Question: Earlier in the summer, a number of Covid Risk Assessment Charts made the rounds, such as this one. I’ve not seen any charts like these recently in general or new charts with updated information. I have been noticing many of the high risk activities (according to the various risk assessment charts) are now widely happening. In particular, team sports for both children and adults appear to be happening, and the start of the academic year seems to be a major factor. Have any of the risks associated with any of these activities changed, or is it that our society has decided these activities outweigh the risks?

Answer: I think people’s behavior has changed over the months for various reasons — risk perceptions have changed, risk/benefit calculations have changed, people have a more nuanced perception of risk, and some people are tired of minimizing risks. Some of the change is evidence-informed and some of it is just human behavior. Turning to sports, if you were looking for a yes/no or do/don’t answer, you’re unlikely to get it. On 18 September, the American Academy of Pediatrics (AAP) updated its clinical guidance on return to sports for children and adolescents. And CDC offers sports recommendations for youth and adults, as well as this colorful risk diagram (Figure 1) and helpful video. The upshot of all this guidance is== make your own determination based on your/your child’s circumstances and try to minimize as much risk as you can. Here are a few excerpts from AAP guidance:

• “Ultimately, the decision falls on parents/guardians to decide whether they will allow their children to participate in sports.”
• “Because prolonged, close contact with a person infected with SARS-CoV-2 is the main driver of transmission, the sport (number of players, spacing, and frequency and duration of contact) and setting (indoor versus outdoor, size and ventilation of facility) will likely influence risk of infection. Although it is not likely the main form of transmission, it is possible for SARS-CoV-2 to be transmitted on surfaces; therefore, sports with shared equipment, facilities, or common surfaces may pose additional risk.”
• “Weighing the risk versus benefit of return to sport is driven by the sport and setting, local disease activity, and individual circumstances, including underlying health conditions that place the athlete or household contacts at high risk of severe disease should they contract SARS-CoV-2 infection.”
• “Risk can be decreased but not eliminated by athletes, parents, coaches, and officials following safety protocols.” [Note: CDC and AAP offer many pieces of guidance for reducing risk for those who choose to play/coach/spectate.]

Figure 1. Low Risk to High Risk Continuum of Sports Competition (from CDC)