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As cases surge with the return of students, quarantines are leading to questions

Through the first month of competition in Oregon high school sports, things still aren't quite back to normal. Games are being played — though not all of them, and not necessarily when they were originally scheduled. There are numerous reasons for the many cancelations and forfeitures around the state: the devastating shortages of athletic officials and bus drivers, the ongoing air quality issues caused by late summer wildfires and, of course, COVID-19.

With the pandemic still ongoing and classes back in session, cases are starting to pop up around the hallways of Oregon's high schools. When that happens, students are taken out of class — and in turn, taken out of the game.

"We're trying to make sure our schools are open safely," said Jefferson County Public Health director Michael Baker. "We've got record positive cases right now, but we need our schools open."

State and federal guidelines provide 'no local flexibility'

Schools present a unique challenge from a public health perspective, as large populations gather for extended periods of time five days a week. For that reason, the county must move swiftly to mitigate the potential spread of the virus when a case does arise.

"The schools are required to follow different guidelines that the rest of the community," said Baker. "Those directives come from the Department of Education and the Oregon Health Authority (OHA). There is a little bit of local control, in that the state mandates present us with options that we can choose from locally."

Those options from the state are extremely limited, though, according to Baker. The local control amounts mostly to counties selecting a specific duration of time that students must remain isolated or quarantined, as well as deciding whether testing is required prior to returning to school. The OHA offers options of a 14-day quarantine with no required testing to return to school, as well as a shorter 10-day period with no required testing thereafter. The shortest option is a 7-day isolation period, but that option requires a negative test.

"We really have no local flexibility," Baker reiterated. "We are required to meet the guidelines. These are state investigative guidelines we're following."

He further noted that those guidelines are routinely updated by the state, which adds an extra layer of confusion and complexity to tracking and managing the most recent surge of cases.

"Each local health authority is going through the same thing," Baker added. "It's this difficult situation of being the local face for state and federal guidelines that we don't have any control over."

Tracking cases puts added stress on shorthanded faculties

Daniel Barendse, the athletic director at Madras High School, says that situation puts athletic departments around the state in a bind. Because of federal HIPAA laws, schools are not always able to give students and families as many answers as they would like.

"A lot of that information can't be shared openly," explained Barendse, referring to his students' protected health information. "So, only certain people in our district have access to that, just like with immunizations. It's challenging because we want to communicate well with families and students, and we want to communicate well with our staff."

Privacy is not the only challenging aspect of the situation for high school administrators. Tracking all of the isolated and quarantined students and charting their scheduled absences and return dates is presenting its own hurdles.

"It's just not easy to track," Barendse said. "I can't even imagine the workload that (the county health department) is under. All of us are so thankful for the work they're doing, but those have to be thankless jobs."

Barendse noted that the district nurse, Kris Hohulin, and the rest of the school administration are handling the added workload of tracking COVID-19 cases on top of their normal duties.

"We don't have any extra staff with us to do this work," Barendse said. "We're still trying to do school, sports, athletics, run contests, run schedules, run our full seven periods a day and be part of a comprehensive high school. And then, at the same time, track COVID in the large numbers that are going on in our community right now."

"We're not experts in this," Barendse clarified. "I'm a teacher, counselor, coach, athletic director, administrator. I've done all those parts, but in terms of (the pandemic), this is all new to us."

Madras High School is not alone, either. Schools all around the state are dealing with these issues.

"We don't make any decisions about the timelines," said Crook County High School athletic director Rob Bonner, echoing his colleague's sentiment about a lack of control. "We work closely with our nurse and the county health department on all of that."

If there is any silver lining here, it is that the chaos has helped forge a strange new understanding and camaraderie among competing athletic departments.

"I've seen it across the board," said Barendse. "There's not a school in the conference you couldn't call and have them say, 'Ah, yeah, we did that too.' Everybody's had their moments."

In a twist of fate that seems like it could only be possible in the time of COVID, Barendse mentioned that weeks after having to cancel the football opener due to a positive test in the Corbett program, the Corbett athletic director — who also serves as the volleyball coach — called Barendse to discuss rescheduling an upcoming match. Only this time, it was the Madras team that was in quarantine.

Athletes must gradually ease back into competition after COVID

The effect of these quarantines on high school sports has been to create a pock-marked schedule filled with forfeitures and cancelations where box scores were supposed to be. Part of the reason for that is because, in addition to the state and local requirements for a student to return to school, athletes have their own specific protocols for returning to play.

"Returning back from COVID, you're supposed to start with this slow progression back," explained Tasji Urhausen, the athletic trainer Madras High School. "You had an illness. You were down for ten days. You're gradually introducing yourself back into physical activity."

"We're not just going to shove you back into competition right away," Urhausen added.

The progression that Urhausen is referring to is the Return to Play (RTP) procedure, which was adopted by the Oregon Sports and Activities Association (OSAA) last year. The RTP procedure, which is based on a 2020 article in the British Journal of Sports Medicine, recommends that "all individuals with a history of confirmed or presumed COVID-19 infection should undergo a gradual return to physical activity." It also provides a step-by-step guide for how to do so.

There are five stages to the RTP procedure, with increased activity, workload, repetitions and duration at each benchmark. Athletes are required to be in each stage for at least 24 hours and withstand the reduced workload without showing any signs of cardiac issues.

Those symptoms include chest pain, chest tightness, shortness of breath, palpitations, lightheadedness and fainting. Chronic COVID symptoms that do not affect the heart, such as loss of smell, are not taken into consideration. If an athlete starts showing cardiac symptoms during the RTP, the evaluation process starts all over.

Urhausen clarified that the RTP procedure cannot begin until the mandatory isolation period is complete.

"They have their ten days at home, because they have COVID," said Urhausen. "In those ten days, you're not supposed to be doing activity. Just rest the entire ten days, because it is a cardiac illness."

That period is when the student is out of school, so athletic competition is obviously a no-go. Once they return to class, however, they still need to ease back into sports.

"Once they're back in school," said Bonner of his student-athletes at Crook County, "then our athletic trainer can get them started on the RTP. We want to get players safe and healthy before we get them back on the field."

The RTP then adds another mandatory four days of reduced workload before athletes can finally go at full speed on day five.

"I understand you want to get back to playing as soon as possible," said Urhausen, "but it's going to be five days regardless."

"That's as short as I can get it," she emphasized. "It's going to be five days."

That means that athletes who have confirmed or presumed COVID cases will miss —at minimum — 14 days of action, with the 15th day being the earliest a player could come back.

It is worth noting that the ten days of isolation and rest is the best-case scenario; if a student is still showing COVID symptoms and/or testing positive at that time, they may not be allowed to return to school immediately, let alone the playing field. The same goes for the RTP — a return on the fifth day assumes that everything goes to plan. Football is unique in that the OSAA requires that the entire team must practice twice at Stage 5 before returning to live competition.

"Hopefully they understand that we're just here for their best care," Urhausen added.

Local health authorities and school districts understand the frustration

The situation serves as a reminder that as different variants of the COVID-19 illness continue to sweep through Oregon communities, life as normal remains on a tentative pause. For students, that harsh reality is unfortunately not a new one.

"We have only had one class that has had a normal year," said Barendse. "And that's our senior class. That's how long we've been dealing with this."

"It's been so long that they probably don't remember it," he added. "It's the same for teachers, for administrators, for the school board. Same for our community, for our bus drivers, our food services. All of that. They have not had a normal year."

With the abrupt end to the 2019-20 school year and the virtualization of 2020-21, hopes were high back in July that this year's ringing of the school bells would also usher in a return to normalcy. Instead, the return of state mandates has brought yet another wave of confusion and frustration.

"I know it's frustrating," said Barendse. "I understand the frustration. It's frustrating to our coaches and our staff, too. It's frustrating to watch our kids having to go through more disappointment."

"I don't know if our community completely understands that we are often just the messengers," he added.

During this time of confusion, Michael Baker says concerned families should feel free to contact their local health departments to discuss their individual situations. Athletic departments are doing their best to track the numbers, but health authorities are the ones with the real expertise in this field.

"If you ever have questions or concerns about what is going on, please call us," Baker offered on behalf of the county health department. "We may be busy, but we're never too busy to talk to a member of our community."

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