One of the most common COVID-19 questions I get from parents pertains to the risk of a player unknowingly infected passing the virus to another player during a game. Since a football or basketball player is often within inches of opponents while not wearing a mask, in-game transmission could be common.

The NFL and NBA don’t seem to think that risk is very high.

The NFL’s chief medical officer claims zero evidence of transmission player-to-player

In response to a question from Sports Illustrated ‘s Albert Breer, the NFL’s chief medical officer, Dr. Allen Sills, claimed “zero evidence of transmission player-to-player on the field, either during games or practices.” He noted that these findings fall in line with other sports leagues around the world.

This idea that there is little possibility of player-to-player transmission during a game is curious to me for a number of reasons.

How close contacts are determined in the NBA

First, while the public has been advised to maintain social distancing, keeping six feet or more from others, contact sports seemingly ignore this warning. The NBA – and likely the NFL – base their contact policies on guidance from the Centers for Disease Control and Prevention (CDC).

A close contact is defined as any individual who has been within six feet of an infected person for a total of 15 minutes or more over a 24-hour period, either all at once or at multiple separate times. According to Tim Cato and Jared Weiss of The Athletic, the NBA used a player tracking system called Second Spectrum to show that players spend no more than five or six total minutes on average within six feet of another player during a game. Technically then, these players aren’t close contacts with teammates or opponents during games.

The CDC guidelines are recommendations for the average person in public. I’m not sure they work for periods of heavy breathing during intense physical exertion, when an infected player could spread the virus through the air even more than at rest.

Can basketball players spread the coronavirus to other players during a game or practice?

COVID-19 spread during sports games compared to public settings

I don’t believe the risk of in-game spread is negligible, but it could be lower than in other public settings, like restaurants. For one thing, football games are outdoors, where the virus can disperse through the air as soon as it leaves the mouth or nose of the infected player. NBA games are played indoors, but teams are filtering the air inside the large arenas using bipolar ionization in their heating and air conditioning systems.

Early testing likely limits some COVID-19 transmission

Plus, these leagues are catching players with the virus much more quickly than what happens in real life. Most Americans don’t get tested unless and until they have symptoms. They can spread the virus for days before they notice symptoms, get tested, and learn the result.

On the other hand, by testing all players at very frequent intervals, even those without symptoms, the leagues learn which players have it and can spread it almost immediately after the virus infects them, giving them less time to spread it to others. While not a perfect solution – there isn’t a perfect solution short of not playing – this testing probably limits spread a fair amount.

Cases of COVID-19 related to sports continue to rise

To me, the debate over whether players spread the virus during games misses the bigger point. No transmission from player-to-player during games and no transmission during sports are different things. Whether a player gets infected during a game or from a teammate in the locker room, pre-game meal or team meeting doesn’t matter. We’re seeing numerous cases of COVID-19 among teams in every sport.

High school sports provide us an even larger pool of athletes, but the data is murky at best.

A study out of the University of Wisconsin concluded that there were fewer cases of COVID-19 among the state’s 30,000 athletes than the state’s almost 224,000 non-athlete adolescents. Only one of the 209 cases with a known source was reportedly caused by actual contact, supporting Dr. Sills argument.

On the other hand, in neighboring Minnesota, health officials claim more than 3,400 cases were connected to sports. In Memphis, Tennessee, health officials claimed to have traced 83 percent of the roughly 500 COVID-19 cases back to sports.

And here in the Lowcountry, in announcing a temporary shutdown of high school sports, Charleston County School District Chief Operating Officer Jeff Borowy argued the number of quarantines following games has been much higher among athletes than the rate among the schools’ general student bodies.

I’m not saying sports leagues are wrong for trying to play. It’s just tricky to know the safest way to do it, short of an NBA-style bubble. As long as the games are going on, we will see more players infected, whether or not they catch the virus during the games themselves.

Note: A modified version of this article appears as my sports medicine column in the January 15, 2021 issue of The Post and Courier.