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by Elaine K Howley

July 27, 2020

What’s changed since March and how that might impact your swimming?

Editor's Note: U.S. Masters Swimming previously covered this topic here.

When the World Health Organization declared the novel coronavirus outbreak a pandemic in mid-March, swimming stopped for a lot of us. Pools around the country closed, and as of late July, only some have reopened, and many are operating in a much-reduced capacity. New protocols have been instituted to help keep swimmers safe, and each facility is approaching its reopening plans a little differently, based on local conditions and regulations.

Over the past five months, we’ve learned a lot about this new disease and how it’s transmitted. Although there’s still a lot that isn’t clear about the coronavirus and the potentially deadly disease it causes, COVID-19 (also called SARS-CoV-2), we have learned a great deal about what to expect from infections and how to slow transmission.

With regards to swimming, here’s a summary of current public health advisories and scientific understanding of what you need to know. Awareness of these key aspects of the virus and how it moves can help you keep safe as pools around the country resume operations.

Airborne Transmission

The coronavirus can be transmitted via tiny droplets, called aerosols, expelled from the lungs. On July 10, the WHO acknowledged the mounting evidence that the virus is airborne—after being urged to declare it so by a group of more than 200 scientists around the world.

This is an important adjustment to previous statements about the nature of the virus, as it lends weight to the understanding that airborne transmission via aerosolized droplets appears to be the predominant way in which the virus moves from person to person. Keeping your distance and wearing a mask have become the key public health recommendations that are currently being urged to suppress transmission rates.

As a result of this updated information, boosting ventilation of indoor spaces has also taken on increased priority. When a volume of air is continually circulating and fresh air enters a space, that can help dissipate aerosolized clouds of the virus that would otherwise accumulate in an enclosed area with poorer ventilation.

Some indoor pool facilities are placing large fans on deck and opening doors and windows or upgrading their HVAC systems to improve airflow, which is good not only for dispersing any airborne viral particles, but also for reducing levels of chloramines that can build up in the space and potentially cause irritation of the lungs and eyes.

Surface Transmission

Studies conducted early in the pandemic found that the virus can survive on hard surfaces like plastic and steel for up to three days, and initially, it was believed that this could be a major route of disease transmission. Now, however, some scientists are suggesting that risk of surface transmission should be a secondary concern. On May 20, the CDC issued revised guidance noting that while it’s certainly possible for someone to contract the virus via a contaminated surface, this is not a primary mode of transmission.

Nevertheless, employees at many public spaces, such as pools and gyms, are being careful to clean all shared surfaces and spaces after each visitor leaves in an effort to eliminate this potential means of transmission. For peace of mind, it’s best to wipe down any shared surfaces frequently with a bleach-based cleaning product and wash your hands before touching your face, nose, mouth, or eyes.

Asymptomatic Transmission

It’s becoming increasingly clear over the past few months that people who are infected but show no symptoms can still pass the virus on to others. Our understanding of exactly how big a threat asymptomatic transmission might be is still evolving, but this is yet another reason to wear a mask when in shared or public spaces even if no one is showing any symptoms of infection.

Chlorine Kills

The CDC reported on March 10 that “there is no evidence that COVID-19 can be spread to humans through the use of pools and hot tubs. Proper operation, maintenance, and disinfection (e.g., with chlorine and bromine) of pools and hot tubs should remove or inactivate the virus that causes COVID-19.” This appears to still be true. Although direct evidence is limited, there’s little reason to suspect that you might get sick with COVID-19 when swimming in properly treated pool water.

On May 20, the CDC issued new safety guidelines for the safe operation of pools and gym facilities, which were updated again on July 15. Things are changing quickly regarding our understanding of this virus, so expect that guidelines and recommendations will continue to evolve as science unravels the particulars of this virus.

In the meantime, check with your pool to find out what its safe use protocol entails, but know that the water itself is not the threat. Rather, it’s the people you’ll come into contact with on your way to and from and at the pool who are potential vectors.

Open Water

During the height of summer, many Masters swimmers are getting their swim on in open water, which seems to be a good alternative to swimming in pools, especially if hours and spaces are limited at your facility. Sunlight rapidly inactivates the virus, and being outdoors where there’s plenty of airflow reduces the chances of transmitting the virus between people. For the time being, open water—as long as you have access to a safe site and a partner to swim with in a socially distanced manner—can be a great option.

Hand Washing Still Crucial

Though surface transmission of the virus seems to be a little less of a threat than was initially thought, handwashing or using hand sanitizers are still considered critical means of reducing the risk of transmitting the virus. Don’t touch your face or eyes with unwashed hands and be careful to wash for at least 20 seconds with soap and warm water or use a minimum 60 percent alcohol-content hand sanitizer and lather your hands for at least 20 seconds if soap and water aren’t available.

Social Distancing Still Key

The closer contact you have with others, the more likely you are to become infected or spread the coronavirus to others. Many public health authorities are now using the term physical distancing to better describe the physical separation that should be kept between yourself and others. Take care to stay at least 6 feet away from others at all times, especially when sharing an enclosed space. This is the simplest way of reducing the risk of viral transmission.

Mask Wearing is Vital

Because it’s now known that the virus can pass easily between people via droplets expelled from the lungs, wearing a face mask when you’re in proximity to others is now considered the most important thing you can do to keep yourself and others safe from infection. Studies have shown that a simple cloth covering can greatly reduce the transmission of viral particles from one person to another via droplets expelled from the lungs while talking, laughing, coughing, or singing. 

Initially, public health officials advised skipping the face mask unless you had symptoms in an effort to make sure that enough supplies would be available to health care workers. But it’s now clear that everyone should wear a mask when in public.

Many pool facilities now require that all patrons wear a mask when entering the facility, and you’ll probably be required to wear the mask on the pool deck, right up until you enter the water. Obviously, don’t wear your mask in the water itself, as a wet mask becomes nearly impossible to breathe through and could be dangerous.

Quarantine As Necessary

It should go without saying that if you’re sick or have received a diagnosis of COVID-19 or a positive COVID-19 test, isolate yourself to reduce the risk of transmitting the virus onward. Initially the CDC was saying you should self-isolate for at least 14 days to avoid sharing the virus with anyone else and wait at least 72 hours after your fever has broken (without the use of fever-reducing medications) to leave isolation.

But as understanding of the virus has evolved, the CDC issued updated isolation recommendations on July 20 that stipulate you should isolate for 10 days after symptoms begin and for at least 24 hours after your fever has broken (without the use of fever-reducing medications). If you have received a positive test but are asymptomatic, you’re also urged to isolate for 10 days from the testing date.

Those recommendations cover mild cases. For more severe cases, the CDC says that isolation for up to 20 days after the onset of symptoms may be warranted.

In all cases, work with your doctor for tailored support and advice, and let the appropriate authorities know about your status so that contact tracers can alert anyone you’ve come into contact with of their potential exposure to COVID-19.

Symptoms and Complications

Initially, COVID-19 was thought to be strictly a respiratory disease, with cough, fever, and shortness of breath being the primary symptoms. But as more people have become infected, it’s becoming increasingly clear that individuals can have a wide range of responses to the virus and symptoms of infection.

Currently, symptoms of COVID-19, which typically arise within two to 14 days after exposure, include:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Congestion, sore throat, or runny nose
  • Nausea, diarrhea, or vomiting

If you have any of these symptoms, contact your health care provider for guidance on how to proceed. You may be told to get a COVID-19 test. Testing still remains difficult to access in some parts of the country, so be prepared to wait a few days for results. During that waiting period, self-isolate and assume that you're positive for COVID-19.

If you or a loved one develops any of the following emergency warning signs of COVID-19, seek emergency medical care immediately:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face

Though COVID-19 is largely described as a respiratory illness with pneumonia being the primary cause of death, it can also cause a hyper-inflammatory response called a cytokine storm, that may be especially dangerous for some people.

In addition, COVID-19 infections have been associated with the development of blood clots and other vascular issues that could trigger a stroke or pulmonary embolism. Emerging research also suggests that it can cause a range of other potentially dangerous inflammatory responses in certain people, with the multisystem inflammatory syndrome in children (or MIS-C) being a rare but scary complication of the infection in kids and teens.

Some people continue to have symptoms for much longer than the typical 14 to 20 days. These individuals are now being called long-haulers, and the virus’ long-term impact on their bodies is being closely watched. Some individuals who have recovered find that they are unable to resume their pre-COVID-19 activities. We also don’t know yet whether having had the illness confers immunity to future infection, and if so for how long.

Case Counts Still Climbing In Many Areas

One of the most frustrating aspects of this pandemic is its local nature. In the beginning stages, densely populated coastal cities were hit hardest. As those regions struggled to contain the virus and eventually flattened the curve, many other areas with much lower case counts pushed to reopen.

Alas, that led to a new spike in infections in other parts of the country. Now, Sun Belt states including Florida, Arizona, and Texas are hotspots that may require additional lockdowns or other mandates to help slow their surge. It’s akin to a massive, deadly game of whack-a-mole that seems likely to continue playing out until we have a vaccine.

Currently, no matter where you live, pay attention to your local public health authorities about what’s safe to do and what activities you should avoid. And be sure you understand and follow the safety protocols being instituted at your pool before you head over for a swim. This advice counts double if you live in a region that’s part of the ongoing surge in cases and deaths.

Vaccines and Treatment

Scientists and researchers are making significant progress in their quest for a vaccine, but while the current outlook is positive and several trials have been going well, we’re still a ways out from having a safe and effective vaccine for COVID-19. Most experts say that although a viable candidate may be identified by late 2020 or early 2021, it will likely take several more months, possibly even years, to ramp up production to the point where everyone can be vaccinated against COVID-19.

In the meanwhile, urgent work continues on the development of effective treatments for the disease. In May, an antiviral drug called remdesivir was found to have modest effect in speeding recovery and reducing risk of death in some severe cases of COVID-19. Since then, there’s been a run on this medication, and shortages could make it difficult to procure for those who’d benefit most from receiving this potential treatment.

In mid-July, another treatment candidate began showing promise. An inhaled from of a commonly prescribed interferon beta drug seemed to reduce the odds of patients becoming severely ill with COVID-19. But this treatment, as with all others, still needs more long-term study to determine its safety and efficacy.

Therefore, as with any disease, your best strategy is to avoid becoming infected in the first place. The arrival of a vaccine will make avoiding that fate easier, and a proven treatment protocol could make the illness less deadly. But until we have those things, you should:

  • Practice social distancing
  • Wear a mask
  • Wash your hands frequently
  • Take care to avoid contact with others who may be carrying the virus
  • Stay healthy by eating right, getting plenty of rest, exercising, and controlling comorbidities such as diabetes and high blood pressure that have been associated with worse outcomes of COVID-19 infection

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