Maine Principal's Association releases new guidelines for return to play

AUGUSTA, MAINE (WABI) - GUIDANCE FOR OPENING HIGH SCHOOL
ATHLETICS AND ACTIVITIES
PURPOSE OF MPA GUIDELINES
The COVID-19 pandemic has sparked dramatic changes across all
aspects of our daily lives. The combination of lifestyle modifications and
potential comorbidities associated with COVID-19 also presents
important, athlete specific health and safety risks as return to sport plans
emerge. While transition periods have a higher risk for catastrophic sport
injury, some of the factors that place athletes at higher risk during these
periods may be amplified because of social distancing measures. Even
athletes within the same team may have a spectrum of risk profiles. As
plans for a return to organized sport begin, healthcare providers and
administrators are giving tremendous consideration for how to reduce risk
while re-introducing sport.
Returning to physical activity is essential for high school aged athletes for both physical and mental wellbeing. Although risk cannot be eliminated entirely, this document serves to decrease the risk of transmission of communicable disease by adding preventative measures until there is a cure, vaccine, or effective treatment of COVID-19.
This document provides recommendations and guidelines for the
remobilization of sports and extracurricular activities in Maine schools.
This is created using the latest research and guidelines and best practice from the Center of Disease Control (CDC), the National Federation of State High School Associations (NFHS), the NFHS Sports Medicine Advisory Committee (SMAC), the National Association of Athletic Trainers (NATA), Korey Stringer Institute (KSI), the Maine Department of Education (DOE), the Maine Principals’ Association (MPA) Sports Medicine Committee, as well as emerging guidance from local and federal government. This policy is a living, working document that is being continuously reviewed and updated. It is designed to specifically address return to physical activity following physical distancing and associated detraining of student-athletes during the COVID-19 pandemic.

INTRODUCTION
The novel human coronavirus, known also as COVID-19 is a respiratory illness caused by a virus (SARS-CoV-2) that affects humans, as well as animals such as cats, dogs, and birds. While many strains of coronaviruses exist generally causing mild respiratory symptoms and only transmitted within the species, SARS-CoV-2 is a recently identified strain. COVID-19 is termed a “spillover event” meaning it can be transmitted between varied species, causing symptoms or respiratory
distress ranging from mild to severe in humans globally.
● COVID-19 is considered a droplet-transmitted disease, spread from person to person through microscopic particles of saliva that are expelled from the mouth or nose when someone talks, coughs, or sneezes. Droplets can be transmitted both through the air if in
close exposure (within 6 feet) or on a surface that has been contaminated with droplets from a person infected with COVID-19. Currently there is no cure, vaccine, or effective treatment.
Both the form and ease of transmission pose unique challenges for returning students to school based athletics and doing so safely.
Reported symptoms of COVID-19 range from very mild to life threatening, generally appearing in an affected person between 2 and 14 days after being exposed to the virus. Symptoms include, but
may not be limited to the following:
● Fever or chills
● Cough
● Shortness of breath or difficulty breathing
● Fatigue
● Muscle or body aches
● New loss of taste or smell
● Sore throat
● Congestion or runny nose
● Nausea or vomiting
● Diarrhea
While certain groups of individuals have been identified as “high risk” for potentially developing severe illness from COVID-19, the nature of the threat continues to remain mainly hidden. Even if a person is only mildly ill, the people they spread it could experience severe or life-threatening
symptoms. Based on currently available information, the following have been identified as potentially “high risk” profiles:
● People 65 years and older
● People of all ages with underlying medical conditions including but not limited to
○ Chronic lung disease including asthma
○ Serious heart conditions
○ Immunocompromised due to illness or
■ Cancer treatment
■ Smoking
■ Bone marrow or organ transplant
■ Immune deficiencies
■ AIDS or HIV
■ Corticosteroid use
■ Other immune weakening medications
● People who are obese (BMI 40 or higher)
● People with diabetes
● People undergoing dialysis
● People with liver disease
Until a proven cure, vaccine or treatment for the virus that causes COVID-19 is found, decreasing potential exposure to respiratory droplets is the guiding principle behind this document.
Definitions: Extracurricular Activities- For this document, extracurricular activities are defined as programs that are governed by the Maine Principals’ Association. It is understood that all these activities are
purely voluntary on the part of the student.
Close Exposure - A close exposure is defined as having a household member with COVID-19, prolonged exposure (>10 minutes) within 6 feet of an individual with confirmed COVID-19, direct exposure to infectious secretions (e.g., being coughed on) or direct physical contact during sports from an individual with COVID-19.

COVID RESPONSE TEAM
Every school should establish a COVID-19 Response Team to help identify and implement policies and procedures for safe return-to-school and sport activities. This team could include the school/team physician, certified athletic trainer, athletic director, administrator, and school nurse. The team could also assist in developing policies related to COVID-19 reporting, screening and contact tracing.
It is crucial that prior to the start of any organized activity a well-developed emergency action plan (EAP) be put in place with specific language regarding COVID-19. It is also important that each location where training is taking place have access to an AED. For more information on developing an EAP, please reference Anyone Can Save a Life: www.anyonecansavealife.org.

PREPARTICIPATION PHYSICAL EXAM
Access to healthcare professionals to complete an in-person preparticipation physical evaluation (PPE) may be limited for the 2020-2021 academic school year. Many districts have a policy that requires a physical exam every two calendar years. Given this may not be feasible in our current pandemic, the following procedures are recommended for the 2020-2021 school year:
● Athletes who had a valid PPE on file for the 2019-2020 academic year be granted a one year extension to receive their PPE. In other words, athletes whose PPE would expire in the 2020-2021 academic year, will be granted a one-year extension to receive a new physical.
● However, all athletes will be required to update and complete the health history questionnaire which should include a COVID-19 specific health history.
(https://www.aap.org/en‐us/Documents/PPE‐History‐Form‐%28English%29.pdf)
○ The health history and COVID-19 specific health history will be reviewed by the school’s healthcare professionals. Positive responses will trigger an evaluation prior to participation in sports.
○ Athletes who are first time participants in athletics, or athletes who did not have a physical exam during the 2019-2020 academic year, will be required to have a physical prior to athletic participation.
● Athletes with a prior COVID-19 diagnosis should undergo a medical assessment before returning to exercise.
○ Every student-athlete with a prior diagnosis of COVID-19, symptoms suggestive of COVID-19, or a “close exposure” to someone with COVID-19 must contact their primary care physician to determine if further evaluation is warranted prior to returning to sports.
■ Regardless of if the medical provider deems further evaluation is warranted, documentation must be provided to the COVID-19 Response Team prior to participation.
○ A medical evaluation is required for student-athletes with a confirmed diagnosis of COVID-19. This may include additional cardiac, such as an electrocardiogram (ECG), pulmonary, and kidney function testing as determined by the physician.
● Those at greater risk for developing severe COVID-19 disease or complications should undergo an informed decision-making process with their medical provider before a return to sports as exposure to teammates and opponents may increase their risk of becoming
infected. Individuals at higher risk of severe COVID-19 include those with a serious heart condition, uncontrolled or moderate to severe asthma, chronic lung disease, diabetes, obesity, pre-existing kidney disease, or a weakened immune system.
○ Once the COVID-19 specific health history and the past medical history of the PPE are completed; the school medical professional will review and recommend any follow-up precautions to the team physician and the athlete and their parents/guardians.
○ All athletes with prior COVID-19 will be screened for ongoing symptoms of chest pain/pressure with exercise, difficulty breathing or dizziness with exercise, or decreased exercise tolerance.
RETURN TO PHYSICAL ACTIVITY
The MPA understands that many student athletes have had limited or even no access to athletic facilities and organized activities for several months, resulting in potentially significant deconditioning. This level of deconditioning places the student athlete at high risk of overuse
injuries with the return to normal activity. When considering plans for a “re-start” of sports activities, consideration must be given to the student athlete’s level of conditioning. Further information concerning return to physical activity/conditioning can be found in Return to Sports and Exercise during COVID-19 Pandemic: Guidance for High School and Collegiate Athletic Programs (Return to Sports and Exercise During the COVID-19 Pandemic )
The following recommendations and guidelines contain a “phase in” approach that includes: 1) a period of voluntary non-sport specific strength, conditioning and agility training (Phase 1); 2) voluntary individual skill activity along with strength, conditioning and agility training (Phase 2); 3) a two week summer period that allows for sport specific activities (Phase3); and 4) a fall sport season (Phase 4).
Phases 1 and 2– Conditioning, Strength Training, Agility, and Individual Skill Activity Phases 1 and 2 should consist of a four-week period, during which, student athletes will have the opportunity to participate in activities to improve conditioning, strength, agility, and individual skill
activity. The four-week period is to be broken down into two parts, with specific guidelines and recommendations implemented for each part. School and district administrators will need to determine if this will be an option on their school campuses. If so, school administrators will need to ensure that adequate staff are present during this time so that all safety precautions are met.
Phase 1 Weeks 1-2 of Conditioning, Strength Training, and Agility (July 6 – July 19)
Use of outdoor facilities only
● Coaches must track attendance of each student and adult daily.
● Students and/or adults who have symptoms of COVID-19 illness or feel sick must stay home
and only return with medical clearance.
● Students and/or adults who have symptoms after arriving at a training session must leave
the site and only return with medical clearance.
● Student groups or “pods” of 10 or less need to be assigned and names recorded.
● Students stay in their “pod” for the duration of Phase 1.
● All students and adults should maintain proper social distancing (6 feet).
● Face masks/coverings are recommended when appropriate. In accordance with CDC guidance, “face coverings are not intended to protect the wearer, but rather to reduce the risk of spreading COVID-19 from the person wearing the mask (who may not have any symptoms of disease).” (CDC Consideration for Youth Sports, 2020) “Face coverings may be challenging for players (especially younger players) to wear while playing sports.” (CDC Consideration for Youth Sports, 2020) “Face coverings should be worn by coaches, youth sports staff, officials, parents, and spectators as much as possible.” (CDC Consideration for
Youth Sports, 2020)
Cloth or disposable face coverings should be worn throughout each phase when not engaging in vigorous activity, such as when sitting on the bench, during chalk talks, interacting with an athletic trainer, etc.
o Medical grade face coverings are not necessary. Cloth or disposable face coverings are acceptable.
o Face coverings should not be worn when engaging in high intensity aerobic or anaerobic workouts, distance running, or swimming.
o Plastic shields covering the entire face (or attached to a helmet) shall not be allowed during contests. Their use during practices increases the risk of unintended injury to the person wearing the shield or teammates.
(2020 NFHS Guidance for Opening up High School Athletics and Activities, 2020)
o Coaches, officials, and other contest personnel should always wear cloth face coverings. (Artificial noisemakers such as an air horn or a timer system with an alarm can be used to signal in place of a traditional whistle.) (2020 NFHS Guidance for Opening up High School Athletics and Activities, 2020)
 Activities are to be limited to conditioning, strength training, and agility. No sport specific equipment or skill activity is allowed.
 Limit of one hour of activities per student per day.
 Students should bring their own water bottle. No sharing of water bottles allowed.
 Disinfectants and hand sanitizers should be available on site.
 Students and adults should practice frequent hand washing when in contact with others or with equipment (jump ropes, weights, etc.)
 Any equipment used should be sanitized after each individual use. For guidance on use and cleaning of equipment, please reference the CDC guidelines:
https://azgovernor.gov/sites/default/files/guidance_for_gyms_fitness_providers.pdf
https://www.cdc.gov/coronavirus/2019-ncov/community/cleaning-disinfecting-decision-tool.html
Phase 2 Weeks 3-4 of Conditioning, Strength Training, and Agility (July 20 – August 2)
Use of indoor and outdoor facilities
● Coaches should continue to track attendance of each student and adult daily.
● Students and/or adults who have symptoms of COVID-19 illness or feel sick must stay home and only return with medical clearance.
● Students and/or adults who have symptoms after arriving at a training session must leave the site and only return with medical clearance.
● Use of outdoor and/or indoor (such as weight rooms, gyms, and wrestling rooms) facilities allowed.
● Student groups or “pods” of 10 or less (indoors), but up to 50 students allowed in designated areas (outdoors).
● Students stay in their “pod” for the duration of Phase 2.
● All participants and adults should maintain proper social distancing.
● Face masks/coverings are recommended when appropriate. In accordance with CDC guidance, “face coverings are not intended to protect the wearer, but rather to reduce the risk of spreading COVID-19 from the person wearing the mask (who may not have any
symptoms of disease).” (CDC Consideration for Youth Sports, 2020) “Face coverings may be challenging for players (especially younger players) to wear while playing sports.” (CDC Consideration for Youth Sports, 2020) “Face coverings should be worn by coaches, youth
sports staff, officials, parents, and spectators as much as possible.” (CDC Consideration for Youth Sports, 2020)
○ Cloth or disposable face coverings should be worn throughout each phase when not engaging in vigorous activity, such as when sitting on the bench, during chalk talks, interacting with an athletic trainer, etc.
○ Medical grade face coverings are not necessary. Cloth or disposable face coverings are acceptable.
○ Face coverings should not be worn when engaging in high intensity aerobic or anaerobic workouts, distance running, or swimming.
○ Plastic shields covering the entire face (or attached to a helmet) shall not be allowed during contests. Their use during practices increases the risk of unintended injury to the person wearing the shield or teammates. (2020 NFHS Guidance for Opening up High School Athletics and Activities, 2020)
○ Coaches, officials, and other contest personnel should always wear cloth face coverings. (Artificial noisemakers such as an air horn or a timer system with an alarm can be used to signal in place of a traditional whistle.) (2020 NFHS Guidance for Opening up High School Athletics and Activities, 2020)
● Activities are to be limited to conditioning, strength training, agility, and individual skill development. Individual sport specific activities and equipment will be allowed, such as individual dribbling and shooting. No form of competition (including 1v1 drills) is allowed.
● Limit of two hours of activities per student per day.
● Students should bring their own water bottles. No sharing of water bottles or other personal items allowed
● Disinfectants and hand sanitizers should be available on site.
● Students and adults should practice frequent hand washing when in contact with others or with equipment (jump ropes, weights, etc.
● Any equipment used should be sanitized after each individual use. For guidance on use and cleaning of gyms and weight rooms, please reference the CDC guidelines: https://azgovernor.gov/sites/default/files/guidance_for_gyms_fitness_providers.pdf
https://www.cdc.gov/coronavirus/2019-ncov/community/cleaning-disinfecting-decisiontool.
html
Phase 3 Extended conditioning and acclimatization period – Guidelines TBD
(August 3 – Aug 16)
Phase 4 TBD