Sports cause outbreaks. Restart sports anyway?

When Kris Ehresmann puts on her mom hat, she chokes up thinking about Minnesota parents with teenagers unable to play high school sports these days.

''The sports that my kids participated in, and the ability to be involved and be a part of that, were some of the happiest times of our high school time together,'' said Ehresmann, one of the most public faces of the Minnesota Department of Health since the COVID-19 pandemic began in March.

On Monday the Minnesota State High School League is poised to decide whether thousands more football and volleyball players can resume playing games this fall in sports deemed as recently as early last month to be too risky.

Ehresmann, the department's director of infectious disease and epidemiology, was asked last week, during one of her many media briefings, what she would advise if her kids were on a team that could be back in action soon.

''I absolutely feel for the parents that feel so strongly about this because I know that for our family it was really such a significant event,'' she said. "My mom hat gets kind of choked up talking about it because I know how significant it is.

"But then if I take that hat off and put my public health hat on,'' she said, the picture presented by the data "is really concerning.''

Sports activities have been associated with 1,769 COVID-19 cases from June 1 through Sept. 16, department figures show. Among those cases, 1,090 involved adults. As of last week, there were no hospitalizations or deaths involving children, she said.

From those infections, another 3,965 Minnesotans were recommended to quarantine for two weeks, she said, an average of 2.2 people per case.

The department has identified 62 outbreaks, defined as two or more cases from one event, from sports activities. Fifty of those outbreaks involved youth sports, the other 12 stemmed from adult activities. Basketball accounted for 16 outbreaks, while football, soccer and hockey each accounted for nine.

The outbreaks were tied to about 140 cases, with half involving youth and the other half among college athletes, Ehresmann said. Social networks were seen as a likely tie-in for the college-aged cases, with the effect of sports participation harder to determine.

Ehresmann noted two outbreaks that underscore the range of virus transmission on and off the field of play.

An AAU basketball tournament in Iowa in late July resulted in 52 cases after a Minnesota team played with infected athletes, resulting in the whole team being infected. Health department senior epidemiologist Jayne Griffith, in addressing high school league board members last week, called it a "very large" outbreak, which included one coach and one parent who attended.

Another outbreak of 10 cases was thought to have started with a hockey player out of town at a hockey camp. Upon returning home, the person played basketball with friends. Some of the basketball players who became infected also play football, resulting in several becoming infected. At least one of the basketball players works at a market where an older employee was infected.

Just one case had a rippling effect through the Eagan High School girls' soccer program, which was shut down last month after a positive COVID-19 test was reported. The individual was not identified, but dozens of players from four teams were advised to quarantine for two weeks before they could resume practice.

"We're concerned about not just games and sports themselves but the socialization that comes along with that,'' Health Department Commissioner Jan Malcolm said. "If indeed we start to see more of these kinds of athletic events, it's just going to be extra important that everybody be aware of the risk, and really pay close attention to and comply with social distancing and mask-wearing guidance.''

In a virtual meeting of high school league board members last Tuesday, health department officials spent 45 minutes sharing data on sports activities in Minnesota and helping board members understand the risks. Back on Aug. 4, those risks were significant enough to prompt the board to postpone football and volleyball — the state's most popular high school sports for boys and girls by participation — until spring.

But Minnesota now stands alone among the five Upper Midwest states by delaying football until spring. Public outcry has grown, leading to a peaceful protest on Sept. 12 outside the governor's residence. Last week the Big Ten reversed course and decided to start playing college football next month.

During the Tuesday meeting, sentiment to return to playing this fall prompted board President Blaine Novak to call the special meeting for Monday. If he hadn't, the board's next scheduled meeting was not until Oct. 1, seen by some as too late to decide a possible football restart.

During the health department's presentation, Griffith said, "We cannot say anything is safe. We aren't able to exonerate any sport during a pandemic.''

Later Ehresmann said she sees "no difference now in risk from earlier in the summer when the MSHSL decided to wait on these sports.'' What's new is data from the start of school sports shows "evidence of transmission,'' she said. "We continue to see a high level of community transmission.''

Malcolm noted that "outdoor venues and outdoor sports appear to be less risky than indoor sports'' but added that sports with high levels of contact, such as football, "just do have a risk.''

Dr. Ruth Lynfield, the department's medical director, acknowledged the "complex issue'' of balancing the amount of virus in the community with people's activities.

"This is not a cold,'' she said. "There are some people who do fine with this, but there are others, including young people, who don't do fine. Along with the sports there are coaches, there are other people who may have underlying conditions, and would have a severe illness if they were to be infected.

"We're only beginning to learn about potential complications that occur in young people,'' she said, noting a recent report from Ohio connecting the virus to college athletes and concerns about a heart condition known as myocarditis.

"We really don't have a sense of all the things this virus can do,'' Lynfield said. "We just have to be aware.''

Staff writer David La Vaque contributed to this report.