Staying safe while you exercise: The Covid-19 sport and gym advisory

5 Sep 2020

Sport is a major part of physical and mental health for most people, and trying to return as soon and as safely as possible is a major concern for many of us. Understandably many people have questions about how to play and train safely. Here’s our advice based on the available evidence.

Coming up with an advisory to cover every niche sport is impossible. We have been approached for advice from groups as diverse as swimming clubs to clay pigeon shooting groups to mountaineers to indoor cricket and squash. The Ministerial Advisory Committee (MAC) on Covid-19 has also given advice on this (here).

However, understand some basic principles and you can almost certainly get back to the sport you love, with some adjustments.

Almost all sports can be made very safe (but not 100% safe), with the following basic principles:

Being sensible goes a long way. Keeping the basic principles in mind and applying them beats trying to follow instructions meticulously.

Outdoors is best. Dispersion with good ventilation helps a lot, and UV light in sunshine is free and effective as a disinfectant. Indoors, especially in closed crowded spaces, is where most transmission happens.

Masks work (although current masks may be impossible to use in swimming pools).

Be in close proximity with someone (<1.5m) for as short a time as possible.

Don’t engage in sporting activity or visit a gym when you are sick.

Sick employees must isolate themselves (see symptoms here ; and guidelines on isolation and quarantine here).

Sensible disinfection and regular hand washing is a good and easy thing to do (see our advisory here).

Be extra careful if you or a close contact has risk factors – advanced age, diabetes, hypertension, cancer, HIV, TB or any other serious illness. If you contract the virus, you may pass it on to someone who can get very ill or die, even if you have no symptoms.

Droplets, aerosol spread and masks: Do I need a mask to play basketball or swim?

Breathing heavily, talking and shouting, often key parts of many sports, increases the risk of spreading the virus; masks can mitigate this, but not completely so. This increased respiratory effort while doing sports increases risk significantly over, say, standing around a braai chatting, and defending at close proximity against an opponent at netball while breathing heavily.

Masks work! They may not be the most comfortable when you are sweating and panting, but they are essential indoors, and probably a good idea even for routine outdoor use.

There are already innovative designs emerging, that are more comfortable and accommodate sweating or even swimming, while fitting better, and minimising the annoying misting-up that people who wear glasses experience when breathing hard.

Anecdotally, people who wear masks for long periods of time during the day seem to have less discomfort wearing it during exercise – as the virus is here for the long haul, it may be worth sucking it up and learning to live with using them pretty much everywhere outside the home. For people who find the masks unbearable, and if exercising for long periods of time, take a mask break. Go to an isolated area, take off your mask and breathe in fresh air for about 10-15 mins.

Considerable concern has been expressed by some people about “rebreathing’’ and that carbon dioxide build up will occur and have health consequences. However, there is no evidence there is any danger in wearing a mask during heavy exercise nor that there is a decreased amount of oxygen breathed in while wearing one. The discomfort athletes feel is almost always related to the heat of the breath building up on their face, and feeling of claustrophobia associated with this, rather than a build-up of carbon dioxide (which, like oxygen, is a gas which easily diffuses through fabric).

Look for a mask that is comfortable. A stitched cotton mask or surgical mask is preferable over T-shirt or elastic masks. In the unlikely event that you breathed enough carbon dioxide to make a difference (a very tight mask with very heavy breathing), you would have to stop until your levels returned to near-normal (you will feel less out of breath), with no long-term harm.

Some people ask if masks are even necessary in certain situations, such as outdoors – golfing, tennis, jogging or mountain biking. Again – be sensible and assess the context. Someone climbing a mountain or jogging with a friend outdoors is probably safe; someone cycling in a tight peloton for hours maybe not as safe.

In addition, think about the unsafe scenarios that follow from relaxing routine universal masking – it may be completely safe playing doubles tennis, but congregating at the drinks area, or going to the toilet, when you left your mask behind, may add to risk. For this reason, simply having routine masking rules may be simpler for most sports, and certainly for gyms, as it makes things easier to monitor for supervisors.

The great outdoors, and indoor ventilation: Should I take my spin bike outside?

Outdoors is your friend!

Doing anything outdoors dramatically decreases risk, especially in sunlight, combining rapid dispersal of droplets with sunlight’s natural and free disinfecting UV light. Outdoor golfers, runners, mountaineers and tennis players should rejoice. Outdoor soccer and hockey players may need to reassess some practices (team huddles, player-on-player post-goal celebrations), but otherwise, as long as not in close proximity with each other for more than a few seconds, should be safe.

Ventilation is also your friend!

You can turn an indoor venue practically into an outdoor one, if you open enough doors and windows, and add a fan for good measure. Think squash courts, gyms, spinning studios.

Distancing: How safe is my child in a rugby scrum with me screaming support on the sidelines?

Physical distancing is important – the 1.5m guidance is simply a guide, but helpful and may not be enough if breathing hard.

Remember that the time you spend in close proximity is important – you want contact to be as short as possible. Think soccer – contact may be briefly less than 1m, but it’s usually for just a few seconds at most, and very unlikely to be a significant contact. A rugby scrum is a different story – avoid it.

Certain contact and team sports may have to adapt substantially. It is difficult to imagine how a rugby scrum or boxing can be made safe, but creative minds may need to be applied to safety measures or changes in rules. Team huddles may be a thing of the past.

Don’t forget the spectators. Shouting support in indoor crowded stands is a bad idea; some distancing, and moving outdoors, and insisting on masks, makes it safer.

Distance and time determine risk: The farther the distance and the shorter the time, the safer. A short distance (let’s say within 1m) over a prolonged period (let’s say 10 minutes) is risky.

Surface spread: Can I pick up my tennis ball after someone has served it?

Disinfection works and is easy (see our guidelines here). The virus can be grown off surfaces, but there is doubt as to whether objects and surfaces are a major source of infection. Again, though, sport is a context where someone may be breathing large amounts of virus heavily onto a surface, so taking some basic precautions can go a long way, until better evidence is available to guide us.

Simple “soap and water’’ wipe-downs of equipment together with regular hand-washing mean commonly handled equipment and balls can be made very safe.

For regular “high touch, high volume’’ contact, like with tennis, squash, net or basketball, can be made safer by ensuring everyone washes their hands thoroughly before starting the game, and regular sanitising happens. The practice of spitting on a cricket ball to shine one side is probably not a good idea.

No deep cleanings, no fumigation or disinfection tunnels are necessary, in any situation to prevent Covid-19, and may be harmful. This is not a tough virus and simple, cheap measures are all that are needed.

So, what about the swimming pool?

A properly maintained pool will have sufficiently high levels of chlorine to inactivate the Covid-19 very quickly. The water is thus not a concern – other swimmers may be. Again, avoid crowding both in and out of the water, place your towel and other stuff somewhere clean, and make sure you use your own only – no sharing of anything.

Outdoors is king also when swimming – air movement and sunshine will quickly take care of any infectious virus.

Children and sport

See our advisory on schools here. Sport provided at schools is a major developmental component of education, and the guidance above should be adapted accordingly to school situations. Children may often share equipment – eg: swimming goggles – and monitoring may need to be better to catch these lapses. If sports classes can go outdoors, they will be very safe that way.

Is my gym taking this seriously? Advice for owners and managers

The virus is likely to be around for the next few years, so having medium- to long-term plans in place is important.

Gyms should even consider rebuilding if needed – the more ventilation, the better – think large open windows and fans, with sunlight. Move activities outdoors wherever possible, if this space is available. Complaints about being cold outdoors or with open windows may need to be met with a “dress warmly’’ firm response.

Booking systems to prevent overcrowding may be needed. There could be a designated time slot for clients at particular risk– over 60 years, with serious chronic diseases – with a reduced capacity allowance. Routine masking should go without saying – no mask, no exercise. Encourage clients to bring their own water bottles and have dedicated filling stations, to decrease clustering at water fountains.

Open, friendly communication in the form of posters and staff insistence regarding masks, physical distancing, hand washing, putting down toilet lids when flushing etc – should be everywhere, as should hand-washing and sanitising stations.

Ideally, sanitising stations should be next to each piece of equipment, to encourage frequent hand disinfection. Equipment (treadmills, spinning bikes, multi-stations, etc) could be moved (or some pieces removed) to provide a 1.5m space between pieces of equipment.

As above, common touch areas should be wiped down regularly with soap and water (see our advisory here) – think weights and strength building equipment. For free-standing weights, consider a “clean’’ pick-up and “dirty” drop-off area, where a cleaner can wipe them down. Provide wipes and disinfectant to clients so that they have the option to wipe down their own equipment.

Showers are probably safe, if ventilation is good, handles wiped down, and users are using soap, which should be freely available in the shower. Singing should be discouraged.

Swimming pools are pretty safe – the virus is immediately diluted by the water and chlorine has disinfectant properties. Try to limit the number of people congregating in one area of the pool, and the same goes for saunas and spas. Masks may be impossible to use in a pool (and as long as physical distancing is done, it’s probably okay); new generations of waterproof masks may be available soon.

Ideally, the staff should work in fixed shifts, to minimise “cross-over’’ with other shifts.

Pay attention to educating staff regarding infection control beyond the gym – the risk using public transport or at home is likely to be substantially higher than a well-organised workplace. Staff should stay home if at all symptomatic and have paid sick leave during this time to avoid covering up symptoms so as to return to work.

Cleaning staff will need specific training on how and where to disinfect. There is no reason to close gyms down for “outbreaks’’ (among clients or staff) – leaving them overnight, with wiping of these common surfaces, is fine.

If staff members or clients are identified with an infection, a non-confrontational and empathic enquiry by the manager to ascertain whether the infection plausibly could have been contracted in the gym (and appropriate action taken, especially as there are occupational health laws around acquiring the virus at work), is a good idea. This can be exceptionally difficult in real life to ascertain with certainty, so rather focus on the prevention mechanisms above.

Cardio equipment – such as spinning bikes and treadmills - should ideally be right next to an open window. For common class work – yoga, pilates, spinning – wiping down surfaces after a session is important. Class work could be streamed live for some members to join online and so reducing the number of people physically attending.

Markers can be placed on the floor for designated individual exercise zones (1.5m apart). Clients should be encouraged to bring their own equipment to classes if possible (yoga mats, yoga ball, resistance bands, etc.)

Coffee and restaurant areas can be opened with the physical distancing, and other guidance above.

Routine temperature-taking at the front is probably unnecessary, but sometimes serves as a useful reminder to any one of the rules. Government guidance requires collection of contact details from everyone entering a gym or facility, so while they are writing in their details, this can be done while taking temperature, ensuring they have an adequate mask and that they are aware of the various safety rules.

Be aware of the Protection of Personal Information (POPI) Act in terms of the safekeeping and destruction of personal information that you collect.

See the link to the government guidelines here.

Testing, testing: Can I rule out I’m infected before my heavyweight prize fight?

See our advisories here and here.

Short answer, PCR testing has a substantial risk of false-negative results if you are positive, and can be positive even though you are no longer infectious, so not a great test to rule out infections (and expensive too).

We have seen some professional rugby and soccer teams going for testing, before a match. This is very risky. Imagine that in a 15-person rugby team, three have Covid-19. On average, about one of the three will have a false-negative result, and gets sent into a scrum while being infectious. Rather than low yield, expensive and administratively difficult testing that gives false reassurance, pay far more attention to the advice above, as this will yield far better results.

At this point, doing a serology antigen test is totally pointless. The test only tells you that you were safe several weeks ago, and nothing about the last two weeks. New antigen-based tests may be useful, so watch this space, but currently be very wary of people marketing these tests to individuals. Throwing money at it will not make it go away – following the precautions will make your risk a lot smaller! DM/MC

*The Scientists Collective Authors:

Dr Karlien Moller, Dr Esther Bhaskar, Dr Bronwyn Bosch, Prof Francois Venter, all at Ezintsha, Wits University;

Prof Wolfgang Preiser, University of Stellenbosch

Andy Gray, Division of Pharmacology, Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal

Prof Shaheen Mehtar, University of Stellenbosch

Dr Elijah Nkosi, Prof Morgan Chetty, both family doctors

Prof James McIntyre, Anova Health Institute

Prof Marc Mendelson, University of Cape Town

Prof Lucille Blumberg, National Institute of Communicable Diseases (NICD)

Dr Angelique Coetzee, South African Medical Association

Prof Yunus Moosa, Head of Department of Infectious Disease, University of KwaZulu-Natal

This is the fifth of a series of Expert Advisories on how to respond to Covid-19 published from time to time by Maverick Citizen. The previous advisories were on:

How long should I isolate or quarantine for? (here)

Practical guidance on disinfecting (here)

Testing for Covid-19? All you need to know about antibody tests (here)

Children, Covid-19 and Classrooms: A 10-point plan for making schooling safe (here)

The series is co-written by some of South Africa’s leading medical scientists and academics, including some members of the Ministerial Advisory Committee (MAC) on Covid-19. It is intended to provide practical life-saving advice based on the best emerging knowledge and evidence of Covid-19.

We are learning all the time so it is highly likely that advice will change as we learn more about the virus, so keep an eye on any new recommendations. However, the basic principles explained in this series will stand and help inform your decisions.

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