The activity at a Honolulu park on June 19 indicated that things were back to normal. It was the first day youth sports teams could practice together; kids worked out with their teammates and coaches as they did a year ago, when no one had ever heard of a disease called COVID-19.
At this practice last week, few if any of the kids wore face masks and neither did their coaches. The young athletes, soccer players who appeared to be about 10 years old, were often closer than 6 feet from one another.
From one perspective, this seems wonderful. After months of being cooped up due to quarantine, kids are allowed to be kids again, playing sports out in the sunshine. They’re improving their game and having fun with their peers.
But from another view, there are concerns. While the coronavirus infection rate remains relatively low in Hawaii, it has — as in other states — increased significantly this month. In recent weeks some isolation restrictions have been lifted. Restaurants, retail stores, churches and beaches are among the gathering places that have reopened in Hawaii.
The risk for children getting sick from the virus is minimal compared to adults. According to numbers from the state Department of Health released June 22, people under age 19 represent 64 of the 816 total in the state who had tested positive for COVID-19. Only one child was hospitalized and none were among the 17 deaths in Hawaii.
But even if no one at a practice or game is showing symptoms, a child could catch the virus and bring it home and spread it to household members who may be vulnerable because of age and/or health issues. Also, children with underlying health issues including asthma and diabetes are at a higher risk of getting sick from the virus themselves.
“There are some transmission risks,” said Dr. Rachel Coel, who is a sports medicine pediatrician at the Kapi‘olani Medical Center for Women & Children. “Children serving as vectors is a concern.”
But Coel and other Honolulu doctors specializing in children’s health understand it’s important for kids to get out and play.
“We’re not against them holding practices. We get it,” said Coel, who is also the mother of 8- and 10-year-old children who play sports. “We want to get back to normal. But can we take some precautions and do some things that we know will help keep us safer?”
Recommendations from health agencies suggest it might be too early for team practices and games, especially if masks are not worn (except while actively practicing or playing in games) and social distancing is not enforced.
Other safety suggestions include not sharing equipment, remembering to avoid contact like high-fives, and practicing in small groups.
Guidelines for interscholastic sports are provided by the National Federation of High Schools and the Hawaii High School Athletic Association. But there is no centralized authority when it comes to sports for younger athletes and free play, including for toddlers. Guidelines on return to play vary from sport to sport, organization to organization and even team to team.
“For the younger kids there’s not a governing body, so you hope the coaches are cognizant,” Dr. Jennifer King, a sports medicine specialist at Kapi‘olani Bone & Joint Center, said.
Since there is are so many conflicting recommendations, King and other doctors say communication with coaches and family doctors is key.
A lack of consistent, very specific guidelines is due to the fluid nature of the coronavirus and that researchers are still learning about it. King suggests that parents “watch the state numbers” of infections daily.
“The higher the number, the more risk there is in the community,” King said.
Tracie Umaki is a neuropsychologist whose children Alex, 10, and Alivia, 5, are both active in sports.
“I trust Alex’s coaches as they’ve been doing Zoom practices with them to keep their skills up, and have emphasized a graduated return (to practices and games) so as to avoid injuries,” Umaki said. “Personally and professionally I feel that a return to sports for youth is an important part of their socialization as well as their mental health.”
Another major concern is that children who have been sedentary for weeks or months may try to do too much too fast and injure themselves due to lack of conditioning.
Since kids have been getting out and playing again in recent weeks, the doctors have treated injuries associated with a rushed return to activity.
“Especially with the little kids, there are a lot of ankle sprains and fractures,” Coel said. “They haven’t been using their muscles and they get tired fast. When little kids get tired they lose coordination and fall.”
And some older children who are on teams have been getting injured because they feel pressure to make up for lost time.
“We tell the kids that they shouldn’t try to go from zero to hero on the first day,” King said.
If infection numbers continue to go up, it’s possible that youth team sports will be put on pause. That doesn’t mean kids should just play video games all day, the doctors said.
“If I had to pick one magic word, it would be calisthenics, for everyone to start a calisthenics program,” said Dr. Christopher Lynch, also a sports medicine pediatrician at Kapi‘olani. “I know it might be hard to get excited about, but it depends. One thing to avoid is the idea that one size fits all.”
To keep younger children engaged, Coel suggests scavenger hunts combined with simple, fun exercises like duck-walks.
“I don’t see 5-year-olds being excited about doing 20 situps,” she said. “Free play is important for their development. At this stage of the game just get them moving and make it enjoyable.”
Kids who can’t safely practice with teammates or play with children from other households can still do so with siblings and parents, and can play catch or basketball without worrying about the ball being sanitary.
“Exercise is medicine,” Coel said. “You can do simple things that aren’t contagious.”