How Ultimate Can Return to Play

Being outdoors is a lot less risky than in. That matters for ultimate.

Photo: Paul Andris — UltiPhotos.com

As the COVID-19 vaccine rollout continues across the United States, ultimate organizers are now facing an increasingly pressing question: how and when do we return to playing ultimate?

From concerns about health and safety in the community to providing equitable access to programming, there are numerous factors that decision-makers will need to weigh as the sport prepares to restart.

As COVID-19 cases have fallen across the United States over the last month, state health departments are increasingly lifting restrictions on sports activities, opening the door to ultimate’s return. But few disc organizations offered normal programming at any point in 2020, even in places where ultimate was allowed by local authorities.

What’s Ultimate’s Risk Level?

Scientists’ understanding of COVID-19 has deepened since early in the pandemic. Initial advice about the importance of sanitizing surfaces and hand-washing has proven far less important than avoiding poorly ventilated indoor spaces with other people. “It’s become clear that transmission by inhalation of aerosols — the microscopic droplets — is an important if not dominant mode of transmission,” Virginia Tech engineering professor Linsey Marr, who specializes in airborne transmission of viruses, told Nature.

That ultimate is primarily played outdoors, where the open-air setting dramatically improves ventilation, is a major factor in reducing the COVID risk of playing. “For outdoor sports, you have such a massive advantage with the outdoor setting, because outdoor transmission is about 20 times less likely [than indoor], and that’s probably an underestimate,” Monica Gandhi, Professor of Medicine and Associate Division Chief of the Division of HIV, Infectious Diseases, and Global Medicine at UCSF, told Ultiworld.

Likewise, data from professional sports suggest that the COVID risks are far greater off the field than on. There have been no documented cases of COVID transmission during an outdoor sporting event, including in the National Football League, which plays a sport considered among the COVID-riskiest — and without masks. “There is no evidence that the virus crossed the line of scrimmage, so to speak,” Allen Sills, the NFL’s chief medical officer, told reporters last month. The league worked with the Center for Disease Control to publish research about their findings during their 2020-2021 season. “For example, short car rides with partial mask use were considered high-risk, whereas prolonged interaction (>15 minutes) in well-ventilated settings (e.g., outdoors) with proper mask use were not,” wrote the authors.

Football’s lack of on-field COVID transmission is good news for ultimate, which features similar durations of face-to-face contact within six feet of distance on the mark as some football players, like the offensive and defensive linemen, have during a play. Still, ultimate is not risk-free.

“There’s nothing magical about being outside if you’re in somebody’s face,” said George Rutherford, Professor of Epidemiology and Biostatistics at UCSF.

Bill Rodriguez, an infectious disease physician and ultimate Hall of Famer that is on USA Ultimate’s medical advisory team, said that close marking is about the “highest risk thing you could do outdoors.”

Many of USA Ultimate’s recommendations for modified game play can serve to mitigate that risk. Requiring marks to be set outside of six feet — as Rochester’s 2020 summer and fall leagues mandated — is one obvious strategy. But simply requiring that players wear masks during competition may be a more robust solution that doesn’t necessitate actual sport modifications.

“If you are playing outside with masks, it’s so safe that the transmission risk is minuscule,” said Gandhi.

Compliance with mask regulations would be the primary challenge of such a system. Even regular breathing can be uncomfortable inside of a proper mask, let alone heavy breathing during an athletic competition. Rutherford said that gaiters or bandanas–while more comfortable–are insufficiently protective: an N95 or surgical mask would be needed.

“Somebody’s going to have be enforcing that,” he said. “And you can’t be wearing them under your nose,” noting that mask compliance in professional sports has been dubious.

Rodriguez emphasized that there is no clear cutoff between risky ultimate and safe ultimate. He described a continuum that depends on interventions like distancing and masks, the baseline level of COVID transmission in the community, and the size and scope of the competition. He said that local play can return on a state-by-state basis as COVID case numbers drop and vaccinations increase, and that local organizers might want to consider a delayed start to spring leagues in order to evaluate case numbers, while “recognizing that the risks don’t go to zero.”

When Can Big National Events Resume?

The return of local competition is on the horizon, but larger tournaments that require travel and draw teams from multiple states or regions are still months away.

“I would feel comfortable planning an event for anytime after July 1st,” said Rodriguez.

While the timeline could change based on vaccine availability and rollout, Rodriguez expects huge drops in infections and hospitalizations in the coming months. Youyang Gu’s COVID-19 Projections website estimates that 60% of the US population will have immunity to COVID-19 either through vaccination or prior infection by mid-May. That 60% mark is often cited as the lower-bound for herd immunity, which can break disease transmission cycles in the wider population, though recent estimates have put the number higher.

Waiting for full herd immunity — what might be called the “end of the pandemic” — to resume playing ultimate might mean that the sport would never return. Gu wrote last week on Twitter that theoretical herd immunity may not be viable even by the end of 2021. We might never reach it.

“Theoretical herd immunity is unrealistic and should not be the endgame,” he concluded. “The endgame is the widespread availability of COVID-19 vaccines that virtually eliminates severe illness. And we are just a few months away from reaching that goal.”

As vaccines become accessible to anyone who wants one, the risk of a return to normal life will fall to the point that states will reopen bars and restaurants and allow people to attend concerts again. Playing ultimate outdoors is almost certainly safer than any of those activities.

That brings us back to Rodriguez’s suggestion that by the third quarter of 2021, ultimate tournaments will be possible. “A big outdoor event after July seems likely to be low-risk,” he said.

That could mean that summer regular season club tournaments take place. Of course, travel-based tournaments introduce many additional COVID risk factors outside of the field of play, including air travel, hotel stays, car rentals, and a wider network of players involved in the events. Efforts to mitigate risks by eliminating common practices like shared hotel rooms or AirBnBs will increase costs. Still, the baseline level of COVID transmission and risk — and vaccine availability — may reduce these risks to a tolerable level.

Could we even have the US Open this year? “The biggest risk of US Open in August is going to be injury,” said Rodriguez, noting that teams may not have their usual preseason, practices, and a gradual ramping up of intensity. “I’d worry more about that than COVID at that time.”

The Youth Club Championships could face additional challenges because children under 16 years old aren’t expected to have access to vaccines until late summer, following ongoing clinical trials in younger populations. Local youth ultimate is likely to begin soon in many states, though: many other youth sports have been operating for months, and children face much lower risk from COVID than older people.

“I absolutely think that children’s sports — especially given the profound impact on their mental health — should be open,” said Gandhi.

Potential Challenges

There are two primary risks to ultimate’s return this spring and summer. One is a slower-than-expected vaccine rollout. Just yesterday, the US’ top public health doctor, Anthony Fauci, pushed back the timeline for when he expects most Americans will have access to a vaccine from early April to late May. The other is complications from new COVID-19 variants out of the UK, South Africa, Brazil, or those yet undiscovered.

Rutherford said that his feelings that strict mask compliance is necessary for ultimate competition in the absence of testing or vaccination were “colored by the fact that these new variants are starting to spread, and we really can’t have a superspreader event with one of those.”

Some experts think that a failure to contain these new variants could lead to a fourth wave of COVID cases in the US this spring. Cases caused by new variants are currently accelerating in Europe amidst a slow vaccine rollout. Existing vaccines have shown to be somewhat less effective against the variants, though they are still highly effective at stopping severe cases, hospitalization, and death.

Many European countries have reentered strict lockdowns in response to high caseloads, which have fallen sharply in recent weeks. Despite the drop in cases, concerns about the COVID variants are leading to reluctance to loosen restrictions. As variants spread in the US, states may again tighten rules around allowed activities.

Muge Cevik, an infectious disease researcher at the University of St. Andrews, recently discussed the risk of outdoor transmission of new variants of COVID, concluding that the risk, while higher than before, is still “relatively low,” and that restricting outdoor activity could be counterproductive to reducing the overall spread of the disease.

So What’s Next?

Playing outdoor ultimate is not a zero-risk activity, but our understanding of the patterns of COVID transmission and evidence from the sporting world suggest that it is a low-risk one, particularly in the presence of science-driven regulations. Gandhi is the co-author of a forthcoming paper in The Lancet that presents a “non-pharmaceutical interventions triangle,” which points to masks, social distancing, and ventilation as three complementary prongs from which to combat COVID transmission.

“As one decreases, the others can compensate,” write the authors. “So with more ventilation (e.g. outdoors), the mask can be less fitted; with higher fit and filtration masks, less distancing and ventilation are required.”

Unmodified ultimate doesn’t allow for social distancing, but its outdoor setting (ventilation) paired with a mask requirement makes it an activity with low transmission risk. Additional layers of COVID safety could include requiring players to test negative for COVID before events or present proof of vaccination.

Along with game play rules, ultimate organizers should also be implementing symptom and exposure questionnaires as well as making plans for contact tracing in the case of a known COVID positive. And care should be taken to identify the far riskier activities associated with ultimate — going out to a restaurant with teammates after games, carpooling with people from outside your household — and discourage them from taking place.

Getting community buy-in while also considering concerns about equitable access to the sport will be important factors as well. Sharp disagreements about returning to play caused a schism in Indianapolis, and a recent Colombian ultimate tournament drew criticism for insufficient adherence to safety measures. Additionally, some players may be reluctant to start playing ultimate due to personal health concerns or because they live with others who are at high risk. Developing plans for how to address access issues — there is a list of suggestions in USA Ultimate’s Return to Play guidelines, which are set to be updated this week — should be a part of organizers’ checklists.

As the baseline level of risk falls as vaccinations increase in the coming months, though, organizers should begin to resume ultimate programming in a measured way. A decision to entirely avoid all risk by continuing not to offer playing opportunities could present unintended consequences, including encouraging less-regulated competition, and fails to consider the increasing costs of not returning to play, including risks to the solvency of disc organizations themselves as well as the health and well-being of the ultimate community.

  1. Charlie Eisenhood
    Charlie Eisenhood

    Charlie Eisenhood is the editor-in-chief of Ultiworld. You can reach him by email (charlie@ultiworld.com) or on Twitter (@ceisenhood).

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