'Not in the position to take the lead': Medical experts wary on Iowa playing summer sports during pandemic

Christine Petersen is the Director of the Center for Emerging Infectious Diseases at the University of Iowa, where she is also a professor in the Department of Epidemiology — the study of diseases in populations.

Petersen specializes in studying zoonoses, which are diseases that can be transmitted from animals to humans. COVID-19 is widely believed to be a zoonotic virus. She knows the disease causing today's global coronavirus pandemic better than most.

She also has a 13-year-old boy at home who had dearly missed playing baseball these past couple months.

So, when Iowa Gov. Kim Reynolds announced in May that high school baseball and softball and youth baseball and softball could resume June 1, Petersen was conflicted.

Did the potential risk of spreading the coronavirus outweigh the benefit of getting kids outside doing physical activity again?

"I do see this from both camps," Petersen told the Register. "There's lots of upsides of physical activity, being outside and healthy athletic competition. So I don't think it's the craziest thing we have done in the last two months. I just would be a lot more cautious about these bigger competitions.

"It's one thing to have two teams face each other, 11 versus 11. It's a whole other thing to have 40 teams ... with their families and grandparents and everybody else descending upon a sports complex."

Petersen and other medical experts the Register spoke to were not completely opposed to baseball and softball being played in Iowa this summer. But they were wary of the idea and have concerns about how COVID-19 could spread as a result.

Petersen is more worried about infections spreading among crowds than players. Baseball and softball are socially distant sports, she said. They're played outdoors. And there's no extended contact like in wrestling or football. If coaches and athletic directors can enforce social distancing in dugouts, and especially if players don't eat and spit out sunflower seeds, the risk of spread among players will be reduced.

Michihiko Goto, assistant professor of infectious diseases at Iowa and a member of Iowa's Infection Prevention Research Group, also said the risk of spread during games in outdoor sports is minimal.

Still, he doesn't think Iowa is ready yet for this step. He said the state's decision to bring back baseball and softball this summer makes him "very nervous."

"Frankly, I was surprised by the decision," he said. "Yes, we will have to accept some risk at some point. And we can’t continue this (lockdown) situation forever. But we have to do it safely and proceed safely, too. And the situation in Iowa is actually not as optimistic as many people do think."

Goto said Iowa has the 11th-most coronavirus cases per capita in the country. In other words, proportional to its population, Iowa has been more affected by COVID-19 than 39 other states. According to Johns Hopkins University data compiled by The Guardian, Iowa currently has 643 cases per 100,000 residents. That's higher than more-populated states, such as California (302 cases per 100,000), Florida (274 cases per 100,000) and Michigan (581 cases per 100,000).

A state affected by coronavirus at Iowa's level, Goto said, should not be leading the charge when it comes to resuming sports.

"What’s right on paper doesn't necessarily mean getting implemented in the real world," Goto said. "I think that what’s right, in my mind, is asking the states with much lower incidence rates to test the strategies. And, if they prove they can do it safely, then we can slowly expand it to states with higher incidence rates.

"Iowa is not in the position to take the lead of the country."

Goto specializes in preventing employee infection at hospitals. He said most infections actually occur in locker rooms or break rooms — anywhere employees might let down their guard and remove protective equipment or not remain socially distant.

In baseball and softball, Goto is concerned about infections in locker rooms or on buses.

Joseph Cavanaugh, head of Iowa's Department of Biostatistics, also said coronavirus is more likely to spread in locations such as locker rooms and buses and that face coverings should be worn whenever possible.

"The risk of COVID-19 transmission is highest in indoor environments with sustained person-to-person interactions and no (personal protective equipment)," Cavanaugh wrote in an email to the Register.

Iowa schools have been instructed to not let baseball and softball teams use the locker rooms, according to Chris Cuellar, the Iowa High School Athletic Association's director of communications.

Regarding bus safety, the Centers for Disease Control and Prevention recommends one occupant per seat in every other seat, while also alternating rows. With a standard 77-seat bus, that would allow only 13 passengers. That's not enough for a full varsity baseball or softball team.

So teams in Iowa will be encouraged to wear face coverings. Families will also be encouraged to arrange their own transportation, if possible. It's recommended siblings sit next to each other on the bus to save space. No open food or drinks will be allowed on the bus. And there should be as many open windows as possible.

"How much can we (make sure we) enforce that as much as possible?" Goto said.

Petersen is most concerned about tournaments with multiple teams — and, in particular, multiple fan bases — converging in one location. The baseball and softball state tournaments in Des Moines and Fort Dodge are examples of such events.

"(If) we get a Quad City tournament with teams from three different states," Petersen said, "the trace-backs that would occur there with three different state public health institutions and trying to figure out who was there and who wasn't there — there’s just no good infrastructure for that the way our siloed system works within states.

"I think (fans) have to be smart about not coming if you're feeling ill at all or you've been around other ill people, or not coming if, even though your beloved grandchild is playing, you are somebody who would be considered immunocompromised."

Terry Wahls, clinical professor of internal medicine, epidemiology and neurology at Iowa, said resuming baseball and softball "certainly" could lead to transmission of the disease. She doesn't necessarily think it's a bad idea to bring those sports back, though, because she said there is a benefit to getting kids outside, physically active and in the sunlight.

To her, healthy habits are just as important as social distancing. The healthier you are, she said, the quicker you can beat the coronavirus.

"That's the kind of message that I'd like to see out there, in addition to the social distancing," Wahls said. "Eat your vegetables. Quit the junk. Please. Have a stress-reducing practice. So, if we do all of those things, yes, this will spread, (but) hopefully more slowly, and we will be less likely to have the more severe cases with COVID-19 if we are as healthy a host as possible."

Matthew Bain covers recruiting, Iowa/Iowa State athletics and Drake basketball for the Des Moines Register and USA TODAY Network. Contact him at mbain@dmreg.com and follow him on Twitter @MatthewBain_.

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