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by Elaine K Howley

April 27, 2020

We’re on the coronavirus’s timeline now

Over the past several weeks, most of us have been unable to swim the way we’re used to. Pools across the country have been shuttered for over a month, and in many locations, beaches and open water venues are also closed or too cold to afford a comfortable workout.

This leaves many Masters swimmers wondering: When will we be able to swim again?

The short answer is: We just don’t know yet. And that uncertainty can be really hard to grapple with. But this is a complex situation with a lot of moving parts. There are several critical components that will dictate when we can safely get back to business as usual in the pool and open water.

Location

When you’ll be able to get back to swimming depends in large part on where you live. Mary Schmidt, an infectious disease specialist based in Virginia, says that for example, in Virginia, “there are areas where there are hardly any infections,” so they may be able to open up earlier. Meanwhile, other locations are still in the throes of the surge and are unlikely to be able to safely open up in the next few weeks.

She also notes that the risk of transmission of the virus “is probably proportional to the amount of people in the community who are infected.” If the risk is low in a specific community, you may be able to get back to swimming. But in locations where there’s still a lot of cases of COVID-19 and a high number of new cases being reported, you’re probably going to have to wait a little longer.

This regional variability has been reflected in stay-at-home orders. During a conference call for journalists affiliated with the Association of Health Care Journalists on April 14, Robert A. Bednarczyk, assistant professor of global health and epidemiology at the Rollins School of Public Health at Emory University in Atlanta said there’s been a “very patchwork implementation of various stay-at-home orders, shelter-in-place orders, and self-isolation orders. And there’s been both good and bad coming out of these.”

The good is that overall, we have managed to “flatten the curve” (or controlling a spike in cases so as not to overwhelm healthcare systems) a bit and have avoided a worse crisis. The bad? Some locations are worse off than others and it’s hard to know when the threat has fully passed. Assessments about safely opening up public spaces are necessarily going to vary from location to location.

Case in point, after instituting a strict lockdown in late February, Japan’s northernmost main island of Hokkaido lifted its state of emergency on March 19 after the number of new infections fell. Less than a month later, a second state of emergency was declared as infection rates rose dramatically. It seems officials were a bit too hasty in trying to reopen businesses and that caused a second wave of transmission.

The lesson from Hokkaido, if we’re smart enough to heed it, is that reopening is going to have to be a phased, gradual event that’s based on local conditions. Depending on the situation on the ground where you live, you might be able to get back to swimming soon. But if you live in a hot spot like New York City or Detroit, you might be in for a longer wait.

The Peak

Another factor to consider is what’s commonly being called a surge or peak. This refers to the most intense point of the crisis when hospitals could be overwhelmed by the influx of COVID-19 patients needing critical care. Stay-at-home orders have sought to “flatten the curve,” meaning that this peak would be made less severe.

In many locations, flattening of the curve has occurred and made a difference. Some hospital systems that anticipated being crippled by COVID-19 have been able to keep up with demand because many people did their part by staying home and delaying spread and transmission.

But it’s important to note that just because your city or state may have hit its peak already, that doesn’t mean you’re out of the woods necessarily. There’s still roughly about half of the total number of infections ahead when you’ve hit the peak. Though you may have helped flatten the curve to protect hospital capacity, such efforts can’t eliminate transmission. The virus is still circulating and transmission is still going to occur, just on a longer timeline with a gentler peak. By design, flattening the curve pushes out the date when the last transmission will occur.

Though the situation in your area may be a little different, as a nation, we’re probably not going to see a full peak until May or later, Bednarczyk says. “Even when we pass that peak, the virus will still be circulating, just at lower levels. My biggest concern is if the restrictions are relaxed too early, we may see a resurgence of disease,” like what’s happened in Hokkaido.

Some scientists are warning that this second wave of disease could be even more dangerous than the first. That’s in part because the virus is continuing to evolve and change, Schmidt notes, which could pose a greater threat. “Already within the United States, some of the codons within the virus’s RNA are changing a little bit.” Over time, those changes can accumulate, “so there’s real concern that this virus could mutate and suddenly become more deadly,” she says.

That risk could also be compounded by normal seasonal changes. Some epidemiologists warn that we could also see another healthcare crisis this fall, when COVID-19 as well as seasonal flu cases increase, creating a perfect storm that might again threaten hospital capacities and force another round of shutdowns.

Immunity

There are also many outstanding questions about whether or not COVID-19 infection imparts durable immunity. Typically, after being infected with a virus and recovering, your body develops antibodies that recognize the disease if you’re exposed again. The immune system “remembers” the previous infection, and you don’t get sick with the same disease a second time.

But we just don’t know yet whether that’s the case with this novel coronavirus. And even if you do develop immunity, we don’t know how long that might last. “If people don’t have long-term immunity and we open up the country and people are traveling back and forth again but we haven’t controlled the virus, we’re going to be back to square one,” Schmidt says.

Testing

The key to reopening pools and other facilities is to know who’s carrying the disease and who might be immune. A lack of testing capacity and our limited understanding of the long-term effects of COVID-19 are hampering our ability to fully quantify the impact the disease is having.

Increasing testing, both for active cases and the antibodies that may signify immunity, would help us make better decisions what can open up and who should continue to self-isolate.

Though testing is still a challenge in many locations, the situation is improving, Schmidt says. And antibody tests are coming online that will help us better understand who’s had the disease. Pharmacies and urgent care centers around the country are also rolling out expanded testing options that should help us get a handle on how widespread the virus is.

“Knowledge is important,” Schmidt says. Decisions about when you can swim again are going to come down to local conditions on the ground in your community, and that knowledge will be driven by testing. Lots and lots of testing. Municipal and county public health officials need to continue surveilling the situation to stay on top of what’s happening.

Contact Tracing

In addition to testing, contact tracing—or figuring out all the people a carrier has come into contact with—is an important piece of understanding who’s vulnerable and who’s still a danger to others. Contact tracing is a common strategy for containing a number of infectious diseases including tuberculosis. It’s also been used extensively in West Africa to ease Ebola outbreaks.

Contact tracing, however, is an onerous, time-consuming, and time-sensitive endeavor that requires dedicated and trained health professionals to perform appropriately. On April 21, Centers for Disease Control and Prevention director Robert Redfield announced that the organization would fund 650 health workers at state health departments to supplement the 600 CDC staff that are already in place to help expand the ability of federal and local authorities to conduct contact tracing. “As we open up, we need to reset our sights on what the primary strategy is to control this virus and that has got to be containment,” Redfield told reporters. “And that means we have to have the testing and capacity to contain-contain-contain this virus.” 

Where contact tracing may make its biggest inroads is alerting folks who’ve been exposed to the risk that they might be an asymptomatic carrier of the disease. The CDC says 25 percent of infected people may have no symptoms. Those individuals can still pass the disease onward, making them a threat to the most vulnerable individuals in the population.

Arrival of the Vaccine

Testing and contact tracing can help us contain the virus as it moves through the population. But prevention is the key to fully returning to a more normal way of life. Only with the arrival of a safe, effective vaccine can we confidently return to business as usual.

The most optimistic of timelines for when that’s going to happen is 12 to 18 months from this past March when the first clinical trials of potential vaccines began. (Currently there are 70 potential vaccines being tested.) Twelve to 18 months might sound like a long time, but in the world of vaccine development, it’s absurdly fast and would set all sorts of records. Some scientists are tempering that expectation saying the timeline until we have a vaccine might be more like 24 to 36 months.

By all estimates, we’ve got a ways to go before COVID-19 is something we can prevent with a vaccine.

OK, Then. When Do We Swim?

For some individuals who have the space and means, a small backyard pool with a tether is helping scratch the itch. For others, dryland training with resistance bands is helping stave off boredom and maintaining some swimming-specific strength and coordination. For a few, access to a safe open water location is a balm for a swim-starved soul.

And yet for so many others, none of these options is available and they’re not swimming at all. This can feel like an untenable and unsustainable state of affairs for those among us who rely on swimming to maintain good mental health.

So yes, we need to get back to swimming. And we will. We just have to open the flood gates slowly, cautiously, with an eye towards evidence-based science.

During an April 17 conference call for water park and swimming pool operators and managers, Justin Sempsrott, an emergency room doctor, medical director for Starguard Elite, and executive director of Lifeguards Without Borders, explained that some facilities may begin reopening on a phased process that follows recent guidance issued by the federal government. Facilities may implement new rules to limit the number of people in the building and may attempt to screen individuals at the door by checking for a fever and asking about symptoms and exposure to known carriers.

However, Schmidt notes that checking for a fever will likely miss up to 50 percent of people who are infected. “You’re more likely to have a fever if you’re 60 or older,” she says, so an absence of fever does not mean you’re uninfected.

In addition, any screening rules will create a burden for facilities that not all will be able to meet. They may not have enough staff available and those staff members may not have adequate training or authority to conduct or enforce screening protocols. Plus, strictly limiting the number of patrons who can enter the facility each day may make it difficult for some facilities to make enough money to warrant opening at all.

Sempsrott also noted that if local hospital and urgent care facilities have not returned to normal operations and are still overwhelmed or focused on COVID-19 cases, then the facility has “opened too soon.”

Both Sempsrott and Schmidt agree that the water is not the concern, because chlorine is an effective disinfectant and properly maintained pools are not transmission points. “If the pool’s properly treated, you won’t get coronavirus from the water in the pool,” Schmidt says. Instead, it’s the locker rooms, the bathrooms, and other communal spaces where patrons or workers tend to congregate that pose the greatest risk. That’s where we’ll need to be most careful when pools do reopen.

In the Meanwhile

While we wait for pools and beaches to reopen, we just have to be patient. Although you might not be able to swim right now, there are a few things you can do to help control the spread of the virus. These small actions may help bring us to a point of better control a little faster. For the time being, continue:

  • Observing local shelter-in-place and stay-at-home orders or advisories and observing local beach closures. If it’s not essential, don’t do it. And think carefully about what “essential” means.
  • Wearing a cloth mask if you do need to go out into a public space.
  • Practicing good physical distancing when in public.
  • Conducting frequent and thorough handwashing.
  • Keeping yourself healthy by eating right, staying hydrated, sleeping enough, and exercising as much as you can while maintaining social distancing.
  • Contacting your healthcare provider if you feel sick or come into contact with someone who’s been diagnosed with COVID-19.

“Do the small things you can do that can really have a big impact on your risk of spreading the virus to those you’re close to,” Bednarczyk says.

And, as a parting thought, Schmidt reminds us that this is all really important for individual as well as public health: “It’s nothing to be taken lightly. I’m frustrated that people are taking this lightly.”

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