Sport Science Institute

COVID-19 Concern Hotline

The NCAA Board of Governors has directed schools and conferences to meet specific requirements if they are to conduct NCAA fall sports during the preseason, regular season and postseason.

The NCAA has established a phone number and email to allow college athletes, parents or others to report potential return-to-sport concerns. The Association will notify school and conference administrators, who will be expected to review and address concerns.

If you are aware of concerns regarding implementation of the NCAA’s Return to Sport guidelines, please call toll free 833-661-CV19 (2819) or email covidconcerns@ncaa.org with the name of the NCAA member institution, sport and brief summary of the concern.

Requirements for Each Division Related to the Conduct of Fall Sports and Championships: FAQs

This frequently asked questions document was developed in support of the NCAA Board of Governors’ recent direction related to the membership’s safeguarding of student-athlete well-being, scholarships and eligibility and its corresponding Requirements for Each Division Related to the Conduct of Fall Sports and Championships (Board Requirements).

As with prior NCAA publications, the content of these materials is intended to be interpreted in a manner consistent with guidance published by the federal, state, and local governments and respective health agencies. These materials are not and should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable governmental and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve.

Questions can be directed to SSI@ncaa.org.

What is the Board of Governors’ authority to impose the Board Requirements on the Association’s membership?

  • The NCAA Board of Governors is authorized to identify and act on behalf of the Association by adopting and implementing policies to resolve core issues and other Association-wide matters. These types of core issues include those stemming from new scientific evidence with anticipated Association-wide impact that are likely to affect a core Association-wide value like student-athlete health and safety.

What is the time period and scope of requirement to follow the Resocialization of Collegiate Sport: Developing Standards for Practice and Competition (Developing Standards)?

  • If competition is going forward:

    The requirement to follow the Developing Standards applies if an institution is allowing its sports teams to engage in any competition (for example, regular season or nontraditional season competitions, scrimmages and practices combining teams from two different institutions) with another institution through at least Oct. 27, the next scheduled meeting of the Board of Governors. In this scenario, testing protocols should align with “in-season” guidance for a given sport’s level of contact risk. While it is recognized that the Developing Standards were previously released as nonmandatory guidance and, as such, are written to include permissive language and modifiers such as “may consider” and “might,” the board intends that they will be considered requirements for institutions that elect to continue with any competition occurring in the fall.

  • If directed practice and conditioning are occurring:

    The Developing Standards document remains guidance if an institution’s student-athletes are not engaged in competition, but the student-athletes remain on campus or are being directed by school personnel if an off-campus, permissible activity is occurring. If directed practices evolve to include personnel from two different institutions, please consult the above scenario.

  • If activities are voluntary only:

    When an institution’s student-athletes are engaged in permissible, voluntary training, it is assumed that testing will be performed in accordance with local/federal mandates and school policy in the same way it is for the broader student population. 

Do the Developing Standards still recommend surveillance testing even where appropriate physical distancing and universal masking can be practiced?

  • The Developing Standards document emphasizes physical distancing/masking and other virus mitigation, but surveillance testing is recommended when those mitigation measures cannot occur.

Why doesn’t the Developing Standards document include testing protocols that are specific to weight training activities?

  • The Developing Standards document was designed to identify and provide guidance related to broad-based COVID-19 risk mitigation in the college athletics space such that its principles may be applicable to and considered with respect to all relevant athletics activities. While the document does not include a sample testing protocol that is specific to weight training activities, the overall content should be considered in any scenario where it may be relevant. In addition, the Developing Standards do include information about various evidence-based resources that have been published by professional organizations in sports medicine and strength and conditioning. These resources may help inform member schools, and institutions are encouraged to leverage all available resources and information as they plan for and engage in these types of activities.

The Developing Standard document’s categorization of sport by contact risk does not appear to consider contact risk related to locker room space and crowding during athletics activities. For example, swimming is listed as a low contact risk sport, but the pool deck and locker rooms are often crowded. Does this need to be accounted for in the sport’s contact risk assessment?

  • The categorization of sport in the Developing Standards document is based on, and limited to, typical proximity and amount of contact between participants, and the ability to implement appropriate masking during practice activities and competitive sport events. It is assumed that each institution will appropriately consider and address these and other infection risks that arise outside these activities to ensure physical distancing, masking and sanitization practices are in place where possible.

The Developing Standards document states that polymerase chain reaction testing is the standard testing method for both baseline and ongoing surveillance testing, and that alternative strategies may need to be considered. Are point-of-care antigen tests, SalivaDirect tests, and isothermal and PCR point-of-care tests acceptable?

  • Yes. At the time of publication and based on then available evidence, PCR testing was identified as the standard testing method for both baseline and ongoing surveillance testing for purposes of the Developing Standards guidance. However, as indicated in the publication, testing strategies will always remain contingent on the availability of ample testing supplies, laboratory capacity, efficient turnaround time and convenient access to testing. Where these factors create challenges around the implementation of PCR-based strategies and as alternative testing technologies evolve, different strategies may need to be considered, including those identified above, and schools are encouraged to collaborate with state and local health officials to determine whether and how to implement specific strategies and which one(s) would be most appropriate for their circumstances. For more information around testing strategies, relevant factors and alternative technologies, please see the Centers for Disease Control and Prevention’s publication: SARS-CoV-2 Testing Strategy: Considerations for Non-Healthcare Workplaces.

If competition among teams is going forward, the Developing Standards document specifies that officials in football and basketball should be tested in accordance with pre-competition standards. What about officials in other sports?

  • The reference to football and basketball officials was premised on, and intended to highlight the higher risk of exposure for officials in these sports due to their likely proximity to the student-athletes during competition and the challenge with masking while performing their contemplated responsibilities. In any other sport where the same type of proximity and masking challenges may exist for officials, the same type of testing and other risk mitigation practices should be considered.

What is the timeline for the divisions to address the Board Requirements related to student-athlete well-being?

  • The Board of Governors has extended the timeline until Aug. 21 for divisions to address the following pieces of the Board Requirements:

    The eligibility accommodations that must be made for student-athletes who opt out of participating this fall or for those whose seasons are canceled or cut short due to COVID-19. College athletes and their families must know what their eligibility status will be before beginning the fall season.

    Coverage of COVID-19-related medical expenses arising from athletics participation to prevent out-of-pocket expenses for college athletes and their families.

Resocialization of Collegiate Sport: Checklist

The NCAA has released the following guidance documents related to the resocialization of college sports in the wake of the COVID-19 pandemic:

  • “Core Principles of Resocialization of Collegiate Sport” (5/1/20)
  • “Resocialization of Collegiate Sport: Developing Standards for Practice and Competition” (7/14/20) 
  • “Resocialization of Collegiate Sport: Action Plan Considerations” (5/28/20) 

Each of the above publications was intended to supplement and update the prior publications to reflect most recent emerging data and information available at the time of release. The NCAA has also published  and continues to supplement an FAQ document that contains questions/answers pertaining to the publications.  As the resocialization publications have been updated, they have rendered certain of the FAQ content outdated. Those outdated portions of the FAQ have been removed from the published version and have been archived to this document solely for purposes of historical reference. This content is no longer consistent with the Association’s published position and should not be relied upon as guidance.

Questions can be directed to the NCAA Sport Science Institute at ssi@ncaa.org.

Below is a checklist that was created in consultation with the NCAA COVID-19 Advisory Panel; the American Medical Society for Sports Medicine COVID-19 Working Group; and the Autonomy 5 Medical Advisory Group to support efforts by athletics administrators and other institutional personnel responsible for evaluating and implementing policies and procedures around the resocialization of collegiate sport. The content of the checklist is reflective of the information provided in the following three NCAA resocialization publications released to date: Core Principles of Resocialization of Collegiate Sport; Resocialization of Collegiate Sport: Action Plan Considerations; and Resocialization of Collegiate Sport: Developing Standards for Practice and Competition. As the NCAA resocialization publications were offered as guidance for membership and not intended as mandated requirements, this checklist is not intended and should not be interpreted as a clinical practice guideline or legal standard of care. Rather, like the NCAA resocialization publications, this checklist is offered as a guide and, as such, is of a general nature, intended to be considered and applied as deemed appropriate by the school and its athletics department in consultation with relevant medical and administrative leadership personnel and in a manner consistent with applicable federal, state, local and institutional guidance and requirements. 

Education

There is a plan to share, on an ongoing basis, relevant information from and updates to the NCAA resocialization documents and other related governmental and institutional policies and materials with the following audiences:

Before interacting with student-athletes and resuming material responsibilities on campus, staff from each of the above-named departments participate in meetings or other opportunities designed to educate them about the following topics and their professional responsibilities:

Mitigating Risk

Daily Self-Health Checks

Face Coverings and Physical Distancing

Outdoor Training

Practice Considerations

Team Travel

Student-Athlete Return to Campus

Transition Periods and Return to Activity

COVID-19 Infection Managment

Time- based strategy

For individuals who test positive but never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive PCR test for SARS-CoV-2.

Time-based strategy

For most people with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and at least 24 hours after resolution of fever, without the use of fever-reducing medications, and with improvement of other symptoms.

Return to Activity After Infection

Sport Classification and Testing Strategies

Low contact risk: bowling, diving, equestrian, fencing, golf, rifle, skiing, swimming, tennis, track and field.

Intermediate contact risk: acrobatics and tumbling, baseball, beach volleyball, cross country*, gymnastics, softball, triathlon*.

High contact risk: basketball, field hockey, football, ice hockey, lacrosse, rowing, rugby, soccer, squash, volleyball, water polo, wrestling.

*The level of risk in cross country, track and field and triathlon are dependent upon the student-athlete’s proximity to other unmasked individuals. For example, the start or finish of a race may involve a group of athletes who are breathing heavily in a group space with a breakdown in physical distancing.

Considerations for Low Contact Risk Sports:

  • Diagnostic testing upon arrival to campus.
  • During summer athletic activities and out-of-season athletic activities: surveillance testing in conjunction with a university plan for all students, plus additional testing for symptomatic and high contact risk individuals.
  • During in-season (preseason, regular season, postseason): symptomatic testing and high contact risk testing thereafter.

Considerations for Intermediate Contact Risk Sports:

  • Diagnostic testing upon arrival to campus.
  • During summer athletic activities and out-of-season athletic activities, and in-season (preseason, regular season and postseason): surveillance PCR testing, for example, 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained, plus additional testing for symptomatic and high contact risk individuals.
  • Symptomatic testing and high contact risk testing as appropriate.

Considerations for High Contact Risk Sports:

  • Diagnostic testing upon arrival to campus.
  • During summer athletic activities and out-of-season athletic activities: surveillance PCR testing, for example, 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained, plus additional testing for symptomatic and high contact risk individuals.
  • During in-season (preseason, regular season and postseason): weekly PCR testing of all athletes, plus “inner bubble” personnel for whom physical distancing, masking and other protective features are not maintained.
  • Additional testing for symptomatic and high contact risk individuals.

  • Before campus departure and within 72 hours/three days of competition for football and within 72 hours/three days of the first of the week’s set of games for other high-risk sports.

  • Lack of ability to isolate new positive cases or to quarantine high contact risk cases on campus.
  • Unavailability or inability to perform symptomatic, surveillance or pre-competition testing when warranted.
  • Campuswide or local community test rates that are considered unsafe by local public health officials.
  • Inability to perform adequate contact tracing consistent with governmental requirements or recommendations.
  • Local public health officials stating that there is an inability for the hospital infrastructure to accommodate a surge in COVID-19-related hospitalizations.

Core Principles of Resocialization of Collegiate Sport: Developing Standards for Practice and Competition Frequently Asked Questions

The NCAA has released the following guidance documents related to the resocialization of college sports in the wake of the COVID-19 pandemic:

  • “Core Principles of Resocialization of Collegiate Sport” (5/1/20)
  • “Resocialization of Collegiate Sport: Developing Standards for Practice and Competition” (7/14/20) 
  • “Resocialization of Collegiate Sport: Action Plan Considerations” (5/28/20) 

Each of the above publications was intended to supplement and update the prior publications to reflect most recent emerging data and information available at the time of release. The NCAA has also published  and continues to supplement an FAQ document that contains questions/answers pertaining to the publications.  As the resocialization publications have been updated, they have rendered certain of the FAQ content outdated. Those outdated portions of the FAQ have been removed from the published version and have been archived to this document solely for purposes of historical reference. This content is no longer consistent with the Association’s published position and should not be relied upon as guidance.

Questions can be directed to the NCAA Sport Science Institute at ssi@ncaa.org.

This frequently asked questions document has been developed in support of the release of the document Core Principles of Resocialization of Collegiate Sport: Developing Standards for Practice and Competition (Practice and Competition Guidance), the third in a series of three resocialization documents intended to provide guidance to the NCAA membership about issues arising from the COVID-19 global pandemic. The content of the Practice and Competition Guidance updates and extends, and in some cases replaces, the guidance provided in the previous two documents. Consequently, FAQ content from the previous two resocialization documents (Core Principles and Action Plan) has been archived and will be made available to the membership as a historical document.

As with prior NCAA publications, the materials are meant to be consistent with guidance published by the federal government and its health agencies. This document is reflective of the relevant scientific and medical information available at the time of print. These materials are not and should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve.

Questions can be directed to SSI@ncaa.org.

Why was this third document created?

The Practice and Competition Guidance was written to update and extend the guidance provided in the prior two documents (i.e., Core Principles and Action Plan) regarding resocialization of collegiate sport. The primary purpose of the document is to consider the development of standards regarding COVID-19 risk mitigation during practice and competition, including testing. Importantly, this third document was written and released in the setting of a considerable increase in COVID-19 infections in many parts of the country. This increase in infection spread is occurring at a time when students and student-athletes are preparing to return to campuses, and in some Division I sports, while student-athletes are returning to participate in required summer athletic activities.

Are COVID-19 testing considerations an important part of this document, and if so, why?

Yes, this document provides new and expanded guidance on COVID-19 testing, including suggested protocols for testing based on the contact risk of individual sports. Testing is one way to mitigate COVID-19 spread. Because there is a higher risk of infection spread in some sports relative to others, testing is a way of identifying and tracking new infections, including potential team outbreaks, in the setting of athletic practice and competition.

Why does the document place so much emphasis on masks/cloth face coverings? What role does masking play in the prevention of COVID-19 infection?

Universal masking, along with physical distancing, cough and sneeze etiquette, and hand sanitization, has been shown to markedly decrease the risk of COVID-19 infection spread. We have learned much about the importance of masks/cloth face coverings since the beginning of this pandemic, and a growing body of evidence demonstrates that face masking effectively decreases the probability of spread. This is why all athletics personnel are encouraged to wear a mask/cloth face covering at all feasible times, but especially when physical distancing isn’t practical or possible. This includes outdoor spaces where physical distancing is not possible (for example, an outdoor sporting event). We anticipate emerging information regarding masking recommendations when in poorly ventilated areas for a more prolonged period of time and will provide updated information to the membership as it becomes available. Because wearing a face mask becomes impractical for student-athletes during some aspects of practice and during competition, testing becomes an important and complementary tool for tracking potential COVID-19 spread.

What is the role of face shields in the prevention of COVID-19 infection spread? Is there any risk from using them, especially if they are placed on football helmets?

While the CDC continues to recommend wearing “cloth face coverings” in public settings where other social distancing measures are difficult to maintain, some health experts believe it is reasonable to conclude that face shields may be an effective alternative. The use of a face shield, an emerging consideration as either an alternative or supplement to a face mask/cloth face covering, similarly may mitigate spread of virus from an infected individual to a noninfected person. The CDC does not currently recommend that the face shield may replace a cloth face covering, but does note that individuals may choose to use a face shield when sustained close contact with other people is expected, provided the shield wraps around the sides of the wearer’s face and extends to below the chin if used without a mask/cloth face covering.

Schools may want to consider the effectiveness of face shields as a potential alternative to the use of masks/cloth face coverings for protection of others against exposure by infected individuals as they may offer some protection from COVID-19 spread but with less impediment in terms of heat, moisture and effective communication. They also have the potential added benefit of preventing wearers from touching their face.

The idea of a face shield that attaches to an athletic helmet for purposes of virus protection is new, and there is no published data available that speaks specifically to potential health and safety considerations related to their use. However, those face shields that have been custom-manufactured to affix to the face mask of a football helmet clip on and off easily, and anecdotal evidence to date suggests that their use may be well-tolerated by student-athletes. 

Importantly, these products are considered helmet add-ons and require confirmation from the helmet manufacturer that the helmet can retain necessary National Operating Committee on Standards for Athletic Equipment certification when the shield is added. Schools are advised to confirm with the manufacturer of their football helmets before deciding to purchase or add a face shield product.

Why does the document place such emphasis on outdoor training? Why is it necessary to differentiate between outdoor and indoor?

Although the primary means by which COVID-19 is spread is by respiratory droplets (thus masks/cloth face coverings helping to decrease respiratory droplet spread), there is also emerging evidence that the virus may persist in an aerosolized form in the air, thereby increasing the possibility of airborne spread. But risk of such airborne spread is reduced when people are  outdoors or in well-ventilated spaces. Therefore, the document emphasizes that whenever possible, outdoor athletic activities are preferable to indoor, all other factors being equal.

The first document, Core Principles of Resocialization of Collegiate Sport, emphasized three progressive phases of engagement in athletic activity, with each phase lasting at least two weeks. Does the Practice and Competition Guidance override that recommendation?

The Core Principles document was written at a time when it was reasonable to anticipate national guidance on surveillance, testing strategies and contact tracing. However, national guidance never fully materialized. Instead and as it became apparent that many of the virus-related risks and behaviors would vary by geography, state and local authorities became the primary source of public health guidance. At the same time, considerable evidence has emerged regarding the efficacy of masking/cloth face coverings, which was not emphasized at the time of the first publication, and which has important implications for comprehensive COVID-19 prevention strategies. Given the shifting public health authority paradigm and the evolving evidence about how to mitigate COVID-19 infection spread, the Practice and Competition Guidance reflects a move away from the original phase-in criteria but continues to emphasize the importance of the first two weeks of athletics engagement and a holistic approach to policies for mitigating COVID-19 infection spread with a new focus on the strategic use of testing.

Why does the document recommend the use of functional units as a consideration for group practice and physical conditioning activities?

As the Practice and Competition Guidance describes, a functional unit may be composed of five to 10 individuals, all members of the same team, who consistently work out and participate in activities together. When an individual tests positive for COVID-19, it is the responsibility of local public health officials, through the use of contact tracers, to identify all high-risk contacts of that newly infected individual. Training in smaller functional units can reduce the burden of contact tracing because it limits the number of people who are likely to be considered high-risk contacts of an infected individual to those within the established functional unit. The strict use of functional units for training, when combined with good risk mitigation behaviors outside athletics, also can mean the avoidance of full team or large group quarantines if a student-athlete tests positive.

The document identifies rowing as a high contact risk sport. Can this classification be clarified further, to account for the differences between small and big boats?

The classification of rowing as a high contact risk sport is based on the fact that, in sculls of two or more people, there is an increased probability of exposure arising from both the proximity of the athletes to one another and the amount of time that exposure is maintained during practice and/or competition events. However, for single-occupancy sculls, rowing would have a low contact risk. Double-occupancy sculls also can be considered a low contact risk if these two individuals live in the same household. Rowing in large sculls (8+, 4+, 4x) is considered a high contact risk scenario.

The pre-competition testing recommendation states that testing should be done within 72 hours of competition for football, or within 72 hours of the first of a week’s set of games for other sports with high contact risk. Is it reasonable to substitute three calendar days for the 72-hour recommendation?

Yes. Seventy-two hours is meant as a general guide, and a testing paradigm allowing three calendar days is consistent with the intent of the 72-hour recommendation. This means, for example, that if a football game is scheduled for midafternoon Saturday, testing could be done Wednesday morning, as opposed to sometime after midafternoon Wednesday. This may help with testing logistics, including the time needed to get samples to a lab. Importantly, schools should consider protocols that ensure student-athletes can continue to observe all risk mitigation strategies after testing has been done.

What if the pre-competition test was performed on time but the test result release is delayed?

The Practice and Competition Guidance calls for test results to be available to team medical personnel within the 72-hour window before competition begins so that any necessary contact tracing, isolation of infected individual(s) and quarantining of at-risk teammates and staff can be completed before the start of the event. Competing without test results is not consistent with the intent of the Practice and Competition Guidance.

Our conference has suspended/canceled the fall competitive season, but our school will allow student-athletes to train in the fall while they are on campus. Do the COVID-19 testing considerations described in the Practice and Competition Guidance apply to these student-athletes during this time? Does the contact risk classification of the sport influence testing decisions? 

The Practice and Competition Guidance was intended to provide suggested testing protocols to be considered as part of a competitive season. In the event that a school (or conference) elects to cancel or discontinue a competitive season, it would be expected that student-athletes would be tested in a manner consistent with any protocols that have been implemented as part of school policies for the broader student body and that the athletics department would continue to evaluate the potential applicability of all other state, local and institution guidance and other relevant health and safety information (for example, the NCAA resocialization materials) that may be relevant to the student-athletes’  level of continued athletic engagement. If training occurs as part of voluntary/required summer athletic activities, or out-of-season athletic activities, recommendations for such training are provided in the Practice and Competition Guidance document.

The document states that polymerase chain reaction testing is currently the gold standard testing method, but it notes that alternative strategies may need to be considered as testing technology evolves. What does this mean for my campus as we are trying to finalize our testing protocols for fall sport student-athletes?

PCR lab-based testing has a very high sensitivity (few false negatives) and specificity (few false positives). It is conceivable that PCR testing may become more impractical over time, especially if there continue to be delays in processing tests and providing timely results. Point-of-care tests may become a feasible alternative solution, including point-of-care antigen testing, point-of-care isothermal nucleic acid amplification testing and point-of-care PCR testing. The membership will be provided updates about these emerging technologies and their applicability to sport as that information becomes available.

The document states that a school should have in place a mechanism for notifying an opposing team in the event a student-athlete who participated in a competition with that opposing team tests positive within 48 hours after the competition. Can this recommendation be explained further?

The 48-hour reference was intended to suggest a window after competition during which teams should continue to be vigilant about the possibility that pre-competition infection, or infection in connection with a competition event, may have occurred. Regardless of when testing is performed or when symptoms manifest, it is extremely important for teams to carefully track all student-athletes and personnel who travel and participate in competition activities, such that, if one of those individuals develops symptoms or tests positive during or after the competition, the school is able to effectively implement applicable contact tracing protocols and notify impacted individuals, including those who may be part of an opposing team or its staff.

Who decides the status of fall athletics competition schedules?

Decisions related to whether fall competition schedules will be modified or discontinued may be influenced by three primary decision-making authorities:

  • State and local public health authorities: (See “Considerations Related to the Discontinuation of Athletics” in the Practice and Competition Guidance).
  • Member schools and athletics conferences.
  • Association governance: The NCAA Board of Governors has authority to determine the continuation or discontinuation of all fall sport national championships, with the exception of the Football Bowl Subdivision College Football Playoff, and divisional governance has the authority to manage requirements related to membership and student-athlete eligibility.
Has the Centers for Disease Control and Prevention provided any material updates that would impact the information included in the Practice and Competition Guidance?

Yes. The CDC continues to update its recommendations based on emerging research and evidence. Subsequent to the publication of the Practice and Competition Guidance, the CDC published the following research-based findings pertaining to the Duration of Isolation and Precautions for Adults with COVID-19:

  • Individuals with mild to moderate COVID-19 remain infectious no longer than 10 days after symptom onset.
  • Individuals with more severe to critical illness or severe immunocompromise likely remain infectious no longer than 20 days after symptom onset.
  • While recovered people can continue to shed the virus for months after illness onset, they do so at concentrations considerably lower than during illness, making infectiousness unlikely.
  • Research has not shown that clinically recovered people have infected others.

The CDC believes the above findings strengthen the justification for relying on a symptom-based strategy, rather than test-based, for ending isolation of infected patients, so that these individuals are not kept unnecessarily isolated and excluded from activities. Accordingly, the CDC has updated its recommendations as they relate to this population as follows:

  • For most people with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.
  • A limited number of people with severe illness may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consultation with infection control experts should be considered.
  • For individuals who test positive but never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive PCR test for SARS-CoV-2.
  • For people who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious diseases experts, but for all others, a test-based strategy is no longer recommended except if considering discontinuation of isolation other than as outlined above.
  • For people previously diagnosed with symptomatic COVID-19 who remain asymptomatic after recovery, retesting is not recommended within three months after the date of symptom onset for the initial COVID-19 infection, and quarantine is not recommended for these individuals in the event of close contact with an infected person. 
  • For individuals who tested positive but never developed symptoms, the date of first positive PCR for SARS-CoV-2 should be used in place of the date of symptom onset. 
  • If new symptoms develop in previously infected individuals within three months after the date of initial symptom onset, and if an alternative etiology cannot be identified by a provider, the person may warrant retesting and consultation with an infectious disease expert, especially in the event symptoms develop within 14 days after close contact with an infected person.
Are there any other updates that would impact the information included in the Practice and Competition Guidance?

Yes. Experts from the American Medical Society for Sports Medicine COVID-19 Working Group have updated their exercise recommendations for college student-athletes infected with COVID-19, and they now recommend that athletes with new infection and no symptoms follow the same exercise recommendations as athletes with new infection and mild illness. This means that those newly infected athletes with no symptoms should not exercise for at least 10 days, and possibly longer if symptoms develop. The updated recommendations can be found on the AMSSM website.

Resocialization of Collegiate Sport: Developing Standards for Practice and Competition

The NCAA has released the following guidance documents related to the resocialization of college sports in the wake of the COVID-19 pandemic:

  • “Core Principles of Resocialization of Collegiate Sport” (5/1/20)
  • “Resocialization of Collegiate Sport: Developing Standards for Practice and Competition” (7/14/20) 
  • “Resocialization of Collegiate Sport: Action Plan Considerations” (5/28/20) 

Each of the above publications was intended to supplement and update the prior publications to reflect most recent emerging data and information available at the time of release. The NCAA has also published  and continues to supplement an FAQ document that contains questions/answers pertaining to the publications.  As the resocialization publications have been updated, they have rendered certain of the FAQ content outdated. Those outdated portions of the FAQ have been removed from the published version and have been archived to this document solely for purposes of historical reference. This content is no longer consistent with the Association’s published position and should not be relied upon as guidance.

Questions can be directed to the NCAA Sport Science Institute at ssi@ncaa.org.

Original release: July 16, 2020
Updated: August 14, 2020

As indicated below, these materials are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve. The most recent content updates to these materials are indicated with highlighted text within.

Executive Summary

This third publication on resocialization of collegiate sport updates the prior two documents and provides new guidance specific to the prevention of community spread of COVID-19 in the athletics setting.  Importantly, the guidelines provide NCAA members tools to assist with their efforts to provide a healthy and safe environment for those participating in athletics.  Key takeaways from the guidance include:

  • Asymptomatic and pre-symptomatic spread of COVID-19 is common in young adults.
  • COVID-19 remains high risk for certain individuals, including those with a Body Mass Index of 30 or greater.
  • Testing strategies should be implemented for all athletics activities, including pre-season, regular season and post-season.
  • Testing and results should be obtained within 72 hours of competition in high contact risk sports.
  • Polymerase Chain Reaction (PCR) testing is the preferred method of testing, but alternative strategies will be considered as testing technology evolves.
  • Daily self-health checks should be performed by all student-athletes and athletics personnel before entering any athletics facility.
  • Physical distancing and masks/cloth face coverings are an integral part of athletics, and should be practiced whenever feasible.
  • Although face shields are not proven to offer the same risk mitigation as masks/cloth face coverings, they should be integrated into sport where feasible.
  • Universal masking should be observed on all sidelines, including when an athlete moves from the playing field to the sideline to confer with a coach.
  • Training should occur outdoors.  When not feasible, indoor training with good ventilation is preferable to indoor training with poor ventilation.
  • Hand sanitization, cough/sneeze etiquette, physical distancing and masks/cloth face coverings are key in COVID-19 risk mitigation.
  • Time-based strategies for resuming activities after positive test results should follow CDC recommendations.
  • All individuals with high-risk exposure must be quarantined for 14 days.
  • All student-athletes and athletics personnel should understand that COVID-19 risk mitigation practices should be observed at ALL times, including non-athletic related activities.

This third NCAA publication regarding resocialization of collegiate sport is intended as an update and supplement to the original publication, Core Principles of Resocialization of Collegiate Sport, and the second NCAA publication Resocialization of Collegiate Sport: Action Plan Considerations. The first publication provided guidance for phasing in sports and was consistent with the federal publication Guidelines: Opening Up America Again. The second NCAA publication emphasized personal and institutional considerations related to preventing the spread of COVID-19.

The first two documents were written within the conceptual framework of a national projection for a downward rate of COVID-19 infection in the United States. As the graph below indicates, when the NCAA began discussions about return of sport after the cancellation of 2020 winter and spring championships, there was an expectation that such a return would take place within a context that assumed syndromic surveillance, national testing strategies and enhanced contact tracing. Although testing and contact tracing infrastructure have expanded considerably, the variations in approach to reopening America for business and recreation have correlated with a considerable spike in cases in recent weeks. This requires that schools contemplate a holistic strategy that includes testing to return to sports with a high contact risk.

The information in this third publication was developed in consultation with the NCAA COVID-19 Advisory Panel, the American Medical Society for Sports Medicine (AMSSM) COVID-19 Working Group, which is composed of sports medicine physicians from NCAA member schools who supplement and support the work of the advisory panel as it relates to specific areas of COVID-19 risk: the Autonomy-5 Medical Advisory Group, which includes team physicians and infectious disease experts from the five autonomous conferences; the National Medical Association; the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. This document also takes into consideration available recommendations from the Centers for Disease Control and Prevention.

These materials are intended to do two things:

  • Update and extend the guidance provided in the first two resocialization publications in light of new and emerging information.
  • Provide new guidance about considerations specific to the prevention of community spread of COVID-19 in the athletics setting, including, specifically, examples of recommendations for COVID-19 testing for individuals in sports with a high contact risk.

As with prior NCAA publications, the materials are meant to be consistent with guidance published by the federal government and its health agencies. This document reflects the relevant scientific and medical information available at the time of print. These materials should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve.

The federal government has not yet published uniform federal guidance related to certain practices like diagnostic testing protocols, contact tracing and surveillance. But as individual states have reopened businesses and entertainment venues, the NCAA COVID-19 Advisory Panel, the AMSSM COVID-19 Working Group, and the Autonomy-5 Medical Advisory Group have reviewed and evaluated those practices. Through this anecdotal evidence and related analysis and discussion, these groups have been able to identify certain practices that should be highlighted for more focused consideration by member schools.

This publication provides NCAA members tools to assist with their efforts to provide a healthy and safe environment for those participating in athletics.  While we encourage consideration of various factors and actions, we do not speak to every possible scenario, and in no event should members fall below national or public health standards set by their local communities.   

Risk of Transmission of COVID-19

As reported by the CDC, while surface contact may be a risk, the most impactful determinant of COVID-19 spread is human-to-human contact.[1] COVID-19 spread is greatest when individuals are in a crowded environment with prolonged close contact. Further, the risk of COVID-19 transmission is greater in indoor areas with poor ventilation. Indoor areas with good ventilation are better, and outdoor areas are best. Thus, COVID-19 spread is most likely when individuals are in prolonged close contact in an indoor area with poor ventilation, which has implications for both sport training and sport competition planning.[2] 

The CDC defines high risk of COVID-19 transmission as any situation in which there has been greater than 15 minutes of close contact, defined as being less than 6 feet apart, with an infectious individual.[3] Importantly, there is a risk of transmission from being present with infectious individuals who are symptomatic, pre-symptomatic or asymptomatic.

Asymptomatic spread of COVID-19 is of significant concern in the college sport environment because, like the broader student body, it is largely composed of younger adults (18-29 years of age). These individuals will often remain asymptomatic after being infected with SARS-CoV-2, but even though they have no symptoms, they are still capable of spreading this virus, which causes COVID-19. If they infect another younger adult, the risk of an adverse outcome is low, although the long-term consequences to cardiopulmonary health to themselves or other younger adults remain unknown. In contrast, contact with that same asymptomatic/minimally symptomatic individual presents a potentially lethal risk for high-risk category individuals who are far more likely to have an adverse outcome if infected with the coronavirus that causes COVID-19. Relatedly, pre-symptomatic spread is also a concern, as these individuals are infected with COVID-19 but have not yet developed symptoms or signs of this disease.

The CDC recently updated its guidance to emphasize that, among adults, the risk for severe illness from COVID-19 increases with age, with older adults at highest risk and 8 out of 10 COVID-19-related deaths reported in the United States to date occurring in adults age 65 and older. In addition, the CDC also has established that individuals of any age with the following underlying medical conditions are at increased risk: [4]

Finally, the CDC has advised that children who have complex medical situations, who have congenital heart disease or who have neurologic, genetic, metabolic conditions are at higher risk for severe illness from COVID-19 than other children.

While data is still fairly limited, the CDC has said people with the following conditions might also be at an increased risk for severe illness from COVID-19:[5]

As published data confirms that the risk of death from COVID-19 increases with age and high-risk underlying medical conditions, students and student-athletes who are not in high-risk categories themselves may be unlikely to have complications from COVID-19, but they represent a significant threat to any high-risk category individuals with whom they may have unprotected contact. These risks must be considered as part of the risk/benefit ratio of resocialization of collegiate sport. Of note, sports such as football may have an overrepresentation of student-athletes (for example, football linemen) who meet the high-risk criteria as it relates to obesity. For this reason, prevention and testing strategies should recognize that some athletes may have an increased risk of adverse outcomes from COVID-19.

Mitigating Risk With Daily Self-Health Checks

Every student-athlete and all athletics personnel should practice at least daily self-health evaluations before participating in any aspect of in-person athletics activities. Individuals who identify any of the following symptoms or signs during the daily self-health evaluation should be encouraged to contact the designated athletics health care representative by telephone or virtual visit before coming on campus or to any athletics facility:

  • Shortness of breath or difficulty breathing.
  • Cough or other respiratory symptoms.
  • Headache.
  • Chills.
  • Muscle aches.
  • Sore throat.
  • Congestion or runny nose.
  • New loss of taste or smell.
  • Nausea, vomiting or diarrhea.
  • Pain, redness, swelling or rash on toes or fingers (COVID toes).
  • New rash or other skin symptoms.
  • High-risk exposure: a new contact with an infected individual or prolonged contact with a crowd without physical distancing (for example, attended a party in which there was no masking or physical distancing).
  • Temperature of 100.4° Fahrenheit or above.

Mitigating Risk With Face Coverings and Physical Distancing

Emerging data makes it clear that along with hand washing and good sanitization practices, physical distancing and universal masking are the most effective strategies for preventing COVID-19 spread at the community level. While the CDC continues to recommend wearing “cloth face coverings” in public settings where other social distancing measures are difficult to maintain, some health experts believe it is reasonable to conclude that face shields may be an effective alternative.[6] The use of a face shield, an emerging consideration as either an alternative or supplement to a face mask/cloth face covering, similarly may mitigate spread of virus from an infected individual to a non-infected person. The CDC does not currently recommend that the face shield may replace a cloth face covering, but does note that individuals may choose to use a face shield when sustained close contact with other people is expected, provided the shield wraps around the sides of the wearer’s face and extends to below the chin if used without a mask/cloth face covering.[7] Thus, even where state and local requirements may permit otherwise, schools should consider the recognizable benefit of requiring face coverings and appropriate physical distancing wherever possible in the college athletics environment.

In sport, universal masking would mean that all individuals engaged in athletics activities would wear a mask/cloth face covering during all phases of non-water-based activity that involve proximity to other individuals. This practice could present a challenge during activities involving contact to the head or face region or strenuous exercise. Where a mask/cloth face covering cannot be safely tolerated, schools should consider implementing physical distancing protocols that encourage at least 6 feet between individuals. Schools may want to consider the effectiveness of face shields as a potential alternative to the use of masks/cloth face coverings for protection of others against exposure by asymptomatic individuals. Because face shields are usually made from clear plastic and they generally extend below the chin and around the ears, they may offer some protection but with less impediment in terms of heat, moisture and effective communication. They also have the added benefit of preventing wearers from touching their face.

Face shields also have been developed for football helmets and are made to affix to the helmet’s rigid face mask. Like masks/cloth face covering, the shields are designed to prevent the outward projection of respiratory droplets during coughing, sneezing, heavy breathing, or grunting. It should be noted that these products are considered helmet add-ons and require confirmation from the helmet manufacturer that the helmet can retain necessary National Operating Committee on Standards for Athletic Equipment certification when the shield is added. Schools are advised to confirm with the manufacturer of their football helmets before deciding to purchase or add a face shield product.

Theoretically, if a team can successfully implement universal masking and distancing practices during athletically related activities, it could reduce the risk of spread in the event of an infected team member. Individuals who participate in athletics activities while in proximity (less than 6 feet) to an infected individual and who may otherwise be considered a high-risk contact because of that proximity, could possibly not be considered a high-risk contact for contact tracing purposes if the infected individual was wearing a mask/cloth face covering during those athletics activities. In other words, in addition to lowering the risk of transmission, universal masking practices may potentially ease the operational burden that would otherwise accompany managing a community or team outbreak. This theoretical consideration is likely to be in flux as we understand better the operational considerations for “prolonged exposure” and “close contact in sport.” 

Mitigating Risk With Outdoor Training

There is good evidence[2]  that risk of COVID-19 transmission is greater in indoor areas with poor ventilation. Indoor areas with good ventilation are better, and outdoor areas are best. This means, to the extent possible, there should be maximization of outdoor activity during training as a strategy to mitigate COVID-19 risk. 

When outdoor training is not feasible, or for indoor sports, it is important to try to ensure that ventilation systems are operating properly, air flow is maximized, and physical distancing is maintained. Consider the following CDC recommendations:[2] 

  • Ensure proper maintenance of ventilation systems.[8]
  • Increase circulation of outdoor air as much as possible by opening windows and doors, using fans and following other related methods if doing so does not create a hazard.
  • Install transparent shields or other physical barriers in common areas of training where physical distancing may be compromised.
  • Use signs, tape marks or other visual cues placed 6 feet apart to encourage physical distancing in common training areas.
  • Increase the percentage of outdoor air in HVAC systems.
  • Increase total airflow supply to occupied spaces.
  • Disable demand-control ventilation controls that reduce air supply based on temperature or occupancy.
  • Improve central air filtration.
  • Consider running the building ventilation system even during unoccupied times to maximize dilution ventilation.
  • Generate clean-to-less-clean air movement.
  • Consider using portable high-efficiency particulate air fan/filtration systems to help enhance air cleaning, especially in higher risk areas.
  • Ensure exhaust fans in restroom facilities are functional and operating at full capacity when the building is occupied.
  • Consider using ultraviolet germicidal irradiation as a supplement to help inactivate the coronavirus.

Impact of State and Institutional Guidelines on Early Resocialization Guidance

As states have evaluated regional risks as they relate to emerging data such as COVID-19 infection and death rates and available medical resources, they have established their own reopening (or resocialization) guidelines. The variations in these resocialization practices and requirements between states are often significant. In addition to this lack of consistency between states, many of the state-level practices are inconsistent with the Guidelines: Opening Up America Again, the federal publication upon which the original Core Principles of Resocialization of Collegiate Sport was based.

For example, many states have elected to forgo strict adherence with the two-week phased intervals of resocialization that were described in the federal Guidelines and Core Principles document and, instead, implemented strategies and practices that emphasize long-term adherence to more practical strategies that mitigate and minimize campus and community spread.

Similarly, the size of the group or gathering has become less of a focus in these state-level strategies as emerging data has suggested that even a very small group can pose a substantial risk if none of the individuals in that group practices risk mitigation strategies (for example, masking and physical distancing). Conversely, if large groups are assembled and effective risk mitigation strategies are in place, such gatherings are consistent with promoting health behaviors that reduce COVID-19 spread.[9] Therefore, the six-week phased-in resocialization approach originally presented in the Core Principles document should now be interpreted and applied in a way that takes into account this emerging data and emphasizes risk mitigation strategies for all groups, regardless of size.

It remains that the first two weeks of return to campus deserve special consideration because student-athletes are converging from multiple parts of the country and may well be asymptomatic, pre-symptomatic, or symptomatic carriers of COVID-19. As athletics departments continue to develop protocols related to student-athlete re-entry to campus, including testing athletes upon campus return, the following considerations identified in the Action Plan document remain relevant, and may warrant consideration of additional testing based on the athlete’s timeline:

  • Confirmation of no high-risk exposure to COVID-19 for at least two weeks before returning to campus.
  • Absence of typical COVID-19 symptoms.
  • Assessment of risk factors involved in traveling back to school.
  • Management of infected individuals in accordance with local public health guidance.

Strategies for Transition Periods and Return to Activity

As member schools plan for a return to organized activity for fall sports, questions have emerged about the structure of activity during identified transition and acclimatization periods. COVID-19 has undoubtedly increased the complexities and will continue to impact health and safety considerations related to returning to athletics and preseason activities. Traditional transition and acclimatization considerations (for example, cardiovascular conditioning, heat, altitude) are still very relevant, and when coupled with the loss of spring and summer activities and other physical and nonphysical impacts related to COVID-19, they can create complex re-entry challenges for student-athletes.

Recommendation No. 3 of the NCAA’s Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes (Catastrophic Materials) speaks to the vulnerability of student-athletes during the first week of activity of a transition period in training and the importance of establishing a seven- to 10-day initial transition period during which student-athletes are afforded the time to properly progress through the physiologic and environmental stresses placed upon them as they return to required activities.

In addition to the NCAA guidance that can be found on the NCAA Coronavirus Resource Page, various evidence-based resources have been published by professional organizations in sports medicine and strength and conditioning. These resources may help inform member schools as they design and implement evaluation activities, physical conditioning and practice sessions during these transition periods impacted by COVID-19. Schools are encouraged to leverage all available resources and information as they plan for return to campus and athletics activities. A nonexhaustive list of some of these materials is included for reference:

Strategies for Resuming Activities After Positive Test Results – Asymptomatic Individuals

The CDC has published strategies for the resumption of normal activities for people who have tested positive for COVID-19 but who have not had any symptoms.[10] Any decision to discontinue isolation of infected individuals should be made in the context of local circumstances.

Symptom-based strategy

For individuals who test positive but never develop symptoms, isolation and other precautions can be discontinued 10 days after the date of their first positive PCR test for SARS-CoV-2.

Strategies for Resuming Activities After Positive Test Results – Symptomatic Individuals

The CDC has published strategies for the resumption of normal activities for people who have tested positive for COVID-19 and who have symptoms.[10] Any decision to discontinue isolation of infected individuals should be made in the context of local circumstances.

Symptom-based strategy

For most people with COVID-19 illness, isolation and precautions can generally be discontinued 10 days after symptom onset and resolution of fever for at least 24 hours, without the use of fever-reducing medications, and with improvement of other symptoms.

A limited number of people with severe illness may warrant extending duration of isolation and precautions for up to 20 days after symptom onset; consultation with infection control experts should be considered.

For people who are severely immunocompromised, a test-based strategy could be considered in consultation with infectious diseases experts, but for all others, a test- based strategy is no longer recommended except if considering discontinuation of isolation other than as outlined above.

Other Considerations Related to Resumption of Activities After Positive Tests

The CDC has identified other information that athletics departments should consider as part of their development of protocols related to the discontinuation of isolation for infected individuals after positive test results.10 For example, for certain populations, including those containing individuals with conditions that may weaken their immune system, a longer isolation timeframe for infected individuals may be desired to minimize the chance of prolonged shedding of the virus. Similarly, it should be noted that recommendations for discontinuing isolation in people known to be infected with COVID-19 may be different than CDC recommendations on when to discontinue quarantine for people known to have been exposed to COVID-19. For example, the CDC still recommends 14 days of quarantine after high-risk exposure based on the time it takes to develop illness if infected. Thus, it is possible that a person known to be infected, but who has been tested, could leave isolation earlier than a person who is quarantined, but who has not been tested, because the possibility of infection remains where testing has not occurred.

Cardiac and Exercise Considerations for Resumption of Exercise After COVID-19 Infection

The COVID-19 virus can potentially negatively impact any endothelial structure, including the heart and lungs, thereby posing a potential risk to individuals who return to exercise post-infection. Published data suggests that athletes with prior COVID-19 infection should undergo cardiac screening.[11],[12] However, it should be noted that the data referenced in these publications was gathered from individuals who suffered severe complications from COVID-19. These individuals did not show the clinical case presentation typical to younger adults who contract the disease and infrequently develop severe complications. To date, there have not been any evidence-based recommendations published to guide the return to exercise in asymptomatic or minimally symptomatic athletes who have become infected with COVID-19.

However, a group of experts from the American Medical Society for Sports Medicine and the American College of Cardiology have developed the following considerations, which are available on the AMSSM websiteThese recommendations for cardiac testing are based on expert consensus with limited evidence.

Prior Infection

Athletes with a confirmed past infection (antibody or prior diagnostic test), and mild to moderate illness or asymptomatic, (i.e., managed at home):

  • A medical evaluation or routine pre-participation exam can be performed, including a symptom screen.
  • Electrocardiogramand echocardiogramcan be considered.
  • Further workup as indicatedin conjunction with a cardiologist.

Athletes with a confirmed past infection and severe illness (hospitalization) or ongoing cardiovascular symptoms(>14 days from onset of symptoms):

  • Medical evaluation with symptom screen.
  • Additional testing, which may include:
    • Cardiologyconsultation, electrocardiogram; blood troponin 48 hours after exercise and echocardiogram.
    • Consider additional cardiac tests such as cardiac MRI, Holter, stress test, chest X-ray, spirometry, pulmonary function tests, d-dimer and chest CT.

New Infection

Athletes with new infection and either no symptoms or mild illness:

  • No exercise for at least 10 days, or longer if symptoms persist.
  • Monitor for development of symptoms during isolation.
  • Cardiac recommendations as above,including consideration of echocardiogram for asymptomatic and mild illness.
  • Further work-up as indicated in conjunction with a cardiologist.

Athletes with new infection and mild illness (common cold-like symptoms without fever):

  • No exercise for at least 10 days, or longer if symptoms persist.
  • Monitor for symptom development with exercise.
  • Cardiac recommendations as above,including consideration of echocardiogram for asymptomatic and mild illness.
  • Further work-up as indicated in conjunction with a cardiologist.

Athletes with new infection and moderate illness (fever and flu-like illness):

  • No exercise for at least 14 days, or longer if symptoms persist. 
  • Monitor for symptom development with exercise.
  • Cardiac recommendations as above.
  • Further work-up as indicated in conjunction with a cardiologist.

Athletes with new infection and severe illness (hospitalized):

  • For more severe illness, hospitalization, or ongoingcardiovascular symptoms, a comprehensive medical evaluation and cardiologyconsultationis recommended.
  • Consider cardiac MRI.

Athletes placed in quarantine for high risk contact but who are not infected with COVID-19:

  • Exercise in quarantine is permitted if such exercise does not cause cardiopulmonary symptoms.
  • Monitor for development of symptoms during quarantine.
  • If symptoms develop, with or without exercise, test for SARS-CoV-2.

Updated Strength and Conditioning Considerations

Because of the number of respiratory droplets that are distributed into the air during a typical strength and conditioning work-out, athletics departments should consider the potential risk mitigation benefits of implementing clear physical distancing and masking practices during such sessions, and such sessions preferably should occur outdoors. See also “Mitigating Risk With Outdoor Training” above. These risks and benefits would apply to athletes and coaches (including strength and conditioning specialists), as well as any other essential personnel involved in these workouts or located within the workout space. See also “Mitigating Risk With Face Coverings and Physical Distancing” above.

Updated Team Practice Considerations

Available data supports the idea that, although sport has many positive effects, group practice activities have the potential to significantly increase the risk of COVID-19 spread if proper distancing and/or masking practices are not implemented, and if air flow/ventilation is compromised. As athletics departments account for and plan to address these risks they should consider the following:

  • Face Coverings During Team Practice Activities. See “Mitigating Risk With Face Coverings and Physical Distancing” above.
  • Working in Functional Units. Schools should consider the establishment of “functional units” as a strategy to minimize the potential spread of COVID-19. A functional unit may be composed of five to 10 individuals, all members of the same team, who consistently work out and participate in activities together. Assuming that these individuals observe appropriate sanitization, physical distancing and universal masking practices at all other times and do not otherwise place themselves in high contact risk scenarios (for example, attending off-campus social events), the individuals would only be considered high risk to one another. A similar strategy is to have one unit of a team always train against another unit of a team. For example, the first unit of the football team always training against the third unit of the football team; and the second and fourth units always training together. This means that if an individual from one of those units does become infected, the entire team may not be impacted, and contact tracing may be more manageable than it would be otherwise in the event of an infection.
  • Electronic Whistles. Schools should consider the use of electronic whistles in practice scenarios as a strategy to avoid the deep breath and forced burst of droplet-filled air that results from the use of a traditional whistle.

Impact of Activities Outside of Athletics

Student-athletes are students first and, although they may be under relatively strict supervision during their daily commitments to athletics, it is likely that little supervision exists during their remaining hours (for example, in the dorms, at the dining facilities, at parties). For this reason, campus policies coupled with a commitment from each student-athlete to practice infection control are integral to the successful mitigation of the risk of COVID-19 spread within and outside of the athletics department. Without the broader campus policies and practices to guide their behavior when away from athletics, student-athletes may incur more risk through their everyday activities than they might as a participant in a sport with high contact risk. Before assuming that the implementation of sanitization, distancing and masking practices are an effective strategy for mitigating risks within the athletics setting, a school should consider whether and to what extent those mitigation practices are successfully occurring outside of athletics activities and whether/how testing protocols may provide an effective supplement to those practices.

Updates Regarding Testing Methodologies

The polymerase chain reaction test, by way of a nasopharyngeal swab, with testing for amplification of the nucleic acid of the SARS-CoV-2 virus, is currently considered the gold standard and has a very high sensitivity and specificity. However, testing paradigms are still rapidly changing, and other strategies may become available. For example, rapidly emerging testing strategies include the use of nasal swab or salivary samples rather than nasopharyngeal swabs. In addition, emerging point-of-care PCR testing will provide results more immediately instead of the typical 24-hour or more wait for laboratory-based PCR testing.

Another emerging strategy is point-of-care antigen testing, which assesses for the presence of a viral protein. With this method, up to 50 tests in one hour can be performed and can selectively identify any positive results without having to rerun the tests (as is typical for other types of bulk batch testing). Point-of-care antigen testing currently has relatively low sensitivity of around 70% to 90%, meaning it could miss some positive cases, but the sensitivity has been improving rapidly. On the other hand, its specificity is essentially 100%, meaning that the test should not produce false-positive results. Point-of-care antigen testing costs less that typical lab-based PCR testing. Because such testing may allow a combination of increased testing frequency combined with rapid speed of reporting, this may provide a benefit for surveillance testing that outweighs high sensitivity tests that are coupled with delayed (for example, more than 48 hours) reporting.[13]

Serology testing, either using IgG or IgM antibodies, has not been sufficiently validated to warrant its use for diagnostic testing purposes. Antibody testing may be considered to screen for possible previous exposure to SARS-CoV-2, but should not be used as the sole modality to determine potentially infected individuals.

Diagnostic testing refers to either PCR or point-of-care antigen testing to confirm or negate infection with COVID-19.

Surveillance testing is used to track patterns of spread in a community setting. Typically, a percentage of the population, or the entire population of a defined group, is tested without regard to whether the individual is symptomatic or may be engaged in high contact risk behavior. Surveillance testing may be used to help mitigate risk of an outbreak due to the sport activity. Repeat surveillance testing of someone who previously tested positive for the virus should not need to be performed; however, these individuals should continue to follow all risk mitigation strategies. Testing should be performed for new COVID-19 symptoms. This is an evolving area of research, and recommendations may need to be adjusted as new information arises about the definitive possibility of reinfection.

Diagnostic testing in athletics may be considered a combination of surveillance testing, testing individuals/groups engaged in high-risk exposure, and testing individuals with suspected COVID-19 infection. At present, scientific studies do not provide clear guidance on the following:

  • Test sensitivity in asymptomatic people.
  • Prediction rules for estimating the pretest probability of infection for asymptomatic individuals to allow calculation of post-test probabilities after positive or negative results.
  • Thresholds for ruling out infection for a variety of clinical situations, including sport. Therefore, the testing strategies for asymptomatic athletes noted below are based on consensus recommendations and are subject to change as more data emerge.[14]

For the purposes of this document, based on current evidence and standards, PCR is the standard testing method for both baseline and ongoing surveillance testing. Testing strategies are always contingent on the availability of ample testing supplies, laboratory capacity, efficient turnaround time and convenient access to testing. If PCR testing in a community is prioritized for symptomatic individuals, if PCR supplies/turnaround time are compromised, or as testing technology evolves, alternative strategies may need to be considered.

Sport Classification Update

The categorization of sport risk was previously noted in the Action Plan document and is based on consensus from the NCAA COVID-19 Advisory Panel and the AMSSM COVID-19 Working Group and on the probability and significance of respiratory droplet spread during vigorous exercise when physical distancing and masking are not applied or are not possible. Importantly, the sport classification refers to sport-specific training and competition and not cross-training or other aspects of training. For example, swimming is a low contact risk sport, but dry land training activities such as trampoline, stretching, and tumbling may be associated with higher risk activity if risk-mitigating strategies noted above are not in place.

The risk assessment has now been updated below to include all NCAA-sponsored sports, including both winter and spring sports. Importantly, this risk assessment differs from the National Federation of State High School Associations and the United States Olympic and Paralympic Committee and also may differ from state/local risk categorization guidance.

  • Low contact risk: bowling, diving, equestrian, fencing, golf, rifle, skiing, swimming, tennis, track and field.
  • Medium contact risk: acrobatics and tumbling, baseball, beach volleyball, cross country*, gymnastics, softball, triathlon*.
  • High contact risk: basketball, field hockey, football, ice hockey, lacrosse, rowing, rugby, soccer, squash, volleyball, water polo, wrestling.

* The level of risk in cross country, track and field and triathlon are dependent upon the student-athlete’s proximity to other unmasked individuals. For example, the start or finish of a race may involve a group of athletes who are breathing heavily in a group space with a breakdown in physical distancing.

Low Contact Risk and Medium Contact Risk Sports

If a team in a low contact risk or medium contact risk sport can successfully implement physical distancing and universal masking practices during all sport activities, then the risk of potential spread related to those sports will decrease. This becomes an important consideration as schools evaluate risks related to competition with other member schools and make decisions about how to employ testing resources and strategies. In any low contact risk or medium contact risk sport or other scenario where appropriate physical distancing and universal masking practices cannot always be maintained, schools should consider necessary testing strategies and protocols to mitigate community spread of COVID-19. Testing protocols should address student-athletes and all “inner bubble” personnel including coaches, medical staff, officials and other essential personnel who are at high risk of exposure. Two examples of possible testing protocols are provided below:

  • Scenarios Presenting Medium Contact Risk:
    • Diagnostic testing upon arrival to campus.
    • During summer athletic activities and out-of-season athletic activities: surveillance PCR testing, for example, testing 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained, plus additional testing for symptomatic and high-contact risk individuals.
    • During in-season (preseason, regular season and postseason): surveillance PCR testing, for example, 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained, plus additional testing for symptomatic and high contact risk individuals.
    • Symptomatic testing and high-contact risk testing as appropriate.
  • Scenarios Presenting Low Contact Risk:
    • Diagnostic testing upon arrival to campus.
    • During summer athletic activities and out-of-season athletic activities: surveillance testing in conjunction with a university plan for all students, plus additional testing for symptomatic and high contact risk individuals.
    • During in-season (preseason, regular season, postseason): symptomatic testing and high contact risk testing thereafter.

High Contact Risk Sports

Because it is highly unlikely that physical distancing and universal masking can always be maintained during practice and competition in high contact risk sports, schools should consider necessary testing strategies and protocols to mitigate community spread of COVID-19. Testing protocols should address student-athletes, plus all “inner bubble” personnel (coaches, medical staff, officials and other essential personnel) for whom physical distancing, masking and other protective features are not maintained.

For high contact risk sports teams returning to campus and engaging in voluntary and required summer athletic activities and out-of-season athletic activities, schools should contemplate initial testing upon return. Further, schools should consider surveillance testing every two weeks thereafter during voluntary and required summer athletic activities, as well as out-of-season athletic activities for all student-athletes and “inner bubble” personnel if physical distancing, masking and other protective measures are not maintained. For high contact risk sports that are in-season (preseason, regular season, postseason), weekly surveillance testing should be performed for student-athletes, plus “inner bubble” personnel for whom physical distancing, masking and other protective features are not maintained. (See Table 1 below for graphic summary.)

Table 1. Testing Strategy Considerations for High Contact Risk Sports

Arrival on Campus

All athletes and “inner bubble” personnel are tested.

Summer Athletic Activities (Voluntary)

Surveillance PCR testing, for example, 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained*, plus additional testing for symptomatic and high contact risk individuals

Summer Athletic Activities (Required)

Surveillance PCR testing, for example, testing 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained*, plus additional testing for symptomatic and high contact risk individuals.

In-Season (Pre-Season, Regular Season, Post-Season)

Weekly PCR testing** of all athletes, plus “inner bubble” personnel for whom physical distancing, masking and other protective features are not maintained; additional testing for symptomatic and high contact risk individuals.

Out-of-Season Athletic Activities

Surveillance PCR testing, for example, 25%-50% of athletes and “inner bubble” personnel every two weeks if physical distancing, masking and other protective features are not maintained*, plus additional testing for symptomatic and high contact risk individuals.

* Those unable to fully implement appropriate sanitization, physical distancing and masking in all activities.

** Competition testing may account for the weekly testing

Updated Competition Considerations

With respect to competition with other schools, athletics departments should consider how best to secure reasonable assurance that the same risks have been adequately considered and addressed by the other team. Schools should consider how to share testing results and related safety assurances to opposing teams before the start of an event in a manner consistent with applicable health information and education privacy laws. Further, in conjunction with local public health officials and contact tracers, schools should have in place a mechanism for notifying other schools should an athlete from one team test positive within 48 hours after competition with another team.

Pre-Competition Testing

School and conferences should contemplate pre-competition testing protocols that include all high contact risk student-athletes and officials, plus “inner bubble” personnel for whom physical distancing, masking and other protective features are not maintained.  Schools should plan to secure the resources necessary to both perform the tests and to manage the details related to any positive results. In addition to general health and safety risks related to potential disease spread, the complexities related to pre-competition testing should encourage schools to limit the number of “inner bubble” individuals involved with each competition. 

For all high contact risk sports, protocols should be contemplated that include testing of student-athletes within 72 hours of competition for football and within 72 hours of the first of the week’s set of games for other high contact risk sports. Officials in football and basketball, due to their close contact with athletes, should also be tested weekly. Athletes must continue all infection risk mitigation behaviors after testing.

If PCR testing cannot be performed within 72 hours of competition, then the competition should be postponed or canceled, or an alternative plan for testing should be developed and agreed upon. This should include consultation with conference and local health officials before implementation. If an alternative, agreed upon testing strategy results in a lower sensitivity test result, repeat testing before competition should be considered to mitigate false negative results.

Clinical-Based Testing and Isolation

In addition to routine surveillance and pre-competition testing, schools and conferences should contemplate protocols that include clinical evaluation for student-athletes and/or other athletics personnel who develop COVID-19 symptoms after pre-competition testing, including testing for the presence of the virus. If a student-athlete or staff member becomes symptomatic between testing and competition, protocols should be considered that include isolating the student-athlete or staff member until repeat results are available, in each case in a manner consistent with applicable state, local and institutional recommendations.

Game Officials

Officials and referees may operate in proximity to student-athletes and school personnel during or as part of competition events. As a result, they may create risk for these individuals, and may also be at risk for contracting the disease from student-athletes. Athletics departments should consider how best to plan for and address these additional risks. For example, schools should consider the implementation of appropriate distancing and masking practices, as well as the use of electronic whistles, and should consider how best to ensure that officials are aware of any other competition-specific practices or expectations that will be implemented for risk mitigation purposes (for example, teams not swapping benches between periods). Note: Officials and referees in football and basketball would be considered part of the “inner bubble” of personnel deemed essential to the conduct of competition for purposes of pre-competition testing as noted above. Additional considerations also may need to be given to logistical issues, such as locker room and hospitality facilities typically used by officials and referees, and ingress and egress strategies to competition venues. 

Universal Masking

As part of agreed-upon competition protocols, schools and conferences should contemplate universal masking for all coaches and other personnel who are present at the event. This can help prevent the unwitting spread of infection to others with whom they may have close contact, especially when talking at a close physical distance as is so common on the sidelines or bench area. Similarly, because wearing a mask/cloth face covering/face shield will not adequately protect a coach from infection by an infectious athlete, schools and conferences should contemplate a policy of universal masking for all student-athletes when they are not playing and when they move from the court/field to the sidelines for timeouts or between-period strategy discussions.

Team Travel

Public travel poses logistical challenges related to potential exposure and appropriate risk mitigation. Schools should continue to evaluate the current data regarding risks related to commercial plane and other travel, and travel protocols should be considered that include physical distancing, as possible, and universal masking for all individuals traveling with others by private car, van, chartered bus or chartered plane. Schools should also plan for proper communication of all travel rules, protocols and expectations to everyone in the travel party. When feasible, schools should aim to travel and play the same day to avoid overnight stays. For overnight stays or same-day travel, prepackaged meals or room service should be considered. If restaurant dining is the only option, consider take-out food or outdoor eating as preferable alternatives.

Updated Contact Tracing Considerations

Effective contact tracing is critical in breaking the chain of transmission and limiting the spread of infection for infectious diseases such as COVID-19. However, there is no federal oversight of contact tracing programs, and the number of contact tracers in this country is currently inadequate to effectively manage disease spread among individuals and groups of people with high contact risk exposure. As a result, athletics departments, in consultation with institutional leadership, should consider evaluating the availability of, and accessibility to, local contact tracing resources. Where the availability of local contact tracing resources is identified as inadequate, schools should consider the need for and benefit of training on-site personnel through accepted courses such as the Coursera class. Staff who complete formal training in contact tracing can be an invaluable resource with respect to institutional risk-management efforts and resources.

Considerations After a Positive Test Result

When an athlete tests positive for COVID-19, local public health officials must be notified, and contact tracing protocols must be put in place. All individuals with a high risk of exposure should be placed in quarantine for 14 days as per CDC guidance. This includes members of opposing teams after competition. The difficulty is defining individuals with a high risk of exposure, and in some cases, this could mean an entire team (or teams). The CDC defines a close contact requiring quarantine as:[15]

  • An individual who was within 6 feet of someone with COVID-19 for at least 15 minutes.
  • An individual who provided care at home to someone who is sick with COVID-19.
  • An individual who had direct physical contact with the person (touched, hugged, or kissed them).
  • An individual who shared eating or drinking utensils.
  • An individual who was sneezed or coughed on by an infected individual or who somehow was touched by respiratory droplets from an infected individual.

Considerations Related to the Discontinuation of Athletics

At the time of this writing, the rate of spread of COVID-19 has been increasing in many regions of the country. Because of this increase, it is possible that sports, especially high contact risk sports, may not be practiced safely in some areas. In conjunction with public health officials, schools should consider pausing or discontinuing athletics activities when local circumstances warrant such consideration. Some examples of such local circumstances that might trigger a conversation with local public health officials include:

  • A lack of ability to isolate new positive cases or quarantine high contact risk cases on campus.
  • Unavailability or inability to perform symptomatic, surveillance and pre-competition testing when warranted and as per recommendations in this document.
  • Campuswide or local community test rates that are considered unsafe by local public health officials.
  • Inability to perform adequate contact tracing consistent with governmental requirements or recommendations.
  • Local public health officials stating that there is an inability for the hospital infrastructure to accommodate a surge in hospitalizations related to COVID-19.
 

Autonomy 5 Medical Advisory Group Roster

  • Angelo Galante, Team Physician at Georgia Tech University
  • Paul S. Pottinger, Infectious Disease at University of Washington
  • Chris Hostler, Infectious Disease at Duke University and partner in Infection Control Education for Major Sports
  • Catherine O'Neal, Infectious Disease at LSU
  • Christopher Kratochvil, Executive Director, Global Center for Health Security, University of Nebraska Medical Center
  • Cameron Wolfe, Infectious Disease at Duke University and partner in Infection Control Education for Major Sports
  • Sankar Swaminathan, Infectious Disease at the University of Utah
  • Doug Boersma, Head Athletic Trainer at Purdue University
  • Kerry Kenny, Big 10 Administrator
  • Brad Hostetter, ACC Administrator
  • Charlie Hussey, SEC Administrator
  • Michael Strickland, ACC Administrator
  • Mark Rudner, Big 10 Administrator
  • Ed Stewart, Big 12 Administrator
  • Woodie Dixon, Pac 12 Administrator
  • Kyle Goerl, Team Physician at Kansas State University 
  • Douglas Aukerman, Team Physician at Oregon State University 
  • Jay Clugston, Team Physician at University of Florida

COVID-19 Resources for Transition Periods and Return to Activity

This information is provided for primary athletics health care providers, strength and conditioning professionals, and athletics health care administrators, and includes content excerpted from guidance originally developed by the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports Prevention and Performance Subcommittee that was utilized for the purpose of informing the work of committees within the NCAA governance structure in all three divisions. 

As member institutions begin to plan for a return to organized activity for fall sports, questions have emerged about the structure of activity during identified transition and acclimatization periods, COVID-19 has undoubtedly increased the complexities, and will continue to impact health and safety considerations, related to return to athletics and preseason activities. Traditional transition and acclimatization considerations (e.g., cardiovascular conditioning, heat, altitude) are still very relevant and, when coupled with the loss of spring and summer activities and other physical and non-physical COVID-related impacts, they can create complex re-entry challenges for student-athletes.

Recommendation 3 of the NCAA’s Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes (Catastrophic Materials) speaks to the vulnerability of student-athletes during the first week of activity of a transition period in training and the importance of establishing a 7-10 day initial transition period during which student-athletes are afforded the time to properly progress through the physiologic and environmental stresses placed upon them as they return to required activities.

In addition to the NCAA guidance that can be found on the NCAA Coronavirus Resource Page, various evidence-based resources have been published by professional organizations in the sports medicine and strength and conditioning space. These resources may help inform member schools as they design and implement assessment and evaluation activities, and physical conditioning and practice sessions during these COVID-impacted transitions periods. Institutions are encouraged to leverage all available resources and information as they plan for return to campus and athletics activities and a non-exhaustive list of some of these materials is included for reference below:

NOTE: The above list is not exhaustive. The links are being provided as a convenience and for informational purposes only. They do not constitute an endorsement or an approval by the NCAA, and the NCAA bears no responsibility for the accuracy, effectiveness or legal status of the content of these external sites or for that of subsequent links. Please contact the individual site owners for answers to questions regarding content.

American Medical Society for Sports Medicine Working Group Roster

  • Dr. Chad Asplund, Professor; Family Medicine and Orthopedics; Mayo Clinic Sports Medicine – North Central University, Minnesota Intercollegiate Athletic Conference
  • Dr. Doug Aukerman, Director of Sports Medicine; Senior Associate Athletic Director, Sports Medicine –Oregon State University, Pac-12 Conference
  • Dr. Chad Carlson, President – American medical Society of Sports Medicine
  • Dr. Deena Casiero, Director of Sports Medicine; Head Team Physician – The University of Connecticut, American Athletic Conference
  • Dr. Cindy Chang, Clinical Professor and Fellowship Program Director; Primary Care Sports Medicine; Depts. of Orthopedics and Family and Community Medicine; University of California, San Francisco – Team Physician; University of California, Berkeley, Pac-12 Conference
  • Dr. Stephanie Chu, Associate Professor Department of Family Medicine/Sports Medicine; Team Physician – University of Colorado, Pac-12 Conference
  • Dr. Carly Day, Head Team Physician – Purdue University, Big Ten Conference
  • Dr. Kyle Goerl, Team Physician – Kansas State University, Big 12 Conference
  • Dr. Kimberly Harmon, Head Football Physician – University of Washington, Pac-12 Conference
  • Dr. Eugene Hong, Chief Medical Advisor Clemson Athletics; Clinical Professor Orthopedics and Family Medicine Medical University of South Carolina – Clemson University, Atlantic Coast Conference
  • Dr. Matt Leiszler, Football Team Physician; Athletics Healthcare Administrator – University of Notre Dame, FBS Independent Schools
  • Dr. Sourav Poddar, Associate Professor and Director of Primary Care Sports Medicine; University of Colorado SOM; Medical Director – University of Colorado, Pac-12 Conference
  • Dr. Tracy Ray, Team Physician; Piedmont Healthcare; First Vice President of the American Medical Society of Sports Medicine – University of Georgia, Southeastern Conference
  • Dr. Mark Stovak, Professor, University of Nevada, Reno – Dept. of Family and Community Medicine; Team Physician, UNR Athletics; Vice Chair, NCAA Committee on Competitive Safeguards and Medical Aspects of Sports – Mountain West Conference
  • Dr. Karin VanBaak, Assistant Professor – University of Colorado, Pac-12 Conference

Core Principles of Resocialization of Collegiate Sport: Archived Frequently Asked Questions

Along with the Resocialization of Collegiate Sport: Developing Standards for Practice and Competition document, the SSI has issued an updated FAQ here. This archive of the original Core Principles of Resocialization of Collegiate Sport: Frequently Asked Questions has been superceeded by the Core Principles of Resocialization of Collegiate Sport: Developing Standards for Practice and Competition Frequently Asked Questions and is here for reference only.

This frequently asked questions document was originally developed in support of the release of the document, Core Principles of Resocialization of Collegiate Sport (Core Principles) which was developed in consultation with the NCAA COVID-19 Advisory Panel (Advisory Panel). It has been updated to support the release of a companion document, Resocialization of Collegiate Sport: Action Plan Considerations (Action Plan), and to address resocialization-related questions received since the release of the Core Principles document. This revision also includes information reflective of input received from the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports Prevention and Performance Subcommittee and the American Medical Society for Sports Medicine COVID Working Group in response to membership inquiries specific to the COVID-19 situation.

These materials are offered as further guidance for the concepts in the Core Principles and Action Plan documents and are meant to be consistent with the Guidelines for Opening Up America Again published by the federal government (Federal Guidelines) and its corresponding health agencies and otherwise reflective of the best available scientific and medical information available at the time of print. These materials are not and should not be used as a substitute for medical or legal advice. They remain subject to further revision as available data and information in this space continues to emerge and evolve. In the meantime, questions can be directed to SSI@ncaa.org.

*Indicates new or updated content.

Section I: Core Principles of Resocialization of Collegiate Sport

Is the Core Principles document intended to represent formalized best practices or Association-wide policy? In other words, are member schools obligated to follow these guidelines?

Unlike many of the other health and safety materials disseminated by the NCAA, this document is not formally endorsed by any third-party organization and does not represent Association-wide policy. Rather, its purpose is to provide broad guidance to the membership based on currently available evidence regarding COVID-19 and resocialization at both the society and sport level. As our understanding of COVID-19 is rapidly evolving, it is likely that these Core Principles may be updated.

Importantly, a decision to follow the Core Principles  is to be made at the individual school level, with the approval of institutional leadership, and in concert with applicable guidance from local and state public officials with regard to return to campus, return to practice, and return to competition. In the end, institutional and governmental leadership will determine who can participate in, assist with and watch student-athlete practices and competition.

Although the Core Principles document is meant to serve as guidance, there are several places in the document where the word "must" is used rather than "should." Why the difference?

The members of the advisory panel believe that when these Core Principles are followed, certain criteria are essential to, and must be in place for, proper resocialization of sport to occur. This includes the following:

  • There must not be national directives that preclude resocialization.

  • State and local authorities must have a resocialization plan in place.

  • A school's athletics department must have a resocialization plan in place.

  • Athletics health care providers must have access to personal protective equipment.

  • There must be the ability to work on the local/regional level to assess immunity, provide rapid diagnostic testing, have a surveillance system in place and develop transparent risk analyses.

Although these represent strongly worded statements from the advisory panel, in keeping with the spirit of the document, the overall content is meant to serve as guidance only.

How did the Core Principles document originate?

The first draft of the Core Principles of Resocialization of Collegiate Sport was written in consultation with the Advisory Panel. The Federal Guidelines were published as the NCAA draft document was being reviewed. As there were many similarities between the NCAA draft document and the Federal Guidelines, the decision was made to merge the content from these two documents.

Was the Core Principles document reviewed by the NCAA membership before its release and, if so, how?

Yes. NCAA Chief Medical Officer Brian Hainline presented the document to numerous membership committees and groups before its public release. These included the following:

  • Association-wide: Board of Governors and Committee on Competitive Safeguards and Medical Aspects of Sports.
  • Division I: Strategic Vision and Planning Committee, Division I Council, Presidential Forum, Board of Directors, Football Oversight Committee, Competition Oversight Committee, Men's and Women's Basketball Oversight Committees, and Collegiate Commissioners Association.
  • Divisions II/III: Management Councils and Presidents Councils.

Even though the content of the Core Principles document mirrors the Federal Guidelines, many states seem to be opening up in a manner that is not completely consistent with the Federal Guidelines. What does this mean for member schools?

As is reflected in the Federal Guidelines, each state has the authority to implement resocialization in a manner that it deems appropriate. This may mean that the Core Principles document will not be followed precisely or at all. As the Core Principles and the Federal Guidelines are meant to provide nonbinding guidance, each member school must operate in accordance with guidance from local and state public officials but will have the flexibility to further develop guidelines that are more consistent with the Core Principles or even more restrictive than the Core Principles. The Core Principles are meant to serve as guidance for the resocialization of sport.

*What type of activities are recommended in Phase One?

Phase One contemplates the beginning of sport resocialization for each sport once a team reconvenes on campus after the gating criteria have been satisfied. Phase One can be considered a testing phase, to help determine the readiness of an athletics department to begin working with student-athletes. It is recommended that physical distancing and strict sanitation measures remain in place. Masks are necessary when physical distancing is not possible, and repetitive handling of a shared object such as game balls and other shared equipment should be avoided. In keeping with updated CDC guidance, if game balls are shared, this should be done in a controlled manner with strict attention to sanitizing hands, the ball, and avoidance of face touching. It is particularly important to adhere to strict sanitation procedures: Common areas such as gyms and training rooms should remain closed unless strict distancing and sanitation measures can be implemented, and group activities should be limited to 10 or fewer individuals.

*What type of activities are recommended in Phase Two?

Phase Two is a continuation of Phase One, but the size of gatherings can be increased to 50 people, as long as physical distancing and sanitation practices remain in place. Masks are still recommended when physical distancing is not possible. This phase allows for more organized group activities, and the sharing of common objects such as game balls should be done in a controlled manner with attention to sanitizing balls and hands, and avoidance of face touching. If equipment is shared, it should be done with attention to sound sanitizing practices.

*What types of activities are recommended in Phase Three?

Phase Three signifies that Phases One and Two have been successfully implemented, meaning that protocols involving personnel, athletes and infrastructure were followed/amended as necessary and federal and/or state gating criteria were satisfied. Careful adherence to infection control remains in place, but it is during Phase Three that repetitive handling of common objects such as game balls and other shared equipment may become more commonplace, but still with sanitizing practices in mind. Because of the increase in contact among individuals, it remains important to be aware of the possibility of new infections and the important role that contact tracing will play in those scenarios.

*When teams gather on campus for the first time, in what resocialization phase do they start? Is it possible to begin either summer access or fall practice in Phase Two or Phase Three if that is the status of the community in which the school is located?

As noted above, each state has the authority to implement resocialization in a manner that it deems appropriate and each member school should decide whether and to what extent to apply the Core Principles in accordance with guidance from local and state public officials.

That said, the structure of the Core Principles document contemplates that each team will begin organized activities in Phase One, regardless of the status of the institution's community resocialization efforts. As teams reconvene for the first time, student-athletes and staff may be relocating from distant locations with varying public health situations and resocialization policies. While schools are free to apply some or all of the Core Principles, the document contemplates the start of activities at Phase One for each sport team to account for a more restrictive resocialization plan that may want to provide more time for schools to understand the health status of all members of the team, and to proceed more conservatively.

*In what phase can competition with other schools begin? Do we have to wait for the completion of a two-week Phase Three before starting to compete?

Unlike Phase One and Phase Two of resocialization, which are well-defined two-week phases, Phase Three doesn’t contemplate a specific timeframe but, rather, is designed to continue until such time as effective and accessible treatment or widespread vaccination and/or immunity exist. The model contemplates that schools will continue Phase Three precautions during that time so as to be ready to respond in the event of infection in an athletic team.

Phase Three activities contemplate the repetitive handling of common objects, such as game balls and other shared equipment, and the commencement of high contact activities like practice and competition. However, because the Phase Three guidance in the Core Principles document does not speak to the physiological and mental health aspects of practice and competition readiness, answers to this question must be generated by the school in close consultation with the coaches, student-athletes and applicable medical staff of each team.

*What is the guidance on distancing between groups?  For example, during Phase One when group size is limited to 10, do the Core Principles contemplate that two groups of 10 should be in the same facility? If so, is minimum distancing contemplated between groups?

These decisions should be evaluated by the school on a case-by-case basis in light of the totality of the applicable risks. While not specifically stated, it is reasonable to conclude that physical distancing would be contemplated within groups, even when those groups are small.

*Do the Core Principles address the possibility of a setback or resurgence in cases in a later phase of resocialization? For example, if a school has successfully progressed to Phase Two but suddenly finds it is no longer complying with the gating criteria, do Core Principles contemplate that the institution would rebound to Phase One, or implement 14 days of shelter in place?

Based on the capabilities of currently available testing alternatives, existing standards of care suggest a quarantine period of at least 14 days for all newly infected individuals and their high-risk (e.g., "inner bubble") contacts. Accordingly, if infection occurs after the commencement of team practice activities and impacts a broad group of individuals, this response plan could involve, among other things, temporarily or permanently ceasing in-person activities. If the infection occurs during a period in which a competition takes place, the response and mitigation plan will likely need to contemplate the safety of student-athletes and staff from the opposing team. Additional details can be found here.

Section II: Resocialization of Collegiate Sport: Action Plan Considerations

*What is the role of the Action Plan document in relationship to the original  Core Principles document? Who wrote the Action Plan document?

The Action Plan document serves as a follow up to, and assumes the premise of, the Core Principles. The information in the Action Plan document, which was developed in consultation with the NCAA COVID-19 Advisory Panel, is also offered as guidance and is meant to be consistent with guidance published by the federal government and its corresponding health agencies and otherwise reflective of the best available scientific and medical information available at the time of print. The Action Plan is not and should not be used as a substitute for medical or legal advice. Rather, it is intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines and it remains subject to further revision as available data and information in this space continues to emerge and evolve.

*Is testing a necessary component of successfully implementing resocialization of sport?

Universal access to testing is strongly preferred. Importantly, there are two types of tests to consider.

The first type of test is diagnostic testing, which means that the test result indicates if an individual is currently infected with COVID-19. Most diagnostic tests are performed in a laboratory using the polymerase chain reaction technique for identifying the SARS-CoV-2 virus that is responsible for COVID-19, and the turnaround time for test results is usually between 8 and 48 hours. The current standard is for the sample to be obtained via a nasopharyngeal swab, although nasal swabs and salivary samples are being studied as alternatives. Point-of-care diagnostic tests are also being developed, and although such tests may provide a result within minutes, they require further validation. Additionally, a new antigen point-of-care test has been developed, which also must undergo further validation steps Although the infrastructure for diagnostic testing has been steadily increasing, it is not likely that the federal or state governments will be providing such tests at the school level. Therefore, each member school, or each conference, should consider developing relationships within the broader community health care infrastructure that will allow ready access to such testing.

The second type of test — serological testing — is still in the developmental stages. Theoretically, this type of test will determine whether an individual has antibodies to SARS-CoV-2, and the presence of such antibodies might confirm immunity to future infection or reinfection. The validity of such tests is in the early stages, and there are few that are U.S. Food and Drug Administration-approved. Serological testing may be useful in the future to help determine immunity.

The third type of test — surveillance testing — is an important aspect of the mathematical modeling and epidemiological analysis of COVID-19. Surveillance testing can be used to monitor virus movement, effect on certain groups of people and patterns of growth and decline. Such testing is currently still in its infancy. Because emerging adults may develop COVID-19 with minimal or no symptoms, diagnostic testing provides a method to mitigate infection spread, which is one reason why such testing is an important component of resocialization of sport.

*Is contact tracing a necessary component of successfully implementing resocialization of sport?

In order to efficiently and effectively respond to a new infection, athletics departments, in conjunction with the member school and local public health department, should evaluate how best to identify contact networks and trace contact interactions for staff and student-athletes. There are various ways to accomplish this including, among other concepts, the identification of contact "bubbles." The "inner bubble" for each individual would include the applicable staff member or student-athlete and those other individuals with whom they must interact with regular frequency and at an intimate level. The individual's "outer bubble" would include other people, like support staff and other campus personnel with whom the individual may have infrequent and non-intimate contact. The identification of the participants in each bubble network can facilitate contact tracing if an individual becomes newly infected and can help the school and applicable authorities prioritize the removal, isolation, and quarantine of other at-risk individuals. 

*The Action Plan describes universal masking as one of the strategies to mitigate COVID-19 spread. Does this apply indefinitely? What type of mask is recommended?

Universal masking generally means all individuals wear masks when they are in public spaces, especially indoors or when physical distancing is not possible. Wearing masks and enhanced infection control principles applies indefinitely in Phase Three; in other words, Phase Three is not a return to pre-COVID practices, but rather reflects the fact that the SARS-CoV-2 virus remains a threat because a vaccine or effective treatment has not yet been developed. Universal masking applies to athletes, coaches and staff, but breaks down for athletes during practices and competition because of the impracticality of wearing masks during intense exercise. This is why surveillance and other infection control measures, as outlined in the Action Plan, remain important. 

The primary purpose of wearing a mask is to reduce viral spread to those with whom we have close contact. Cloth or surgical masks are acceptable. N-95 masks and other personal protective equipment are reserved for health care workers who are treating individuals with potential or actual COVID-19 infection. 

*For those colleges/universities that expect student-athletes will complete mandatory medical exams prior to returning to campus in the fall, what if  student-athletes cannot get exams because their personal physicians are not available to perform the exam?

This issue has been considered by the Prevention & Performance Subcommittee of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. The subcommittee has been charged to provide timely input on emerging health and safety related questions arising from the COVID-19 pandemic and includes several practicing physicians.

The subcommittee noted that while the delivery of health care has undoubtedly changed with the advent of COVID-19, general access to health care and the number of available practicing physicians and nurse practitioners has not. For the great majority of individuals, necessary care appointments are still available and very accessible. The subcommittee noted that most mandatory medical exams are conducted before student-athletes return to campus and are scheduled within 2 to 4 weeks before return. Therefore, student-athletes should not have difficulty scheduling and completing an appointment with a physician or appropriately licensed nurse practitioner over the summer months.

For those student-athletes who are not able to complete an exam before arriving to campus, schools will need to address the requirement once the student arrives. In most cases, this should not create an unreasonable burden on resources, and in fact, many schools have always required that mandatory medical exams be conducted on campus. So, while there would be no change in process for these schools as a result of COVID-19, schools should give operational attention to this issue and begin planning accordingly.

*What about team travel?

Consistent with the Federal Guidelines, the Core Principles document contemplates non-essential travel as one of the activities that would resume in phases. While the Federal Guidelines contemplate that non-essential travel might resume in Phase Two, that guidance is geared toward individual travel and does not contemplate the COVID-related complexities related to large group team travel. Assuming a school has otherwise accounted for and adequately addressed these complexities, it is reasonable to conclude that the Core Principles document would contemplate team travel could resume as part of Phase Three but we anticipate that this question will be addressed in more detail in the future as we develop both a better understanding of COVID-19 and the travel industry's response to infection control.

Section III: Playing and Practice Seasons Issues

Is the current calendar for fall championship events still in place?

The working assumption of sport resocialization is that the current dates for fall championship events remain in place as scheduled, although governance committees, conferences and related staff working groups within each division continue to evaluate potential adjustments to practice and regular season competition schedules.

*Since we are working with the current fall championship calendar, what considerations are being given to possible modifications in summer practice, preseason and the playing season?

At the time of this writing, the Division I Council has established that student-athletes may voluntarily return to campus on June 1, 2020. The Council also adopted temporary legislation to prohibit a school from conducting required summer athletics activities (pursuant to NCAA Division I Bylaws 13.11.3.9, 13.11.3.10 and 17.1.7.2.2.5) in basketball and football through June 30. 

In making both decisions, the Council established that the primacy of student-athlete health and safety in any decisions related to such issues is paramount. Access to institutional facilities should be provided in compliance with applicable state and local regulations regarding the use of such facilitates, group size restrictions and any other articulated limitations. Each school should use its discretion to make the best decisions for its student-athletes within the applicable restrictions and parameters.  

Deliberations continue in all three divisions about the playing season calendar for all fall sports.

How is a determination for "safe competition" made?

The specific path to "safe competition" will vary from campus to campus, depending on geographic, demographic and other risk considerations that are unique to each institution, campus, community and student body. A successfully implemented phased-in strategy, like the one outlined in the Core Principles document, is one indication that competition may be able to occur safely. However, our understanding of COVID-19 is increasing rapidly, and we anticipate that emerging data and information will allow us to more fully address this question in the future. This could possibly include an adjustment or cancellation of events in response to local or national circumstances.

*If student-athletes are restricted from participating in required summer activities on campus because of COVID-19, can student-athletes safely participate in virtual workouts with strength and conditioning coaches?

This question was considered by the Prevention and Performance Subcommittee of the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. Assuming that a workout is truly voluntary (both in perception and legislatively), the subcommittee identified a potential health and safety benefit related to providing flexibility for strength and conditioning coaches to observe certain aspects of virtual workouts, especially where the observation or specific health and safety feedback (e.g., proper form) has been requested, unsolicited, by the student-athlete. This feedback has been shared with the NCAA's Academic and Membership Affairs group so as to inform future interpretive actions on these questions. It has also been shared with membership bodies in each of the three governance divisions for future consideration.

In response, the Division I Council Coordination Committee determined that a strength and conditioning coach may, beginning June 1, 2020, virtually observe a student-athlete’s voluntary workouts for health and safety purposes (e.g., proper form, technique) and have discussions with the student-athlete related to such workouts, provided the student-athlete initiates the request for the observation and/or discussion. A strength and conditioning coach is not be permitted to conduct the virtual workouts. The Coordination Committee encourages the continued review of possible scenarios in which a voluntary workout could be conducted by a strength and conditioning coach. The Coordination Committee noted that, consistent with feedback from the Prevention and Performance Subcommittee, a school that elects to permit strength and conditioning coaches to virtually observe student-athlete workouts should proactively take into consideration its overarching responsibility to protect the health of, and provide a safe environment for, each student-athlete. Each school should also proactively address how the strength and conditioning coach would respond in the event that an unsafe workout environment is observed or in the event that a medical emergency occurs during the observational session.

With respect to required and/or school-conducted virtual physical athletically related activities, the subcommittee identified that the health and safety risks would be no different than they are for on-campus workouts such that if all existing health and safety requirements are met, there would be no student-athlete well-being rationale for prohibiting these types of activities. However, the subcommittee acknowledged that it would be challenging, but not necessarily impossible, for a school to adequately address all existing health and safety precautions via a virtual model, and that the challenge would vary depending on the workout model being used (e.g., one or two athletes versus large groups or entire teams). For example, Division I legislation requires the presence of first aid/AED/CPR-certified personnel during all physical, countable athletically related activities. Additionally, Association-wide catastrophic injury prevention materials provide that workout plans should be prepared in advance, documented and should account for various health and safety considerations including a workout location designed to accommodate venue-specific emergency action planning and that a school should have emergency action plans that account for, among other things:

  • Fast access to AED technology.
  • Specifics related to the venue, sport and circumstances which, for virtual workouts, would vary further by student-athlete circumstance.
  • A wide variety of risks including, among others, head and neck injuries, cardiac arrest, exertional heat illness and heat stroke, exertional rhabdomyolysis, asthma, exertional collapse associated with sickle cell trait and diabetic emergency.

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