When the COVID-19 pandemic abruptly stopped global sports in March, much of the focus was on the economic impact it would have on the professional game and on major college sporting events. It was a financially daunting reality, one that is still ongoing as clubs around the world cope with hosting games in front of no fans or very few of them.
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Yet simultaneously, a concerning crisis emerged quietly among adolescent athletes, for whom sports were also on hold.
For these young players, competition and elite-level training were replaced by isolation, virtual activities and limited physical movement. According to a University of Wisconsin study from May, led by Dr. Tim McGuine and involving more than 3,200 adolescent athletes across all high school and club sports, physical activity levels decreased by 50 percent when compared to pre-pandemic levels.
The same study states, “If extrapolated to the rest of the country, this could be the least physically active that children have ever been.”
Beyond the obvious physical issues that come with such a lack of activity, the pandemic has also had a distinctly negative effect on the mental health of these athletes. And plans to re-start play, such as they exist, come with their own challenges.
This past spring was replete with unknowns regarding COVID-19. There was no precedent for establishing safety protocols for professional or amateur sports, and little information existed on how the novel coronavirus could be contracted and transmitted among young people.
For the ECNL, a network of soccer teams that includes 113 girls clubs and 131 boys clubs, the creation of a return-to-play process was overseen by chief medical advisor Dr. Drew Watson. In May and June, Watson worked with ECNL president and CEO Christian Lavers to formulate a plan, only to find that there were few best practices to base the plan on.
“In the beginning of April, we really had no idea what sort of evidence or information there was to help guide groups returning to participation,” Watson said. “Coming into the summer as groups were starting to return, we didn’t really know what the incidence was within this particular population. There’s information from both the CDC (Centers for Disease Control) and the American Academy of Pediatrics that will report COVID incidents on a state level between zero to 19 years old. But what we didn’t really know was what the burden of disease was within soccer and what the incidence was over the first two to three months of athletes returning.”
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The challenge, according to Watson, was to determine how to mitigate risks for clubs and athletes that were returning with little concrete public health information and medical evidence. Their focus, primarily, was on providing coaches, clubs and parents with information that would help them manage a difficult situation.
Then, Watson read McGuine’s University of Wisconsin study, which aimed to gauge how COVID-related athletic restrictions were impacting the mental health of young athletes. The findings drove Watson to change the trajectory of his initial endeavor. Among the participants in McGuine’s study, 65 percent reported anxiety symptoms in May, with 13.4 percent of those polled reporting severe anxiety. 68 percent reported symptoms of depression that same month, with nearly half of the participants reporting severe symptoms.
“That really surprised me as to how dramatic, particularly the mental health consequences appeared to be,” Watson said.
Watson, who has his own clinical practice in sports medicine, is also an assistant professor in the department of orthopedics and rehabilitation at the University of Wisconsin, and the team physician for the school’s division of intercollegiate athletics. Watson is a long-time youth soccer coach and also serves as the team physician for Forward Madison FC of USL League One.
As a physician, Watson has completed extensive cardiac exercise physiology research and studies on the mental health impact that injuries have on athletes. Doing another similar study, this time building on McGuine’s work in the pandemic era, seemed natural. With ECNL’s return-to-play strategies playing out over the summer, in August Watson approached the organization about rolling out a “simple survey.” The goal, according to Watson was “to try and better inform some of the discussions about the risk of playing versus the risk of not playing.”
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Over 13,000 adolescent athletes from across the country participated. The results were alarming.
“Within that 13,000 plus participants, 50 to 100 of them were from Wisconsin, so we could compare their physical activity and mental health to that historical data from about 3200 Wisconsin athletes prior to COVID-19,” Watson said. “And just comparing those, what we found was physical activity levels have dropped by 50%. But I think what was most impactful out of that for us was that if you look at the proportion of our Wisconsin athletes that report moderate to severe anxiety — so the sort of symptoms that you would normally think would warrant referral and evaluation and possible intervention for depression — that proportion of kids with moderate to severe depression was less than 10%, but when we surveyed them in May it was 33%. So it had more than tripled before those first couple of months after the school and sports cancellations during COVID-19.”
Iggy Moleka is the executive director of soccer at United Futbol Academy (UFA), an ECNL club headquartered in Suwanne, Georgia. The club operates throughout the state, and like other youth soccer organizations around the country, UFA has had to restructure training and game-day protocols due to COVID-19. Yet, it was the psychological toll on his players that concerned Moleka the most.
“I never thought that (COVID) would impact kids as much as it has,” Moleka said. “I really think that it has impacted them mentally. I’ve had many players in the early stages that were very frustrated with the fact that they were stuck at home and not being around a team environment.”
Moleka, who coaches UFA’s U-16, U-17 and U-19 girls teams, instituted a phased approach that was similar to the way MLS clubs implemented their own return-to-play strategies. It began with weekly virtual training sessions via video chat in the spring, followed by individual training sessions with no physical contact and a limited number of players on the pitch over the summer.
Moleka would schedule additional Google Hangout meetings in the evenings so that his players could talk and share their thoughts about the realities that they were experiencing. His players missed their teammates and stressed the need to get out of their houses to play soccer. He said that those meetings were “hard to do.”
“I had to prepare myself mentally to come in front of the screen and give those kids a sense of hope,” said Moleka. “I’m not trying to be dramatic, but that’s really what it was. The coaches, the staff had to be ready to get in front of those kids and be like, ‘Hey, it’s gonna be okay.’”
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The temptation and peer pressure that teenagers deal with socially has been exasperated during the pandemic, especially during this past summer. Moleka said that he sounded like “a broken record” when his players admitted that they wanted to socialize with their friends away from the field.
“They’re young. They want to live. They’re full of life,” he said. “And as much as they know that something can happen to them, they do not really want to (accept) that limitation of ‘I cannot go to the lake with 15 of my friends. It’s the summer I should go.’ I kept reminding them, ‘Okay, how much do you care about your team? Because if just one of you is not doing the right thing off the field, we have to go into quarantine and we’re not able to get together.”
Moleka said that COVID positive cases increased among his players after many schools in Georgia reopened for in-person teaching in August and September. The ECNL dealt with positive COVID situations over the last seven months as well, according to Lavers. Players opting out of competition also took place around the country.
“You may have scenarios where an entire club gets put into quarantine because of an exposure or a bunch of positive tests or local restrictions. That changes every week,” Lavers said. “You may have scenarios where 90 percent of the teams can play, but one team specifically is in quarantine or one team specifically has a bunch of players who are not comfortable playing. And so that age group is removed from the schedule.”
For Moleka, the mental health toll brought on by the coronavirus also hit him at home.
“Kids need sports. Kids need to exercise,” Moleka said. “I have three children of my own and I’ve seen them changing physically by putting on more weight and also seeing them being anxious, not being too happy by just being home all the time. We’re very family oriented, but they need that time to interact with others and run around.”
COVID-19 is personal for Nuno Piteira as well. The boys director of coaching at the Gwinnett Soccer Academy (GSA), one of the Atlanta area’s premier ECNL clubs, Piteira lost his mother to COVID-19 in July. She passed away in Portugal.
“Unfortunately, I was not allowed to go home because my own country shut the door on the (United) States because of our own COVID-19 situation, so I’m very sensitive to what we are dealing with,” said Piteria.
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While Georgia has remained relatively steady, on October 8th, Johns Hopkins University reported 56,191 new COVID-19 cases in the U.S. That’s the highest single-day count since August 14th. Piteira said that GSA’s objective heading into the fall and winter was to “keep this thing going for as long we can control it.” Strict return-to-play protocols have been in place at the club since March, and while they too have had to deal with positive cases, Piteira said that GSA has not had any outbreaks.
“We’ve had a handful of teams that we’ve had to quarantine including our own U-19s,” Piteira said. “One of the boys got diagnosed with COVID-19 so for two weeks we went into quarantine. He got retested, came back negative and we went back in and that’s part of the challenge. Kids are getting it when they’re not with us.”
Piteira’s message to his players has been twofold. On one hand he said, the pandemic has empowered his players to become responsible, selfless citizens. On the other hand, harsh lessons about life and death have become a normal talking point when he meets with them.
“I’m always reminding the boys that we’re still living under a certain situation,” said Piteria. “When they’re not with us, be careful because then ultimately, it does affect all of us. A team is a community. If you’re on your own compromising certain things and behaving a certain way, when you come back to us, it could affect us. It’s a privilege to be on this journey. All of us come from different backgrounds, but it’s the game that brings us together.”
Flu season in the U.S. has medical experts on high alert. According to the COVID Tracking Project, hospitalizations nationwide due to the coronavirus increased by more 2,000 last week to 34,322. It’s imperative that diligent match-day and training protocols at the youth soccer level remain in place. This is especially important if clubs are traveling to other states. GSA teams played in the Nike Concorde tournament in August and have traveled to Alabama, Tennessee and South Carolina for matches as well. Piteria praised the protocols he saw in Greenville, S.C.. Moving forward, GSA will continue to reassess their own COVID safety measures and evolve throughout the fall and winter seasons.
The ECNL has combined their return-to-play and training protocols with unique emphasis on mental health. It was a sensible decision considering the number of challenges that the coronavirus has levied on communities around the country. In addition to working with Dr. Watson, Lavers retained Dr. Cristina Fink as the organization’s mental performance advisor.
COVID-19 has given elite adolescent athletes an unexpected preview of what their lives can be like without the daily competition. Lavers described the ECNL as “a training and competition platform that was created to try and improve and raise standards and all aspects of youth soccer.”
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Yet, the pandemic has refocused the organization’s priorities and provided both club staff and players with valuable life lessons. COVID-19 has forced teenagers to deal with new forms of stress and unprecedented social challenges. Their patience has been tested like never before and while surely these young athletes are adjusting, the end of the pandemic remains uncertain.
“So much of their identity is wrapped up in who they are as an athlete and I think there’s also a caution there that you need to separate who you are on an athletic field from who you are as a person,” said Lavers. “I have an incredible amount of empathy for these kids who invest so much of themselves and their time into things that they can’t do.
For us who are working with kids, it is a reminder to put things in the proper priority. We are working with young kids who are developing into young adults. Hopefully we can help guide them through this and when things return to normal, they’ll be stronger people for it and we will have helped that process.”
(Top photo of Nuno Piteira courtesy ECNL)
