Guidance for State Associations to Consider in Re-opening High School Athletics and Other Activities

The National Federation of State High School Associations (NFHS) has released guidance for its 51 member state high school associations to consider in re-opening high school athletics and other activity programs across the nation.

The National Federation of State High School Associations (NFHS) has released guidance for its 51 member state high school associations to consider in re-opening high school athletics and other activity programs across the nation.

The guidance document was developed by 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 that regularly develops position statements related to medical aspects of conducting high school athletics.

In sharing this guidance document with state high school associations leaders on Monday, Michael Koester, M.D., chair of the NFHS SMAC, stressed that the guidance developed by the committee is intended as ideas for state associations to consider with their respective sports medicine committees and state health departments in designing return-to-activity plans that will be in accordance with state or local restrictions.

Similar to the manner in which different parts of the country have re-opened ahead of others due to containment levels of the virus, the guidance document was developed with the realization that there likely will be variation in what sports and activities are allowed to be played and held from one part of the country to another.

Along those same lines, the NFHS guidance document describes a staged approach to re-opening high school sports and other activities, similar to the phases of “opening up” outlined by the White House last month. The committee suggests that 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 are greatly indebted to the NFHS Sports Medicine Advisory Committee for its work in formulating this guidance for re-opening high school athletics and activities,” said Dr. Karissa Niehoff, NFHS executive director. “It is important to be clear that this is guidance for individual states to consider as they return to activities this fall. States will utilize the guidance in this document as it best fits their state after consulting with local and state health departments.”

The guidance developed for state associations suggests 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 present more of a concern for transmission of the virus than lower-risk sports like individual running events and golf.

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

The NFHS guidance document also addresses a possible progression for returning to activities, hygiene practices, transportation to and from events, social-distancing suggestions during contests and a tiered approach to who should be allowed to attend events.

Here are the the three phases of the plan:

Phase 1

Pre- workout Screening:

• All coaches and students should be screened for signs/symptoms of COVID-19 prior to a workout.

Screening includes a temperature check.

• Responses to screening questions for each person should be recorded and stored so that there is a

record of everyone present in case a student develops COVID-19 (see Appendix II for sample

Monitoring Form).

• Any person with positive symptoms reported should not be allowed to take part in workouts and

should contact his or her primary care provider or other appropriate health-care professional.

• Vulnerable individuals should not oversee or participate in any workouts during Phase 1.

Limitations on Gatherings:

• No gathering of more than 10 people at a time (inside or outside).

• Locker rooms should not be utilized during Phase 1. Students should report to workouts in proper gear

and immediately return home to shower at end of the workout.

• Workouts should be conducted in “pods” of students with the same 5-10 students always working out

together. Smaller pods can be utilized for weight training. This ensures more limited exposure if

someone develops an infection.

• There must be a minimum distance of 6 feet between each individual at all times. If this is not possible

indoors, then the maximum number of individuals in the room must be decreased until proper social

distancing can occur.

Facilities Cleaning:

• Adequate cleaning schedules should be created and implemented for all athletic facilities to mitigate

any communicable diseases.

• Prior to an individual or groups of individuals entering a facility, hard surfaces within that facility should

be wiped down and sanitized (chairs, furniture in meeting rooms, locker rooms, weight room

equipment, bathrooms, athletic training room tables, etc.).

• Individuals should wash their hands for a minimum of 20 seconds with warm water and soap before

touching any surfaces or participating in workouts.

• Hand sanitizer should be plentiful and available to individuals as they transfer from place to place.

• Weight equipment should be wiped down thoroughly before and after an individual’s use of

equipment.

• Appropriate clothing/shoes should be worn at all times in the weight room to minimize sweat from

transmitting onto equipment/surfaces.

• Any equipment such as weight benches, athletic pads, etc. having holes with exposed foam should be

covered.

• Students must be encouraged to shower and wash their workout clothing immediately upon returning

to home.

Physical Activity and Athletic Equipment:

• There should be no shared athletic equipment (towels, clothing, shoes, or sports specific equipment)

between students.

• Students should wear their own appropriate workout clothing (do not share clothing) individual

clothing/towels should be washed and cleaned after every workout.

• All athletic equipment, including balls, should be cleaned after each use and prior to the next workout.

• Individual drills requiring the use of athletic equipment are permissible, but the equipment should be

cleaned prior to use by the next individual.

• Resistance training should be emphasized as body weight, sub-maximal lifts and use of resistance

bands.

• Free weight exercises that require a spotter cannot be conducted while honoring social distancing

norms. Safety measures in all forms must be strictly enforced in the weight room.

• Examples (including by limited to):

o A basketball player can shoot with a ball(s), but a team should not practice/pass a single ball among

the team where multiple players touch the same ball.

o A football player should not participate in team drills with a single ball that will be handed off or

passed to other teammates. Contact with other players is not allowed, and there should be no

sharing of tackling dummies/donuts/sleds.

o A volleyball player should not use a single ball that others touch or hit in any manner.

o Softball and baseball players should not share gloves, bats, or throw a single ball that will be tossed

among the team. A single player may hit in cages, throw batting practice (with netting as backstop,

no catcher). Prior to another athlete using the same balls, they should be collected and cleaned

individually.

o Wrestlers may skill and drill without touching a teammate.

o Cheerleaders may not practice/perform partner stunts or building. (Chants, jumps, dances without

contact are permissible.)

o Tennis players may do individual drills, wall volleys and serves.

o Runners should maintain the recommended 6 feet of distancing between individuals

Hydration:

• All students shall bring their own water bottle. Water bottles must not be shared.

• Hydration stations (water cows, water trough, water fountains, etc.) should not be utilized.

Phase 2

Pre-Workout/Contest Screening:

• All coaches and students should be screened for signs/symptoms of COVID-19 prior to a workout.

Screening includes a temperature check.

• Responses to screening questions for each person should be recorded and stored so that there is a

record of everyone present in case a student develops COVID-19 (see Appendix II for sample

Monitoring Form).

• Any person with positive symptoms reported should not be allowed to take part in workouts and

should contact his or her primary care provider or other appropriate health-care professional.

• Vulnerable individuals should not oversee or participate in any workouts during Phase 2.

Limitations on Gatherings:

• No gathering of more than 10 people at a time inside. Up to 50 individuals may gather outdoors for

workouts.

• If locker rooms or meeting rooms are used, there must be a minimum distance of 6 feet between each

individual at all times.

• Workouts should be conducted in “pods” of students with the same 5-10 students always working out

together. Smaller pods can be utilized for weight training. This ensures more limited exposure if

someone develops an infection.

• There must be a minimum distance of 6 feet between each individual at all times. If this is not possible

indoors, then the maximum number of individuals in the room must be decreased until proper social

distancing can occur. Appropriate social distancing will need to be maintained on sidelines and

benches during practices. Consider using tape or paint as a guide for students and coaches.

Facilities Cleaning:

• Adequate cleaning schedules should be created and implemented for all athletic facilities to mitigate

any communicable diseases.

• Prior to an individual or groups of individuals entering a facility, hard surfaces within that facility should

be wiped down and sanitized (chairs, furniture in meeting rooms, locker rooms, weight room

equipment, bathrooms, athletic training room tables, etc.).

• Individuals should wash their hands for a minimum of 20 seconds with warm water and soap before

touching any surfaces or participating in workouts.

• Hand sanitizer should be plentiful and available to individuals as they transfer from place to place.

• Weight equipment should be wiped down thoroughly before and after an individual’s use of

equipment.

• Appropriate clothing/shoes should be worn at all times in the weight room to minimize sweat from

transmitting onto equipment/surfaces.

• Any equipment such as weight benches, athletic pads, etc. having holes with exposed foam should be

covered.

• Students must be encouraged to shower and wash their workout clothing immediately upon returning

to home.

Physical Activity and Athletic Equipment:

• Lower risk sports practices and competitions may resume (see Potential Infection Risk by Sport below).

• Modified practices may begin for Moderate risk sports.

• There should be no shared athletic towels, clothing or shoes between students.

• Students should wear their own appropriate workout clothing (do not share clothing), and individual

clothing/towels should be washed and cleaned after every workout.

• All athletic equipment, including balls, should be cleaned intermittently during practices and contests.

• Hand sanitizer should be plentiful at all contests and practices.

• Athletic equipment such as bats, batting helmets and catchers gear should be cleaned between each

use.

• Maximum lifts should be limited and power cages should be used for squats and bench presses.

Spotters should stand at each end of the bar.

Hydration:

• All students shall bring their own water bottle. Water bottles must not be shared.

• Hydration stations (water cows, water trough, water fountains, etc.) should not be utilized.

Phase 3

Pre- Workout/Contest Screening:

• Any person who has had a fever or cold symptoms in the previous 24 hours should not be allowed to

take part in workouts and should contact his or her primary care provider or other appropriate healthcare professional.

• A record should be kept of all individuals present.

• Vulnerable individuals can resume public interactions, but should practice physical distancing,

minimizing exposure to social settings where distancing may not be practical, unless precautionary

measures are observed.

Limitations on Gatherings:

• Gathering sizes of up to 50 individuals, indoors or outdoors.

• When not directly participating in practices or contests, care should be taken to maintain a minimum

distance of 3 to 6 feet between each individual. Consider using tape or paint as a guide for students

and coaches.

Facilities Cleaning:

• Adequate cleaning schedules should be created and implemented for all athletic facilities to mitigate

any communicable diseases.

• Prior to an individual or groups of individuals entering a facility, hard surfaces within that facility should

be wiped down and sanitized (chairs, furniture in meeting rooms, locker rooms, weight room

equipment, bathrooms, athletic training room tables, etc.).

• Individuals should wash their hands for a minimum of 20 seconds with warm water and soap before

touching any surfaces or participating in workouts.

• Hand sanitizer should be plentiful and available to individuals as they transfer from place to place.

• Weight equipment should be wiped down thoroughly before and after an individual’s use of

equipment.

• Appropriate clothing/shoes should be worn at all times in the weight room to minimize sweat from

transmitting onto equipment/surfaces.

• Any equipment such as weight benches, athletic pads, etc. having holes with exposed foam should be

covered.

• Students must be encouraged to shower and wash their workout clothing immediately upon returning

to home.

Physical Activity and Athletic Equipment:

• Moderate risk sports practices and competitions may begin.

• There should be no shared athletic towels, clothing or shoes between students.

• Students should wear their own appropriate workout clothing (do not share clothing), and individual

clothing/towels should be washed and cleaned after every workout.

• Hand sanitizer should be plentiful at all contests and practices.

• Athletic equipment such as bats, batting helmets and catchers gear should be cleaned between each

use. Other equipment, such as hockey helmets/pads, wrestling ear guards, football helmets/other

pads, lacrosse helmets/pads/gloves/eyewear should be worn by only one individual and not shared.

• Maximum lifts should be limited and power cages should be used for squats and bench presses.

Spotters should stand at each end of the bar.

• Modified* practices may begin for Higher risk sports:

o *Continue pre-practice screening as in Phases 1 and 2. Shower immediately after

practices/contests.

o Re-assess epidemiology data and experiences in other states and other levels of competition to

determine when Higher risk sports competition may resume.

Hydration:

• All students shall bring their own water bottle. Water bottles must not be shared.

• Hydration stations (water cows, water trough, water fountains, etc.) may be utilized but must be

cleaned after every practice/contest.

E. Contests

1. Potential Infection Risk by Sport (modified from United States Olympic and Paralympic

Committee – Sports Medicine recommendations)

Higher Risk: Sports that involve close, sustained contact between participants, lack of significant

protective barriers, and high probability that respiratory particles will be transmitted between

participants.

Examples: Wrestling, football, boys lacrosse, competitive cheer, dance

Moderate Risk: Sports that involve close, sustained contact, but with protective equipment in place

that may reduce the likelihood of respiratory particle transmission between participants OR

intermittent close contact OR group sports OR sports that use equipment that can’t be cleaned

between participants.

Examples: Basketball, volleyball*, baseball*, softball*, soccer, water polo, gymnastics* (if equipment

can’t be sufficiently cleaned between competitors), ice hockey, field hockey, tennis*, swimming relays,

pole vault*, high jump*, long jump*, girls lacrosse, crew with two or more rowers in shell, 7 on 7

football

*Could potentially be considered “Lower Risk” with appropriate cleaning of equipment and use of

masks by participants

Lower Risk: Sports that can be done with social distancing or individually with no sharing of equipment

or the ability to clean the equipment between use by competitors.

Examples: Individual running events, throwing events (javelin, shot put, discus), individual swimming,

golf, weightlifting, alpine skiing, sideline cheer, single sculling, cross country running (with staggered

starts)

2. Transportation to events

Schools must consider social distancing requirements when scheduling contests and events

for the fall. Social distancing (as required by state or local health department) will need to be

maintained on buses/vans. Thus, multiple buses/vans and/or parental/guardian transportation

will likely be needed.

3. Social distancing during Contests/Events/Activities

a. Sidelines/benches

Appropriate social distancing will need to be maintained on sidelines/bench during contests

and events. Consider using tape or paint as a guide for students and coaches.

b. Who should be allowed at events?

Group people into tiers from essential to non-essential and decide which tiers will be

allowed at an event:

1. Tier 1 (Essential): Athletes, coaches, officials, event staff, medical staff, security

2. Tier 2 (Preferred): Media

3. Tier 3 (Non-essential): Spectators, vendors

Only Tier 1 and 2 personnel will be allowed to attend events until state/local health

departments lift restrictions on mass gatherings.

F. Athletic Training Services

Given the coming financial crisis at the state and local levels, the NFHS SMAC fears that

athletic trainer positions will be seen as a “luxury” and those positions will be at risk during the

budgeting process. It is also assumed that athletic trainers supplied to high schools by hospitals

and sports medicine clinics are also at risk as many medical clinics and hospitals have suffered

severe revenue loss during the pandemic.

Athletic trainers in high schools are positioned to play a vital role as sports return following

this pandemic. As health-care professionals, they can take lead roles in developing and

implementing infection control policy throughout the school. Whenever needed, state

associations and their SMACs should promote the importance of athletic trainers in high

schools and their role in injury evaluation, treatment and risk minimization as well as being a

vital component of any return-to-school and athletics plan.

2. Return to Physical Activity

Current pre-season conditioning and acclimatization models assume that athletes have deconditioned

over the summer months. The current pandemic may result in students being deconditioned for four

to five months. The NFHS is currently involved with a number of other organizations in developing

consensus guidelines for fall sports practices. These guidelines will be sent to state associations

immediately after they are finalized and approved by all involved organizations.

3. Hygienic

A. Illness reporting

Create notification process for all event athletes, coaches, event staff, media, spectators and

vendors if the organizers/medical personnel learn of suspected or confirmed cases of COVID-19 at

the event.

B. Considerations for Officials, Coaches, Other Personnel

1. Vulnerable individuals should not participate in any practices, conditioning activities,

contests or events during Phases 1 and 2.

2. Masks may be worn, social distancing enforced and “Hygiene Basics” adhered to in all

situations.

C. Hygiene Basics

CONTINUE TO PRACTICE GOOD HYGIENE

• Wash your hands with soap and water or use hand sanitizer, especially after touching frequently used

items or surfaces.

• Avoid touching your face.

• Sneeze or cough into a tissue, or the inside of your elbow.

• Disinfect frequently used items and surfaces as much as possible.

• Strongly consider using face coverings while in public, and particularly when using mass transit.

PEOPLE WHO FEEL SICK SHOULD STAY HOME

• Do not go to work or school.

• Contact and follow the advice of your medical provider.

OTHER CONSIDERATIONS

1. Wide availability of hand sanitizer at contests and practices. Participants, coaches and officials should

clean hands frequently.

2. Wiping down ball and equipment frequently.

3. No pre-game and post-game handshakes/high-fives/fist bumps.

4. Officials and sideline volunteers should be given option to wear face coverings (may use artificial

noisemaker in place of whistle).

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