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Social distancing and mandatory mask use were key recommendations provided by the DIAA Sports Medicine Advisory Committee that met two days ahead of a critical vote on fall sports.

SMAC passed a series of recommendations that now go to the DIAA Board of Directors, who will decide whether accept them, and also adjust the high school sports calendar to place fall sports back in the fall, when they meet Thursday morning.

The group of physicians and doctors looked at various topics, including the safety of sports in a COVID-19 environment, plus a potential timetable for a return to sports.

Dr. Bradley Bley, who is SMAC's voting member on the DIAA Board, cited a group of studies, including one from the University of Wisconsin stating that two-thirds of athletes suffered from anxiety and depression during the dismissed spring 2020 season in most areas.

"If these social distancing requirements were eased, would some of this improve? Do the long-term side effects of social distancing outweigh the risks of current infections and deaths related directly to coronavirus?"

Mandy Minutola, SMAC's representative from the Delaware Athletic Trainers Association, said like everyone else on the virtual conference they want to get students back on the field, but not in a rush.

"We are obviously extremely aware of mental health. A lot of times in the school, we're one of the only people that the athletes will confide in for mental health--so we take that extremely seriously and understand the ramifications this has had, but we can't stress enough how important it is that this is done safely, appropriately, and in the right way."

DIAA Executive Director Donna Polk said she spoke with a group of conference presidents last week, who recommended a two-week gap from the start of practice to games, in an attempt to make up for lost time, but Minutola balked, saying the gap should be four to five weeks.

"We can't emphasize enough that importance of proper acclimatization back to sports. A lot of these kids have been potentially not doing much since March. Everyone is not on the same playing field, and that's how we need to look at this, as the whole. We need to make sure that every single athlete is returning appropriately, and safely."

Dr. Michael Axe, SMAC Chair, agreed that two weeks wasn't enough and came up with the compromise recommendation.

"No, we wouldn't consider that, we don't think that's medically safe. So, three weeks for other sports, and four weeks for football, is what we're going to recommend."

The conference presidents suggested three timelines to DIAA based on the two-week practice period, with practices starting on either September 21, 28, or October 5, 2020.

All would get football, the final fall sport to finish, completed on December 19, 2020, with winter sport competition permitted starting on December 21, 2020.

The committee also recommended mandatory mask use for all medium and high-risk sports. Bley said medium-risk sports such as field hockey and soccer could have been considered for no masks without contact, but that wasn't realistic to him.

Indoor sports, including volleyball, are required by Delaware to have mask use.

"It's going to be really hard to avoid contact, which is the recommendation, soccer doesn't have to wear a mask as long as there's no contact. I think it's a good idea to require masks for all of our sports."

Athletes with asthma and cardio-respiratory conditions were also considered by SMAC, with Axe saying there would be no recommended medical exemptions from mask use. 

"They either wear the mask or they don't play, that's the point. What will happen is they will have to have a trial, they'll have to wear a mask and try to perform their activities. If they're having trouble breathing, that's certainly something their physicians should be aware of, but I'm not willing to take that person on the field to find out, it has to be done before that."

Accounting for the increased mask use, SMAC also gave recommendations for continuous play sports that include field hockey and soccer, saying that the periods should be shortened. Field hockey already announced they're going to four 15-minute quarters, while SMAC suggested soccer go with three or four 20-minute periods.

Dr. Julie Knowles said there's research that suggests those intermissions, which would include a two-minute period of no coaching to allow for social distancing without masks on, are of medical importance.

"Between the 18-23 minute mark with a surgical mask, there's a large reduction in performance and ability to play, and a tax on the system with a higher respiratory rate and heart rate due to breaking in all the carbon dioxide."

Getting the athletes on the fields of play was important according to Bley, who went through some pros and cons when it comes to how COVID-19 could affect young athletes.

"On the downside, we know that some children may have higher risk of myrocarditis. Children also appear to have higher viral counts, at least children under the age of 10, which theoretically could increase the rate of spread."

"On the bright side, many kids with COVID-19 don't have symptoms, and very few are hospitalized. Transmission rates from children under the age of 10 to adults seems to be very low despite higher viral loads. There is now data that shows asthma is likely not a risk factor for severe disease, and with newer treatment such as remdesivir, steroids, and anti-coagulation, mortality has been significantly reduced in those that are severely ill. "

SMAC decided to not take specific stands on starting dates, or whether schools should limit programs to varsity-only, saying that's not their role in DIAA.

"We've made our statement, which is social distancing and mask wear is critical, that simple. I don't know how we can be any more helpful in any other discussion, because we're not going to take that away."

The DIAA Board of Directors will meet Thursday at 9 a.m., where they will ultimately make the decision whether to stick with their Winter-Fall-Spring schedule beginning in December, or try to get competition back on the field by mid-October.

A change in plans would still have to be approved by the Delaware Board of Education at their meeting on September 17, so the fall clock is already ticking.