions to reduce
the spread of COVID 19 and lower the risk of another spike in cases and
deaths, including at sporting events, regardless of if these events
involve spectators or not. Each intervention alone confers some protection. So, some of these best practices include
washing your hands often with soap and water for at least 20 seconds, or using hand
sanitizer that contains at least 60% alcohol if soap and water are not available.
Maintaining at least six feet of
physical distance between yourself and others when outside of your home. Avoiding close contact with people
who are sick and staying home if you get sick in accordance with CDC guidance. Cleaning and disinfecting
frequently touched surfaces often. And using cloth face coverings
in community settings when physical distancing cannot be maintained. It's especially important to practice these
safe behaviors at what we call key times, or times when your risk of
exposure might be elevated.
So, for example, washing your hands with
soap or water or using hand sanitizer after exiting mass transit upon arriving
at a venue, or using a cloth face covering when attending an event where maintaining
social distance is harder to do. So, when thinking about holding a sporting
event, whether in a local high school, or at a large facility with a
professional sports team, there are a number of factors to consider and to account for.
And these include the overall
number of attendees. So, larger gatherings of people offer more
opportunities for person to person contact, and, therefore, pose greater risk
of COVID 19 transmission. Are there ways to minimize
close person to person contact? Are there ways in which, to significantly
reduce the number of participants, or hold the event over several days? The number of people attending
who are at greater risk of more severe illness after
contracting COVID 19. So, older adults and persons with severe
pre existing health conditions are thought to be at increased risk. So, how might you consider instituting
precautions to protect those at greatest risk. And finally, the level of transmission
in the community where it's being held, and the level of transmission in areas
from which your attendees will travel from.
Large events and mass gatherings can
contribute to the spread of COVID 19 in the U.S. via travelers
who attend these events and introduce the virus from other communities. So, one way to view the risk of
COVID 19 spread is by stratifying it. The lowest risk is when sporting events minimize
the number of spectators, and there is limited or minimal community transmission in
the area, and there are no spectators from areas with higher transmission.
Greater risk occurs when sporting events limit
the number of spectators and are held outdoors and put in place protocols to maintain social
distancing, proper cleaning and disinfection, the use of cloth face coverings
by spectators and staff, and some of the other precautions
I've already mentioned. The underlying community transmission
in this case is minimal to moderate and only a small number of spectators
are from areas of higher transmission. And finally, higher risk occurs at indoor
sporting events with an even larger number of peck spectators, where some of the precautions identified
above are only loosely followed. The underlying level of community
transmission is substantial, but controlled, and there is a moderate number of spectators
from areas with higher transmission. And finally, the highest risk
is when there is substantial and uncontrolled community transmission, and
the event is held without implementing any of the health and safety
precautions identified above. And many spectators are from
areas with high transmissions too. So, there are specific precautions
you should consider for food service. Use of physical barriers and guides. Seating arrangements, and educating
attendees about these precautions. But I don't have time in my
opening remarks to attend to them.
But we'll try to do so in some of the Q&As. So, at its core, our ability to prevent
new infections depends on two things. First, reducing the rate at
which someone infected comes in contact with somebody not infected. And second, reducing the probability
of infection if there is a contact. So, organizers should continually assess,
based on current conditions, again, whether to postpone, cancel, or significantly
reduce the number of attendees for events, and robustly implement strategies shared
here and further outlined on the CDC webpage. Sports are really a core part of my identity. Both watching events as a sports fan and
competing directly against other athletes. I can't tell you how much I miss it.
But these are unprecedented times, and
protecting public health is paramount, while we also do not lose
sight of the other impacts. We all understand that and are
making these needed changes. So, thank you for all that you are
doing to keep everyone safe and healthy. Together, we can do what needs to be done. We can cheer on our local and
professional sports teams as a spectator. In doing so, we simply need to take the
necessary precautions to protect ourselves and others, especially those most vulnerable
for severe outcomes, and to be attentive to the current level of community
transition, transmission. So, with that, I'm going to turn it over
to my colleague and subject matter expert on our youth sports considerations,
Dr. Jill Daugherty. She will outline those considerations
and discuss how we might apply, they might apply to participation
in sports across the lifespan. Jill? >> Thank you so much. As Dr. Baldwin just mentioned, CDC is
continuing to provide tools to assist partners in making decisions about how
to protect their communities. CDC has released several guidance and
considerations documents that are relevant to sports programs operating as safely
as possible during the COVID 19 pandemic.
I want to highlight a few in particular
that you might be interested in. For all audiences, you might want to look
at our considerations for youth sports, our interim guidance for gatherings and
community events, our interim guidance for businesses and employers, business frequently asked questions,
and decision tool or workplaces. For swimmers and divers specifically, we
have considerations for aquatic centers. I also want to note that on Friday,
May 22nd, CDC held a stakeholder call that was focused on youth sports leagues. While the call was tailored to a
younger audience, much of the guidance and the questions and answers
applied to all ages. So, you can find a recording of that call on our
website, and also on the CDC's YouTube channel. So, today I'm going to highlight just a
few considerations that can be applicable to both adult and youth sports organizations.
Additionally, more detailed information
is available on CDC's website. So, first to reiterate what Dr. Baldwin noted, a
general principle to remember is the more people that a person interacts with, the closer the
physical interaction, the longer the time of that interaction, and the more sharing
of objects, including sports equipment used by multiple players, the higher
the risk of COVID 19 spread. CDC's guidance for operating during the COVID
pandemic generally falls into four topic areas; promoting behaviors that reduce spread,
maintaining healthy environments, maintaining healthy operations, and
preparing for if and when someone gets sick. The behaviors that sports organizations
can promote to reduce the spread of COVID 19 among athletes, coaches, sports
officials and others are the same actions that all people should be practicing. This includes following healthy
hygiene practices. For example, washing hands often, and covering
coughs and sneezes, staying home when sick, practicing physical distancing as much as
possible, and using cloth face coverings when physical distancing cannot be maintained.
To maintain healthy environments, sports
programs and organizations can consider cleaning and disinfecting frequently touched surfaces
and shared objects and equipment using the CDC and EPA guidance for cleaning and disinfecting
for businesses, public spaces, workplaces, schools and homes, and potentially modifying
layouts to promote physical distancing. Considerations for maintaining healthy
operations include designating one person to be responsible for responding
to COVID 19 concerns. And additionally, sports organizations can
consider conducting daily health checks of coaches, officials, staff, and players. Finally, sports organizations should plan
for the possibility of someone becoming sick. This includes ensuring that
coaches, staff, officials, players, and families know that sick
individuals should not attend practices or games or other group activities. In the event that an employee is suspected
or confirmed to have a COVID 19 infection, it also means doing the following
in consultation with state and local health authorities. First, determining which employees
may have been exposed to the virus, and they need to take additional precautions. Second, informing employees of their possible
exposure, but maintaining confidentiality as required by the Americans
with Disabilities Act. Third, instructing potentially
exposed employees to stay at home for 14 days and self monitor for symptoms.
And fourth, follow the CDC guidance for
closing off affected areas and cleaning and disinfecting them appropriately. Now I want to turn it over to my
colleague, Dr. Ken Mead, for a few comments. >> Thank you. As Drs. Baldwin and Daugherty indicated,
there are many ways in which the guidance for youth sports, for general businesses, or
for the community at large actually overlap with the work of protective guidance
applicable to competitive athletes. Collegiate athlete programs
are unique challenges as you progress from the D3 to the D1 level. And those opportunities for interaction, whether
it be through the intensity of the sport, collective housing, the duration and intensity
of practice, the number of support staff, and the modes of travel, all start to increase
those opportunities for prolonged interaction. Transitioning to the professional level, the athletic machine just
gets bigger and more complex.
But there is one major challenge
at the pro level. All of these interactive members of
the sports organization are employees. The sport is now their livelihood. And aside from the moral and the financial
benefits, there's a legal general duty to exercise due diligence in the
protection of these employees from potentially hazardous work environments. Sarah, I'll pass it back to you for the Q&A. >> Excellent. Thank you. All right, so, I think this first
one is relatively straightforward, and I'm going to direct it over to Dr. Baldwin. Basically, when is it safe for
athletes and teams to restart play? >> Right. So, the considerations we're discussing
today really gives sports programs choice, as I said earlier, while at
the same time calling out some of those inherent risks associated
with those choices. So, we view our job at CDC is to
enable sports programs or leagues to make those informed choices
by understanding the risks.
So, when we talk about the safety of our
athletes and coaching staff on the field of play, the lowest risk really does correspond
to performing individual skill building drills or conditioning at home, and the highest risk
level is really full competition between teams from two different geographic areas. And as I mentioned earlier, there's a gradual,
there's like sort of a graduated levels of risk between those two extremes. So, sports programs and leagues really
need to remember that large events and mass gatherings can contribute to the
spread of COVID 19 in and between communities. So, interesting, with most
respiratory viruses, people are thought to be most contagious when
they are most symptomatic. But we know that the virus that causes
COVID 19 might spread before someone experiences symptoms. And so this poses unique challenges
for us and you, and frankly something that we really need to account for. So, again, remember that each intervention
alone, social distancing, frequent handwashing, cleaning and disinfection, and use of
cloth face coverings offer some protection.
But, again, when you stack or
layer these safeguards together, that's when you can lower the risk the most. I was asked recently on another call if
I could assign an attributable fraction to how much protection each mitigation
strategy affords or provides. In other words, what intervention
will make the most difference? And unfortunately I can't because
of the novelty of the virus in the infancy of the science on the virus. But for now, we really do need to implement
as many of them as possible, especially, as I mentioned earlier, at those key
times when risk of exposure is greatest.
And some of our success hinges on the extent
to which these behaviors are practiced with the regularity or the fidelity
that these circumstances demand. And, unfortunately, if recent
media reports serve as a guide, we have a way to go before these
behaviors become the social norms that frankly we need them to be. So, when you consider when and how to restart
play, all of this needs to be accounted for. We need to be thinking about the safety
of spectators and communities in addition to the athletes, coaches, and other
staff members or personnel in attendance. >> Excellent. And it's as if you read my mind, because
my next question was actually going to be, when do you think it will be safe to
resume play from the spectator standpoint? Should leagues be considering playing
in an empty stadium at this point? >> Yeah, great question. Very important. So, again, large sporting events are
examples of what we call mass gatherings. This category includes things like
conferences, festivals, parades, and concerts. Jill cited this. CDC has some interim guidance tailored to venue
managers and other individuals responsible for planning mass gatherings dated in mid March.
And frankly, we aim to release hopefully
some updated considerations this week. Or if not this week, very soon. Organizers need to remember that
mass gatherings, as I said earlier, really could contribute to the spread
of COVID 19, including via travelers who attend these events from outside of
the community in which they take place. This is a very fluid situation, so you
really need to continually assess based on those current conditions whether to postpone,
cancel, or significantly reduce the number of attendees if possible at an event. And this all needs to be done, again, in
really close coordination with local officials. I mentioned this earlier, but there
are several key factors to consider when determining the need for
postpone or cancel a large gathering.
And these include the overall number of
attendees, the number of people attending who are at greater risk of more severe
illness, the density of attendees within a confined area during an event, and the
level of transmission in your local community and the level of transmission in areas
from which your attendees will travel. So, we recognize the draw of sports and other
mass gatherings, and frankly the tension that exists between convening
these meetings and the economic and other benefits that come from it. But we need to act with an abundance of
caution to help protect public health. And I wish there were easy
answers, but they're not. So, it's really up to us at CDC to name the
risks and help you make informed choices as you balance and attend
for those risks and benefits.
So, is it possible to hold an event,
but significantly reduce the number of attendees that are physically present? This, of course, would allow spectators to follow social distancing
and other recommendations. In addition, is it possible to
hold the event without spectators and broadcast it entirely to a virtual audience? And I know some sports are
already exploring that approach. And finally, it's really critically important
to make special arrangements for those at higher risk of severe illness. And those, those really are
the most vulnerable among us. So, vulnerability increases with
age, especially over the age of 65, and among people who have serious
underlying medical conditions. Again, these decisions need to
account for those local conditions. So, at minimal to moderate
levels of community transmission, it's recommended to cancel community wide
mass gatherings or move to smaller groupings. And in instances where the, there are
substantial community transmission, it is recommended to cancel
gatherings of any size. So, over time, as we continue
to flatten the curve, the risk of community transmission
will decrease, and we can slowly and deliberately relax those
mitigation measures, and frankly, begin to fill up the stands,
as we all like to see.
>> So, Grant, you mentioned different levels of community COVID 19 transmission,
like minimal or moderate. Can you explain that a bit? For example, can leagues or venue
managers determine what level of transmission is happening in their community? Is there a way for them to figure that out? >> Sure, yeah. It is frankly a great example of why you really
need to consult with your local health officials in making these kinds of decisions. We have a document on our website called
the CDC community mitigation framework. I'm pleased to report we released an
update to that framework just last week. That document describes basically
the goals, the guiding principles, and strategies for community mitigation to
reduce or prevent local COVID 19 transmission. In that document, the guiding principles
really serve for us as [inaudible] to the rest of the framework, and include some of the
things I've highlighted a little bit already. Each community is unique. We need an admonition not to exceed public
health or healthcare system capacity, and in understanding that communities
need to make those informed choices, scaling mitigation strategies up or down, and layering in those safeguards
as we talked about earlier.
It also includes a series of tables that outline
the different levels of mitigation needed, given underlying levels of community
transmission, key demographic, community, and other characteristics to consider. And frankly, some of those cross cutting
strategies a community might implement. They're all outlined. But it's really local health officials who can
determine the levels of COVID 19 transmission in a community, as well as the capacities of the
local public health system and healthcare system to manage any increases in
cases that might occur. And this means that in healthcare, that we
have adequate staffing, a surplus of in patient and ICU beds, and the critical medical
equipment and supplies, such as PPE.
It also means that for public health system
capacity that we have, we have the availability to detect, test, contract, trace, and
isolate those who are or might be sick or who have been exposed to someone
known or expected of having COVID 19. So, again, that CDC's interim
guidance for mass gatherings and community events emphasizes the
need to communicate very intentionally with local health authorities
and other community partners when you are considering
whether to host your event. >> Excellent. There's a question that came
through the chat box, thinking about large concerts,
festivals, sporting events. Are there any best practices when it
comes to encouraging social distancing, thinking about these large events, you
know, really wanting to keep people safe? >> Yeah, so, we, we recommend
canceling or reducing the size of community wide mass gatherings
at a minimal to moderate level of community COVID 19 transmission.
So, for example, a large gathering may
include events that have over 250 people. However, the definition of a large
gathering is really at the discretion of community leadership, based, again, on those current circumstances the community
is facing, and the nature of the event. Again, our job is really to help
communities make informed choices. Some sporting events that includes spectators,
there are steps you can take to plan, prepare, and to proceed with mass gatherings. So, they include things like meeting
with emergency operations coordinators or planning teams at your
venues and developing a plan to address how COVID 19 may impact frankly all
aspects of your event, such as entry and egress, seating, ticketing, food services,
lodging, staffing, security, and others.
And the details of a given venue's COVID
19 should be based on the size and duration of your event, the demographic
of the participants, the complexity of your event operations,
and frankly the of on site services and activities that you may offer. Again, I do want to emphasize the importance of
maintaining physical distance between spectators and staff in your event planning, whether it
is in lines, seating areas, concession stands, restrooms, and frankly even
getting to and away from the event. So, again, as such, it's really important to
engage community partners and stakeholders as the local public health, and
that includes local public health and law enforcement officials, vendors,
suppliers, hospitals, hotels, airlines, other transportation companies, as
you develop and execute your plan, to sort of build in those
precautions that help you maintain sort of physical distance between participants. >> Excellent. And should folks be concerned or
be doing anything in particular when it comes to bathrooms in sporting venues? >> Yeah, good question. So, given that restrooms are often a
really crowded area at sporting events, event management really may want to
consider specific contingency plans to maintain physical distancing in restrooms.
And if necessary, limit the number of
people allowed inside at a given time. So, may make a couple suggestions of
what those strategies might look like. So, designating a staff member or volunteer
to monitor, enforce physical distancing in and around restrooms, using markings and
signage to help separate between people. So, for example, indicating where to
stand in line or making foot traffic flow in one direction only, redirecting
individuals away from the busiest restrooms or temporarily increasing the overall
number of restroom facilities. So, in addition, cloth face coverings are
recommended wherever physical distancing of six feet or more is difficult. And as Dr. Daugherty mentioned, CDC
and EPA have jointly developed guidance for cleaning and disinfecting public spaces. And those include guidance on restrooms. So, it provides step by step instructions
for public spaces, including restrooms. So, sporting event venues should develop a
plan for routine cleaning and disinfection, including regular cleaning and disinfection of
high touch areas, such as doorknobs, faucets, toilets, and other restroom furnishings.
So, the guidance also gives, includes
some considerations about the safety of our very important custodial staff. So, they are at increased risk
of being exposed to the virus, as well as any toxic effects
associated with cleaning chemicals. So, they should, of course,
wear appropriate PPE. So, to protect your staff and to ensure
that the products are used effectively, staff should be instructed on how
to apply the disinfectants, again, according to the label instructions
and any other precautions.
>> Excellent. Thank you. And before I switch gears over
to the subject matter experts, I'll just ask one more question of you. Grant, I know you've made a few comments about
concessions and foods within sporting venues. Can you talk a little bit more about that, and
specifically what folks might want to consider when it comes to dining halls
and cafeterias for staff? >> Yeah, thanks, Sarah. I think I'll be a little bit briefer here
since I feel like I've talked for a good while. So, I'm going to point you to CDC's
considerations for restaurants and bars. So, many of the principles and suggestions
included there will also be relevant to staff cafeterias or concessions. I'll also point you to the Food and
Drug Administration has a best practices for retail food stores, restaurants, food pickup and delivery services during
the COVID 19 pandemic. I think those could be of
great assistance to you.
Those resources include a checklist,
a great infographic designed to assist retail food establishments
that might be, might have been closed or partially closed during
the COVID 19 pandemic, and are in the process of preparing to re open. Again, those materials are available
by searching the CDC website, and use the following search term, best practices for reopening retail food
establishments during the COVID 19 pandemic. >> Excellent. Thank you. So, switching gears, thinking about athletes
being exposed, I'm going to ask Jill a question. In thinking about how different
sports have different exposure risks, are individual sports considered
to be safer than say team sports? And, for example, even let's say a sport like
running, do you have any feedback on that? >> Yeah, absolutely. This is an important consideration. The risk of COVID 19 exposure and
spread can be different between sports, depending on the type of activity.
So, activities that require
close interaction and sharing of equipment probably carry a higher risk
of exposure and spread than activities that can be done alone or
with smaller groups and those that don't require the sharing of equipment. So, as we've already mentioned, a general
principle we like to follow when we're thinking about these issues is the more
people a player interacts with, the closer the physical interaction is, the
longer that interaction, and the more sharing of equipment, the higher the risk of
the COVID 19 spread is likely to be. So, sports that require frequent closeness
between players may make it more difficult to maintain social distancing, and,
therefore, probably present increased risk for COVID 19 spread compared to sports
where players are not close to each other.
So, for close contact sports like wrestling
or basketball, play may be modified to safely increase distance between players. For example, a sports program might consider
focusing on individual skill building or conditioning versus competition. They could also consider limiting the
time players spend close to one another by playing full contact only
in game time situations. Or you could think about decreasing the
number of competitions during a season. So, those are just a few
strategies to think about. >> Excellent. Thank you. I'm seeing in the box there's a question.
Is there any specific guidance
associated with high school sports versus professional sports, amateur sports? Maybe I'll throw this at Ken
to start us off with this one. >> Sure. Thank you. So, much of the youth sports
guidance that we talked about earlier is applicable
to other levels of athletics. But there are some differences, of course. As the athletes' age mature, more of the
responsibility or the impetus is going to fall upon them to follow certain rules
for social distancing and washing their hands and those kind of things in their
environment that they can control. The nuanced responsibility between collegiate
professional athletics is a little different, it's worth noting, because since the exposure within professional athletics
are occupational exposures, so are expected to have a
reasonable responsibility for providing worker protection
for that scenario. >> Yeah. >> Jill, did you have a comment here as well? >> Yeah, I just wanted to jump in and
just piggyback on what Ken is saying.
So, for collegiate athletes,
CDC's considerations for higher education suggest
the following strategies, which are in line with what
we're talking about today. Namely, pursue virtual group event,
gatherings or meetings if possible, and promote social distancing of at least six
feet between people if the events are held. And also to limit group size
to the extent possible. Pursue options to convene sporting events
and participate in sports activities in ways that reduce the risk of transmission of COVID 19
to players, families, coaches, and communities. And also limit any non essential
visitors, volunteers and activities involving external groups
or organizations as much as possible, especially with individuals who are
not from the local geographic area.
For example, the same community,
town, city, or county. >> Excellent. Thank you. Ken, what screening should
we use for players and staff? >> Like other organizations and businesses,
sports teams may consider conducting daily in person or virtual health checks, looking
for symptoms or temperature screening of their players and staff before
they enter the team facility. Of course they're going to want to follow
the state and local public health authorities and your occupational health
services in that activity.
If implementing in person health
checks then is going to be important to conduct them safely and respectfully. You're going to want to remember to
maintain social distancing and barrier or partition controls during
those testing activities. And to use personal protective equipment
as necessary to protect the screener. However, reliance on PPE alone is
less effective of a control method. And it's also a little bit
more difficult to implement. So, given the PPE shortages
and training treatments. You should complete the health
checks in a way that helps to maintain social distancing guidelines, such as providing multiple
screening entries into the building. Follow guidance from the Equal
Employment Opportunity Commission, which is regarding confidentiality and
medical records from health checks. And to prevent stigma and
discrimination in a workplace, make employee health screenings
as private as possible.
Do not make determinations and risks
based on race or the country of origin. And be sure to maintain confidentiality of
each individual's medical status and history. >> Excellent. And another question for you, Ken. Should we be testing all players,
for example, before games? >> That's probably a common question. In general, CDC does not currently recommend
that viral or serologic test results be used for decisions of admitting or excluding persons
from settings like schools or workplaces. Viral tests only determine potential
infection at the single point in time, and so you may miss cases in the
very early stages of infection. Positive test results may be more likely
to be false positives in communities that have low rates of community
transmission, while the presence of anti SARS CoV 2 antibodies
likely indicates a prior infection.
Until we know the durability
and duration of immunity, and until those items are fully established,
it cannot be assumed that individuals with truly positive antibody
test results are protected from [inaudible], excuse me, future infection. Persons who test positive by
serological tests should continue to follow the CDC recommendations
to prevent infection for SARS CoV 2. Testing of athletes and staff for COVID 19
may be appropriate in the limited context of case investigations and contact tracing. For example, following the identification
of a positive case in an athlete or coaching staff member, CDC contact
tracing guidance encourages states with available resources to test high
risk contacts of the confirmed case. In general, CDC currently recommends testing
under several scenarios subject to the guidance of state and local health departments
and the judgment of treating clinicians. This includes testing individuals with symptoms
consistent with COVID 19, as you might identify through your symptoms screening, testing
asymptomatic individuals with known or potential exposure to SARS CoV 2, such as
during case investigations and contact tracing.
And then testing to determine
resolutions of infection. Can you discontinue home isolation or
discontinue the work exclusion activity? >> So, when we're thinking about an
athlete or a staff member that's sick, how should we be responding to this? And I guess I'll first hand this over
to you, Jill, to hear some thoughts, and then I'd love to hear what
you have to say as well, Ken. >> Yeah, Sarah, I'm glad that
you're asking that question. Making a plan in advance is going to
make your response smoother and smarter. In general, a good plan should follow
the guidance and direction of state and local health authorities,
and would include steps for how you would address a couple of issues. First of all, ensuring that coaches,
staff, officials, players and families know that sick individuals should
not attend sporting activities. Second, safely transporting anyone who is
sick to their home or a healthcare facility. Third, provide education on what to do
if you're sick in coordination with local or state health authorities, identifying
those who have had close contact with a person diagnosed with COVID 19, and advising them to stay home
and self monitor for symptoms.
And note that steps should always be taken
to maintain confidentiality in accordance with applicable law and regulation. Fourth, advising individuals with COVID 19 about
home isolation and how to know when it is safe for them to end their home isolation. Team members or staff with
COVID 19 shouldn't return until they have met CDC's criteria
to discontinue home isolation. And then lastly, make sure to close off areas
that were used by a sick, the sick person, and not, not using those areas until
after cleaning and disinfecting them. And I also want to check in with my colleague,
Dr. Mead, to see if he wants to add anything from the worker safety perspective
on this question. >> Thank you. I agree a lot with the importance
of planning ahead. And I do want to clarify
that there's a difference between a sick athlete and
an athlete with COVID 19.
When someone is sick, either self identified
or through screening, they should stay at home, or if they're already at the facility,
they should leave immediately. Evaluation by a healthcare
provider can determine whether or not the sick person actually has COVID 19. The positive test result for
COVID 19 should trigger a series of immediate protective actions, which would
include isolation of the COVID positive person, contact tracing and quarantine of
potentially exposed contacts, and lastly, through disinfection of potential certain spaces in which the COVID positive
person recently occupied. >> Excellent. And Ken, what protocols should
be followed by leads that span across more than one jurisdiction? >> So, local authorities having a
jurisdiction for the local area, they're going to have the
final say on the minimum levels of protection and protective activities.
However, if the sport or the league
protective policies are more stringent than the local requirements, then they
should continue to follow those as well. >> Excellent. Thank you. Jill, how do we promote physical distancing
between players during practice or competition? >> That's a really great question. So, of course CDC does encourage social
distancing in sports programs, if feasible. And there are several general strategies to
do this, which may or may not apply based on the nature and level of sport. So, for instance, programs could
identify a staff member or a volunteer to help maintain distance among their players,
coaches, umpires, referees, and spectators, you know, if state and local
directives allow for spectators. They could also space players
at least six feet apart on the field while they're
participating in the sport. For example, during warmup, during skill
building activities, or doing simulation drills. They could also discourage
unnecessary physical contact on things like high fives, handshakes, fist bumps or hugs. If keeping physical distance is difficult of
players and competition or group practice, they could consider relying on
individual skill work and drills instead.
A league or a program could also provide
physical guides, such as signs and tape on floors or playing fields
to make sure that coaches and players remain at least six feet apart. They could also limit the
use of shared transportation. If practices or competition facilities are
shared, it's possible to add buffer times between each team's entry or exit and
clean and disinfect facilities between use. Some programs are deciding to cohort their
players in small groups with dedicated coaches or staff and make sure that
each group of players and coaches [inaudible] mixing
with other groups. Teams might consider staging intrateam
scrimmages instead of playing games with other teams in order to
minimize exposure between players.
And then it's also possible to stagger times
or locations for each cohort to limit contact between groups as much as possible. If organizations are not able to keep in place
safety measures during competition, for example, maintaining social distancing or keeping
players six feet apart at all times, they may consider limiting participation
to, within team competition only. For example, scrimmages between members of
the same team, or team based practices only.
Similarly, if organizations are unable to put in place safety measures during team based
activities, they may choose individual or at home activities, especially if
any members of the team are at high risk for severe illness from COVID 19. >> Excellent. Thank you. Should we be spacing people out on the
sidelines, including on benches or in dugouts? >> So, I would say you're going to
know your program and sport best. And there are likely different
approaches for different sports. But you can consider using signs or tape
marks or other visual cues, such as decals or colored tape on the floor, placed six
feet apart to indicate where to stand when physical barriers are not possible. You could also consider assigning staff
or another leader to remind players and staff to maintain social distancing. >> Excellent. Thank you. We received a couple questions about
breathing, sports that have heavily, you know, heavy breathing associated
with them, exercising. So, curious, Ken, if maybe you could share, is
more than six feet of social distancing needed when playing those types of sports, or
involved in those types of activities? How much would you recommend
should be considered? >> So, as you mentioned, COVID 19 is transmitted
person to person through respiratory droplets.
And the studies and the evidence of infection
control report that these droplets are going to travel around six feet, two arms' lengths,
and this is why the big importance and the focus on social distancing as well as
cough based coverings are important. It is reasonable to assume, however, that
under heavy exertion or rapid deep breathing that the resulting aerosol distances or the
generation, it might be different than that from the general public in
their day to day activity. So, could be greater than six feet. It's not really known. Social distancing, however,
increases the dilution between the source of the potential recipient. So, generally speaking, more distance is better. But we're unable to identify a
minimum distance that's always going to be safe under all circumstances. >> Thank you. Jill, is it safer for athletes to train
outdoors instead of indoors at this time? >> Yeah, there's definitely some evidence to
suggest that prioritizing outdoors activities over indoor activities is recommended in order
to decrease the risk of COVID 19 transmission. If you are playing inside,
you could consider ensuring that ventilation systems operate
properly and increasing circulation of outdoor air as much as possible.
That might help. However, I do want to say that you should
not open windows and doors if doing so poses a safety or health risk. For example, if there's a risk
of triggering asthma symptoms to players or others using the facility. If you're playing outside, keep
in mind that additional health and safety implications beyond
COVID 19 may apply. For example, pay attention to the temperature. Ensure personnel are properly
hydrated and dressed. And monitor players and staff to prevent
heat related injuries or illnesses, which is really important now that
we're going into the summer season. >> Definitely. You know, going back to this idea of maintaining
six feet distance, I'm curious, Jill, do folks need to close down locker rooms or
gyms if athletes can't maintain that distance? >> Great question.
So, we talk about this in our youth
sports considerations document. And this falls under the
healthy environment bucket. So, sports programs may consider modifying
layouts to promote physical distancing, including by closing communal youth spaces,
such as locker rooms, or restricting the number of people allowed in at one time to ensure
that everyone can stay at least six feet apart. Other considerations that are
related to this include cleaning and disinfecting frequently touched surfaces
or shared objects and equipment, at least daily or between use, providing physical guides, such
as signs and tape on floors or playing fields to ensure that coaches and players
remain at least six feet apart. And also ensuring ventilation systems
operate properly and increasing circulation of outdoor air as much as possible.
And with regard to your question about the
maximum number of players or staff allowed in an area, CDC has not set any
specific numbers for these situations. In general, the number that is chosen should
allow for appropriate social distancing or cohorting, as decided by
each individual sports program. And this will depend on whether the activity
is indoors or outdoors, the age of the player, the level of spread of COVID 19 in the individual locality,
and the type of sport played. >> Excellent. Thank you. The CDC recommends delaying or
canceling non essential travel. Can you clarify how this
applies to athletes and teams that must travel frequently for competition? Should they cancel those games then? And I'll pose that to Jill. >> That's a great question. So, as the country continues to
reopen, decisions on when and where to travel should be based upon risk
assessment of the affected communities. In general, traveling outside of the
local community may increase the chance of exposing players, coaches and fans to COVID
19, or unknowingly spreading it to others.
This is the case particularly if a team from
an area with high levels of COVID 19 competes with a team from an area
with low levels of the virus. So, to reduce the risk of spread, sports
programs may want to consider competing only against teams in their local area, or decreasing
the number of competitions during a season, limiting the participation to staff and
athletes who live in the local geographic area, or limiting other activities involving
external groups as much as possible, especially with individuals from
outside of the local geographic area. And I just lastly want to
say that COVID 19 cases and deaths have been reported
in all 50 states at this point. And the situation is constantly changing. So, when you're considering traveling away
from your local community, the athletes, coaches and staff may want to ask, is
COVID 19 spreading where you're going? Is it spreading in your community? Will you and those you're traveling
with be able to maintain six feet of social distancing during and after your trip? Are you or those you're traveling with more
likely to get very ill if exposed to COVID 19? Do you live with someone who's more
likely to get very ill from COVID 19? Does the state or local government where
you live or at your destination require you to stay home for 14 days after traveling? And then lastly, if you get sick with COVID
19, will you have to miss work or school? So, lots to think about when you're
making these decisions about travel.
>> Excellent. Thank you. So, continuing with this theme of travel. How should a team, or what
should a team consider rather that typically travels via group bus or a plane? >> So, travel groups should be limited
to just the screened cohort of athletes, and then the support staff
that travels with them. And the mode of travel should consider,
should be considering of distance, as well as the increased exposure that
may occur if you're using multiple modes and have to switch from one to the other.
When exposure to the gym of public
or unscreened people is unavoidable, such as perhaps through an airplane terminal,
then face coverings, social distancing, and minimized exposure periods
should be encouraged. >> Excellent. Thanks, Ken. And another question for you. There are some players and staff that have
shared housing for training camps and travel. How should they go about setting
up these situations safely? >> Well, once the initial screening and the
effective sequestration protection of athletes and the support staff, once you've
successfully implemented that, then concepts such as shared
housing for training camps and travel should not introduce
a significant risk.
It is also important to continue your
everyday prevention activities, however, such as frequent handwashing,
covering coughs and sneezes, and avoiding sharing objects, such as towels. >> Thank you. I'll throw another question at you, Ken. Can COVID 19 be passed through sweat? And with that in mind, how would one
clean or disinfect a locker room or gym? >> Sure. So, as a reminder, so, COVID
19 spreads mainly from person to person through respiratory droplets that are produced when the infected person
coughs, sneezes or talks. And these droplets can land in the
mouths or noses of people who are nearby or possibly be inhaled into the lungs. There is no evidence to date that indicates
that transmission of COVID 19 has occurred through exposure to body
sweat of an infected person. However, CDC continues to encourage frequent
handwashing and frequent disinfection of high touch surfaces to
include exercise equipment. Regarding the question on cleaning
and disinfection, follow the cleaning and disinfection guidance from CDC
and EPA that we mentioned earlier. Clean and disinfect frequently
touched surfaces at least daily or between uses as much as possible.
Shared objects and equipment should be cleaned and disinfected before each
individual, if possible. Develop a schedule for frequent cleaning, as
well as routine cleaning and disinfection. Ensure that the disinfectants being
used are effective against SARS CoV 2. You can find a list of products
on the EPA website. Also be sure to follow them the
manufacturer's instructions. Discourage the use or sharing of items,
excuse me, discourage the sharing of items that are difficult to clean,
sanitize, or disinfect. Also, definitely don't let your
players share towels or clothing or any other items they may use to
wipe their faces or their hands. >> Great. Thank you, Ken. And I think that kind of rounds out the hour.
Typically, we wrap up these calls for those
of you who have called in in the past. We normally do it at about 4:45. But today, since we had so many great
questions, we decided to prolong it a bit. So, I will turn things over to Dr. Baldwin
and see if you've got any closing remarks or additional thoughts before we wrap up. >> Well, thanks, Sarah. And I just wanted to express my appreciation
for everyone joining the line today, and the robust dialogue that we've had. Please feel free to reach out to CDC
if you have additional questions. We are here in service to you. And, again, thanks for your
commitment and all you're doing to keep our sports venues and our athletes safe. >> Excellent. Thank you. And yes, thank you, everyone, for joining today. As I mentioned earlier in the call, this call
was recorded, and it will be posted online and available for your listening
and viewing pleasure in the future.
As a reminder, this call
takes place every Monday. If you've got any questions about these
calls, don't hesitate to reach out to us. Our e mail is eocevent377@cdc.gov. Thank you, again, for your participation,
and we hope to hear from you next week. Bye bye..
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