The COVID-19 pandemic has limited the public’s access to medical care and many healthcare providers are seeing patients only for acute illness and other urgent health issues. All states and the District of Columbia require that student-athletes obtain a yearly pre-participation physical evaluation (PPE) in order to participate in sports during the school year.

The specific requirements can vary from state to state. Some states require a PPE on an annual basis, and in others the required time interval can range to as many as every three years. Because it is uncertain when healthcare providers will start seeing patients for non-urgent conditions, there is now an ongoing discussion in all jurisdictions regarding the flexibility of current PPE requirements.

It has been proposed that state authorities grant a one-year extension for a PPE that expires before or during the 2020-21 school year, and that schools be allowed to accept documented out-of-state PPEs for transfer students.

At the present time, education officials are very concerned about the liability issues associated with the reopening of schools in the fall. A major problem in this regard is that many state guidelines are not strict requirements, but rather slightly varied recommendations that are subject to interpretation.

The decision regarding PPEs is different in that state law will determine what the specific requirements will be. As such, it is imperative that school officials, athletic directors and coaches follow the state's law.

In jurisdictions that are allowing some flexibility, I would recommend that schools adhere to the highest standards. Permitting the extended use of an “expired” PPE is not in the best interests of the student-athletes. Although medical resources might be scarce at the present time, the health and safety of the students is of paramount importance.

Extending the duration between PPEs is a deviation from the standard of care, but before making this decision look for alternatives that can help maintain the highest level of safety and care. High school football coaches across the nation are now receiving authorization to start summer strength and conditioning programs.

Unfortunately, we have already had one conditioning-related death, and numerous conditioning programs have been suspended due to positive COVID-19 tests. The permitted use of an expired PPE brings with it a certain element of risk and should be considered only as a last resort.