In 1975, I bought a four-cylinder Chevrolet Monza. In my opinion in was a terrible buy and a lousy car. There was one episode after another of maintenance issues and the four-cylinder engine was just a piece of junk.
I survived that car long enough to trade it in on a Toyota Celica. I felt like I had gone from the bottom to the top in the world of driving. The ride was so smooth and the acceleration was sweet in comparison to what I had been driving. I drove that car about eight years and never had an issue.
That was way back then. Today is different in America. Overall, our cars are better, safer, more powerful, and more efficient than ever before. We have come a long way in our auto industry and we can be thankful for one thing – competition. Germany, Japan and China have put us on our toes the last 50 years and the competition has simply made us work harder to deliver a competitive product. We do have a choice and choices are good.
Don’t get upset if someone starts a private school in your county. When I was a child, we had one choice for elementary and high school.
I grew up in Appalachia. We only had one doctor in our county seat town. I can remember my mother and I sitting for two hours waiting to see Dr. Ford in Inez, Kentucky. We desperately needed a couple more doctors for the sake of the community and for the sake of Dr. Ford. A second doctor down the street would have helped. Today, the town has more access to doctors which is good for everyone.
Can you imagine if McDonalds was the only fast-food hamburger chain? In some communities, it may be. However, in many communities there is a McDonalds, a Burger King, and a Hardees often all within a block or two. Seems to me like they all do well even though there is competition.
What if you only had one gasoline station in town? Or, what if one gasoline distributor owns all the local gasoline stations? Then the price of gas would be very high. In some communities, people are struggling with this exact scenario. Gas is outrageous partly because there isn’t enough competition. Don’t knock those who are trying out electric cars as it brings another level of competition to the playing field.
Don’t get upset if someone starts a private school in your county. When I was a child, we had one choice for elementary and high school. In 1964, our county (Martin county Kentucky) was said to be the poorest county in the United States. President Lyndon Johnson even began his campaign on poverty there. We didn’t know we were poor but we were either very poor or marginally poor. My dad had a coal mining job. We always had food to eat but there was no way he could have paid tuition for a private elementary or high school. It wouldn’t have mattered because there wasn’t a choice.
I loved my schools and loved my friends from those days, but we didn’t have much. The public school made it possible for us to receive an education. I can remember having two terrible teachers in those days who slept through many of our classes. They should have been retired or fired many years prior. They were good people, and they were loved, but their days of teaching and handling a class had long passed. Obviously, this can happen in many places. Children rarely recuperate from what was supposed to be taught during that formative period.
A private school in town could take money from the public school if the tax money follows the student to the private school or even to another district. It might even be home school. Twenty-nine states and the District of Columbia have at least one private school choice program.
This aggravates and terrifies some school boards and administrators. Why be afraid of competition? I don’t think very many people want to pay extra money to send their kids to a private elementary or high school. There is almost always extra tuition and fees to pay even if the tax money follows the student.
There will always be a few who choose the private school. Let them do it and don’t worry about it. Just be a great public school with zero tolerance for bullying. Expect respect and work from the students. Support the teachers and expect them to do their jobs. Give the students all the support and love they deserve. Thus, you won’t have to worry much about local competitors.
Most every town has the Baptist, Methodist, Catholic churches, and more. You can be one of these or nothing at all. You have a choice.
I recently went into an ice cream shop that had over 100 flavors. The decision was tough but black cherry won over all the other flavors. The competition was fierce, but I’m so glad I had a choice.
He is the author of 13 books including Uncommom Sense, the Spiritual Chocolate series, Grandpa's Store, Minister's Guidebook insights from a fellow minister. His column is published weekly in over 600 publications in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
You’re a doctor. You have fifteen minutes with your patient, who cries as she ticks off a laundry list of vague symptoms. Depression is very common, you think, and it could explain all of those symptoms. Do you diagnose the patient with depression, noting it in her medical record, or do you begin an expensive, time-consuming investigation?
Now, replay the scenario from the patient’s perspective. You’re Elke Martinez, a veterinary technician, and you’ve developed muscle and joint pain, headaches, fatigue, and gastrointestinal problems. You go to your primary care doctor, part of the Kaiser Permanente healthcare system, and he attributes your symptoms to depression and anxiety. You know that’s not right, since you’re already being treated for those issues, and the treatment works. What do you do?
What Martinez did was humor her doctor. She attended Kaiser’s group cognitive behavioral therapy classes. The classes didn’t improve any of her symptoms, but they did consume a lot of her time and energy. Meanwhile, she saw more doctors to try to figure out what was actually wrong, but every Kaiser-affiliated doctor asked her about the psychiatric diagnosis already in her chart. “You can see on their face that they’re already checked out,” she says. These experiences undermined not only her trust in her doctors, but also in herself: “You get told this enough and you start to believe it and doubt yourself.”
Your odds of having an experience similar to Martinez’s are shockingly high. A 2017 meta-analysis published in The Lancet showed that for every 100 patients seen in primary care, 15 of them will receive a misdiagnosis of depression.
The problem takes a particular toll on patients who are chronically ill. A 2014 survey by the Autoimmune Association found that 51 percent of patients with autoimmune disease report that they had been told that “their disease was imagined or they were overly concerned.” And a 2019 survey of 4,835 patients with postural orthostatic tachycardia syndrome found that before getting a correct diagnosis, 77 percent of them had a physician suggest their symptoms were psychological or psychiatric.
Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc.
In our culture, aspersions against patients with poorly understood chronic illness still run deep. Just a few months ago in OpenMind, we covered longstanding efforts to label as head cases and confabulators individuals with fibromyalgia, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent symptoms of Lyme disease, and long covid. You can read it here.
Patients affected by rare disorders (those with fewer than 200,000 sufferers in the United States) also suffer enormously from this type of dismissal. According to the National Organization for Rare Diseases, if you initially receive a false psychiatric diagnosis, it takes you 2.5 to 14 times as long to get diagnosed compared to those who were never misdiagnosed, and between 1.25 and 7 times as long as those who received a false non-psychiatric diagnosis.
Even when a patient is in fact depressed or anxious, that might not be the correct explanation for their physical symptoms. The causation may go in the other direction: The patient might have a physical illness that’s causing their psychological distress. Lyme disease patients, for example, are often misdiagnosed
as having depression, bipolar disorder, and more. Yet as a
2021 study pointed out, these patients are often depressed precisely because they are ill. Systemic, whole-body or brain infection can cause impaired sleep, attention, memory, and performance, all of which contribute to depression. Targeting those psychological symptoms without effectively treating the underlying infection will never work.
Psychological diagnoses are often the easiest ones for doctors to make, and the hardest ones for patients to shake. Once a psychological diagnosis is entered into a patient’s medical records, it becomes the starting place for every subsequent doctor who reads it. Patients may not even know the diagnosis is there, since they often don’t see their records (although they have a right to — see Tools for Readers, below).
Martinez realized that the only way she was going to get a proper diagnosis of her physical symptoms was by leaving the Kaiser system, so that she could go to a new set of doctors who couldn’t see the psychiatric misdiagnosis in her chart. Thirteen years after her symptoms started, she finally got an explanation: She has Ehlers-Danlos Syndrome, a disorder of the connective tissue that can cause devastating symptoms throughout the body. By the time she received a proper diagnosis, she was disabled and had to give up the career she loved in veterinary work. And she was luckier than many. On average, with a psychiatric misdiagnosis, it typically takes patients 22 years to get diagnosed with Ehlers-Danlos syndrome.
Photo: SHVETS Production/PEXELS
Incorrect psychiatric diagnoses in medical records can cause long-lasting havoc. When one U.S.-based patient I interviewed, who requested anonymity, was erroneously diagnosed with Munchausen’s syndrome — meaning that she was accused of fabricating her illness — she became unable to get medication for her severe pain for several months, while her therapist worked to persuade the psychologist who diagnosed her to remove it from her chart. In the meantime, she resorted to taking large doses of Ibuprofen, which resulted in a stomach ulcer.
Another patient that I interviewed, also in the U.S., told me that her exhaustion led to a diagnosis of depression while she was a medical resident, even though her low energy was sufficiently explained by her autoimmune disease. When she received her medical license, it came with conditions. Due to her diagnosis of mental illness, she was required to receive a high level of supervision, making it impossible for her to practice.
Yet another patient I spoke with lost the ability to digest food, weighing in at 85 pounds at 5’7”, but the local hospital wouldn’t admit her to the emergency room because her medical records diagnosed her problem as psychiatric. Since she lives in a remote area and is too ill to travel, she hasn’t been able to access medical care at all; last I heard, she had not gotten to the bottom of her digestive woes.
Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports.
The problem of misdiagnosing physiological illness as psychological is particularly pernicious because it evokes the loaded and sexist aura of the old, discarded term "hysteria." Sigmund Freud claimed, without evidence, that unconscious traumatic memories can be converted into symbolically relevant physical symptoms. In so doing, he gave doctors permission to think of literally any symptom as having a psychological origin, even in the absence of psychological symptoms. This led to the term “conversion disorder,” which has multiplied into endless euphemisms designed to cover over its sexist origins, including somatization disorder, functional disorder, and bodily distress disorder. Specialists sometimes argue over fine distinctions between the terms, but fundamentally, they all imply that looking for physical causes for your symptoms will be fruitless and that you should instead address them psycho-behaviorally.
Even today, doctors routinely use the term “medically unexplained symptom” to imply a psychological origin for a patient’s physiological reports. In UpToDate, a highly respected online guide for evidence-based treatment, a search for “medically unexplained symptoms” reroutes to an entry on somatization in psychiatry. Both the language and the culture of modern medicine systematically nudge some doctors toward the assumption that ambiguous symptoms are psychosomatic; it is a culture we need to change. “As a matter of peculiar professional fact, there is no term that names diagnostic uncertainty without also naming psychological diagnosis,” bioethicist Diane O’Leary and health psychologist Keith Geraghty state in the Oxford Handbook of Psychotherapy Ethics.
Writing in The American Journal of Bioethics, philosopher Abraham Schwab at Clarkson University notes that psychological diagnoses may be incorrect either because the doctor doesn’t have the knowledge to come to the proper biomedical diagnosis or because the patient has a biological condition that is not yet understood by medical science. “As a result,” he says, “psychogenic diagnoses should carry with them low levels of confidence.”
In practice, though, a psychological diagnosis tends to override other interpretations, making it difficult for doctors to discover a medical explanation for the patient’s symptoms. That’s partly by design: Investigating undiagnosed medical conditions is expensive, and it often doesn’t lead to treatment that relieves the patient's symptoms. The widely used MacLeod’s Clinical Investigation Handbook cautions that “if [patients with medically unexplained symptoms] are not managed effectively, fruitless investigations and harm from unnecessary drugs and procedures may result.” Furthermore, a patient’s very determination to find a medical explanation can be dismissed as “doctor-shopping” and viewed as an indication of somatization.
Mental health professionals have historically resisted making records available to their patients.
Patients with erroneous psychological records face enormous obstacles since their doctors are discouraged from seeking out the physiological cause of their suffering and further complaints may be met with further suspicion. But there are ways to push back against these challenges, and the place to start is by accessing medical records — and then pushing to get errors fixed.
Mental health professionals have historically resisted making records available to their patients. Common justifications are that patients suffering delusions will become hostile if told in records that their beliefs aren’t correct, or that clinicians will hold back in their note-taking because they’re worried about the reaction of the patient. But some other professionals have argued for encouraging patients to review records, writing in the Journal of the American Medical Association: “The clinician who actively solicits open and ongoing dialogue, including a patient’s opinion about a note’s accuracy, may enhance both clinical precision and the treatment relationship.”
Since 1996 the Health Insurance Portability and Accountability Act (HIPAA) has given patients a legal right to access their medical records. Starting in October of 2022, the 21st
Century Cures Act made it easier to do so. In particular, the Act requires that healthcare providers provide patients access to all the health information in their electronic medical records without delay and without charge. This rule does not include notes from psychotherapy sessions that are not contained within the regular medical record, but it does include any diagnoses made. If a patient believes anything in that record is wrong — such as an incorrect psychiatric diagnosis — they can request that it be changed. See the “Tools” section below for specific guidance on how to purgi falsehoods from your medical record.
Fully fixing the problem of incorrect psychiatric diagnoses, and the array of challenges that result from them, will take a major shift in mindset in the medical profession. It will require a much more nuanced understanding of the complexities of how our mental and physical states affect one another bidirectionally. It will require an acceptance that psychological treatment is an adjunct for physical treatment, rather than a way of getting rid of responsibility for a problematic patient. And it will require a transformation in our healthcare system so that doctors have the time they need to investigate complex patients.
Such changes are beyond what any individual patient can accomplish. But in the meantime, patients can at least ensure that their medical records aren’t making their quest for accurate diagnosis and effective treatment more difficult.
When a group of physicians gathered in Washington state for an annual meeting, one made a startling revelation: If you ever want to know when, how — and where — to kill someone, I can tell you, and you'll get away with it. No problem.
That's because the expertise and availability of coroners, who determine cause of death in criminal and unexplained cases, vary widely across Washington, as they do in many other parts of the country.
Photo: Gerd Altmann/Pixabay
"A coroner doesn't have to ever have taken a science class in their life," said Nancy Belcher, chief executive officer of the King County Medical Society, the group that met that day.
Her colleague's startling comment launched her on a four-year journey to improve the state's archaic death investigation system, she said. "These are the people that go in, look at a homicide scene or death, and say whether there needs to be an autopsy. They're the ultimate decision-maker," Belcher added.
Each state has its own laws governing the investigation of violent and unexplained deaths, and most delegate the task to cities, counties, and regional districts. The job can be held by an elected coroner as young as 18 or a highly trained physician appointed as medical examiner. Some death investigators work for elected sheriffs who try to avoid controversy or owe political favors. Others own funeral homes and direct bodies to their private businesses.
The various titles used by death investigators don't distinguish the discrepancies in their credentials.
Overall, it's a disjointed and chronically underfunded system — with more than 2,000 offices across the country that determine the cause of death in about 600,000 cases a year.
"There are some really egregious conflicts of interest that can arise with coroners," said Justin Feldman, a visiting professor at Harvard University's FXB Center for Health and Human Rights.
Belcher's crusade succeeded in changing some aspects of Washington's coroner system when state lawmakers approved a new law last year, but efforts to reform death investigations in California, Georgia, and Illinois have recently failed.
Rulings on causes of death are often not cut-and-dried and can be controversial, especially in police-involved deaths such as the 2020 killing of George Floyd. In that case, Minnesota's Hennepin County medical examiner ruled Floyd's death a homicide but indicated a heart condition and the presence of fentanyl in his system may have been factors. Pathologists hired by Floyd's family said he died from lack of oxygen when a police officer kneeled on his neck and back.
In a recent California case, the Sacramento County coroner's office ruled that Lori McClintock, the wife of congressman Tom McClintock, died from dehydration and gastroenteritis in December 2021 after ingesting white mulberry leaf, a plant not considered toxic to humans. The ruling triggered questions by scientists, doctors, and pathologists about the decision to link the plant to her cause of death. When asked to explain how he made the connection, Dr. Jason Tovar, the chief forensic pathologist who reports to the coroner, said he reviewed literature about the plant online using WebMD and Verywell Health.
The various titles used by death investigators don't distinguish the discrepancies in their credentials. Some communities rely on coroners, who may be elected or appointed to their offices, and may — or may not — have medical training. Medical examiners, on the other hand, are typically doctors who have completed residencies in forensic pathology.
In 2009, the National Research Council recommended that states replace coroners with medical examiners, describing a system "in need of significant improvement."
Massachusetts was the first state to replace coroners with medical examiners statewide in 1877. As of 2019, 22 states and the District of Columbia had only medical examiners, 14 states had only coroners, and 14 had a mix, according to the Centers for Disease Control and Prevention.
The movement to convert the rest of the country's death investigators from coroners to medical examiners is waning, a casualty of coroners' political might in their communities and the additional costs needed to pay for medical examiners' expertise.
The push is now to better train coroners and give them greater independence from other government agencies.
"When you try to remove them, you run into a political wall," said Dr. Jeffrey Jentzen, a former medical examiner for the city of Milwaukee and the author of "Death Investigation in America: Coroners, Medical Examiners, and the Pursuit of Medical Certainty."
Lawmakers "didn't want their names behind something that will get the sheriffs against them," Collins said.
"You can't kill them, so you have to help train them," he added.
There wouldn't be enough medical examiners to meet demand anyway, in part because of the time and expense it takes to become trained after medical school, said Dr. Kathryn Pinneri, president of the National Association of Medical Examiners. She estimates there are about 750 full-time pathologists nationwide and about 80 job openings. About 40 forensic pathologists are certified in an average year, she said.
"There's a huge shortage," Pinneri said. "People talk about abolishing the coroner system, but it's really not feasible. I think we need to train coroners. That's what will improve the system."
Her association has called for coroners and medical examiners to function independently, without ties to other government or law enforcement agencies. A 2011 survey by the group found that 82% of the forensic pathologists who responded had faced pressure from politicians or the deceased person's relatives to change the reported cause or manner of death in a case.
Dr. Bennet Omalu, a former chief forensic pathologist in California, resigned five years ago over what he described as interference by the San Joaquin County sheriff to protect law enforcement officers.
"California has the most backward system in death investigation, is the most backward in forensic science and in forensic medicine," Omalu testified before the state Senate Governance and Finance Committee in 2018.
San Joaquin County has since separated its coroner duties from the sheriff's office.
The Golden State is one of three states that allow sheriffs to also serve as coroners, and all but 10 of California's 58 counties combine the offices. Legislative efforts to separate them have failed at least twice, most recently this year.
AB 1608, spearheaded by state Assembly member Mike Gipson (D-Carson), cleared that chamber but failed to get enough votes in the Senate.
"We thought we had a modest proposal. That it was a first step," said Robert Collins, who advocated for the bill and whose 30-year-old stepson, Angelo Quinto, died after being restrained by Antioch police in December 2020.
The Contra Costa County coroner's office, part of the sheriff's department, blamed Quinto's death on "excited delirium," a controversial finding sometimes used to explain deaths in police custody. The finding has been rejected by the American Medical Association and the World Health Organization.
When something like this affects rural areas, if they push back a little bit, we just stop.
Lawmakers "didn't want their names behind something that will get the sheriffs against them," Collins said. "Just having that opposition is enough to scare a lot of politicians."
The influential California State Sheriffs' Association and the California State Coroners Association opposed the bill, describing the "massive costs" to set up stand-alone coroner offices.
Many Illinois counties also said they would shoulder a financial burden under similar legislation introduced last year by state Rep. Maurice West, a Democrat. His more sweeping bill would have replaced coroners with medical examiners.
Rural counties, in particular, complained about their tight budgets and killed his bill before it got a committee hearing, he said.
"When something like this affects rural areas, if they push back a little bit, we just stop," West said.
Proponents of overhauling the system in Washington state — where in small, rural counties, the local prosecutor doubles as the coroner — faced similar hurdles.
The King County Medical Society, which wrote the legislation to divorce the two, said the system created a conflict of interest. But small counties worried they didn't have the money to hire a coroner.
So, lawmakers struck a deal with the counties to allow them to pool their resources and hire shared contract coroners in exchange for ending the dual role for prosecutors by 2025. The bill, HB 1326, signed last year by Democratic Gov. Jay Inslee, also requires more rigorous training for coroners and medical examiners.
"We had some hostile people that we talked to that really just felt that we were gunning for them, and we absolutely were not," Belcher said. "We were just trying to figure out a system that I think anybody would agree needed to be overhauled."
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
URBANA -- To say time was of the essence for Tammi Fanson on July 18, 2022, would be an understatement.
The Gibson City, Illinois, woman had been dealing with high blood pressure, stress, fatigue and shortness of breath, but she chalked it up to life just being difficult. But on that day, she found herself at her local Gibson Area Hospital in the midst of a heart attack.
Fanson was then taken by ambulance to OSF HealthCare Heart of Mary Medical Center in Urbana, Illinois – around 40 minutes on a regular drive but half that with the blaring red lights. That, combined with the cooperation between the two hospitals, and Fanson was fast-tracked straight to the cardiac catheterization laboratory at OSF Heart of Mary, something Tammi and her husband Doug say saved her life.
"They knew me," Tammi Fanson says. "They knew exactly what was going on. There must have been a lot of communication even before I got there. So it was very comforting."
"The comfort that she had knowing this crew was waiting for her, it’s pretty remarkable," Doug Fanson adds.
Fanson’s case is an example of the importance of what’s known as door to balloon time. That measures the time between when a patient has first contact with a medical professional to when a balloon is placed in their heart’s arteries to get rid of blockages and resume blood flow. For Fanson, she had a balloon within 27 minutes of arriving at OSF Heart of Mary.
"Time is muscle here in the cath lab," says Jo Lehigh, a registered nurse at OSF Heart of Mary who was on Fanson’s care team. "Every minute that goes by could be tissue death."
That means Lehigh and other OSF caregivers in the cath lab have to be agile. For starters, they have a limited response time to get to the hospital once they get the page that a patient is inbound.
On the balloon process itself, Lehigh says physicians start by accessing an artery through a patient’s wrist or groin.
"We send in a catheter. We go up into the heart and we shoot in contrast dye. The contrast dye helps us to visualize the artery to see where the blockage is located and how severe it is," Lehigh says. "And from there, the doctor goes in with a small balloon on the catheter and inflates the balloon. Then we'll go in with a stent and another balloon to open it up. So we have blood flow after it's all said and done."
The Fansons praise Lehigh for the care Tammi received.
"She was our angel," Doug Fanson says, the emotion in his voice strong.
Tammi Fanson recalls Lehigh at her side in the heat of the battle to save her life.
"I said, ‘Am I going to be OK?’" Fanson says. "And she was right there assuring me that everything was going to be OK."
Lehigh followed up with Fanson, too, during her stay at OSF Heart of Mary.
"I do go down and check on the patients. I make sure they're doing OK and just kind of show my face because a lot of times they can remember my name and remember my voice, but they don't really remember me or what I looked like." Lehigh says. "So I have to go down there and just kind of keep up on them and make sure they're doing OK. I think that builds a good relationship."
Four heart stents later, Fanson is now recovering at home and is doing well. She’s enrolled in cardiac rehabilitation, a typical but vital part of the path back to normal. But most importantly of all, Fanson has a new lease on life. She appreciates the importance of diet, exercise, healthy blood pressure and knowing your family history of heart troubles. And she’s found ways to reduce stress, at least temporarily, like watching the sunrise with no distracting devices in sight.
"I could have easily went back to sleep that night," Tammi Fanson says, recalling the evening that changed her life. "Don’t do that. Go in [to the hospital]. Get your regular checkups. And listen to your body."
"Listen to [your health care providers]. Rely on them. Lean on them. They’re experts," Doug Fanson says. "It helps you get through the traumatic times."
Lehigh concurs with all those sentiments. She adds that if you find yourself in Fanson’s shoes – having sudden, significant symptoms of a heart attack – don’t drive yourself to the hospital. Call
9-1-1.
"The ambulance is going to have everything there that you need," Lehigh says. "They’re going to have the electrocardiogram, the aspirin. They’re going to have all the equipment and supplies they’d need to help make this a smooth and quicker process."
This spring, high school senior Nathan Kassis will play baseball in the shadow of covid-19 — wearing a neck gaiter under his catcher’s mask, sitting 6 feet from teammates in the dugout and trading elbow bumps for hugs after wins.
"We’re looking forward to having a season," said the 18-year-old catcher for Dublin Coffman High School, outside Columbus, Ohio. "This game is something we really love."
Kassis, whose team has started practices, is one of the millions of young people getting back onto ballfields, tennis courts and golf courses amid a decline in covid cases as spring approaches. But pandemic precautions portend a very different season this year, and some school districts still are delaying play — spurring spats among parents, coaches and public health experts across the nation.
Since fall, many parents have rallied for their kids to be allowed to play sports and objected to some safety policies, such as limits on spectators. Doctors, meanwhile, haven’t reached a consensus on whether contact sports are safe enough, especially indoors. While children are less likely than adults to become seriously ill from covid, they can still spread it, and those under 16 can’t be vaccinated yet.
Less was known about the virus early in the pandemic, so high school sports basically stopped last spring, starting up again in fits and spurts over the fall and winter in some places. Some kids turned to recreational leagues when their school teams weren’t an option.
But now, according to the National Federation of State High School Associations, public high school sports are underway in every state, though not every district. Schedules in many places are being changed and condensed to allow as many sports as possible, including those not usually played in the spring, to make up for earlier cancellations.
Coaches and doctors agree that playing sports during a pandemic requires balancing the risk of covid with benefits such as improved cardiovascular fitness, strength and mental health. School sports can lead to college scholarships for the most elite student athletes, but even for those who end competitive athletics with high school, the rewards of playing can be extensive. Decisions about resuming sports, however, involve weighing the importance of academics against athletics, since adding covid risks from sports could jeopardize in-person learning during the pandemic.
Tim Saunders, executive director of the National High School Baseball Coaches Association and coach at Dublin Coffman, said the pandemic has taken a significant mental and social toll on players. In a May survey of more than 3,000 teen athletes in Wisconsin, University of Wisconsin researchers found that about two-thirds reported symptoms of anxiety and the same portion reported symptoms of depression. Other studies have shown similar problems for students generally.
"You have to look at the kids and their depression," Saunders said. "They need to be outside. They need to be with their friends."
Before letting kids play sports, though, the Centers for Disease Control and Prevention said, coaches and school administrators should consider things like students’ underlying health conditions, the physical closeness of players in the specific sport and how widely covid is spreading locally.
Karissa Niehoff, executive director of the high school federation, has argued that spring sports should be available to all students after last year’s cancellations. She said covid spread among student athletes — and the adults who live and work with them — is correlated to transmission rates in the community.
"Sports themselves are not spreaders when proper precautions are in place," she said.
Still, outbreaks have occurred. A January report by CDC researchers pointed to a high school wrestling tournament in Florida after which 38 of 130 participants were diagnosed with covid. (Fewer than half were tested.) The report’s authors said outbreaks linked to youth sports suggest that close contact during practices, competitions and related social gatherings all raise the risk of the disease and “could jeopardize the safe operation of in-person education.”
Dr. Kevin Kavanagh, an infection control expert in Kentucky who runs the national patient safety group Health Watch USA, said contact sports are "very problematic," especially those played indoors. He said heavy breathing during exertion could raise the risk of covid even if students wear cloth masks. Ideally, he said, indoor contact sports should not be played until after the pandemic.
"These are not professional athletes," Kavanagh said. "They’re children."
A study released in January by University of Wisconsin researchers, who surveyed high school athletic directors representing more than 150,000 athletes nationally, bolsters the idea that indoor contact sports carry greater risks, finding a lower incidence of covid among athletes playing outdoor, non-contact sports such as golf and tennis.
Overall, "there’s not much evidence of transmission between players outdoors," said Dr. Andrew Watson, lead author of the study, which he is submitting for peer-reviewed publication.
Students, for their part, have quickly adjusted to pandemic requirements, including rules about masks, distancing and locker rooms.
~ Matt Troha
Dr. Jason Newland, a pediatrics professor at Washington University in St. Louis, said all sorts of youth sports, including indoor contact sports such as basketball, can be safe with the right prevention measures. He supported his daughter playing basketball while wearing a mask at her Kirkwood, Missouri, high school.
Doctors also pointed to other safety measures, such as forgoing locker rooms, keeping kids 6 feet apart when they’re not playing and requiring kids to bring their own water to games.
"The reality is, from a safety standpoint, sports can be played," Newland said. "It’s the team dinner, the sleepover with the team — that’s where the issue shows up. It’s not the actual games."
In Nevada’s Clark County School District, administrators said they’d restart sports only after students in grades 6-12 trickle back for in-person instruction as part of a hybrid model starting in late March. Cases in the county have dropped precipitously in recent weeks, from a seven-day average of 1,924 cases a day on Jan. 10 to about 64 on March 3.
In early April, practices for spring sports such as track, swimming, golf and volleyball are scheduled to begin, with intramural fall sports held in April and May. No spectators will be allowed.
Parents who wanted sports to start much earlier created Let Them Play Nevada, one of many groups that popped up to protest the suspension of youth athletics. The Nevada group rallied late last month outside the Clark County school district’s offices shortly before the superintendent announced the reopening of schools to in-person learning.
Let Them Play Nevada organizer Dennis Goughnour said his son, Trey, a senior football player who also runs track, was "very, very distraught" this fall and winter about not playing.
With the reopening, he said, Trey will be able to run track, but the intramural football that will soon be allowed is "a joke," essentially just practice with a scrimmage game.
"Basically, his senior year of football is a done deal. We are fighting for maybe one game, like a bowl game for the varsity squad at least," he said. "They have done something, but too little, too late."
Goughnour said Let Them Play is also fighting to have spectators at games. Limits on the numbers of spectators have riled parents across the nation, provoking "a ton of pushback," said Niehoff, of the high school federation.
Parents have also objected to travel restrictions, quarantine rules and differing mask requirements. In Orange County, Florida, hundreds of parents signed a petition last fall against mandatory covid testing for football players.
Students, for their part, have quickly adjusted to pandemic requirements, including rules about masks, distancing and locker rooms, said Matt Troha, assistant executive director of the Illinois High School Association.
Kassis, the Ohio baseball player, said doing what’s required to stay safe is a small price to pay to get back in the game.
"We didn’t get to play at all last spring. I didn’t touch a baseball this summer," he said. "It’s my senior year. I want to have a season and I’ll be devastated if we don’t."
PONTIAC - People everywhere are conquering their cabin fever and are enjoying the great outdoors after a long, bitter winter. But before you head out for that hike, health care experts remind you to take precautions to avoid tick bites. Read more . . .
CHICAGO - An Illinois law professor is weighing in on what she called a "very public and open test of due process" for immigrants being deported from the United States without court hearings. Read more . . .
CHAMPAIGN - In a show of solidarity against President Donald Trump's trade and immigration policies, which critics say are harming families and retirement savings, more than a thousand protesters gathered Saturday at West Park near downtown Champaign for the Hands-Off! Mobilization rally. Read more . . .
Photo Galleries
A couple of runners found themselves in the wrong race at this year's Illinois Marathon. Over 60 photos from the race that you should see.
