SPORT MEDICINE ADVISORY COMMITTEE
UPDATE:
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As of March 21 the number of confirmed cases of COVID-19 is over 285,000 globally, with approximately 91,000 recovered and over 11,800 deaths. The largest surges in cases continue to be in Europe (with Italy, France, Germany and Spain being hardest hit) and Iran. The USA has also reported accelerated numbers of new cases. Of note there have been more cases in Canada than in Japan at this point.
In Canada, the numbers are rising at an accelerated rate, with over 1,000 confirmed cases, and 12 deaths. The Public Health Agency of Canada still states that the overall risk of infection in Canada is low, but the entire nation needs to work together to “flatten the epidemic curve” through minimising spread is key.
Hygiene and Social Precautions:
- All Canadians should stay at home, work from home, and exercise at home to the extent this is possible.
- Maintain a distance of 2 metres from other people.
- There is a preferred hierarchy for handling coughs and sneezes.
- Best practice is to expel respiratory droplets into disposable tissue, dispose of it safely, then immediately wash or sanitize hands.
- Expelling respiratory droplets onto a flexed elbow is better than no protection or an unprotected hand but it is non-optimal, as virus then remains on either the clothing or skin of the elbow depending on attire, either of which then need to be washed.
- For protection of others – assume you are infected and behave as such.
- For your protection – assume all others are infected and behave as such.
Updated Government of Canada Recommendations:
- All non-essential travel outside Canada is to be avoided, the US border is closed to non- essential traffic. All Canadians currently abroad are urged to return to Canada ASAP.
- All travellers returning from any destination outside of Canada are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation).
Sports and Institutes:
- The IOC and IPC are working daily with International Sport Federations to develop fair alternate qualifying processes.
- INS, CSIO, CSIC, CSCS, CSCM, CSIP and CSCA are all physically closed but are providing remote services as many staff are working from home. Contact your regional institute or centre as below for details on accessing service. These are left here for rapid access.
- If you as an athlete are not formally affiliated with an institution then your first choice of medical contact should be your personal or family physician, your sport’s team physician or IST lead. If they are not available or you do not have any of these then you may seek advice from the CMO of your region’s closest Canadian Sport Institute (see contact information below).
- Services currently available at Canadian Sport Institutes and Centres:
CSI Pacific
- All CSI Pacific staff are working remotely and at present, providing only remote support and services to their sporting partners.
- As the Camosun Athletic and Exercise Therapy Clinic is closed, Medical and Paramedical providers are also only able to provide remote services at this time. If an athlete would like a medical consultation, please contact CSI Pacific CMO Dr. McCluskey at [email protected].
- If an athlete would like a physiotherapy consultation, please email Sue Lott at [email protected].
- If you would like a Strength and Conditioning Consult, please contact your sport's CSI Pacific Strength and conditioning lead.
- If you would like a Physiology consult, please consult your sports physiology lead.
CSI Calgary
- Physicians are available for in-person clinical appointments by contacting our Medical Coordinator at 587-830-2240 or [email protected]. General advice and/or follow-up appointments can also be arranged remotely via telephone pending each athlete's unique situation.
- Athletes in need of sport therapy services should contact their team therapist directly by email or telephone to schedule in-person or virtual rehabilitation. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number / email address above.
- Strength and conditioning staff are also available for in-person or remote consultation, please contact your coach directly by email or phone.
CSC Saskatchewan
- Nutrition and mental training, and strength and conditioning contact your service provider via email, or Travis Laycock at [email protected] or the Athlete Services Manager Kia Schollar at [email protected]
- Game Plan and mental health services contact Lisa Hoffart (Game Plan Advisor) [email protected]
- CSCS/Sask Sport offices are closed to the public, but can be reached via email at [email protected] or cell phone at 306-281-5814.
CSC Manitoba
- Nutrition and Sport Psychology services continue as usual. Please contact your service provider or the Athlete Services Manager, Scott Sywy ([email protected]) for access.
- Strength & Conditioning services are being provided over video link. National Team and NSO identified athletes are being provided with equipment for home use following an assessment of needs and space constraints. Please contact your service provider or the Athlete Services Manager, Scott Sywy ([email protected]) for more information.
- Lab/Physiological testing is available to athletes on a 1-to-1 basis, provided they have adhered to any quarantine or self-isolation protocols following travel or potential exposure. To discuss specific circumstances, please contact our Physiologist, Jeremie Chase ([email protected]).
CSIO – switchboard 416-596-1240
- Physicians are available for remote consultation by contacting our Medical Coordinator at 647-725-4105 or [email protected]. We are actively contacting everyone who had an existing physician appointment when we closed.
- Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number or email address above.
- Strength and conditioning staff at CSIO also remotely communicating with the athletes they normally train, are available for remote consultation, and can be contacted directly by email or phone.
INS Québec
- Physicians are available for remote consultation either by contacting them directly or through our medical secretary who is working remotely too 514-255-1000 ext 301 or email: [email protected]. All athletes who had an appointment were contacted either by phone or email.
- Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the medical secretary at the number / e-address above.
- Strength and conditioning staff are also available for remote consultation. They are working on developing home programs, implementing web sessions (for small groups) and we are exploring equipment loan programs.
CSC Atlantic
- CSCA staff is all working remotely. All performance services experts are prepared to assist athletes and coaches as required.
- All Game Plan services are available as well as inquiries regarding specific challenges that athletes are facing through this period of uncertainty.
Additional Information
- As noted before athletes should not seek on-site medical attention for respiratory conditions (cough, fever, runny nose, sore throat) at CSI clinics if they are feeling ill. Consult with local public health authorities or CMOs by telephone or email to discuss treatment, isolation or the need for testing.
- Over the last 48 hours there have been multiple closures and restrictions on public gatherings, restaurants, bars, casinos, gyms, libraries, etc. across the country. This varies by region. Check the provincial links here (PROVINCIAL LINKS) or your own city links for details and specifics.
Caution re: Anti-Inflammatory Medications / NSAIDS:
- There have been some suggestions published in recent medical literature that people with suspected COVID-19 should avoid non-steroidal anti-inflammatory drugs (so-called NSAIDs such as: ibuprofen / Advil / Motrin; naproxen / Aleve; diclofenac / Voltaren; ASA / Aspirin; others) for symptoms and use acetaminophen / Tylenol instead.
- While some authorities including WHO are questioning the evidence on this issue, we believe it is presently prudent to avoid NSAIDs, and recommend that if symptomatic relief of fever or aches and pains is required, you should use acetaminophen (e.g. Tylenol or other brands thereof), not NSAIDs.
Training Environments:
- It is currently recommended that all Canadians should stay at home and exercise at home to the extent that is possible.
- Canadians who should be self-isolating for reasons of recent travel, any symptoms of illness, or contact with will ill should NOT train in outdoor environments; they must remain at home.
- Athletes with symptoms of illness are advised not to exercise and seek medical advice.
- If it is not possible to train at home, then training in outdoor or indoor fitness facility environments must follow practices that maintain distance and hygiene:
- Avoid crowded spaces; no spaces should contain more than 50 people.
- Avoid public transit if possible. Walk, ride a bike, or use a private vehicle if possible.
- Spacing of 2 metres between people (equivalent to 4 m2 of space per person in indoor environments) must be maintained.
- Do not share equipment; each athlete must use their own equipment.
- If training in indoor environments, wash or disinfect your hands before and after touching any equipment or surfaces. Disinfect all touched surfaces with EPA-approved disinfectants (70% alcohol, quaternary ammonium chlorides, 4% hydrogen peroxide).
Mental Health:
- The National Sport Partners have initiated a COVID-19 Mental Health Task Group that will coordinate sharing of best practice within the community of Mental Performance Consultants (MPCs) and Sport Psychologists. National initiatives will be driven by the Task Group, if needed, in response to NSO-driven requests and needs. For more information speak to your NSO or COPSIN MPC/Sport Psychologist or Chief Medical Officer (see below for contact details).
- Athletes can reach out to mental health professionals or mental performance consultants through their NSO or at regional institutes by email.
AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.
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Updated links from the Government of Canada and WHO
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All countries recommend no travel and require 14 day self-isolation upon return.
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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.
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This joint message is from the Own the Podium led Sport Medicine Advisory Committee comprised of Chief Medical Officers from the Canadian Olympic Committee, the Canadian Paralympic Committee, and the Canadian Olympic and Paralympic Sport Institute Network (COPSIN). It is meant to guide National Sporting Organizations (NSOs) in decision-making with respect to travel to competitions within and outside Canada. Information has been obtained from the World Health Organization, Government of Canada and Australian Institute of Sports websites. Other references are listed in this document. This advisory will be updated regularly and distributed to NSOs and other high performance sport partners.
The outbreak of severe respiratory illness related to the new coronavirus (COVID-19) continues to have an expanding impact internationally. The World Health Organization (WHO) provides regular updates which guide our recommendations. The latest WHO statements can be found at
WHO website on Coronavirus disease (COVID-19) outbreak.
COVID-19 is a virus in the coronavirus family. Coronaviruses in this family are responsible for illnesses that range from the common cold to more serious illnesses such as Severe Acute Respiratory Syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV). COVID-19 is a new virus and so health officials are still learning about its impact and severity. At this time, it appears to cause an illness similar to the flu with the most common signs of infection being fever, cough and shortness of breath. In severe cases patients can develop pneumonia, severe respiratory distress, kidney failure and death.
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Epidemiology: The numbers
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The reports from China suggest that with COVID-19:
- 1% have no symptoms
- 81% have mild symptoms
- 14% have severe symptoms that cause them to miss work or go to the hospital
- 5% have severe symptoms that lead to ICU admission, including a fatality rate of 2.3%
- The fatality rate is highest in those that are elderly and have other medical conditions
- The estimate of risk to athletes (i.e., younger and healthier) is thought to be similar to the risk of health care workers; 0.3% fatality rate
The number of cases in Canada is small. At this time the risk of contracting COVID-19 in Canada is very low.
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It appears that COVID-19 is more contagious than the typical influenza virus.
The virus is transmitted primarily through respiratory droplets. Those that are experiencing symptoms are more likely to spread the illness than those that have the illness but do not have symptoms. There is ongoing research to determine if there are other possible modes of transmission such as fecal or air.
The estimated incubation period (time from initial expose to onset of symptoms) is between 1-14 days but is about five days on average. Symptoms can persist for longer than three weeks, although the duration of illness will be highly variable.
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Recommendations for protecting yourself and preventing spread of this illness include frequent hand washing and covering both your nose and mouth when coughing. Try to cough or sneeze into your arm, away from others, or into tissue paper (to be disposed in toilet). Wash your hands immediately afterwards. You should avoid close contact with anyone showing symptoms of respiratory illness.
Research on respiratory infections in travelling sporting teams suggests that the most likely pattern of spread occurs within a team, rather than from external sources. When an unwell team member joins the team, due to regular close physical contact between team members, the infections can spread readily (Valtonen et al, 2019). Consideration should be given for delaying travel for team members who are unwell.
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What to do if you think you have COVID-19
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Because the early symptoms of COVID-19 are similar to other respiratory illnesses, if you have any of the common symptoms (fever, cough and shortness of breath) you should contact your doctor’s office and arrange to have a consultation.
Treatment:
At this time, there is no specific treatment for COVID-19. The goals of medical management are to identify other treatable causes of illness (such as influenza), manage any complications from COVID-19 and provide advice on how to limit the transmission from known cases.
There are efforts internationally to produce a vaccine and to identify if any of the currently available antiviral medications are effective and safe. An update is expected to be released in mid-2020. A vaccine will likely take longer as it will have to go through longer clinical trials to confirm safety and efficacy.
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Travelling to sporting events
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On Airplanes:
Vigilant hand and face hygiene should be practiced. Stay hydrated.
The European Centre for Disease Control (EDCD) has published research into the risk of contracting
Infectious Diseases on Aircraft
. While there are currently no data available on the transmission risk for COVID-19 during airline travel, we look to the risk related to similar diseases, such as influenza and SARS. The ECDC concluded that the quality of evidence to assess the risk of transmission of influenza onboard an aircraft is not adequate. SARS transmission has been documented from airline travel with transmission most likely from those who are severely ill or those experiencing rapid deterioration, usually in the second week of their illness.
On Return from Travel:
Public Health authorities recommend some combination of self-monitoring and self-isolation on return from international travel; the specific advice of each provincial and territorial authority may vary depending on the regions traveled to, and can be found in the table above.
Athletes and coaches who are currently unwell with fever, cough or shortness of breath should delay their flight and seek medical review. If you become unwell during your flight you should notify the flight attendants, place a P2 or N95 face mask on and seek medical review as soon as practical on arrival.
Face Masks:
Face masks are most effective in preventing transmission when worn by people who are unwell. If you are well, masks only need to be worn by those who have close contact with those who are unwell (i.e., recommended for health care workers). Correct fitting of face masks is most important to their effectiveness. A good resource is the Australian New South Wales Health web site (
How to Fit a Face Mask
).
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Considerations for Athletes, Coaches, Sport Organizations & Event Producers:
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Athletes and Coaches:
Prior to travelling overseas for training camps and competitions
- The risks associated with travel and competitions vary with multiple factors including location, age and origin of participants, indoor vs outdoor venues, and contact vs non-contact sports, among others. Check with your team physician, NSO CMO, or SMAC CMO for detailed consideration of these issues.
- Make an appointment with your team physician or regular doctor prior to departure to ensure that your vaccinations are up-to-date and that you will have enough of your regular medications, with the appropriate documentation, for your entire trip and at least an additional week. Vaccinations need to be administered well in advance of travel to be effective.
- Travel advisories change frequently. Check the Government of Canada Travel Health Notices regularly prior to departure as well, as the immigration department of the country you will travel to next.
- It is best to have contingency travel plans in place with the ability to change flights if needed.
- There is no need to alter your exercise or training if you are feeling well, nor do you need to wear a mask in public.
National Sporting Organizations (NSOs):
- Where travelling to places with an elevated risk, NSOs are urged to have a team doctor travel with the team. Other health professionals should not be expected to coordinate or provide medical care.
- Having appropriate travel insurance for your team that can be relied upon in the event a medical evacuation is necessary.
- When planning training camps, consider factors such as ease of access to medical resources and the prevalence of infection rates in neighbouring countries.
- Sporting Events in Canada:
- There have been very few cases of COVID-19 diagnosed in Canada. There is currently no indication for event organizers to delay or postpone sporting events in Canada.
- For international athletes travelling to compete in Canada, only the Government of Canada should provide details the current travel restrictions in place. At present, the Government of Canada is asking only those that have returned from the Hubei province in the last 14 days should self-isolate for 14 days and contact your local health authority within 24 hours of arriving in Canada. There are no other recommendations. Event organizers should not impose additional restrictions on international athletes. All travelers that have symptoms of fever, cough and shortness of breath should be advised to have a physician assessment.
- Mass gathering and sporting events can pose additional infection control challenges in general. If there is concern regarding your event, please discuss with your Chief Medical Officer who can help put in place risk mitigation strategies in conjunction with your local public health unit if required.
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