If you’re not aware yet, we are facing a global pandemic in the coronavirus outbreak. There is a lot of misinformation and poor thinking going on around this disease.
I am not a virologist or immunologist but I have been following this closely since January and I believe that many in the movement community would benefit from a basic overview of what is going on and how we need to adjust our training in order to help slow down the spread of this epidemic.
To prepare for this article I spoke with a member of the UW virology department off the record and various friends who are involved in closely related fields, as well as reading everything I could find on the subject.
Coronavirus vs the Flu
It is still common to hear that the coronavirus pandemic is no different than a bad flu season.
As of today, March 8th, there are 3,802 reported deaths due to coronavirus worldwide. The common flu has already killed 6,600 people in the USA this flu season, so it could be easy to dismiss the coronavirus as hyped.
The issue with the coronavirus however is that it can scale much faster than influenza.
Currently in Seattle experts believe the virus has been spreading for 7 weeks, there are now 26 dead and between 300-8000 infected. The doubling rate is 2-7 days.
By comparison, in China 6 weeks after the first case was reported there were 2 deaths and 43 known cases.
1 month later in China there were over 43,000 cases and over a 1000 deaths.
In the last 24 hours in Italy there were 133 fatalities. Up from 233 the day before, the disease was first identified in Italy on February 21st.
We have a population with some immunity to flu due to previous exposure; on average the flu infects between 9-45 million people per year in the USA. Epidemiologist Marc Lipsitch of Harvard estimates the coronavirus may infect 40-70 percent of the population; that is 148 to 259 million people. Even with a case fatality rate similar to flu we are looking at a much larger impact with this disease.
We also have systems in place that are known to help mitigate flu infections. We are far less prepared for coronavirus.
We have approximately 330,000 beds available at any given time for patients, at current doubling rates coronavirus infections will exceed that capacity by some time in May.
Overwhelming the medical system is exactly what happened in Wuhan, China. Due to that the fatality rate in Wuhan was 5.8 percent while it was just .7 percent in the rest of China, this is because the system was much better prepared by the time the virus hit the other provinces.
Even at .7 that makes it multiple times more deadly than flu.
While the numbers for coronavirus are currently small, without an effective mitigation strategy we could easily see a pandemic on the scale of the Spanish flu which killed 40 million people or worse.
The American Health Association is projecting 480,000 deaths in the next year due to coronavirus and this is with very conservative numbers.
There is a great deal of uncertainty about coronavirus; this is not an excuse for inaction, if there is a 10 percent chance that this is a threat like Spanish flu, we should prepare as if it will be.
The Basics of Coronavirus
The virus is spread by droplets from the mouth and nose and requires contact with mouth or nasal tissue to infect. Sneezes, coughs and nasal drips spread the droplets and they can be picked up via contact with surfaces where these drops have fallen.
Early symptoms of the virus are a fever and dry cough. If you experience these symptoms you need to self quarantine and get tested as soon as possible. As the disease progresses it attacks the lungs and pneumonia sets in.
Based on the lastest World Health Organization report.
Coronavirus has an R.0 of approximately 3.0 which means for every person infected they will likely infect 3 people. This creates an explosive exponential infection potential. Flu by comparison has a R.0 of 1.3. Coronavirus is more than twice as infectious. It can also be asymptomatic but contagious for up to 14 days.
Based on research on 72 thousand cases in China.
- 81% are mild
- 19% are severe
- 5% require a respirator
- 3.4% die.
The mortality rate should lead us to be cautious but can not be relied on since there are potential error sources that could make it significantly higher or lower.
On the good news end, many mild cases are probably unreported so this would mean the mortality rate was possibly much lower.
On the negative side, the course of the disease can be 3-6 weeks and many people who are now sick may still die. In studies that look at only those who have fully recovered or died the mortality rate is around 5.8 percent.
The similar SARS coronavirus of 2002-2003 also left many people with long term disabilities after recovery from the illness. So looking just at the case fatality rate is not a good judge of the overall potential for impact of this virus.
How Bad Could This Be?
The take home here is that this illness is likely at least an order of magnitude more deadly than the flu, and over twice as infectious. There is a great deal of uncertainty around the numbers which means it could be better, but it could also be worse!
The good news is that for people under 40 the risks are approximately the same as for influenza and no fatalities have been reported for children under 10.
The mortality count is largely driven by the oldest cohorts. People over 70 and with underlying health issues need to be very worried.
The biggest problem we face is that we have insufficient capacity to absorb the number of cases that could easily develop if this epidemic is uncontrolled.
In the US we have less capacity in our healthcare system than China and far less than most other first world nations. Our government also does not really have the unity or power to mount an aggressive containment/mitigation campaign similar to what has been successful in China. Our byzantine healthcare system is also going to discourage people from getting care.
So far the response of American authorities has been appalling. We have not been instituting any broad scale testing, testing is at the patients expense, the testing kits initially put out by the CDC had a 20% false negative rate, and have been recalled. Doctors who want kits can not get them, and schools and major events that should have been shut downt have not been.
As of the last check the USA government has performed just 1,893 tests for coronavirus, this is in a population of 360 million people. By comparison, Australia with a population of 23 million has performed over 100,000 tests, South Korea has tested over 300,000 thousand people.
We are desperately behind in our response to this and it is going to cost lives.
Many organizations are now responding independently of the government. The UW Virology Department has developed their own test and is testing 100’s of people daily.
In Seattle, every major tech company has asked the majority of its workforce to start working from home. The University of Washington and multiple other colleges have moved all classes to an online format, and festivals like Comic-Con and South by Southwest have been cancelled.
Much of this should have been done earlier. The Seattle school system continues to remain open until there is a confirmed case of COV-19 infection. This is a dangerous policy as there is so little testing that by the time a case is found many more cases will already exist.
How Do We in the Movement Community Respond?
Due to the way in which this disease spreads, movement, fitness, and sport activities are particularly effective vectors for the disease.
Here is great set of general recommendations borrowed from Taylor Pearson’s blog
“Here are some suggestions individuals can use to reduce their risk.
- NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc.
- Use ONLY your knuckle to touch light switches, elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove.
- Open doors with your closed fist or hip – do not grasp the handle with your hand, unless there is no other way to open the door. Especially important with bathroom and post office/commercial doors.
- Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.
- Keep a bottle of sanitizer available at each of your home’s entrances AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands.
- If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain the infectious virus that can be passed on for up to a week or more!
- Try not to touch your face. (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you – it is lung-specific.
What I have stocked in case the pandemic spreads near me:
- Latex or nitrile disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
- Hand sanitizers – must be alcohol-based and greater than 60% alcohol to be effective.
- Try to get a few months’ supply of your prescription medications.
- Stock up on commonly used medications, e.g. pain relievers, cough suppressants, antibiotic ointments and creams, and the like.
- Bleach, alcohol, and other household cleaners that will kill viruses on shared surfaces.
- 3 days of water for everyone in your household (1 gallon/person/day) – It’s very unlikely anything will happen to the water supply in most places. Even in Wuhan which has been the most severely affected area so far, the water never stopped working. However, it’s so important that it’s worth it just in case.
- Two weeks’ worth of non-perishable food – just get something you’ll eat anyway. I like Ready Rice, Canned Tuna or Canned Chicken, and protein bars.
- If you think you’ll fret a lot about whether you need to go to the hospital, get a pulse oximeter ($20 on Amazon). Readings consistently below 90-94% are pretty bad and mean you should seek immediate treatment.
- Everything that makes you feel better and healthier, in general, helps your immune system too, so get good sleep, eat healthy, and take Vitamin D if you’re deficient.
- Masks and Goggles – People are coming down really hard against face masks for coronavirus. See: US Health Officials Say Americans Shouldn’t Wear Face Masks To Prevent Coronavirus – Here Are Three Other Reasons Not To Wear One. It’s true that standard-issue surgical masks may not help much, especially if you aren’t trained in their use. The coronavirus isn’t airborne; wearing a mask while walking outside is unnecessary – it’s when you’re kissing your spouse or chatting around the water cooler or touching a doorknob that you really want to worry. Any mask weak enough to stay comfortable while wearing for long periods, or even weak enough to talk through, is probably too weak to work. There’s a good NYT article about some of these issues here. If people with masks risk compensate even a few percent, that’s enough to make them a net negative. The best argument not to get masks is that if random people buy up all the masks, there won’t be enough left for health care workers or the very sick. I agree this one is a good point. However, it is true that an N, P, or R rated respirator, worn properly, in specific high-risk situations, can be an appropriate part of a safety strategy. I think an accurate treatment of the topic would admit this, while also stressing the reasons most masks might not be appropriate for most people in most situations.”
Recommendations for Movement Practitioners
Unfortunately gyms will be primary vectors for this disease and the closer contact required by the activity the better it will serve as vector. Here are some health and safety suggestions for various practices.
Strength and General Movement Training:
If you are doing a strength training or general movement routine I recommend finding a way to move it out of the gym and do it at home or in an outdoor space.
Like with strength training, it’s highly beneficial to take your training outdoors and away from highly trafficked areas.
Handicap rails in a highly trafficked area will be a great place to pick up coronavirus.
Refrain from spitting on your hands and shoes for traction, this is a very common habit in parkour but also an ideal way to spread the virus. I personally bought a chalk bag to replace this habit.
Bring 60+ percent alcohol wipes to training and wipe down surfaces before training on them. If you are training in a group stay 6 feet away from each other as much as possible, and make sure to wipe down surfaces again whenever a new athlete is going to train in a previously used area.
Martial Arts/Contact Improv/Partner Dance
This is the real killer, there is no good way to practice something like Brazilian Jiu Jitsu or Contact Improvisation that does not put you at high risk of being infected or spreading infection.
Shadow Boxing, heavy bag work with tight attention to hygiene and general athletic development are the best things for martial artists to do until this virus is under control. Obviously isolated or solo dance practices would be safer than partner dancing or attending dance classes.
If you do choose to practice, make sure you wipe down all surfaces with an alcohol based sanitizer before and after use, avoid touching your face during training and wash your hands thoroughly before and after practice.
Just like the Martial artist there is no completely safe way to train. Non-contact drills with good space between athletes, and very very tight attention to hygiene will minimize risks.
Advice for Professionals
Don’t put your head in the sand on this. This may be the most difficult professional year of your life, getting contingency plans in place earlier could save your business or career!
Many gyms will close and many coaches will be out of work. Start paying close attention to hygiene now, look for alternative ways to work with clients and minimize risk.
Be smart before the virus breaks out in your community!
A Plea to Students
If you want your gym or martial arts school to still be around when this virus is contained, consider keeping your membership running or donating a certain amount to help the school keep its doors open.
Personally, I just signed up for 3 months of kickboxing at a studio near my home. Because of the outbreak I will not be attending classes, but I am not asking for my money back because I know I will want to go back when it is safe again and I want that school to still be there when that happens.
Overall this is a rough and worrisome situation. There are a lot of uncertainties about how the next few months are going to play out, but what is certain is that each one of us has an important part to play upholding the health and safety of our communities, both locally and globally.
By staying informed and up to date on this issue, committing to higher standards of hygiene and self awareness, and making responsible decisions around your activities and emergency preparations, you are not only setting yourself up for the best chance of avoiding illness, you might be saving the lives of those around you.
If you know something I don’t, have good recommendations or important resources to share please do so.
I will regularly be updating this post with new sources of information as I find them.