It’s still unclear whether high school extracurricular activities will resume in the fall. However, even if Gov. Eric Holcomb’s Back on Track Indiana plan goes according to schedule through the target reopening date of July 4, Parkview Health officials don’t expect sporting events to look the way they normally do.

“Fourth of July is a mile marker, not the finish line,” Parkview Total Health Chief Officer Dr. Michael Knipp said during a May 27 seminar in Parkview’s continued Roadmap to a Healthy Reopening series in partnership with Greater Fort Wayne Inc.

The state is currently in stage 3 of Gov. Holcomb’s five-stage reopening plan, meaning social gatherings are still restricted to 100 people or fewer. Facial coverings are still recommended until June 14, restaurants are limited to 50% capacity and gyms have finally reopened.

Even as we progress through the governor’s intended timeline, Parkview officials expect to see new COVID-19 patients.

“The virus is here, and we’re going to continue to have cases,” Chief Innovation Officer Jolynn Suko said. “We don’t expect a vaccine for another 12 to 18 months, and we don’t have enough infection to confer any type of herd immunity, so our goal is to keep the surges as low as possible and as many people as safe as possible.”

Keeping those surges low has meant implementing safe practices, and according to Parkview doctors, athletes and team staffs should be prepared to implement those practices even if the Indiana High School Athletic Association and other athletics organizations give programs the green light for their fall seasons.

Dr. Knipp indicated that while teams will have to wait for further guidance from the governor, he does anticipate some return to extracurriculars in the fall.

“We’re waiting on organizations like the NCAA, the IHSAA, the OHSAA to come through with their recommendations on what we can do,” Parkview Sports Medicine Medical Director Dr. Joseph Mattox said. “And the best thing we can do up until that moment is to prepare. We’re ready to do what we believe is the new norm, and the new norm is going to keep changing — the goalpost is going to keep moving.”

Parkview offered some simple steps May 27 to stop the spread of COVID-19 during extracurriculars:

• Do not share or minimize shared equipment

• Launder clothing and uniforms more frequently (after each use)

• Clean equipment regularly at home with EPA-recommended cleaner

• Replace personal items like mouth guards after illness

• Physicals should be done by local pediatrician or primary care doctor — whether or not it’s required

One of the biggest questions remaining is how sports programs will coordinate their efforts to ensure that what is in place at one school is safe for any visitors.

“The hope is that the IHSAA comes through with very solid policy that’s in line with our surrounding states and all their policies are very similar — kind of like with concussions,” Dr. Mattox said. “The fear is that doesn’t happen. The timing of when things can happen will be based on your state and local authorities, but hopefully those overall policies coming from the IHSAA and Ohio and other places are very much in line with the CDC and what Parkview is doing so it will just seamlessly fall into place — so your conference at EACS will have the same status as the SAC conference so we can play each other and know your kids are safe on my campus and my kids are safe on your campus.”

During last week’s seminar, Parkview officials were on hand to answer questions from viewers pertaining to school sports and other activities:

What is the fall sport and activity forecast? What about spring?

We anticipate the return of sports and extracurriculars this fall. What, when and how may look different, including schedules and number of participants at one time. Focus must be safety of players, families and staff.

The spring season will look like the fall as there will likely be no widely accessible vaccine until summer 2021 or later.

What do we need to know about multisystem inflammatory syndrome in children? We know that children aren’t at high risk to die from COVID-19, but do we need to be concerned about the new development?

New child complications will not change the course of action. Coaches and trainers know their student athletes and participants, and can contact their doctors if there is any concern.

“Our athletic trainers in the area with Parkview Sports Medicine and our partners are very in tune with all their athletes, so when someone is outside the norm we should get them back to their primary care physician or pediatrician for evaluation,” Dr. Mattox said.

Do teachers and coaches need to wear a mask in a gym, choir or band setting?

For instructors, a face shield may be more appropriate for use than a cloth mask. If you mandate, you should be able to provide for all staff working with participants in close proximity: a face shield or three cloth masks per person — one to wear, one to wash and one as backup.

Remind individuals about all the other ways they can maintain good hygiene.

Should participants wear masks?

It will be hard for a wide variety of athletes to participate with masks on. For athletes, the mask may be more harmful and cause overheating or reduce needed inhalation.

“Having a mask on a wrestler would be very difficult. Having a mask on a lineman in football, with their size and the heat outside, is going to be another difficult situation with overheating,” Dr. Mattox explained. “So, we’re going to have to use our training and be aware of all of their medical conditions — not just COVID-19. We want to make sure we’re aware of all the risks.”

Knipp recommended coaches on the sidelines during sporting events consider wearing a face shield if they will be in close proximity with heavily breathing athletes.

Do hockey helmets work as masks?

A hockey helmet with a visor is more effective than a helmet with a metal cage. USA Hockey is offering guidance and updating this. The state of Illinois has mandated the plastic shield for all players. Parkview will share the best practice on its Parkview Business Contact site.

Can participants share equipment?

Continue good cleaning of shared items and common touch surfaces between use, including helmets, bats, rackets, flags, balls, pucks, etc. if not handled wearing a glove. Soiled items should be cleaned thoroughly.

“The TinCaps — every player has five gloves, 10 bats and however many they need to choose from, so not sharing is easy. When you get down to these other teams, it’s going to be what’s feasible,” Dr. Mattox said. “If you have someone that can’t afford a glove or can’t afford a bat, we’re going to have to find out a way to help with that. You’re going to maybe need to deem someone who’s going to be the sanitizer before the game or before the practice.”

Can we allow spectators at events? If so, how do we do so while minimizing risk of virus spread?

Follow state and local guidance on size of groups allowed and specific activity recommendations.

Start by considering all your “places” where spectators would be, including parking, lobby, ticketing, stands and restrooms. Design your entry and exit to support one-way traffic flow.

Limit the number of people in each “place.”

What measures should we consider implementing for concessions at events?

All staff and volunteers should be communicated with about expectations and precautions prior to working in concessions.

Staff and volunteers should maintain a 6-foot distance if feasible, wear masks and wash hands regularly.

Distance lines should be marked to keep customers 6 feet apart. Traffic should be one-way.

Consider having a dedicated cash-taker. For larger operations, consider investing in order-ahead technology or other touchless payment options.

Communicate regularly prior to and throughout the event about concessions, and encourage purchases throughout the event — not just at prime times.

“Spreading people out is a very important consideration,” Parkview Food and Nutrition Services Corporate Director Wesley Oburn said. “Is it possible that you create multiple popup-type concession stands that might be littered throughout the event center or ball field or venue, just to move people around and keep lines from forming?”

Can we continue to offer team meals?

“It can be considered — just carefully,” Dr. Knipp said.

Follow the governor’s order on dining area capacity. No self-service, shared utensils or drink stations, and no more than six people per table.

Use the hierarchy of controls and design the space to accommodate social distancing, including personal protective equipment, hand washing, hand sanitizing and disinfecting.

Eliminate potluck or buffet-style meals. Only serve commercial-kitchen-prepared food.

Use disposable plates and silverware.

Can participants stand in a close row or sit on a bench, or do they need to remain 6 feet apart?

If you are conducting games or competitions, you’ve received permission to do so by the state and local officials and your activity’s governing body.

Social distancing of 6 feet is ideal if feasible.

Consider ways to use your entire space for the function of a “bench.”

What are some creative ways organizations are offering activities?

Parkview Sports Medicine offered virtual performance training to athletes.

Choir practices can be offered through remote technology.

Live-stream practices and/or competitions for parents if you limit access to the facility.

Stand 6 feet apart for the national anthem, starting lineups or curtain call.

Teach choreography by posting YouTube videos.

“I think this is an area where a lot of the local coaches probably fall into a high-risk category,” Dr. Mattox said. “To keep them involved with the team, we’re going to have to use some of this technology.”

Who makes the decision on what is or is not done?

The same individuals or groups who make the decision currently.

For your activity and place:

• State and local government

• Accrediting and/or governing body of your sport or activity

• Organization’s board and/or administration

For your participants:

• All of the above

• Coach

• Parent and participant

“I would say when it comes to the decision of who’s playing: Based on quality of play, that would (be) coach. Based on wellness, that would be athletic trainers, physicians and medical care providers making those decisions.”

Dr. Knipp added that teams may have to resort to only intra-conference play if some teams enact different rules than others.

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