Dr. George Chiampas on indoor soccer safety during the pandemic

For coaches, players, parents, referees and administrators considering indoor soccer amid the COVID-19 pandemic, U.S. Soccer has released an Indoor Considerations Recommendations Guide. In June, U.S. Soccer created its detailed PLAY ON recommendations and best practices for return-to-play phases. We checked in once again with Dr. George Chiampas, U.S. Soccer’s Chief Medical Officer, who also serves on the FIFA Medical Committee and is Chairman of the Concacaf Medical Committee.

SOCCER AMERICA: I'm just reading that, while COVID-19 is spiking around the nation, indoor environments such as gyms, restaurants, hotels and houses of worship account for the majority of COVID infections. With cold weather upon us, one expects even more indoor gatherings. What's the first step a club and coach should take when considering indoor soccer?

GEORGE CHIAMPAS: To look at our U.S. Soccer Cold Weather Guidelines to determine if you have the option to continue playing outdoors, while adhering to those guidelines and our [COVID] Play On recommendation guides.

SA: If playing outdoors is not an option, it's possible to play soccer indoor safely?

GEORGE CHIAMPAS: Obviously, going indoors adds an increased risk. For indoor soccer, much depends on the indoor facility, in addition to adhering to mask-wearing guidelines. What's good about our guidelines is that they walk you through and provide risk assessments on the facility types. The overall objective is to provide a framework that allows those using different types of facilities -- older or newer, bigger or smaller facilities -- to make the best assessment with regards to risk.

SA: What are the key issues regarding facilities?

GEORGE CHIAMPAS: For example, a very large facility, over 60,000 square feet, is likely your lowest risk environment. The amount of air exchange within that facility -- if it has a higher number of air exchange per hour -- also provides a lower-risk environment environment vs. a smaller facility, such as a gym in an older building.

A gym in an older building could have a very low amount of air exchanges in an hour -- less than two -- that would be a high-risk environment. In those high-risk environments, we also speak about wearing masks vs. larger environments with higher air exchange, where you may be able to stick to the guidelines of always wearing masks short of when physically active during activities.

There are more risks in an indoor environment, but there’s a lot that we can do to mitigate them.

U.S. Soccer PLAY ON Indoor Considerations for COVID-19 Guidelines include risk-assessment tables for facility type, air exchange rate, mask-wearing and "overall risk interpretation and recommendations."

SA: How were the indoor guidelines created?

GEORGE CHIAMPAS: We worked with a couple experts out of the University of Iowa [James Stacey Klutts, M.D., Ph.D., Clinical Associate Professor of Pathology] and [Jon Houtman, Ph.D., Associate Professor of Microbiology and Immunology] and continued to speak with coaches, and looked at a multi-disciplined approach for indoor guidelines. We aim to provide guidance and information for clubs, parents and players to be able to make the best decisions for themselves.

SA: Science has continued to provide more information about COVID spread. How do you think U.S. Soccer's return-to-play guidelines have held up since their release in June?

GEORGE CHIAMPAS: They absolutely stay true today. We have not needed to change the platform and the guidelines that we created.

From the outset, we very clearly spoke about mask-wearing. We drew a very clear line with regards to what the expectations are around wearing masks. That masks are to be worn at all times, other than when being physically active on the field, whether it be training or competition. That hasn't changed today.

Unfortunately, we still get a mixed message across the country with regards to mask-wearing.

SA: What do you think about teams traveling across state lines -- such as California teams traveling to Arizona -- to play where the regulations are less strict?

GEORGE CHIAMPAS: Individual pods, individual families going to different states playing and returning home in the same day, or playing and staying in a hotel while following all the mitigation strategies and adhering to state regulations are generally safe.

You should obviously follow your state guidelines, such as restrictions with regards to quarantine upon your return. Obviously, adhere to those.

What I would be concerned about are tournaments where players are traveling collectively in buses or staying in hotel rooms together for multiple days. Those are without question high-risk environments.

SA: I've been coaching in Northern California following regional and U.S. Soccer guidelines and it's gone well. One thing I'm curious about, though, is how concerned we need to be about surfaces. We don't use bibs, which is no problem. But what about the soccer ball, for example?

GEORGE CHIAMPAS: I don't want us to get complacent. I don't want us to feel that it's something that we don't need to continue to implement. But we haven't necessarily seen massive outbreaks with regards to touching surfaces. Some of that may be because individuals are much better at hand hygiene.

I think generally we're seeing that the participation of sport, when you follow the guidelines, is safe. What we are seeing is when you're not following the guidelines, and you have long periods of non-physical distancing without wearing masks -- those are the elements and the moments where we are seeing COVID spread.

The different stories we see of COVID spread across youth sports I think are from environments where the strict mitigation strategies haven't been put in place.

SA: How worried should we be about the current COVID spike?

GEORGE CHIAMPAS: There are things that you can control and things you cannot control. If the positivity rate in your community is generally high, the risk of getting COVID outside of the indoor facility is also high. If you're going to the grocery store, if you're going to school, if kids are getting together outside of soccer, and the positivity rate in your community is high -- your risk of bringing it into the indoor soccer environment is also high.

What's also critically important, if someone does come into the environment of soccer and they eventually test positive, if you actually follow the guidelines -- that's why the guidelines exist -- it doesn't necessarily close the team. Because you can contact trace and if you followed the guidelines, there wouldn't have been high-risk environment exposures, because you maintained social distance. Because you wore masks, short of playing on the field.

We know that on the field, the interactions are short and probably not exceeding the 15 minutes CDC guidelines consider high-risk exposure.

SA: The women's national team had U.S. Soccer's first national team camp, in Colorado Oct. 18-28, since the pandemic outbreak. What was the key to it being successful?

GEORGE CHIAMPAS: We implemented our guidelines. We stressed the importance of each individual's responsibility. We stressed it collectively as a team as well. The adherence to the guidelines allowed us to have a successful and safe camp.

Our [national team] guidelines are no different than what we provide to our clubs across the country, other than the testing capabilities that we implemented in our national team environments.

SA: It seems remarkable to me that various youth sports have generally been able to function amid the pandemic while so many parts of our society struggle.

GEORGE CHIAMPAS: Sports without question are guiding examples of how we can more forward in society. I think we've seen that across different sports, across different levels.

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LINKS (to download various guidelines)
Indoor Considerations for COVID-19

Cold weather Guidelines

U.S. Soccer PLAY ON home page

U.S. Soccer PLAY ON recommendation guides

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