With the nation’s healthcare system under duress in preparation for a flood of coronavirus cases, young athletes with an array of joint and other injuries are being asked to cancel planned surgeries, rehabilitation sessions and visits to sports medicine doctors. In many cases, hospitals have had to make the hard decision to simply suspend non-essential onsite treatments while some private practices are stressed about whether to still serve youth.
Among those that have suspended services: Emory Healthcare in Georgia and Hospital for Special Surgery in New York.
“As sports medicine providers, we need to accept that we are not providing essential care, and likely contributing to exponential spread of the virus through in-person office visits and elective surgeries as well as removing valuable resources,” said Dr. Scott Boden, chair of the department of orthopaedics at Emory University School of Medicine and vice president of business innovation at Emory Healthcare. “While there is clearly a financial impact, the reality is that these visits can and should be postponed or done by telehealth.”
Not all parents of young athletes are taking the news well. Dr. Alex Diamond, director of the Program for Injury Prevention in Youth Sports at Vanderbilt University, said although most parents are understanding, he’s still having a few “fight” doctors to come in person or use this time out of school and work to get appointments done. Rescheduling elective surgeries has upset parents the most. If it’s not an urgent issue, such as an acute injury, fracture, infection or tumor, Diamond said visits should be rescheduled or done via telehealth.
“We need more physical distancing, and our physicians and staff need help as the surge hits and our coworkers become infected while resources and manpower become more and more limited,” Diamond said. “This is also not the time for doctor shopping to just go to the next person who is open and seeing all comers. This rewards behavior that goes against what our larger community needs to be practicing right now.”
Other doctors are facing the opposite problem – a sudden lack of demand for their services. Dr. Chad Carlson, who operates Stadia Sports Medicine in West Des Moines, Iowa, said his clinic has seen a 80% drop in appointment requests since COVID-19 was declared a pandemic. On March 23, despite safety measures he put in place to assuage the fears of patients regarding transmission during in-office visits, he temporarily closed his practice to limit costs.
Carlson said he hoped to keep it open because Iowa has not been as hard-hit by COVID-19 as other states.
“We’re not trying to jeopardize anybody, but there are no right answers to this,” said Carlson, who also serves as president of the American Medical Society for Sports Medicine said. “This is all going to start rolling onto our banks’ line of credit and I’m personally responsible for our overhead every month. It’s one thing if you’re an employed physician through an academic institution, and your salary really isn’t at risk. But I have my family and five employees that work for us that are dependent on the revenue that’s generated through our practice, so that’s another layer of stress.”
Over the past decade, as the trend toward early specialization in sports has grown, so has the need for medical care. Among children 14 and under, more than 3.5 million receive medical treatment for sports injuries annually. According to the Centers for Disease Control and Prevention, more than half are preventable. Overuse injuries also are responsible for nearly half of all sports injuries to middle and high school students. (See: Project Play’s Youth Sports Facts).
A 2019 study by Brown University found that kids who specialize in a sport engage in higher levels of vigorous exercise than their peers and may be more likely to sustain injuries, such as stress fractures, tendinitis and ACL tears. The findings, drawn from a multiyear national study of more than 10,000 older children and teens, suggest that those who engage in the most hours of intense activity per week are the most likely to be injured.
The American Physical Therapy Association (APTA) has told its members to use their professional judgment whether to continue providing care. However, the New York chapter advises that physical therapists should provide in-person services only when essential to the patient’s recovery or the patient’s setting and transition to telehealth as much as possible.
Dr. Lawrence Gulotta, a sports medicine surgeon at Hospital for Special Surgery (HSS), said a pause in elective sports surgeries is certainly justified at this point and the hospital’s main focus is easing the impact of COVID-19 on New York City. On the other hand, delaying surgery jeopardizes an athlete’s ability to play next season.
“Even in this time of self-quarantine and social distancing, it is likely that athletes will sustain new injuries that need to be evaluated,” Gulotta said. “It may be difficult for them to figure out where to be evaluated since most physician’s offices are closed, and there is concern with going to an emergency room for fear of diverting medical resources away from those with more pressing COVID-19 issues, or of becoming exposed themselves.”
HSS has set up ortho urgent care centers at its main campus in Manhattan, and at surrounding outpatient care centers in local communities it serves. If the injury does not require urgent attention, HSS is making telehealth visits available.
Doctors encourage parents and young athletes who play too much to treat the coronavirus shutdown as a valuable opportunity to simply rest their bodies and recover. Besides, Boden said, now is not the time to endure the ramifications of a surgery, even if younger people appear less susceptible than the elderly to the worst effects of contracting the virus.
“Surgery can depress the immune system,” he said, “so at this time it is hard to justify any truly elective surgery or office encounters if we are to help slow the spread of COVID-19 and flatten the curve so it doesn’t overwhelm our healthcare resources.”
Do you have a topic that you would like Project Play to explore in future COVID-19 youth sports coverage? Email Jon Solomon at jon.solomon@aspeninstitute.org.
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