UPDATE #16 | 20 May 2020
Advisory on COVID-19
SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

NOTE: THERE WILL BE A SUBSEQUENT ADVISORY ON COVID-19 PROVIDED ON 21 MAY, 2020 AT 4:00 PM EDT.


Disease Update
The number of confirmed cases of COVID-19 is over 5 million with 2 million recovered and 325,000 deaths. Mortality rate worldwide is at 6.52%. We are continuing to see prolonged second waves in countries that had relaxed their restrictions and some countries that had relaxed are now restarting more restrictive measures again. This is being monitored closely as this will have an impact on how other countries including Canada manage restrictions and relaxations in the future.

In Canada we have over 79,000 cases, 5,900 deaths and 40,000 (51%) recovered. Of the 33,000 presently active cases in Canada 97% are classified as mild. Several provinces have gone more than 14 days without any new cases, and most provinces have plans in place for stepwise relaxation of restrictions.

This progressive relaxation of restrictions will have an impact on training and access to facilities, but timing will differ across regions and across different sports and is yet to be finalised or confirmed. SMAC, OTP, COC, CPC, Sport Canada and all sport partners / task groups are working to pre-empt these relaxations to ensure safe and rapid return to training with the emphasis on targeted high-performance sport.


Training
As per the previous updates we strongly encourage athletes to take this enforced self-isolation period to work with their Coaches, HPDs, IST and CMOs to address any known biomechanical and physical deficiencies that are easily addressed with home training and NOT to be attempting to reach peak performance this summer (the rationale have been addressed in earlier releases). In addition, we would recommend taking this opportunity to also work on mental resilience and mental training.

 
Institutes and Training Facilities
At this stage all Canadians remain under national and provincial public health guidance and as such all institutes and public training facilities remain closed at this time. The timing and level of operations possible will be dependent on the local restrictions in place at the time and vary from one institute to another. A summary of present status is below.
 
INSQ
Offering virtual services and in negotiation with Public Health on potential opening of the facility although no specific dates are known at this time. 
 
CSIO
  • The Government of Ontario has approved, in principle, group training for professional and high-performance sports that meet requirements set out by the separate Ministries of Health, Labour, and Sport.
  • CSIO is working with its partner sports to submit proposals specifying adequate traffic control, distancing, and hygiene / disinfection protocols to resume group training for a number of sports at several venues, to begin as approvals are granted.
CSIO Services :
  • Remote services continue to be offered to affiliated athletes pending any re-opening.
  • When S&C space re-opens, it will be for targeted partner sport groups. Open / drop-in training hours will not yet resume.
  • Other IST services (medicine, therapy, nutrition, mental performance, physiology, biomechanics) services will continue to be available remotely only for the time being.

CSI Calgary
CSI Calgary facility / indoor training remains closed at this time. There is a Phase 1 Return to Indoor Train/Play/Work ready for when the government allows opening.
 
CSI Pacific
CSI pacific is still closed and are offering virtual services as per previously. Currently they are preparing a return to sport document with their building partners and hoping for opening early to mid-June in collaboration with public health officials.
 

Return to Training in Clubs and Groups
The Return to Sport Task Force is in the final draft of their National Framework for COVID-19 Return to High Performance Sport and the paper is expected to be released on or about 25 May 2020. 

Along with this framework there is also a Club Risk Assessment and Mitigation Checklist Tool that has been developed and will be available simultaneously for use by sports clubs and facilities.


Testing for COVID-19
  A subgroup of the Sport Medicine Advisory Committee has created enhanced testing and monitoring protocols for returning sports which may include testing through the Canadian Sport Institutes or local testing centers. The plan will be released in a special SMAC update on May 21 2020.
 

Mental Health Update
The Psychology of Return to Group Training
As NSOs develop their plans for return to group training, there are many factors that need to be taken into consideration including risk assessment, risk mitigation and organization of logistics. Leaders are encouraged to consider the psychological response and incorporate strategies to protect mental health and promote mental fitness as teams return to the training environment.

Returning to group training environment is going to be a vastly different experience for everyone as restrictions necessitated by the Covid-19 pandemic start to be lifted. In addition to changes in ‘how’ teams are able to train and the mitigation efforts required to train (i.e. masks, physical distancing), there will be a psychological component that accompanies the extent of changes, and the accumulated effects of the previous isolation period. The sport community should anticipate a range of reactions, and embrace flexibility and adaptability taking individual experiences into account throughout the planning and reintegration process. A framework adapted from psychology expert Dr. Bill Howatt can assume 3 individual types of reactions:

1.       Come back to training with no issues- let’s get back at it!
  • These individuals have not been significantly impacted and are ready to start training.
  • Need to manage these individuals’ expectations regarding the “new normal” and be clear on risk mitigation procedures to which they must adhere.

2.       Fearful and anxious of contamination or second wave
  • These individuals have high levels of fear and anxiety of exposure to virus and may not be comfortable with returning to group training yet feeling the pressure to do so.
  • Need to explore individual comfort levels and respond without judgement, creating a psychologically safe environment for all to train and choice for all involved.

3.       Personally, impacted by COVID-19 or experienced secondary trauma
  • These individuals are significantly impacted financially, psychologically, and/or emotionally as a result of COVID-19 related losses (e.g., loss of loved ones, job loss).
  • Need to be sensitive to personal circumstances and have options for necessary supports with potential gradual reintegration.

The aim of this framework is to create awareness that a range of reactions will exist, and that the different responses will require different supports from the environment. Individuals may also cycle among the different reactions. As such, leaders and medical professionals should be aware and assess for individual differences, and ensure the necessary supports are in place to meet these needs.  

As a starting point, the following are some recommendations to consider based on the framework that has been presented and the needs that have been identified by the Mental Performance Consultant community currently serving the NSOs.

Assess individual needs and different levels of comfort for returning to group training
  • Although the risk assessment/ mitigation process may demonstrate that return to group training is prohibited, need to explore individual perspectives, and offer choice without judgement.
  • Recommendation: Consider having a group session to present the information and follow this up with individual meetings as required with either MPC or objective staff member. Provide a list of resources that athletes, coaches and staff can access if in need of further psychological support (Game Plan Resource).

Attend to anxiety that may be produced by perceived disadvantages and/or fear of contamination
  • As international, national, and provincial restrictions get lifted across different timelines, athletes and coaches may focus in on the competitive advantage that can come with earlier access to training environments. Anxiety can start to rise, which can lead some individuals to be tempted to make decisions that are not fully or partially aligned with health regulations.
  • Recommendations: Redirect athletes’ attention to focus on what is within their control and the opportunities that may exist. This can involve identifying the gains that can be made under the current training circumstances and opportunities to develop areas (like mental fitness, injury recovery) that may otherwise not have been a focus. This can also assist with perspective by working back from the Olympics/Paralympics and looking at what is needed to be optimally prepared (i.e., use successful return from injury in limited time frame at past Games as case examples)

Manage frustration that may come with new ‘risk mitigation’ training protocols
  • As teams return to group training, there will be increased efforts to mitigate risks and thus new training protocols to which the sport community will need to adapt, leading to potential frustrations and depletion of energy.
  • Recommendations: Manage expectations by clearly outlining the procedures and efforts required by individuals entering the training environment. This will help athletes to conceptualize and understand modifications and make adaptations to transition to the ‘new normal’. 

In summary, when planning for return to group training, leaders can optimize their sport environments by considering all aspects of the athlete’s experience (including fluctuating emotions), have open and honest conversations about benefits and drawbacks of new protocols, and ensure supports are in place to attend to the mental and emotional needs of the sport community. 


AN UPDATE WILL BE PROVIDED EVERY SECOND WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.
Updated links from the Government of Canada and WHO
Further Questions:
Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

  • Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
  • Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
  • Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
  • Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
  • Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
  • Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca