Staying Healthy While You Travel

When Will It Be Safe To Travel Amid COVID-19? Doctors Weigh In

Staying Healthy While You Travel | Johns Hopkins Medicine

  • Travel restrictions are still in place over much of the country and the world amidst the COVID-19 pandemic.
  • Experts say traveling via car is lower risk than on a plane or cruise ship.
  • The risk of COVID-19 while traveling won't be totally eliminated until there's a vaccine.

After staying close to home the last two months, wanderlust is running high.

You might be wondering, when will it be safe to travel again?

It's the billion-dollar question airlines, destinations, and hopeful home-bound travelers are all asking. And there's no exact answer yet, though the International Air Transport Association, the largest global airline organization, estimates traveler numbers won't return to pre-novel coronavirus pandemic levels until 2023, according to its latest forecast.

Right now, there are still widespread travel restrictions in place from the Centers for Disease Control and Prevention limiting global travel, and local ordinances discouraging even domestic trips. Before air travel can start to rebound, obviously those will need to be lifted.

But doctors do have a sense of what needs to happen so travelers can resume exploring the country and the world. Here's what infectious disease experts say about when you can travel again and how to do it safely.

When will it be safe to travel around the U.S.?

Many states are reopening. However, that doesn't mean they're welcoming tourists, at least not yet. In fact, Maine and Hawaii are two states with strict 14-day quarantine requirements for all out-of-state visitors. Others, New York, remain in lockdown.

“I would be somewhat hopeful that travel restrictions will release further in the coming months, although we may still see limitations in certain areas if there are 'hot spots' of outbreaks,” Dr.

Kelly Cawcutt, MD, associate medical director, infection control & epidemiology at the University of Nebraska Medical Center, says.

Still, pinpointing an exact date for jetting off is tough. “I think it is very difficult to determine when it will be safe to travel domestically and internationally,” Dr. Cawcutt says.

She notes that places Wuhan, where the COVID-19 outbreak originated, have seen increases in cases after reopening.

“It is unclear how significant the second wave of cases may be, but certainly we remain at risk and we'll need to monitor these situations a very closely in the coming weeks to months still,” she adds.

When will it be safe to travel internationally?

In March, the U.S. State Department issued an unprecedented global Level 4: Do Not Travel advisory. The restrictions on any travel abroad for U.S. citizens and residents still remains. In fact, the Canadian-U.S. border closure to nonessential travel has been extended through May 21, though President Donald Trump says, “It will be one of the early borders to be released,” per AP News.

But, there is a glimmer of hope if you're hoping to add a stamp to your passport in 2020. Some countries are slowly opening up again and others are providing timelines on when travel to their borders is ly to resume. For example, popular Mexican beaches, around Los Cabos and Cancun, announced plans to reopen for tourism in June, per Travel Agent Central.

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Doctors agree that international travel will resume, but domestic travel, the exact timing is more difficult to predict. “I suspect as outbreaks settle down in countries, communities reopen, and the potential second peak is passed, international travel will become somewhat safer,” Dr. Cawcutt told Women's Health.

How can you stay safe once travel is allowed?

How you plan to travel also impacts how safe or risky venturing away from home can be. “I think there are differences between independent vehicle travel and other group travel scenarios, such as airline travel,” Dr. Cawcutt told Women's Health. Taking a road trip in your own car allows you to limit your exposure more than in the tight quarters of an airplane or cruise ship.

Worth noting: Cruise ships have been docked under no-sail orders from the CDC since March. Royal Caribbean plans to resume operations for the majority of its fleet on June 12, according to its website. Carnival Cruise Line is phasing back itineraries starting in August, but most international sailings are still on hold, according to a press release.

As for traveling by plane, train, or cruise ship, here are Dr. Cawcutt's tips for staying safe:

  • Bring your own hand sanitizer and mask.
  • Maintain some level of physical distancing from other travelers.

You should also consider the availability of medical care in your intended destination, if you get sick abroad. “Resources and access to care may vary markedly, and among critically ill patients in the hospital the duration of stay easily could be two to three weeks,” Dr. Cawcutt told Women's Health. “Medical evacuation could be limited or even prohibited in some areas.”

Still, the risk of contracting novel coronavirus won't really disappear until there's a vaccine.

“It will be safe to travel—domestically and internationally without social distancing of 6 feet or more between people, all of whom are wearing masks to protect others—when there is a safe and effective vaccine and 90 percent or more of the world’s population has received it,” Dr. Noreen A. Hynes, MD, Director of Geographic Medicine Center of the Division of Infectious Diseases, The Johns Hopkins Hospital, told Women's Health.

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Staying Healthy While You Travel

Staying Healthy While You Travel | Johns Hopkins Medicine

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Preventing illness or injury is a big part of making your trip relaxing andenjoyable. It is important to take certain precautions. Some destinationshave environments that may be very different from the area you live in.Also, travel to developing countries poses certain extra risks.

Healthy preparations before you travel

If you are planning to travel outside the United States, the CDC recommendsthat you:

  • Prepare a complete travel itinerary. List each destination, length of stay, and types of activities planned.
  • Contact your travel agent to obtain local health information. This should include food and beverage precautions, information regarding insects and other pests, and the availability of emergency medical care.
  • Check with your insurance company to determine what coverage your policy provides for travel abroad.
  • Consider the potential benefits of travel insurance and medical evacuation insurance.
  • Contact your healthcare provider for an up-to-date immunization record. Make an appointment to receive necessary vaccines at least 6 weeks before you plan to leave.
  • Obtain specific information on preventive health recommendations your itinerary by contacting the CDC's Travel Information website .
  • Identify contact information for the U.S. Embassy or Consulate in the country or countries you will be visiting for assistance in case of a medical emergency.

Be sure to also get prescription medicines refilled to last the entiretrip. Take extra prescriptions for medicines and/or eyewear, in case it isnecessary to have them filled while abroad. Wear a medical informationbracelet, if necessary. Also, take along a first aid kit for minoremergencies that may arise.

Healthy reminders for while you are traveling

Eat carefully if traveling to a country with an increased risk oftraveler's diarrhea. According to the CDC, travelers' diarrhea is the mostpredictable travel-related illness. Here are some tips to try to avoiddiarrhea:

  • Eat foods that are steaming hot and well-cooked. These are usually the safest.
  • Avoid eating foods from street vendors, no matter how appetizing they look.
  • Avoid unpasteurized dairy products and raw or uncooked seafood.
  • Peel fruits yourself.
  • Drink commercially bottled water or carbonated beverages.
  • Avoid ice.
  • Use bottled water when brushing your teeth.

If you are traveling to a country with an increased risk of malaria, get aprescription for preventive medicine for this disease from your healthcareprovider. The medicine needs to be taken before you go on your trip, duringyour travels, and for a certain number of days after you return, dependingon the type of medicine prescribed.

Avoid swimming and any water activities in freshwater lakes and streams asyou may be exposed to certain diseases. If you are traveling to a countrywith an increased risk of disease transmitted by mosquitoes, such asmalaria or yellow fever, be sure to protect yourself with insectrepellents, special clothing, and bed nets.


Long shadow cast by psychiatrist on transgender issues finally recedes at Johns Hopkins

Staying Healthy While You Travel | Johns Hopkins Medicine
Paul McHugh, the former chief of psychiatry at Johns Hopkins Hospital, helped to end Johns Hopkins’s pathbreaking transgender surgery program nearly 40 years ago.

(Courtesy of Johns Hopkins Medicine)

Nearly four decades after he derailed a pioneering transgender program at Johns Hopkins Hospital with his views on “guilt-ridden homosexual men,” psychiatrist Paul McHugh is seeing his institution come full circle with the resumption of gender-reassignment surgeries.

McHugh, the hospital’s chief of psychiatry from 1975 to 2001, still believes that being transgender is largely a psychological problem, not a biological phenomenon. And with the title of university distinguished service professor at Johns Hopkins Medicine, he continues to wield enormous influence in certain circles and is quoted frequently on gender issues in conservative media.

“I’m not against transgender people,” he said recently, stressing that he is “anxious they get the help they need.” But such help should be psychiatric rather than surgical, he maintains.

Hopkins, however, is moving beyond McHugh. This summer, it will formally open a transgender health service and will resume, after a 38-year hiatus, an accompanying surgical program.

Once at the forefront of ­gender-identity science — and site of the nation’s first “change-of-sex operations,” as the headlines announced in 1966 — Hopkins abruptly halted those surgeries in 1979.

Johns Hopkins Hospital hopes to return to the forefront of transgender medicine with a new transgender health service formally opening this summer. (Bill O'Leary/The Washington Post)

The main trigger was a study by Jon Meyer, who ran the hospital’s Sexual Behaviors Consultation Unit. In the study, Meyer concluded that although “sex-change” surgery was “subjectively satisfying” for the small sample surveyed, the operations they underwent conferred “no objective advantage in terms of social rehabilitation.”

“With these facts in hand,” McHugh later wrote, “I concluded that Hopkins was fundamentally cooperating with a mental illness.”

Two months later, its gender-identity clinic was shut down.

Many scientists subsequently challenged the methodology behind Meyer’s study, as well as his interpretation of the results, but in the decade that followed, other academic hospitals often cited the research when they discontinued their own transgender surgical programs.

The decision to restart operations initially was made public in July and then repeated in October on the health system’s website in a letter titled “Johns Hopkins Medicine’s Commitment to the LGBT Community.

” The letter stressed “strong and unambiguous” support of the LGBT community and made clear that when “individuals associated with Johns Hopkins exercise the right of expression, they do not speak on behalf of the institution.”

At the same time, the letter emphasized a hallmark of American higher education: the freedom to express contrarian views. “Academic freedom is among our fundamental principles,” it said, “essential to the self-correcting nature of scientific inquiry, and a privilege that we safeguard.”

McHugh, many people assumed, was the unnamed impetus for both declarations.

Hopkins’s shift not only reflects the public’s far broader discussion about transgender rights and protections, but also the controversies that the discussion engenders.

In February, the Trump administration revoked federal guidelines put in place under President Barack Obama that had directed public schools to allow transgender students to use restrooms matching their gender identity.

And North Carolina passed its own restrictive “bathroom bill” for public spaces — legislation that drew such condemnation, especially from outside of the state, that lawmakers last week voted to repeal the law.

“Obviously there’s a lot of apprehension and anxiety in the transgender community, because we don’t know how health care is going to be impacted [by Trump’s agenda], especially for transgender youth,” said Paula Neira, clinical director of the new Hopkins program. “I think it shows that what we’re doing is timely.”

But as the plans for the transgender health service were coming together last fall, a 143-page report, titled “Sexuality and Gender,” appeared in the New Atlantis, a science and technology magazine published by the Ethics and Public Policy Center, a conservative Christian think tank. It was authored by McHugh and Lawrence S. Mayer, a professor of statistics and biostatistics at Arizona State University and, at the time of the publication, a scholar in residence at Hopkins.

The pair contended that neither sexual orientation nor gender identity is biologically determined. Although the New Atlantis is a small publication, the report dismayed many in the Hopkins medical community and beyond.

Those included Dean Hamer, a scientist at the National Institutes of Health for several decades and one of the first researchers to identify a genetic link to homosexuality.

Hamer termed some of the authors’ statements “pure balderdash.”

The paper gained traction with conservative media, however.

“People began citing the New Atlantis article as a reason to support legislation against transgender people,” said Tonia Poteat, a Hopkins epidemiologist who is an expert on transgender issues.

The result: In October, Poteat and a half-dozen colleagues at the university’s Bloomberg School of Public Health denounced the report, writing that it “mischaracterizes the current state of the science on sexuality and gender.” More than 600 students, faculty members, interns, alumni and others at the medical school also signed a petition calling on the university and hospital to disavow the paper.

“These are dated, now-discredited theories,” said Chris Beyrer, a professor at the public health school and part of the faculty group that denounced McHugh’s stance.

In an interview from his home in Baltimore, where he still sees patients, McHugh explained that the “duty of all doctors who propose a treatment is to know the nature of the problem they propose to treat. The issue of transgender [people] is, the vast majority coming for surgery now don’t have a biological reason but a psychosocial reason.”

While McHugh successfully lobbied for more than 30 years to keep gender-reassignment surgery from becoming a Medicare benefit, he supports the operation for those born with an intersex condition, which means having a reproductive or sexual anatomy that doesn’t fall into the typical definition of male or female.

Most recently his name was prominent on an amicus brief in opposition to the case of Virginia transgender student Gavin Grimm. The teen sued his school district to be allowed to use the bathroom of his gender identity — an issue that until last month was headed to the Supreme Court.

“People with abnormalities of development should be helped to find their place as they see it best,” McHugh said. “But they are a tiny number of the transgender population seeking and being given treatment.”

Those involved in Hopkins’s transgender health services disagree with his positions. But the 85-year-old doctor, who still teaches an occasional course, says he bears no animus toward them.

In fact, he appreciated a visit made last fall by W.P. Andrew Lee, the head of plastic and reconstructive surgery at Hopkins.

Lee wanted to tell the former psychiatry chief that the hospital would be resuming gender-affirmation surgeries, as they are called these days.

The visit was “a professional courtesy,” Lee said in an email to The Washington Post. He declined an interview request.

McHugh elaborated a bit on their conversation and how the two had disagreed: “When I said [surgery] reduced options, he said he was thinking about the people who were pleased about the treatment.”

Their stalemate, the psychiatrist knew, wasn’t going to affect the hospital’s decision.

So far, the new transgender health service involves 25 to 30 professionals across a number of departments, including plastic surgery, urology, endocrinology, nursing and social work. The surgeries will take place at Hopkins Hospital and possibly at some of the system’s satellite centers.

Despite important gender research the university maintained over the years, it has ground to recover. The long break in its surgical program, coupled with McHugh’s vocal positions on gay and transgender issues, caused Hopkins to lose standing within the LGBT community.

“It took an exceptionally long time,” Beyrer said. “Too long.”

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Coronavirus: Practicing Wellness While You Stay at Home

Staying Healthy While You Travel | Johns Hopkins Medicine

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In light of the COVID-19 pandemic, many people are working from home these days. Under normal circumstances, telecommuting can offer a pleasant break from your daily routine. You can enjoy freedom from a long commute and the luxury of working in your sweats.

But this situation is far from normal. Harpreet Gujral, program director of integrative medicine at Johns Hopkins’ Sibley Memorial Hospital, offers the following suggestions on staying centered and healthy when you’re working at home during the pandemic.

Greeting the Day

If you’re waking in the morning and feeling uncertain because your routine is so different, Gujral suggests a 15-minute ritual to get prepared for your day.

“First thing in the morning, I recommend spending 10 to 15 minutes on self-care. I take a moment to think about three things I’m grateful for. They can be simple things, such as a comfy blanket, a safe home, warmth, spring trees, blue sky or blossoming trees.”

Many of us lunge for our cellphones as soon as we’re conscious, but Gujral says she makes a point not to pick up her phone for at least 15 minutes.

Breathing for Stress Relief

Before the day’s demands take over, Gujral recommends becoming centered with some stress-relieving breaths.

“Take a few minutes to really focus on your breathing. There is a technique called 4-7-8 breathing, or relaxing breath, which helps you concentrate on deep breaths.

The practice is simple: Breathe in for a count of 4, hold for a count of 7 and breathe out for a count of 8.

Practicing this for four breaths four times each day or more can help relieve anxiety and reset the autonomic nervous system,” Gujral says.

Here’s how to do it:

Image courtesy of Healthy at Hopkins, an employee health resource at Johns Hopkins Medicine.

Gujral says staying active can increase immunity and boost mental health. “Stress puts us up in our head, and we forget about the rest of our bodies,” she says. “Try 10 minutes of qi gong — movements that help you practice mindfulness — or use stretches and yoga poses to bring your awareness back into your body.”

Even if you don’t know how to practice these disciplines, she says, you can simply close your eyes and move your awareness into your feet to feel more grounded. “Concentrate on your feet and their connection to the floor and the earth to get your worries,” she advises.

Social distancing doesn’t mean you have to isolate yourself or to stay inside. Gujral says gardening and hiking outdoors, and taking notice of the natural world, helps alleviate anxiety and improve well-being.

“Home air can get stuffy,” she says. Gujral suggests getting outside each day for 15 minutes of fresh air and sunshine, which helps the body make vitamin D. “Vitamin D deficiency can create vulnerability to the common cold,” she notes.

Eating Well

Good nutrition is essential in stressful times. “We need the best nutrition now,” Gujral notes, adding that trying to boost your immunity with supplements may not be as helpful as simply eating whole foods.

“Eat meals rich in plant-based foods, especially leafy vegetables and fruit,” she says. “Work in the whole rainbow of produce colors to get all the phytonutrients.”

Taking steps to cut out inflammatory foods such as sugar and bad fats is a good idea. These foods might be more tempting when you’re feeling tense or worried. “Don't eat your feelings. Cook homemade foods with ginger and turmeric. A little rosemary can be good for focus,” she says. Drink plenty of water, and consider green or black tea.

“Bring in something from outdoors for your at-home desk,” Gujral suggests. “Rocks, branches, flowers, even a picture, photograph or screen saver depicting a beautiful, calming scene can help remind you of nature.

“And don’t forget the power of music. Listening to music that inspires you can help you focus and improve your mood.”

Staying Focused

Gujral acknowledges that it can be hard to concentrate on work when your daily routine is off-kilter and the future is uncertain. Consume social media conservatively.

If aromatherapy agrees with you, a little eucalyptus or jasmine can make your home office more conducive to calm productivity. Gujral says it’s important to remember that essential oils are not effective treatments for disease, but they can help uplift mood or create a more relaxing environment.

Practicing Mindfulness

It’s also important to keep in touch with friends, especially the ones who uplift you, and give people the benefit of the doubt during this challenging time.

Most important are mindfulness and gratitude, Gujral says. “Focus on what’s at hand,” she says. “When you wash your hands, take a moment and say to yourself, ‘I fill my heart with gratitude for what’s going well.’ Sprinkle this affirmation through your day, with every hand-wash.”

What you need to know from Johns Hopkins Medicine.


Staying healthy and health resources

Staying Healthy While You Travel | Johns Hopkins Medicine

People with COVID-19 have reported a wide variety of symptoms ranging from mild to severe. Common symptoms include cough and shortness of breath or difficulty breathing. Other symptoms may include fever, chills (sometimes accompanied by repeated shaking), muscle pain, headache, sore throat, and loss of taste or smell.

Information for employees

Employees, postdocs, and house staff who feel ill or are concerned about exposure are encouraged to call our Employee COVID-19 Call Center at 443-287-8500, seven days a week, between 7 a.m. and 11 p.m. You should also use the call center (not Occupational Health) if you need clearance to return to work after being tested or recovering from COVID-19.

The Employee COVID-19 Call Center is staffed by Johns Hopkins nurses and physicians and specially trained nursing and medical students. When you call, a representative will instruct you about next steps depending on your circumstances. They will arrange for testing if needed and assist in transmitting information to Occupational Health.

You are always free to call your personal primary care provider, and should continue to do so for family members who have symptoms, but JHU employees should call the Employee COVID-19 Call Center so that we can give you the best direction for your circumstances and arrange for testing if needed.

Information for students

Last update April 6, 5:30 p.m.

If you are feeling ill—especially if the below criteria pertain to you—you are asked to call University Health Services or the Student Health and Wellness Center, rather than come in, so that initial guidance can be provided by phone:

  • Symptoms of cough, shortness of breath, and/or fever of 100.4 or higher
  • Travel from an area identified as high-risk for COVID-19
  • Close contact with any person known to have COVID-19

University Health Services and the Student Health and Wellness Center are ordering COVID-19 tests for those who meet the criteria set by Johns Hopkins Infection Control.

These criteria are updated on a regular basis, and the most current criteria for testing will be used when you are assessed over the phone.

Postdocs and house staff should contact the Employee COVID-19 Call Center at 443-287-8500.

If it is determined, the criteria, to administer a COVID-19 test, it could take up to 24 hours to arrange for the test during the week. If your test is being ordered on a weekend, you will be contacted on the next business day to arrange testing. The turnaround time for test results averages one to two days.

A full list of health support resources, including mental health, for students is available at

Homewood Student Health Center

Students (full- or part-time) affiliated with the following schools should contact the Homewood Student Health and Wellness Center at 410-516-8270 (online scheduling has been temporarily disabled):

  • Carey Business School
  • Krieger School of Arts and Sciences (including Advanced Academic Programs)
  • Peabody Institute
  • School of Advanced International Studies
  • School of Education
  • Whiting School of Engineering (including Engineering for Professionals)

The Student Health and Wellness Center’s current schedule is:

  • Monday through Friday, 8:15 a.m.–4:45 p.m. (closed 12:30–1:30 p.m.)
  • No evening or Saturday clinic

When the clinic is closed you will be connected with our nurse advice line for medical concerns.

For non-urgent and routine matters, you are encouraged to reschedule for a later date or a telemedicine visit. If an in-person visit is medically necessary, please avoid bringing family and friends.

University Health Services

Students (full- or part-time) affiliated with the schools of Medicine, Nursing, and Public Health should contact University Health Services at 410-955-3250. University Health Services remains open to Hopkins students, post-doctoral fellows, house staff, and trainees.

  • Please call UHS and do not visit the clinic. UHS nurses screen all patients for COVID-19 before making an appointment or having you stop in.
  • In most cases, for the safety of patients and staff, rather than have you visit the clinic in person, we plan to utilize telemedicine or phone visits as much as possible.
  • For in-person visits, you may notice that fewer staff in the office, and that visits may be spaced out. You may also notice rearranged waiting and staffing areas that promote social distancing.
  • When you call the clinic, since many staffers may be working from home, you maybe be asked to leave a voicemail message. UHS staffers will be checking these messages and getting back to you promptly to assist with your concern.


Health experts: Travel games should be last to return in youth sports

Staying Healthy While You Travel | Johns Hopkins Medicine

As some states begin to reopen from coronavirus pandemic restrictions, youth sports are starting to return in pockets of the country. How kids return to organized sports will be shaped by what local and state authorities allow, what leading sport and public health bodies recommend, what liability risks exist, and what parents are willing to accept.

On May 13, the Aspen Institute’s Project Play hosted our fifth webinar, this one aimed at understanding what steps should be taken to safely bring youth sports back. Parents are watching. Only 52% of parents are comfortable with their child participating in travel sports, much less than school sports (68%) and community sports (67%), according to a new survey reported on by Project Play.

Below are highlights from our discussion with several of the nation’s top medical and legal experts creating guidance on return to play issues in youth sports.

Travel sports vs. local sports

Lauren Sauer, Johns Hopkins Medicine: “I think the travel game issue is going to be a huge challenge for youth sports, and that will be dependent on the sporting type and how players interact. … Reintroducing more high-level risk activities travel sports means kids mixing in new environments, even before their schools have reopened.

It can mean kids have new exposures, potentially increasing their risk and putting family members at risk. It also means you may be introducing exposure to higher-risk populations.

It’s important to get community buy-in and from local and state public health departments before thinking about introducing these travel sporting events in the regions that are going to be hosting them.”

Dr. Jon Finnoff, U.S. Olympic and Paralympic Committee: “When you do start having kids getting together, it should be small groups and it should be local. It shouldn’t be people traveling around. If they’re mixing groups, then one kid could get sick and spread it to everybody else in a bunch of different groups.”

Phased return for youth sports

Finnoff: “There should certainly be a phased approach. It may be you’re going to start by having individual (activities) archery and things where you can have social distancing easily built into the sport early on. … You don’t have to not practice soccer. You just do individual drills with your own ball but don’t have other people touching the ball.”

Sauer: “I have some concerns about the (United States Specialty Sports Association return to play) document because it’s meant to be a catch-all document for all youth sports. Some recommendations are very specific, some are very broad and not easily teachable or implementable.

There are a lot of sports that can be practiced independently, and if we start with those sports and make sure we have training for healthy and active behaviors from their homes, then we can slowly phase in behaviors to return to youth sports.

The phased approach gives you time to learn these new behaviors that we’re all learning together.”

Finnoff: “If you have close, sustained contact with somebody and you’re breathing vigorously and you have no protective equipment on, the lihood of transmitting an infection is very high compared to a sport that has intermittent close contact or a sport with no close contact. That helps you decide which is a higher-risk sport and when you should be introducing those sports, with lower-risk sports starting earlier.”

Sauer: “The key you want to see when moving from phase to phase is decreasing numbers of cases and that testing and contact tracing are effectively going on in that community.

That means as the cases are going down, the number of tests is going up and the number of positive cases in that testing ratio and the number of contact tracing is manageable. That means the local health department is actually managing their case load, which also means they can support sports events.

We look for somewhere between 3% and 10% on the ratio of positive cases when testing to say we’re in the right direction for the case load. Decisions are to be made at the local level because there are local constraints.”

Finnoff: “If you have active community transmission and the numbers are growing, (it’s problematic) even if local governments are saying it’s safe to go back and reopen.

I think a lot of that is being driven by the economy. Absolutely, the economy is being crushed. But as a doctor and looking at this objectively, I think we need to err on the side of being cautious.

We’re talking about our lives.”

Precautions if you reopen

Dr. Jill Daugherty, Centers for Disease Control and Prevention: “Face coverings are not currently recommended for players during practice or competition. They can be used, if feasible, such as when coaches are explaining the rules and going over strategy.”

Sauer: “Intensifying cleaning, disinfection and ventilation are critical because a lot of these new responsibilities may fall on team members, children or volunteer coaches. That workload, and the skills associated with how to do that, have to be considered when reintroducing sporting events.”

Daugherty: “Modify layouts to promote social or physical distancing. This may include spacing field positions or drills so that children are at least six feet apart. Discourage high fives, handshakes, fist bumps and hugs.

If keeping physical distance among youth players is difficult during competition or practice, you could consider relying on individual drill work and skills instead.

Providing physical guides, such as signage or tape on floors or playing fields to ensure that coaches and players remain at least six feet apart, may be helpful as well.”

Daugherty: “If some of your coaches or staff are at higher risk for COVID-19, you could consider offering options such as virtual coaching and in-home drills that limit risk to others.

Identify small groups (of players) and keep them together.

… If feasible, conduct daily health checks, such as temperature screening and symptom checking of coaches, officials, staff and players in accordance with any applicable privacy laws and regulations.”

Liability risks

Steven Bank, UCLA School of Law: “This is a global pandemic, but it is a regional or local decision about return to play. Community norms are an issue. What might work at some places might not work at others, and I don’t just mean because of regional spread (of the virus).

I also mean because of the physical conditions of your facility and the physical condition of people coming to your facility. That doesn’t mean you can practice what I call legal herd immunity. If everybody is just opening up and not exercising any caution, that does not mean you’re free of risk.

It means you’ve increased your risk.”

Bank: “The closest examples we have of (legal precedent) in liability issues involving infections happened with the spread of MRSA at facilities.

In those cases, courts were most ly to impose a duty of liability when the facility owners or the sponsor of the activity knew or should have known there was an infection.

If we translate it to COVID-19, you need to have protocols in place and you need to be particularly concerned about people who come in with any known conditions and who have issues that start when they’re at your facility.”

Bank: “The biggest thing you need to show that you have exercised reasonable care is you have developed enforced protocol.

Some of the protocols in some national sports organizations imply that players need to be the ones to sanitize or have social distancing among 8-year-olds. That’s going to be really difficult to enforce.

If that’s what you’re relying on for reasonable care, you’re probably not going to meet the standard.”

Bank: “Most (youth sports organization) waivers are probably ineffective. They’re combined with the registration forms as general liability as part of a registration process for your sport.

They probably need to be separated and you probably need to have separate information that informs people of the risks and specifically goes through the kinds of things they are waiving. If you think about comparisons, it’s concussion sheets.

When we have concussion waivers, there are large fact sheets you need to get people to acknowledge.”

Contact tracing

Sauer: “The public health authorities have to be notified when you find a new case. The challenging thing about youth sports is when we’re talking about kids, we don’t have a good sense of how they experience COVID infection broadly.

We have cases that make their way to the hospital or testing because they have minor surgical procedures and we see they have cases, but kids seem to experience COVID-19 much more mildly.

So, finding these cases and figuring out where they came from will ly be linked to public health authorities or a hospital they visit.”

Bank: “Privacy concerns for those who test ill is an issue for organizers. The reality is you’re balancing the federal protection interests for your health with the need to do contact tracing.

I would say an individual organization has to follow the guidelines of the local public health authorities. It’s unrealistic to expect individual sports, clubs and organizations to do contact tracing themselves.

Parent expectations for returning

Bank: “The worst thing an organizer can do is go with the lowest common denominator. I’m going to want to see that they’re being particularly cautious and care about my kid while still allowing them opportunities to play.

And if that includes split squads or only playing once a week or only doing certain activities, heck, my kid is going to be extraordinarily excited to do that.

If organizations are going right back too fast and going right to tournaments, I’m going to be worried.”

Do you have a topic that you would Project Play to explore in future COVID-19 youth sports coverage? Email Jon Solomon at


Healthstat Selected by Johns Hopkins HealthCare to Provide Its Evidence-based Employee Health Programs to Onsite Clinics | Healthstat – Charlotte, NC

Staying Healthy While You Travel | Johns Hopkins Medicine

2 minute read | January 29, 2019

CHARLOTTE, N.C. – Healthstat, Inc. a Charlotte, NC-based provider of onsite, nearsite and shared site employer-sponsored employee health clinics, today announced a 5-year agreement with Johns Hopkins HealthCare, LLC to market, license and implement employee health programs developed by Johns Hopkins Medicine.

According to the terms of the agreement, Healthstat will offer Johns Hopkins’ evidence-based disease management and behavior assessment programs to their network of hundreds of employee health clinics—and their future clinics. These programs allow Healthstat to tackle the complex chronic disease challenges that impact employee health and related health care costs.

Healthstat’s clinical teams support the health and wellness of employees, their families and dependents, and self-funded employer populations across marketplaces, ranging from government agencies to manufacturers to nongovernmental organizations. These high-impact solutions will enable employers to impact their highest-risk populations, which is an essential step in Healthstat’s broader mission to improve the health and wellness of employee populations across the United States.

Johns Hopkins’ evidence-based employee health programs—developed by faculty their research and successful application across the broad Johns Hopkins community—address cancer, chronic conditions such as diabetes, emotional health, and disease prevention, the common drivers of escalating health care costs.

“The integration of Johns Hopkins’ rigorously developed programs into our clinics will enable employers to expand the scope of services already available to their employees,” said Crockett Dale, Healthstat’s chief executive officer. “Our collaboration will harness the broad knowledge base of the Johns Hopkins medical community to inspire employees to change lifestyle habits that lead to poor health and higher health costs for employers.”

“We believe that the most efficient and effective way to improve employee health and positively impact health care costs is to make evidence-based programs conveniently available to employees at the worksite,” said Mark A.

Cochran, Ph.D., the executive director of Johns Hopkins HealthCare Solutions, the business group that develops and manages Johns Hopkins’ employee health programs.

“Our relationship with Healthstat immediately accelerates our efforts.”

About Healthstat

Headquartered in Charlotte, N.C., Healthstat, Inc. is a leading provider of onsite primary care, health-risk intervention, chronic care management and occupational medicine in employer facilities.

Healthstat offers a nationally recognized, proprietary healthcare delivery model that centers on patient engagement to improve health and productivity and lower healthcare costs for employers and their employees.

For more information, visit