Guidance for Youth Sports (Updated)

These guidelines, effective September 30, 2020, supersede previous guidelines for Youth Sports in the City of St. Louis. As we receive additional information about respiratory illness (COVID-19, influenza, etc.) trends in the City of St. Louis and St. Louis Region, and as more scientific and clinical information becomes available on the impact of COVID-19 in youth, these guidelines may be replaced or modified by the City of St. Louis Department of Health.

Introduction

The City of St. Louis continues to balance the importance of activity for children with the reality of sustained community spread of COVID-19 in the City of St. Louis and the St. Louis Region. The intent of these guidelines is to protect the health of staff, students and the community by implementing strategies to slow and mitigate the spread of COVID-19 during youth sports activities and should be interpreted to effectuate this intent.

According to the preponderance of available evidence, youth are less likely to develop symptoms while infected with SARS COV-2, the virus that causes COVID-19. These standardized mitigation measures are necessary to ensure proper protections are in place to reduce the risk of COVID-19 transmission among youth athletes who engage in athletic activities.

According to the American Academy of Pediatrics, no one should attend any sports function as a spectator if they are exhibiting signs or symptoms of COVID-19. Parents and other spectators with high-risk health conditions should strongly consider not attending indoor events or events held outdoors where appropriate social distancing cannot be maintained. Live streaming or recording of athletic events, when available, may allow individuals who are unable to attend to participate in viewing events.

Types of Activities

The risks associated with playing sports with or against other individuals depend on the type of play, the number of individuals participating, and the number of spectators present. For further information, consult the Centers for Disease Control and Prevention’s (CDC) guidance on youth sports.

The risk of COVID-19 spread increases in youth sports settings as follows:

• Lowest risk: Performing skill-building drills or conditioning at home, alone or with family members
• Increasing risk: Team-based practice
• More risk: Within-team competition
• Even more risk: Full competition between teams from the same local geographic area
• Highest risk: Full competition between teams from different geographic areas.

Types of Sports

Sports are classified based on the level of contact between players, as high-frequency of contact, moderate-frequency of contact or low-frequency of contact.

• High-frequency contact sports include basketball, boxing, ice hockey tackle/flag/touch football, martial arts, rugby, water polo, competitive cheerleading, lacrosse, and wrestling.
• Moderate-frequency contact sports include baseball, crew/rowing, dance team, fencing, floor hockey, field hockey, racquetball, soccer, softball, team handball, ultimate frisbee, and volleyball.
• Low-frequency contact sports include diving, extreme sports, gymnastics, rodeo, water skiing, adventure racing, bicycling, canoeing/kayaking, field events (high jump, pole vault, javelin, shot-put), golf, handball, horseback riding, skating (ice, in-line, roller), skateboarding, weight lifting, windsurfing, badminton, bodybuilding, bowling, golf, orienteering, fishing, riflery, rope jumping, running, sailing, scuba diving, swimming, table tennis, tennis, and track.

For sports or activities not included in the above categories that are similar in nature to such other sports or activities, please apply the category most closely associated with the sport or activity. If there is any question regarding the categorization of an activity, please contact the City of St. Louis Department of Health (Health@stlouis-mo.gov) to determine which category applies.

Application

These Youth Sports Guidelines apply to all individuals who attend primary or secondary education institutions, school-sponsored and affiliated sports teams, youth leagues, and non-school sponsored and affiliated sports teams.

Restrictions and Requirements

When allowed, games and competitions are limited to the St. Louis Region. The region is defined as the Metro East, City of St. Louis, St. Louis County, St. Charles County, Jefferson County and Franklin County.

The following restrictions and requirements apply to all high and moderate-frequency contact sports where routine COVID-19 screening and testing of athletes and coaching staff is not performed:

• Face Coverings (e.g., masks, face shields)
  • Face coverings SHALL be worn anytime an individual is not doing vigorous physical activity.
  • Coaches SHALL remain in face coverings at all times.
  • Wearing face coverings before activities and immediately following activities is required, especially prior to screening.
• Team workouts and practices are allowed with restrictions. 
• Practices and team contact drills are allowed but only in groups of 11 athletes or fewer.
• ONLY intra-squad scrimmages (within the team that practices together) are allowed.
• Two coaches are permitted in addition to the group of 11 or fewer athletes.
• Each group of athletes, not to exceed 11 per group, must remain in a separate single space from another group of athletes at any one time. Any single space must have a minimum of a 20-foot barrier from any other single space. No person is allowed within that 20-foot barrier. The 20-foot barrier should be clearly marked, and such demarcation shall be indicated by a wall, tape or cones.
• NO games are permitted.
• NO tournaments, performances, competitions, or showcases are permitted.
• Physical distancing of at least 6 ft distancing SHALL be maintained as much as possible during practice.
• The practice groups must remain the same every day to reduce the amount of exposure for each child.
• Players and coaches should wash/sanitize hands regularly.
  • If washing your hands, please use soap and water and wash them for at least 20 seconds.
  • If using hand sanitizer, please make sure the hand sanitizer contains at least 70% alcohol.
• Players and coaches should disinfect all equipment regularly and between individual uses and each time it is shared with another person.
• Every individual, including coaches, must be screened every day. (See section on daily screening requirements.)
• No two teams should be in the same location at one time. If the same field, gym, or enclosed room will be used in the same day by more than one team, teams must allow sufficient time between sessions to clean the area. No team shall use a field, gym, or similar enclosed room on the same day another team has used any of those locations unless cleaning (compliant with Centers for Disease Control and Prevention guidelines) has occurred after the previous team’s use. 4 This cleaning requirement shall also apply to groups of up to 11 athletes using the same single space as another group of up to 11 athletes even if those groups comprise one team.

The following restrictions and requirements apply to all high and moderate-frequency contact sports where regular COVID-19 screening and testing of athletes and coaching staff is performed:

• Face Coverings (e.g., masks, face shields)
  • Face coverings SHALL be worn anytime an individual is not doing vigorous physical activity.
  • Coaches SHALL remain in face coverings at all times.
  • Wearing face coverings before activities and immediately following activities is required, especially prior to screening.
• Full team practices are permitted with restrictions.
• Competitions are allowed with other teams or individuals within the Region.
• Tournament style competitions are not allowed, such as bracket-style play where multiple teams play back to back, including showcases.
• Tournaments that involve only individual players may be played.
• Physical distancing of at least 6 ft. SHALL be maintained as much as possible during practice and games.
• Players and coaches SHALL wash/sanitize hands regularly.
  • If washing your hands, please use soap and water and wash them for at least 20 seconds.
  • If using hand sanitizer, please make sure the hand sanitizer contains at least 70% alcohol.
• Players and coaches should disinfect all equipment regularly and between individual uses and each time it is shared with another person.
• Wearing masks before activities and immediately following activities is required, especially prior to screening.
• Every individual, including coaches, SHALL be screened every day. (See section on daily screening requirements.)
• Coaches and athletes SHALL be tested regularly (at least every other week).

The permitted activities must be conducted with the following safety measures:

• Daily, athletes and coaches SHALL undergo a standardized health screening and temperature check prior to starting any sports activity allowed by these guidelines. 
• Players SHALL wear a face covering, including during practices and while training, when not actively involved in vigorous physical activity, including practice or training.
• Coaches SHALL wear a face covering at all times.
• Screening times and practice start times SHALL be spaced out to ensure compliance with social/physical distancing requirements.
• The number of players sitting in confined areas (e.g., dugouts) SHALL be limited to allow for social distancing.
• Hand hygiene is essential. Organizations and facilities SHALL promote frequent and effective hand hygiene by supplying ample hand sanitizer dispensers and hand-washing stations with soap and water (preferred).
• The use of locker rooms is strongly discouraged. If they must be used, physical distancing of at least 6 ft, face-covering and air ventilation requirements apply within the locker room. Lockers must not be shared. Cleaning and daily disinfection is required and cleaned and sanitized equipment must be stored in a designated area with unclean equipment in a separate area prior to being cleaned and sanitized according to CDC requirements.
• To the extent people (who shall be limited to only essential persons) are present their identity and contact information must be known and recorded for contact tracing purposes.
• Gathering at the athletic fields or athletic facilities SHALL NOT be allowed by parents, guardians, spectators, volunteers, non-essential visitors and any other individuals who would otherwise be spectators or are responsible for the transportation of the athletes.
• A drop-off and pick-up line for practices with clearly marked distance measures is recommended to avoid unnecessary exposure.
• Water bottles SHALL not be shared. An individual athlete may use their own water bottle, which must be clearly marked with their name. Cups used for water should be single-use and disposed of properly in receptacles that are emptied regularly.
• Coolers must be properly disinfected after each use, and each team or group shall have its own cooler. Athletes, coaches and any other essential personnel shall not root around in coolers, touching items in it. It is recommended that one person with clean gloves be assigned to distribute items from the cooler.
• CDC guidance for cleaning and disinfecting coolers SHALL be followed.
• Whirlpools or cold/hot tubs should be avoided. If they are required in an emergency, follow best practices. Have a cold-water immersion tub on-site or within 5 minutes of the field.
• If ice towels are available, CDC guidance for cleaning and disinfecting should be followed. Ice towels shall be used only once, then discarded or washed properly.
• Team huddles, handshakes, fist bumps, and other unnecessary physical contact are not allowed. Fun alternative expressions of happiness or support that do not involve physical contact are encouraged.
• Any shared equipment SHALL be disinfected with EPA certified products. Equipment SHALL be disinfected, after each use, and if possible, after each inning, set or period of play.
• Any jerseys used during these workouts SHALL be washed daily and not shared among players.

The following restrictions and requirements apply to all low-frequency of contact sports:

• Face Coverings (e.g., masks, face shields)
  • Face coverings SHALL be worn anytime an individual is not doing vigorous physical activity.
  • Coaches SHALL remain in face coverings at all times.
  • Wearing face coverings before activities and immediately following activities is required, especially prior to screening.
• Full team practices are permitted with restrictions.
• Competitions are allowed with other teams or individuals within the Region.
• Tournament style competitions are not allowed, such as bracket-style play where multiple teams play back to back, including showcases.
• Tournaments that involve only individual players, such as golf, may be played.
• Physical distancing of at least 6 ft. SHALL be maintained as much as possible during practice and games.
• Players and coaches SHALL wash/sanitize hands regularly.
  • If washing your hands, please use soap and water and wash them for at least 20 seconds.
  • If using hand sanitizer, please make sure the hand sanitizer contains at least 70% alcohol.
• Players and coaches should disinfect all equipment regularly and between individual uses and each time it is shared with another person.
• Wearing masks before activities and immediately following activities is required, especially prior to screening.
• Every individual, including coaches, SHALL be screened every day. (See section on daily screening requirements.)
• At this time, testing is NOT required for low-frequency contact sports.

The permitted activities must be conducted with the following safety measures:

• Daily, athletes and coaches SHALL undergo a standardized health screening and temperature check prior to starting any sports activity allowed by these guidelines. 
• Players SHALL wear a face covering, including during practices and while training, when not actively involved in vigorous physical activity, including practice or training.
• Coaches SHALL wear a face covering at all times.
• Screening times and practice start times SHALL be spaced out to ensure compliance with social/physical distancing requirements.
• The number of players sitting in confined areas (e.g., dugouts) SHALL be limited to allow for social distancing.
• Hand hygiene is essential. Organizations and facilities SHALL promote frequent and effective hand hygiene by supplying ample hand sanitizer dispensers and hand-washing stations with soap and water (preferred).
• The use of locker rooms is strongly discouraged. If they must be used, physical distancing of at least 6 ft, face-covering and air ventilation requirements apply within the locker room. Lockers must not be shared. Cleaning and daily disinfection is required and cleaned and sanitized equipment must be stored in a designated area with unclean equipment in a separate area prior to being cleaned and sanitized according to CDC requirements.
• To the extent people (who shall be limited to only essential persons) are present their identity and contact information must be known and recorded for contact tracing purposes.
• Gathering at the athletic fields or athletic facilities SHALL NOT be allowed by parents, guardians, spectators, volunteers, non-essential visitors and any other individuals who would otherwise be spectators or are responsible for the transportation of the athletes.
• A drop-off and pick-up line for practices with clearly marked distance measures is recommended to avoid unnecessary exposure.
• Water bottles SHALL not be shared. An individual athlete may use their own water bottle, which must be clearly marked with their name. Cups used for water should be single-use and disposed of properly in receptacles that are emptied regularly.
• Coolers must be properly disinfected after each use, and each team or group shall have its own cooler. Athletes, coaches and any other essential personnel shall not root around in coolers, touching items in it. It is recommended that one person with clean gloves be assigned to distribute items from the cooler.
• CDC guidance for cleaning and disinfecting coolers SHALL be followed.
• Whirlpools or cold/hot tubs should be avoided. If they are required in an emergency, follow best practices. Have a cold-water immersion tub on-site or within 5 minutes of the field.
• If ice towels are available, CDC guidance for cleaning and disinfecting should be followed. Ice towels shall be used only once, then discarded or washed properly.
• Team huddles, handshakes, fist bumps, and other unnecessary physical contact are not allowed. Fun alternative expressions of happiness or support that do not involve physical contact are encouraged.
• Any shared equipment SHALL be disinfected with EPA certified products. Equipment SHALL be disinfected, after each use, and if possible, after each inning, set or period of play.
• Any jerseys used during these workouts SHALL be washed daily and not shared among players. 

Event Attendance

Due to ongoing widespread community transmission of COVID-19, it is recommended that persons not essential for athletic activity operations including spectators, volunteers, parents/guardians, or non-essential visitors not be allowed. At most, each athlete shall be allowed two guests to observe gameplay; however, they must comply with City of St. Louis’ face covering and social/physical distancing requirements. Failure to comply with these requirements may result in their child not being allowed to play for the remainder of the season.

Screening

Every coach, athlete, and official (and any other person – with numbers being limited to those who are essential) SHALL be screened when they enter the campus or facility where the sporting activity will occur. They must wear a face covering for the duration of the health screening unless it is not possible due to a medical condition. A consistent person should be designated to provide healthcare screenings. This person must wear a face covering when screening others.

The screening process is as follows:

• Ask each individual if they have experienced any of the following new or worsening symptoms within the past 24 hours:
  • Fever (temperature greater than 100.4 degrees Fahrenheit)
  • Chills
  • Cough
  • Chest pain
  • Muscle aches
  • Headache
  • Fatigue
  • Shortness of breath or trouble breathing
  • Sore throat, different than your seasonal allergies
  • New loss of smell and/or taste o Diarrhea or vomiting
  • Abdominal pain
•  Ask if they have a close contact who has been diagnosed with COVID-19 in the past 2 weeks.

Positive Screening – If an athlete, coach, or official answers “yes” to any of the screening questions, they SHALL be sent home immediately and told to inform their medical provider. If the athlete’s parent, guardian, or other transportation provider is not present, escort the athlete to a designated isolation room or an area away from others. They SHALL wear a mask or face covering. Individuals who have had a significant exposure (defined as direct contact or prolonged exposure within 6 feet) to a positive COVID-19 individual SHALL quarantine for a minimum of 14 days from the last date of exposure to the positive COVID-19 individual. If the exposed individual has a negative SARS-Cov 2 test, they still must quarantine for 14 days. If the exposed individual develops symptoms during these 14 days, testing for SARS Cov-2 should occur.

The school, coach, or another official, as applicable, is required to contact the City of St. Louis Department of Health Communicable Disease Bureau ((314) 657-1499) to notify the City of St. Louis Department of Health of the positive screening. The notifying individual shall provide information regarding all known contacts of the positivescreened individual. To aid in this contact tracing, all schools, coaches, and other officials conducting the practice or competition must keep a detailed account of all the participants at each practice or competition, including a detailed roster of participants in each practice group

If the individual has health-related questions, the individual must consult with the individual’s own health care provider.

Individuals returning to sports after a COVID-19 diagnosis SHALL consult with both their own health care provider and the City of St. Louis Department of Health. Only the City of St. Louis Department of Health can release a City of St. Louis resident from quarantine. Persons who test positive must be cleared by their medical provider prior to resuming normal activities (including playing sports and attending school in person). If the person does not have a medical provider, they should contact the City of St. Louis Department of Health Communicable Disease Bureau.

In the event an outbreak among athletes is identified, the team will be required to suspend athletic activity until the outbreak investigation is complete and persons have been properly isolated and quarantined. To ensure the City of St. Louis Department of Health can obtain required information staff and athletes shall comply with all information requests related to the outbreak investigation.

Testing

Current scientific evidence indicates that youth are more likely to remain without symptoms while infected with COVID-19. Thus, testing is essential to identify youth athletes who are infectious and is required for youth and coaching staff who participate in high and moderate-frequency contact sports activities. At this time, testing is not required for low-frequency contact sports.

At this time, only Food and Drug Administration (FDA) approved polymerase chain reaction (PCR) based viral tests and the following specimen types are acceptable:

• Nasopharyngeal
  • The specimen is collected by inserting and rubbing a swab on the inside the patient’s nasal passage.
• Oropharyngeal
  • The specimen is collected by inserting and rubbing a swab in the rear of the patient’s mouth. Due to the increase in potential transmission during collection, this is the least preferred method. At this time, specimen types not listed above are not acceptable. If a school fails to use a PCR test and approved collection method, it may lose its approval to compete. Schools shall ensure student and staff health information is collected and stored in compliance with federal and state regulations.

Special considerations for those with health conditions Certain individual athletes on a team may be at higher risk for severe illness than other athletes. Athletes, coaches, parents, and guardians should consider delaying the athlete’s participation in sports and athletic activities if the athlete has any of the following conditions:

• Liver disease
• Chronic lung disease, including moderate or severe asthma,
• Type 2 diabetes,
• Chronic kidney disease,
• Sickle Cell disease (not sickle cell trait),
• Heart conditions; or
• Immunocompromised (e.g., any transplant recipient needing immunosuppressant medications – steroids, biologics, etc., and patients receiving chemotherapy) – if you think your child is immunocompromised, please check with your child’s healthcare provider.

Parents or guardians who have children with these risk factors must be required to consult with their healthcare provider about participation in sports since limited data exist. Coaches and other staff must also exercise caution in attending youth sports activities if they have any of the above-identified conditions.

Enforcement

Organizations, teams, and coaches must understand the importance of enforcing these restrictions and requirements to enable children to continue to participate in sporting activities. The City of St. Louis Department of Health can require an organization or team to cease otherwise permitted activities if the restrictions and requirements are not being followed. In addition to the expectation that organizations, teams, coaching and other sports management staff will enforce the requirements set forth in these guidelines, all other enforcement actions, including a City of St. Louis Department of Health ordered closure and/or court action, remain available to enforce these guidelines.

It is imperative that parents and guardians, as well as those who are organizing and coaching the children/athletes, emphasize the need to follow these guidelines in order to reduce community transmission of the virus so that we can get back to more normal sports activities in the future, including competitive play. This means that unnecessary gatherings and meetings of parents/guardians, volunteers, non-essential visitors and athletes should not be sanctioned or sponsored.

Organizations, teams, coaches, and parents must, in accordance with City of St. Louis Department of Health requirements, cooperate and assist in contact tracing, including maintaining a detailed list of players, coaches, officials, and essential visitors attending practices. Detailed lists for players should be grouped by squads/groups.