Safer Sports

The Best Ways to Keep Sports and Fitness Activities Going During a Pandemic

Today, the nation struggles with a devastating COVID-19 outbreak, but with the hope of widespread vaccine distribution and adoption on the near horizon. In this environment, it can be difficult for recreation managers to figure out how and when to resume sports programs in a safe manner.

According to a variety of experts in airborne diseases, sports medicine, building ventilation and other related disciplines, there is a risk continuum involved with various sports. It starts with very low risks for outdoor sports featuring ample social distancing and increases most with close-contact sports and sports done in poorly ventilated indoor environments.

All these risk calculations must also be informed by the current level of community spread. "The answer to a lot of the questions really depends on where the individual community is with respect to the pandemic," said Alex Huffman, an aerosol scientist and associate professor in the Department of Chemistry and Biochemistry at the University of Denver. "If either now or later that community is in a place where the rates are reasonably low and dropping, then it's a very different situation from most of the country right now where it's high and increasing."

Even now, however, Huffman sees little risk with socially distanced sports outside. "I would feel OK, even right now as things are out of control in most places, with socially distanced stuff outside," Huffman said. "Once we start getting into indoor spaces with a lot more people, especially if you can't respect the social distancing aspect with basketball and volleyball and things like that—that's when it becomes a different scenario. If we're doing socially distanced outside now, great. If you can't do socially distanced, outside is a lot better than inside, but still has risks to it."

The relative risks must be measured by considering the airborne nature of the virus. The consensus currently is that COVID-19 is predominantly transmitted through the air by larger particles often called droplets and by smaller particles often referred to as aerosols. According to Huffman, there's really a continuum between the two types of particles. The big difference is that people spray out the larger particles when they talk or breathe, and they fall relatively quickly to the ground. "That's where the six-foot rule came in," Huffman said.

But the plume of smaller particles that people expel can stay suspended in the air longer, much like smoke. And, like smoke, it can build up in the air in poorly ventilated spaces, mixing into the whole volume of the room's air until it gets ventilated away.

"In close proximity [with other people], you have significantly increased exposure from both droplets and aerosols and then also farther away in the room you have this aerosol spread," Huffman said. "And the closer you are, it's dramatically increasing your risk. That's why distancing and masks are so important."

While a good ventilation system helps to eliminate the longer-distance, lingering room-level aerosols, it cannot remove the transmission risks associated with close contact. "You can have the best ventilation system in the world, but if you're four feet away from somebody, that person is still basically spraying you with virus," Huffman said.

Keeping Your Distance

Sports that are outdoors and allow for ample social distancing in addition can be relatively safe even without masking. But even for these sports, like outdoor golf and tennis, it's important to minimize other interactions related to the sport itself that can put patrons at risk of contracting or spreading COVID-19.

For instance, the U.S. Golf Association's Back2Gold plan features a three-phase approach tailored to different levels of risk, with the first level featuring precautionary measures that include:

» Individual play permitted with strict social distancing with no more than four players per group.
» Walking the course or riding alone in separate golf carts.
» Restrictive course setup that features no bunker rakes, cups modified for no contact and no on-course amenities.
» Practice facilities restricted to 10 or fewer people practicing strict social distancing.
» Golf instruction and club fitting only with strict social distancing. Group teaching and coaching done virtually only.
» Closed clubhouses and golf shops with restaurants open (if at all) for takeout only.

Outdoor tennis, especially singles, can likewise be a low-risk activity even in areas with high community spread. The U.S. Tennis Association has created two Playing Tennis Safely documents, one for players and another for facilities and programmers.

Guidance for Group Sports

To help players, families and communities slow the spread of COVID-19, the CDC has published a list of Considerations for Youth Sports that provides guidance on a risk continuum for sports based on the number of people involved, the closeness of physical contact and the length of interaction. The most high-level guidance is as follows:

» Lowest Risk: Performing skill-building drills or conditioning at home, alone or with family members.
» Increasing Risk: Team-based practice.
» More Risk: Within-team competition.
» Even More Risk: Full competition between teams from the same local geographic area.
» Highest Risk: Full competition between teams from different geographic areas.

The resource also provides greater details on how to assess risks, promote behaviors that reduce spread, maintain healthy environments, maintain healthy operations and respond to a player or coach getting sick.

Another resource with detailed guidance on how to mitigate risks comes from the Harvard T.H. Chan School of Public Health, which published a report in June 2020, Schools for Health: Risk Reduction Strategies for Reopening Schools. The guide includes a section with advice on how to gauge the relative risks of various group sporting activities and how to make every sport safer. Among the guidance you can apply to reduce the cumulative risk of any sport are tactics such as:

» Hold as many practices and games outdoors as possible.
» Limit close contact to gameplay and focus practices on skill development.
» Limit the number of competitions.
» Focus more on local competitions.
» Avoid locker rooms or stagger their times of use.
» Avoid/limit use of shared equipment and disinfect frequently.
» Dedicate some practices to at-home workouts.
» Eliminate spectators and other nonessential personnel.
» Wear face masks whenever possible for athletes and always for coaches and referees.
» Take mask-free water breaks socially distanced from others.
» Have spare masks on hand in case of excess sweating.
» Use hand or electronic whistles instead of mouth whistles.
» Avoid team huddles and high-fives.
» Conduct team meetings remotely or outdoors with social distancing.

Coming Face-to-Face With Higher Risk

In mid-November, Minnesota's health commissioner asked Gov. Tim Walz to pause all youth sports competitions and practices in response to growing outbreaks linked to a variety of sports. At the same press conference, Kris Ehresmann, director of infectious disease epidemiology, prevention and control for the state's Department of Health, listed the number of COVID-19 outbreaks in the state that had already been linked to various sports:

» Hockey: 46 outbreaks
» Volleyball: 41
» Football: 35
» Basketball: 20
» Soccer: 15

"Looking at the Minnesota data for athletes, the sports that have fairly close proximity are having higher rates—football, hockey, volleyball—where there's a lot of face-to-face breathing," said William Roberts, professor in the Department of Family Medicine and Community Health at the University of Minnesota and past president of the American College of Sports Medicine.

Roberts also noted that resistance to masking in group sports isn't really supported by the science. "You can wear a mask in all this stuff," Roberts said. "I Nordic ski in really cold temperatures and I wear a mask just to protect my nose and face from freezing … There are plenty of studies showing that it doesn't affect your oxygen levels and stuff like that—it's just that it's sweaty and it's hot."

Huffman likewise recommends masks as part of a multi-pronged safety strategy, with mask-wearing advice that includes:

» Make sure it fits over your nose and is tight over your chin.» Choose a mask with at least two layers.» Avoid masks with valves. » Choose a single-layer mask over nothing.» Don't consider a face shield a substitute for a mask.» Provide extra masks so athletes can replace a sweaty one with a fresh one.

"A single cotton layer with a bandana or a gaiter doesn't do a great job," Huffman said. "It does do a much better job than nothing. I don't want to disparage it too much because the difference between zero and one layer is far greater than the difference between one and two layers." Likewise, studies have indicated that improved protection is achieved when going with three layers, layering two masks, our doubling up the layers when using a gaiter.

While some sports professional sports leagues have been able to keep going without masks by using strategies such as intensive testing, contact tracing and bubbles, some teams have still suffered large outbreaks. Most importantly, these measures won't be feasible for lower-level sports to adopt anytime soon. "There's no recreational, high school or even college league other than the Big Ten that can afford to do what they're doing to try to keep the numbers down," Roberts said.

Ventilation Considerations

In indoor environments, better ventilation and filtration can go a long way toward limiting the infectious potential of lingering aerosols containing COVID-19. According to Corey Metzger, a licensed professional engineer and school team lead for the ASHRAE Epidemic Task Force, it can be helpful to have a professional look at your HVAC system and current building setup.

He recommends finding someone who's either a licensed professional engineer, a contractor, a testing and balancing company or a commissioning agent who is familiar with the relevant recommendations produced by ASHRAE.

"A lot of systems that have been in place and operating for extended periods of time, especially those more than 3 to 5 years old, may not be operating as intended. There may be benefits just to going in and verifying that the system is working as intended," Metzger said.

If it's not, things like malfunctioning dampers can compromise system performance. "If we're not getting good filtration and we're not bringing in ventilation air, we run the risk of seeing concentrations of any contaminant of concern, but in this case, the virus increasing to a level that becomes more problematic," Metzger said.

Once you know that the system's working properly, it's also helpful to look for opportunities to increase ventilation and filtration. With mechanical ventilation, this can mean letting in more outside air, but the viability of that depends on the outside temperature.

"On those days when it's 40 degrees, they can probably increase that amount [of outdoor air brought in] by a fair quantity," Metzger said. "On the days where it's negative 10 outside, it's probably not a realistic option."

Filtration can likewise help remove COVID-19 particles through the air, either through options like higher-quality MERV 13 filters at the system level if the HVAC system can operate effectively with them, or through things like portable HEPA filters, which can be effective in smaller spaces like locker rooms or offices.

Simply opening windows and garage doors can be another way to improve ventilation in certain fitness environments. This is the approach that 460 Fitness, a CrossFit gym in Blacksburg, Va., has taken. Their policies have been informed by the expertise of one of their members, Linsey Marr, an engineering professor at nearby Virginia Tech University who studies air quality and airborne transmission of viruses.

According to 460 Fitness Owner and Head Coach Velvet Minnick, the gym features bay doors and glass double-doors on three of the four sides of the building and keeps many of them open during group workouts. The gym has also created 10-foot-square individual workout spaces that are separated 10 feet from one another and has limited group classes to 12 people per class.

In the 5,000-square-foot workout area, this keeps the gym nowhere near maximum capacity. The gym also monitors carbon dioxide levels using a handheld CO2 monitor. Outside air has a CO2 level of around 400 parts per million.

"We'll look at the monitor. If it's under 500, we'll keep the doors shut until we start working out … As soon as we start moving, the coach will start cracking open all the doors to make sure that we remain under 500 parts per million. And it ends up at the end of class that all the doors are wide open," Minnick said.

Metzger cautions that monitoring CO2 can be useful, especially with the guidance of an expert like Marr, but that its reliability and appropriateness depends on the situation.

Members at 460 Fitness wear their masks when they enter, while warming up and if they need to use the restroom, and they maintain social distancing always. This multilayered approach to risk management paid dividends when one of the gym's trainers tested positive for COVID-19, potentially exposing 50 athletes to the virus—but no one got sick.

"Once we did have that quote-unquote scare at the end of September, I think it just reassured everyone that what we're doing is right—let's continue doing this," Minnick said. She noted that members are willing to dress in layers to work out in colder weather in return for the added peace of mind.

"I think the biggest thing is that people want to come and work out because they find that it helps with their anxiety," Minnick said. "It's helping with their mental health. It's helping them kind of escape the problems in the world. So, for that one hour, even though they might be freezing cold at the moment, they truly enjoy being there and they feel safe there and they want to be able to take part in that workout. Right now, I think it's more of a mental health thing instead of being performance goal-based."

And, if done with sufficient ventilation, distancing and appropriate mask use, these types of workouts can still be comparatively safe even in areas with high community spread. "I feel pretty good about individual stuff taking place at the gym as long as it's somewhat de-densified," Huffman said.

New ventilation guidelines for non-residential settings from the CDC provide a variety of options starting at zero cost for improving ventilation in any facility. The options, quoted directly from the guidance, include:

» No cost: opening windows, inspecting and maintaining local exhaust ventilation, disabling DCV controls or repositioning outdoor air dampers.
» Less than $100: Using fans to increase effectiveness of open windows or repositioning supply/exhaust diffusers to create directional airflow.
» $500 (approximately): Adding portable HEPA fan/filter systems.
» $1,500 (approximately): adding upper room UVGI systems.

Advice from a ventilation expert can help ensure that any of these strategies are employed more optimally without any dead zones, air currents or other issues affecting part of your building. Some of these strategies will be more feasible in certain environments than others.

"In a gym space or larger space, trying to put in portable HEPA units probably isn't a great option, but there may be opportunities to improve filtration at the central equipment that's serving that space," Metzger said as one example. Even at the system level, the appropriateness of things like MERV 13 filters depends on whether your system can handle their use without compromising system function.

Metzger hopes that the current focus on ventilation won't ebb when the pandemic does. "Many of us who design buildings and assess them on a regular basis have known for years that we have significant deficiencies with ventilation in particular, but indoor air quality in general," he said. As the global population continues to increase, the likelihood of future similar outbreaks will increase too. "Any steps we can take to improve the built environment to make it more resilient are wise and frankly they can have added health and productivity benefits for occupants in general."

For now, many experts encourage thinking about mitigations like ventilation, filtration, distancing, masks, handwashing, avoiding crowds, quarantining and other measures as Swiss cheese. "The process of mitigating risk really needs to be a layered approach," Huffman said. "In any individual situation and cumulatively you can carve off pieces of risk here and there, but you can't ever get it to zero and no one of your tools is sufficient by itself."

A Time for Caution—and Optimism

A wealth of resources is available to help recreation managers make the right choices regarding their fitness and sports programming. But while the benefits of safer exercise and socially distanced sports are indisputable for physical and mental health during these difficult pandemic times, the risks of close-contact sports are also very real.

Given the expected distribution of effective vaccines in the coming months, the risks of close-contact sports in the near term may not be worth the rewards. "If we don't make the effort now to get to the endgame—to get to the vaccine and the time when most people are vaccinated—it's going to extend the period of doubt and misery," Roberts said. "We're all probably going to have to bite the bullet sometime, and I think if we all bit it together in a window of time, we'd all be better off." RM