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Can you safely play indoor sports during the pandemic?

During the colder, darker months, many Americans head indoors to get their exercise. But as COVID-19 cases, deaths and hospitalizations rise, just how safe are indoor sports?

On Feb. 1, coronavirus deaths topped 440,000 in the U.S., with more than 110,000 new cases daily. Experts agree that even as the U.S. begins vaccinations, infections will continue to increase initially.

“One thing we’ve seen time and time again, indoor environments, whether that’s a restaurant or an indoor playfield, give the virus more chances to spread among us, like rolling a dice,” said Mark Cameron, an emerging infectious disease researcher at Case Western Reserve University.

Yet the country is divided on whether that means we should skip indoor sports this season. In a PBS NewsHour/NPR/Marist poll from December, a majority of Americans – 58 percent – said that people shouldn’t play indoor sports this winter.

Indoor sports, whether it’s the NHL finals or a pickup basketball game at a community center, could be riskier than outdoor sports because the lack of air flow could mean particles stick around for a longer period of time. But there is a broad range of risk within that category, too, depending on factors like ability to wear a mask, the amount of physical contact with other players and how much players rely on shared equipment. Spectators, especially when they’re sitting closely together, can also be a worrying factor, as singing, chanting and screaming launch particles into the air.

Some professional sports leagues like the NHL are routinely testing their athletes, going to great lengths to protect them from outbreaks. But most leagues don’t have the resources to form bubbles or to verify that players are not carrying the virus.

We asked three infectious disease experts for their takes on the risks of playing indoor sports. Here’s what they had to say:

What makes indoor sports potentially dangerous?

Without proper ventilation, indoor spaces can limit airflow, so coronavirus particles can hang around in air droplets and potentially infect anyone in the space.

Sports make it easy for the coronavirus to spread between people. Playing sports, as well as observing them, can involve a lot of heavy breathing, chanting, yelling and singing, all of which could project respiratory droplets containing the virus into the surrounding air. This becomes more concerning in contained, indoor spaces where masking isn’t required.

“If you’ve got cases in the individuals, asymptomatic cases in particular, coronavirus will take every single opportunity to spread,” Cameron said.

Games that require close contact, even if players are masked, can also put athletes, coaches and spectators at risk of inhaling the particles and contracting COVID-19.

“This is dominantly a close-distance disease,” said Susan Huang, an infectious diseases expert at the University of California Irvine School of Medicine. “There are things you can do to make it go further in the air, predominantly three feet, often within six feet and uncommonly much further than that.”

Are some sports and facilities riskier than others?

Short answer: Yes, and once again it depends on a sport’s amount of physical contact and the players’ ability to wear masks.

“Think about the closeness, proximity and physical contact of the sport.” Huang said. “What’s the likelihood that my breath will make it into someone’s face?”

Take basketball and ice hockey, for example – they’re both fast-paced, physically demanding sports. They both require closer contact, and players are constantly shouting, panting and getting close to each other. Compare that to indoor sports like singles tennis or indoor track, where athletes can easily wear masks and space themselves out.

Scientists are still debating the impact of temperature and humidity on coronavirus particle spread, but ice rinks have been a noticeable source of infection this winter. The Washington Post reported in early December that Massachusetts recorded more than 100 youth hockey cases in a few weeks, and an asymptomatic referee in Maine exposed up to 400 people in just two days.

Wearing masks and socially distancing, like the Centers for Disease Control and Prevention’s guidelines recommend, can decrease your likelihood of catching the virus, but these measures aren’t foolproof. There is always some risk if you interact with others.

“It’s not just about the sport, but the context,” said Peter Chin-Hong, an infectious disease specialist at the University of California San Francisco. “Even golf outside can be risky if there are too many people gathered closely together.”

All of this isn’t black and white. Multiple layers of protection are important to reduce the risk of transmission. You can’t wear a mask while swimming laps, but you can socially distance between lanes, something you cannot do when playing a sport like team basketball. Although breezier outdoor activities can reduce the risk of spreading COVID-19, any sport or gathering can potentially spread the virus.

“One of the major issues is that even if you’re really close to someone’s face, it doesn’t matter how good the ventilation is,” Huang said.

Can you get the coronavirus from sports equipment?

There’s a chance that you could pick up the coronavirus from shared sports equipment or touching a high traffic area at a facility, like a door handle, and then touching your mouth, nose or eyes.

The CDC recommends frequently wiping down surfaces and avoiding shared equipment, but it’s not always practical to disinfect every volleyball or squash ball each time someone touches it during play.

Still, experts agree that the main concern with indoor sports is spreading through close proximity, physical contact and not wearing a mask.

“Early on in the pandemic we worried more about surfaces,” Chin-Hong said. “I think it’s a theoretical risk still, but probably not as important as projecting through the nose and mouth. A mask is more effective than washing your hands. Other respiratory viruses are more likely to be transmitted by touching things.”

Will the vaccine make it safer for kids to play sports?

The two currently approved coronavirus vaccines are around 95 percent effective against COVID-19 starting 28 days after the first dose, even surpassing the expectations of the nation’s top infectious disease expert, Dr. Anthony Fauci.

“We as a country would have been happy at 50 percent efficacy – that’s a lot in any serious disease.” Huang said. “These that the FDA are reviewing are in 94 to 95 percent efficacy levels. It’s not just a home run, it’s a grand slam.”

But, there are some catches. Millions of people need vaccinations. So far, both of the approved vaccines also require two doses over the course of three to four weeks . And millions of Americans have expressed hesitancy about getting a vaccine, potentially compromising herd immunity.

Kids are one of the last groups on the vaccine priority list, and the vaccines are not yet available to children under the age of 16. Though the vaccines have been testing well in adults, we don’t yet know how effective they’ll be in children because of a lack of testing.

Rollout will be slow, so it’s unlikely that any vaccine will make a large impact for improving the safety of indoor sports this winter. Cameron said that we’ll see an increasingly safe environment over the next six months.

“At some point, but not over the winter, there will be enough people, three-quarters of the population, vaccinated and safe for the rest of us,” he said.

This could mean that indoor youth sport leagues stay riskier for longer – for the entire community. That’s one reason why it’s important for adults to get vaccinated.