covid19 · illness

Virus talk then and now in our fitness communities

March seems a very long time ago.

I remember back in the beginning of the pandemic when some of the fitness spaces I occupy tried to declare some times and places free of ‘virus talk.’

That was back when all talk of COVID-19 among American sports communities seemed highly politically charged. “Do you even know anyone who has this virus?” they asked. People speculated that it was all made up for political causes.

How the world has changed. These days COVID-19 is everywhere and I meet very few people who don’t take it seriously and pretty much everyone I know knows someone who’s had it.

I blogged here and here about blog adjacent friends recovering from COVID-19. A former regular guest blogger has been sharing her story here too.

And last night in my team time trial we had one team member just back from his COVID-19 recovery period, round two. He tested positive and then negative and then got sick again and tested positive again. Did he get it again or not fully recover the first time? Doesn’t matter. We’re very happy he’s healthy and riding and racing again.

Meanwhile another team member was struggling a bit because he’s part of a vaccine trial. We all hoped for him that he got the real thing and not the placebo, likely because he didn’t feel well.

We’re all talking lots these days about COVID-19. It’s a presence in lots of our lives and affecting the way pretty much everyone lives. It’s also exciting that vaccines are in sight and that the light at the end of the tunnel is shining brightly enough to capture our collective attention. The days of “no virus talk” being a thing you could say are over and I’m looking forward to COVID-19 being over too.

Bye!
athletes · covid19 · fitness · illness

More stories of active people and COVID-19 recovery

Earlier this week I started sharing stories of athlete friends who’ve come down with COVID-19

I wrote, “Through my social media networks–mostly academics, but also fitness types–around the world– I know more than 20 people who’ve had COVID-19. The group has had the full gamut of experiences, from spending time on a ventilator in hospital intensive care units to weird, mild flu like symptoms.

What’s been most striking, to me, is the way it’s hit my very fit friends. Some of the people were sick at the start of the pandemic and they’re still not well enough to return to the sports they love at least at their former intensity. Others bounced back quickly and are full steam ahead in their fitness pursuits.

At the same time I keep hearing other friends, most notably ones who haven’t had COVID-19, say they’ll take their chances with the virus since they are fit and active and likely won’t get a bad case of it. I try not to scream “it’s not about you.” It really isn’t. It’s about spreading the disease and hurting someone who is more vulnerable. But it’s also not clear that even a mild case of COVID-19 should be taken lightly.

Personally, for me, I worry about the long term health effects of this particular virus. I mean, don’t get me wrong I find death terrifying too and I find dying alone especially terrifying, but assuming COVID doesn’t kill me it’s the long term effects that scare me. In particular, given that it’s a huge source of pleasure and purpose in my life, I’d hate to not be able to be active as I age.

Of course lots of people have mild versions of the illness and the range of experiences is itself striking. Here’s the blog we’ll be sharing some stories of active people who’ve had COVID-19.”

Here’s the three more voices. I know Michael through the Ontario cycling community. I met Barrett and Brandon on the Friends for Life Bike Rally. Speaking of which, you can sponsor me here!

Michael

Age: 69

Sport: Masters track cyclist

I held the Canadian Hour Record for Masters Men 65-69. That record was eclipsed by my friend, Peter Leiss, in 2019. I also hold the record for the most kilometers/laps on the Milton track. When the Milton Velodrome closed Mar 14, because of the pandemic, I had cycled 208000 laps or 52000 kms on the track since it opened in 2015.

I contracted the Coronavirus in March. We found out by email, after the fact, that I most likely came in contact with an employee of Fortino’s Grocery Store in Oakville on or around Mar 20. The employee had tested positive and was in the store at the same time as I was. Although my wife and I were being careful, going out as little as possible, except for shopping, observing the standard protocols at the time, masks had not been standard, and I was not wearing one.

On April 3, a Friday, I woke feeling out of sorts. By this I mean very angry. Everything was irritating. I remember going out to do a bit of shopping in the morning. Friday evening, I had a burning sensation, at the back of my throat. This is usually a sign that I’m coming down with a cold. Mind you, I rarely get sick, rarely get colds. This back of throat irritation rapidly escalated. I was tired and still very irritated. I went to bed. Next morning, I awoke to the feeling that I had been hit by a runaway train. My entire upper body was in pain – back, chest, shoulders, everything, It was painful to breath. I was short of breath because of this. I was coughing. This caused extreme pain. I could barely move. Going to the bathroom, a few steps was very difficult. Lying down was difficult. In fact for most of 12-14 days that I was really ill, I slept sitting up in an easy chair, with a heating pad on my back, and an humidifier going in the room.

 This continued through Saturday and Sunday. My breathing became more laboured as time wore on. Sunday, we decided I should take Tylenol for the pain. This seemed to help, as least to make it bearable. Please note that I neve ran a fever the whole time I was sick. My temperature average about 36 degrees. We tried calling Public Health to see about getting tested. In April, they asked you if you were running a fever, and if you had traveled out of the country. Since the answer to both questions was no, I did not qualify to be tested. Please isolate, get lots of rest, and fluids. If we had known about the email from Fortino’s, (we did not see it until mid April. For some reason we were distracted), the contact would have meant I could get tested.

The pain and shortness of breath, etc, continued through Sunday. Monday morning, I woke up and the pain was all but gone! However, I couldn’t breathe. I was gasping for air. Any kind of activity, for example, going up stairs to take a shower, would leave me gasping for air. It would take at least 20 minutes for this to calm down enough for me to breathe at a normal pace. I was still coughing. Any effort, change positions on the couch, could trigger a coughing fit. That would be excruciating because it felt like a knife in the diaphragm. And contracting ribs was very painful. I took Manuka Honey to calm these fits. We tried contacting the authorities again Monday with the same result. Monday afternoon, I was so short of breath I was getting very frightened. We actually contemplated calling an ambulance and going to the ER. But the thought of being isolated at the hospital, away from my wife was even more terrifying. So we decided to see if I could calm down enough, sitting still, to get by until the next day. This worked. I got through the night. And each subsequent day. As the days progressed, I felt less pain, except for coughing. The shortness of breath continued. I couldn’t speak. I did not have enough air to form words. This would get worse the more I tried and then start a coughing fit.

I gradually improved over the course of 12 days. By the 14th day of quarantine, I felt like I was over it. We even went for a little walk in the neighbourhood. I could not speak for long. And I was still sort of breath, but I felt much better. We started going for walks each day. I think I even went to a store. About the fifth day, I relapsed. Coughing, shortness of breath, fatigue, and back pains. This lasted almost a week. When I ‘recovered’, we went for a walk to test the waters etc. Back pains and pain though my shoulders persisted. This continued off and on for a month. I was reading everything I could get my hands on about the coronavirus and I was getting very concerned about the constant shortness of breath. I was concerned that Covid19 was doing damage that I was unaware of to my organs. So at six weeks I spoke with my doctor. He said go to emergency and get a chest x-ray.

I presented at the ER. The triage nurse, took down the particulars, checked my pulse and blood pressure and then sent me for an EKG. It spiked! 20 minutes later, I was in a bed, connected to monitors, with an IV line in. They took blood. Then came back later and took more. Next thing I knew I was getting a CT instead of an x-ray. I had suffered from pulmonary embolisms, and my lungs were chocked full of little blood clots. They put me on blood thinners. It’s now almost 7 months since the CT. I have permanent lung damage. I just had another CT to see if there was improvement. The ‘vampire’ my hematologist, took a lot of blood for specialized testing and I will have the results of blood analysis and the CT next week.

I have not been able to return to the level of exercise I was used to before Covid-19. I have suffered from a rotating cycle of back pains, chest pains, shortness of breath, and fatigue since April. My balance was off. My ability to grasp things, to gauge distance was off, meaning I dropped or knocked things over. I had proximity issues. That imaginary space that you observe round yourself that allows you to walk through spaces or around obstacles, was way off. I had to double it. I would wait until my wife moved out of the way before I did anything. I was forever banging into things. Any extended effort, I tried cycling after the vampire felt that I had improved in July, (an echocardiogram had shown no damage to my heart). I took it very easy, riding around the block (an oval similar to riding the track).  I built up slowly. But any kind of extended cardiovascular effort resulted in a flare-up of symptoms. After two weeks, I suffered from sore back and shoulders, and major chills. I was cold all the time. Three sweaters cold, even outside on a warm day. This lasted about three weeks. I have not tried cycling again. But assuming a good result from the CT, I plan to put the bike on the trainer, and start perhaps just 15 minutes twice a day to see if I can begin to get back to my former fitness level. I have spent the last five months doing daily walks. That seems to be fine. I can walk several kilometers but I’m not physically taxing my body in the same way that I would cycling. I’m not sustaining a 130 heartrate for any length of time. But before Covid19, I could do that for 5 hours or more. I could ride the track for 3 ½ hours non stop at that rate.

Another problem – I have memory problems. I forget things right after I do them. And I have a very quick trigger on my state of mind. I can go from calm, cool and collected to rage in the blink of an eye, for the slightest of reasons. This is not normal for me. For the longest time, after the initial illness, I was an emotional mess, depressed, and extremely angry that Covid-19 had robbed me of my fitness and good health.

So, the long and the short of it is Covid-19 really messed me up. I am slowly recovering. The issues today are a fraction of what they were in the first three months. But I’m not the person I was. I do intend to get back to that level. But it will take time and patience.

A final note, my wife, who is 75, remained symptom free the whole time. We remain vigilant and we isolated in a very tight circle. I do not consider myself immune. I have tested negative, but that was after the fact. I never tested positive! I am very certain I suffered from Covid19 and the doctors agree. But without that test, or an antibody test, there is no way to be certain. So we remain cautious.

FB Pages:

www.Facebook.com/theartistsgarret

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www.Facebook.com/TheDayoftheHour

The custom Mariposa bicycle that Michael Kolesar used to set the Canadian hour record M65-69 Category.

Barrett

Age: 42

Sport: Weight Training/Cycling

When: Got Covid mid-October, had very mild symptoms, lost smell, some lethargy and felt run down. Otherwise, fine.

How long it took you to get well and whether you’re back to your former activity levels and athletic performance: Took about ten days to feel myself again, but smell has not returned fully. The pandemic situation has definitely impacted my athletic performance in general, I spent most of my days moving and walking, now mostly sitting. In terms of recovery from the virus, I feel that it took another ten days after I’d recovered from my symptoms that I felt I could do the same amount of work during exercise routines that I had before. And sometimes still feel that my energy levels are not quite the same. I did two exercise classes two days in a row and was exhausted by 8pm on the second day.

Barret is part of Bionic Fitness based in Toronto.

No description available.
Brandon and Barrett

Brandon

Age: 36

Sports: Water polo, cycling, weightlifting

I contracted it on October 5th, symptoms arose mildly on October 9th, more seriously on the 10th and I got tested on the 12th. Positive results came back on the 14th I think. It was awful, I’ve never been that sick in my life. It started with muscle aches which at first I attributed to DOMS (post workout muscle pain) but then it got so bad that I couldn’t be touched. Then I started coughing, getting a tight chest, and headaches. Then I started getting fevers that progressed so badly that I was constantly sweating, I was dehydrated and became delusional. Barrett afterwards told me about things that happened during the worst 4 days and I didn’t remember a few things. If my fever didn’t get better by the 5th day of bad fevers I was going to go to the hospital but luckily I started to recover. I couldn’t eat much during this time because of nausea and I found things tasted very bad, any kind of spice, lemon, ginger, sweetness etc. tasted like metal to me. I lived off of just bread for a few days. Recovery was slow. I’d say I’m not fully recovered yet, my right bronchial tube feels hardened and I still have very mild congestion/post nasal drip. I’m able to exercise and do cardio again but it comes with mild discomfort. I can tell I am improving but it’s very slow. My doctor is sending me for an ECG test.

aging · athletes · covid19 · fitness · illness

Some stories of active people and COVID-19 recovery

CW: There’s some discussion of weight and weight loss in these stories.

Here on the blog we’ve written lots about exercising from home because gyms are closed and about other indirect effects of the pandemic on how we workout. I’ve also written about exercise and how it might affect one’s immune response.

But I’ve been wanting to write about exercise and people who’ve recovered from COVID-19. I was reminded of it again when this passed through my newsfeed: Exercise After Covid-19? Take It Slow.

Jordan D. Metzl writes, “For the past 20 years, when patients asked me about exercising while recovering from a viral illness like the flu, I gave them the same advice: Listen to your body. If exercise usually makes you feel better, go for it.

Covid-19 has changed my advice.

Early in the pandemic, as the initial wave of patients with Covid-19 began to recover and clinically improve, my colleagues and I noticed that some of our patients were struggling to return to their previous activity levels. Some cited extreme fatigue and breathing difficulties, while others felt as if they just couldn’t get back to their normal fitness output. We also began to hear of a higher than normal incidence of cardiac arrhythmias from myocarditis, inflammation of the heart muscle that can weaken the heart and, in rare cases, cause sudden cardiac arrest. Other complications like blood clots were also cropping up.

What was most surprising is that we saw these problems in previously healthy and fit patients who had experienced only mild illness and never required hospitalization for Covid-19.

In my sports medicine practice, a cyclist in her 40s with recent Covid-19 symptoms had leg pain that was abnormal enough to warrant an ultrasound, which showed near complete cessation of blood flow because of arterial and venous blood clots in both legs. Thankfully, our team caught these early enough that they didn’t spread to her lungs, which ultimately could have killed her. Recently, a college student in Indiana with Covid-19 died from a blood clot that traveled to her lungs. As the pandemic has evolved, we’ve learned of a much higher risk of blood clots from people who contract the virus.”

That’s just an except. It’s worth reading the whole thing.

Through my social media networks–mostly academics, but also fitness types–around the world– I know more than 20 people who’ve had COVID-19. The group has had the full gamut of experiences, from spending time on a ventilator in hospital intensive care units to weird, mild flu like symptoms.

What’s been most striking, to me, is the way it’s hit my very fit friends in their 40s-60s. Some of the people were sick at the start of the pandemic and they’re still not well enough to return to the sports they love at least at their former intensity. Others bounced back quickly and are full steam ahead in their fitness pursuits.

At the same time I keep hearing other friends, most notably ones who haven’t had COVID-19, say they’ll take their chances with the virus since they are fit and active and likely won’t get a bad case of it. I try not to scream “it’s not about you.” It really isn’t. It’s about spreading the disease and hurting someone who is more vulnerable. But it’s also not clear that even a mild case of COVID-19 should be taken lightly.

I worry about the long term health effects of this particular virus. I mean, don’t get me wrong I find death terrifying too and I find dying alone especially terrifying, but assuming COVID doesn’t kill me it’s the long term effects that scare me. In particular, given that it’s a huge source of pleasure and purpose in my life, I’d hate to not be able to be active as I age.

Of course lots of people have mild versions of the illness and the range of experiences is itself striking. Over the next few days we’ll be sharing some stories of active people who’ve had COVID-19

Here’s the first two:

Patricia is 62, lives in London, Ontario and she rows, skis, golfs, plays tennis, trail runs and cycles. We know each other through masters rowing.

“I was surprised that I got it. I took all precautions. I had a mild case according to the Health Unit. I thought my allergies were playing up. My eyes were sensitive to light and I had a tightening in my chest. I had night sweats (I thought menopause was rearing its ugly head yet again). Apparently I had a low grade fever. I developed a cough that lasted about a month and lost my sense of taste and smell. I found I was winded easily and that lasted for months. My sense of taste and smell have never fully come back yet. I was in direct contact with an individual who had Covid on March 18th. My cousin passed away from it at the end of March.”

Heather lives in Kansas City, USA and she’s a 46 year old Triathlete/Road Runner/Mountain Climber/Zwift Racer/Cyclist. She’s on Sarah’s Zwift bike team.

“My health story really began when I was a young woman (22).  I was taking birth control pills and ended up throwing a blood clot to my brain, it was misdiagnosed as a migraine and ended up hemorrhaging causing a major stroke.  Being at risk for blood clots is something that is always in the back of my head… too much weight -can  cause blood clots.  Smoking – can cause blood clots, drinking too much – can cause blood clots. Having babies, having too low a heart rate, being too inactive… pretty much all can lead to blood clots.  So when COVID-19 came out to show that every autopsy of those who died with the disease had blood clots throughout their system, I felt I could really not do well if I get it.

In May (3 months into the pandemic) I decided that sitting on the couch and stress eating my way through the lock downs was not going to set me up for successfully fighting COVID.  I started really focusing on dropping the extra 20lbs I had acquired and strengthen my body to give it a fighting chance.  I used My Fitness Pal to track my calories and used the input vs output method of dieting.  I started signing up for challenges that pushed me – 30 day cycling challenge to complete 500 miles.  Climb Mt. Everest Challenge to climb/run/hike or bike 29,029 ft. In 50 days… These challenges along with the calorie watching allowed me to take off the 20lbs and get strong.  My doctor put me on a prophylactic low dose blood thinner in anticipation of getting COVID and I just continued to be as healthy, fit and strong as I could be.


I ended up contracting COVID 19 in the first week of October.  Coming in, my fitness level was strong.  My doctor advised that I not push my heart rate past zone 2 for the 10 day isolation period.  That was a long and hard 10 days of being sedentary.  I rode one Zwift race and I kept my heart rate down under zone 2 and it took me twice as long to finish as the rest of my team (but I got them a point!). 

My case was a mild case.  I had a total of 3 hours of low grade fever, nasal congestion and the typical loss of taste and smell.  After 10 days I felt like I was good to go.  My doctor gave me the green light to get my heart rate up again and when I did I found the result was as if I didn’t have any fitness built up.  My max heart rate was nearly 20 points higher than it had been 2 weeks prior.  I struggled holding speed and stamina and began to think maybe COVID did affect me.


It has been 5 weeks since I was released to work my body as hard as I want and it has been a slow come back.  I race twice a week and ride two more times a week.  I walk and run hills and with every effort I am watching what my heart is doing.  It is slowly coming down and I am able to hang on longer, recover by dropping the heart rate faster and push the way I want to push.


I consider myself lucky to have had a good outcome having had COVID and would caution any athlete to not fight through this one by pushing your body.”

Heather on her bike

This afternoon Michelle Goodfellow shares her story about testing positive for COVID-19.

health · illness · sex

Sex and Trauma After Hysterectomy

CW: This post addresses trauma, flashbacks and PTSD, although it does not directly describe traumatic events. Sex and personal anatomy are referenced.

Six weeks after my hysterectomy, my gynecologist gave me the OK to return to all physical activities–including sex. And a few weeks after that, my husband and I found an opportunity to explore what that meant. I was eager to enjoy a regular sex life again. Before the surgery, while I hadn’t had any pain associated with intercourse specifically, I was afraid of potentially magnifying the pain I was already experiencing. I also felt increasingly alienated from my reproductive system as the months dragged on before the surgery–like my uterus and the surrounding architecture were fighting against me, forcing this mutant litter of fibroids upon me, despite my lifelong disinclination to ever becoming pregnant.

But instead of easing our way back into a regular sex life, I found myself heading into becoming frozen–stuck in place, nearly nonverbal, unresponsive as a possum hoping you won’t drive over it in the middle of the road. I managed to softly say, “no, no, no, no, no,” and everything stopped.

This was the first sign I had that something about the hysterectomy had been emotionally traumatic for me.

I recognized the feeling. My therapist and I had identified that I had many of the markers of PTSD long before the hysterectomy. I can be jumpy for no reason, startled by everyday noises. I can experience emotions disconnected from the present moment–overwhelming dread being the most common. I get heightened into fight or flight at the grocery store, or walking down the street, or driving, and have to work my way back down into my emotional window of tolerance. In these moments of panic or dread or rage, I know that they don’t make sense. I’m aware that they aren’t a true response to something in the present, but a ghost of terrible moments in the past.

But while I knew this about myself, I was not prepared for it to get worse with surgery. Nowhere did I read that this can be a risk, and it seems especially surprising given my past traumas are not sexual. Many of the resources I found as I prepared for the surgery mentioned that many women mourn the loss of their womb, that connection to motherhood in their bodies. I get that, but I wasn’t concerned about it for me. I have never wanted to be a mother, and I’ve always viewed my reproductive system as a sort of vestigial set of organs, that maybe protects my heart and definitely inconveniences me one week out of every month.

My surgeon knew of my PTSD symptoms as well–she got a firsthand look at them on our very first appointment. Her office is unfortunately located in a hospital associated with some of my past trauma, and from about two blocks away, through the entire hour-plus visit, and until I was able to leave, I was in a full-on panic attack flashback. I hyperventilated, found myself crying, and felt totally overwhelmed by the emotions flooding over me. Honestly, I felt completely ridiculous trying to explain to the nurses why I was so clearly struggling with self-control. For the next visit, they prescribed me some Xanax to take before I arrived.

Past traumas increase our risk of future trauma. Our nervous system remembers the feelings of threat, hopelessness, dread and loss of control. It is not a surprise that I was at increased risk of new trauma, but I am surprised that a procedure performed completely under anesthesia can result in trauma. According to my therapist, our bodies can remember what our conscious minds cannot. She equated it to the feelings you have when a tooth is extracted at the dentist–thanks to the novocaine, you don’t feel pain, but your body registers the pressure and physical trauma of the loss of a tooth. And so, apparently, my body registered the hysterectomy as a threat, and now I am finding myself urgently needing to protect myself from future perceived threats.

Now I am startled by simple, intimate experiences. I’ve had to ask my husband to ask permission before he reaches out to stroke my back or leans in for a kiss. Without the “warning,” I can’t breathe through my startle response and reorient to the present moment. Sex scares me. Even the thought of a nonsexual item like a tampon entering my vagina makes me feel anxious–my breathing becomes shallow, my heart starts to race. I am increasingly on edge, so much closer to fight-or-flight than I was before.

You might be asking yourself how common this is. In an admittedly cursory search, I didn’t find a lot of information, but this very recent study found 16.4% of participants experienced multiple symptoms of PTSD 2-3 months after hysterectomy. This older study from the Mayo clinic found a smaller, but robust, increase in the number of people showing signs of anxiety and depression after hysterectomy than compared to a similar population who had not had a hysterectomy. Now, neither of these studies can show us causation–does getting a hysterectomy make people more likely to develop these mental health concerns? Or is it that certain mental health conditions or predispositions make it more likely that someone gets a hysterectomy? Since we can’t do placebo hysterectomies on half of a cohort and then see if there’s a difference in prevalence of PTSD symptoms, I’m not sure how we can suss that out.

Regardless, I can’t help but believe that people would benefit from knowing about these risks in advance. At a minimum, people like me with a history of trauma could potentially work with their mental health professionals in advance to develop a treatment plan, should it be necessary. That is why I’ve decided to write about it, even though it feels very personal. It would be my hope that more patients and doctors can be aware of these risks and be encouraged to talk about them.

It has been a year since I first wrote about my hysterectomy here. At that time, all I was concerned about was my physical health and fitness afterwards–I wanted to stay as strong and physically resilient as I could as I healed. Those physical concerns are in the past now. I can lift however I want. I can run without pain. But I’m still dealing with the consequences of my hysterectomy, and I can’t help but wonder how long these new ghosts will haunt me.

Photo description: a pathway leading towards a sunset or sunrise.

Marjorie Hundtoft is a middle school science and health teacher. She can be found reorienting to the present, picking up heavy things and putting them back down again in Portland, Oregon.

covid19 · Guest Post · health · illness

COVID-19 and the Gym: Building Engineers Weigh In (Guest Post)

by Sarah and Cara

As mechanical engineers who consult on heating, ventilating, and air conditioning (HVAC) systems, we’ve been closely following the evolving body of knowledge about how the SARS-CoV-2 novel coronavirus (the virus which causes COVID-19) spreads through the air. We thought some folks might be interested to know some of what we’ve learned, and how that’s affecting our thoughts on returning to the gym.

Some of the science so far

So far, we know that droplets in the air we breathe out (and in) are infectious to varying degrees depending on the size of the droplets – and that those droplets have the potential to be propelled for varying distances.

Relatively large and heavy droplets fall on and contaminate surfaces. This is a whole other topic, but it seems to be relatively well-known and understood. Also it can be controlled with frequent cleaning, so it’s less important from an engineering point of view. At the moment, our big concern (and the focus of this post) is with the smaller, lighter droplets known as aerosols. 

Scientists and engineers take particular note of so-called “superspreading” events (such as the ones that were mentioned in  Saturday’s post because they point to clues about how an infection is transmitted in a variety of real-world situations.

In the example of the choir in Washington State one mildly symptomatic person infected 52 of their 60 fellow choristers over the course of one or two 2.5 hour practices. Besides sitting close together, it is thought that the act of singing, itself, might have contributed to transmission, as aerosol emission has been correlated with loudness of vocalization.

The dance fitness classes in Cheonan, South Korea gives valuable insight into what factors which affect the risks of exercising indoors. Sports facilities are generally considered to represent a higher risk of transmission due to the warm, moist indoor air coupled with the turbulent air flow generated by intense physical exercise, which can cause more dense transmission of droplets.

Six instructors who were infected at a workshop went on to teach classes for about a week. Not all of them were necessarily even symptomatic. Secondary cases were identified from fitness dance classes with as few as 5 people in a ~60 square meter (~645 square foot) studio. Notably, an instructor who taught 7-8 person Pilates and yoga classes at one of the same facilities did not infect any of her students. Together, these us some insight as to how transmission risk might be mitigated in the short term for group fitness classes : very small class size, limits on movement to maintain physical distance, less aerobically- and movement-intense activities.

In the long term, engineers and building owners will have to address the significant concern that was raised by another notable case of a restaurant in Guangzhou, China one patron infected eight others who were sitting more than 6 feet / 2m away. It appears that air flow from the HVAC system helped carry infectious aerosols from one table to another.

A restaurant seating plan
with arrows showing airflow direction and circles showing the location of those who were infected
https://wwwnc.cdc.gov/eid/article/26/7/20-0764-f1

The role of HVAC in controlling transmission

The possibility that a normal HVAC system can carry it through the air over distances greater than the current physical distancing guidelines is a major concern. While we don’t yet know for sure how infectious COVID-19 is in aerosol form, the Epidemic Task Force of the American Society for Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE, the leading industries standards organization) have stated: “Transmission of SARS-CoV-2 through the air is sufficiently likely that airborne exposure to the virus should be controlled.” 

In hospitals, aerosols are controlled by continuously moving lots of air through infectious spaces to dilute them, adding lots of fresh air, careful airflow design, and HEPA filtration.  All the air in a typical patient room is filtered about once every four minutes. While gym ventilation is actually comparable to that of hospitals – gyms need comparatively good ventilation to keep them from smelling bad – the circulating air may have little or no filtration. Even if a gym’s air handling equipment is modified with HEPA filters, to achieve that circulation the HVAC system draws air from one side of the space and blows it on the other side. Just like in the restaurant example above, air exhaled by someone will move through the breathing zone of those nearby.  

When outdoor temperatures permit, it may be possible to make temporary changes such as opening existing windows and doors to encourage wind and buoyancy-driven natural ventilation in order to increase airflow and dilute contaminants in an existing fitness space. The openings need to be large to make a difference : a crossfit gym with a roll-up garage door and a back door propped open will be safer than a studio with a small open window. Openings on more than one side of the room gives better access to cross-breezes; openings high and low in the space will drive buoyancy flows, especially if the gym is warmer than the outside air.  When natural ventilation is working well, the indoor air will smell like outside, and match the outdoor temperature and humidity levels, so the comfort of the occupants will vary accordingly.

Other approaches to improve airflow in gym spaces, such as redesigning the air distribution to direct fresh air directly onto each occupant, will be expensive and disruptive to install – and unfortunately, still not proven to be entirely effective against airborne infection. There are some HVAC solutions that will reduce the concentration of infectious aerosol droplets in the air in buildings, notably increasing outdoor air volumes; HEPA filtration; and UV lights that sterilize air above the heads of occupants.  These solutions reduce, but do not eliminate, the risk of virus transmission.

What are the risks?

As gym patrons, we miss the motivation of exercising together with others, and access to equipment we don’t have at home. As we start to evaluate the risk of returning to indoor activity, there are a number of airborne infection risk factors which must consider in our decision making:

  • Indoor exposure: Whether an office, a store, or a gym, shared indoor environments have inherent transmission risk. Each additional person occupying the space with us increases the risk.
  • Extended exposure: Being the same place with specific other people for an extended period of time (15 minutes or more). 
  • Stationary exposure: Being in the same position relative to other individuals for an extended period of time, especially if the air conditioning system is blowing past the person next so that you are breathing their air.
  • Increased respiratory droplet exposure:  Intense aerobic activity, shouting and deliberate sudden exhalation reportedly increase the amount and spread of respiratory droplets. A low-intensity yoga class represents a lower risk than, for example, a Kiai (shout) filled karate class or high-intensity cardio class.
  • Mechanical system efficacy and state of maintenance: Many gyms and other fitness spaces are tenants in older or repurposed commercial spaces which are not always in the good repair. HVAC systems lose effectiveness as they get older, and may distribute air poorly. Some owners may even shut off HVAC systems due to safety concerns but these actions could actually increase risk if they reduce the outdoor air flow into the space. 

Controlling the risks 

For any given hazard, there are many different possible ways to address or mitigate the associated risks. Those who have taken a workplace health and safety course may recognize this hierarchy which is commonly used to rank the effectiveness of the various controls.

Heavily adapted (by Cara) from The National Institute for Occupational Safety and Health (NIOSH) guide to Controlling exposures to occupational hazards.[Content source: National Institute for Occupational Safety and Health National Institute for Occupational Safety and Health] 

Preventing infection using an engineering control – like the fresh air system inside a gym  – or administrative controls such as cleaning –  is necessarily less effective than substituting a lower risk activity – such as exercising outside in places where physical distancing can be maintained.

Is outdoors actually safer?

Both published research to date and epidemiological consensus appears to indicate outdoor activities are extremely low risk: a recent, not yet peer-reviewed study of infections in Chinese cities outside Hubei province in January and February showed that less than 1 in 300 outbreaks (only 1 out of 7000 individual infection events) could be traced to contact that occurred outdoors. B.C.’s provincial health officer has been quoted going so far as to say “the risk [of catching the virus] would be infinitesimally small if somebody walks [or runs] by you.” 

The evidence is strong that for the foreseeable future, substituting parks, backyards or even gym driveways will be a reasonably safe way to enjoy exercise with others, while indoor workouts will remain high risk until either the risk of exposure to infection can be eliminated, or effective engineering controls can be implemented. We want to support our fitness spaces, and we are hopeful that the summer weather will allow everyone to use the outdoors to bridge the gap until it’s safe to be together inside again.

Pictured: Yoga practitioners in supine spinal twists on colorful yoga mats in a wide, spaced circle  around an instructor in a park on a sunny day:  2018 Madison Yoga Challenge, Lung Cancer Research Foundation (LCRF)(Flikr) Photo from:Lung Cancer Research Foundation (LCRF)

Cara is an active promoter and designer of sustainable buildings, specializing in multi-unit residential and municipal facilities, enjoys dancing, Jeet Kune Do, acroyoga and circus arts, and bikes to get places.  

Sarah specializes in existing residential and commercial high-rises, and the systems that make them habitable. She spends far too much time poking around the guts of buildings and not nearly enough time on road bikes, sailing dinghies, or skis.

We’re both professional engineers.

 

 

 

fitness · health · illness · self care · strength training · training

How much is too much? Some thoughts with lots and lots of links

So we all know that this isn’t the best time to get into the best shape of your life, no pressure from us, relax and do what it takes to help you cope in these stressful, strange times, but we also know that exercise–some exercise–is good for dealing with stress and anxiety.

So that’s from the point of view of mental health and emotional well-being but there’s also the idea that exercise helps with our immune response.

Yoyo penguin

Okay, how much? Maybe mild to moderate exercise two to three times a week.

According to Alex Hutchinson, everyone agrees that regular, moderate exercise is good for your health.

“Doing regular moderate exercise lowers your risk compared to doing nothing; studies typically find that near-daily moderate exercisers report about half the typical number of upper-respiratory tract infections. That’s an important message for anyone who’s tempted to slack off their fitness routine until life returns to normal.”

Got it. Get moving. Check!

Now!

Okay, but we’ve got lots of time, right? Why not exercise lots more.

The worry is that too much is bad for your immune system. Again from Hutchinson, “If you ramp the dose up too high, your risk climbs steadily until you’re more vulnerable than if you’d done nothing at all. For that reason, Oregon-based elite track coach Jonathan Marcus recently argued on Twitter that athletes should avoid the type of gut-busting workouts that might put them at higher risk. “To train hard now is irresponsible,” he wrote.

(Short version: It looks like intensity is okay, what sets back your immune response is long duration exercise.)

Moderation seems to be key.

Here are two sports scientists writing for The Conversation, How much exercise is OK during the coronavirus pandemic?

“Both too much and too little are bad while somewhere in the middle is just right. Scientists commonly refer to this statistical phenomenon as a “J-shaped” curve. Research has shown exercise can influence the body’s immune system. Exercise immunity refers to both the systemic (whole body cellular response) and mucosal (mucous lining of the respiratory tract) response to an infectious agent, which follows this J-shaped curve.

A large study showed that mild to moderate exercise — performed about three times a week — reduced the risk of dying during the Hong Kong flu outbreak in 1998. The Hong Kong study was performed on 24,656 Chinese adults who died during this outbreak. This study showed that people who did no exercise at all or too much exercise — over five days of exercise per week — were at greatest risk of dying compared with people who exercised moderately.”

Exercise dog!

Interestingly, exercise rates are on the rise during the covid-19 pandemic among everyday exercises and down for elite athletes. In a way, that’s not a surprise for serious competitive athletes. All of their competitions are cancelled. They are just in maintenance mode mostly. For us, everyday types, we actually have some time, some of us, and exercise is one of the few things we can do outside. We’re moving more and they’re moving less and maybe we’ll all meet in the moderate middle. Go us!

It’s the same I think for strength training and weight lifting. The moderates like me, have installed home TRX-es and bought the odd kettlebell. I’m glad I got mine before they all sold out. But some of the serious gym rats I know have just out and out declared it bulking season and say that if there aren’t big weights available, they’re just waiting it out and doing lots less.

Okay, but not everybody is moved to moderation. Some people are making a personal challenge out of these odd times, like the 13-year-old boy who ran 100 miles in Quarantine Backyard Ultra or the man who ran a marathon on his PAris balcony during lockdown.

And none of this is shared with any advice giving intentions. If you care what sports scientists have to say about how much exercise is best during a pandemic, then go follow the links above and read away. If you need, from the point of view of your mental health and well-being to do more or do less, than do what you need to do.

It’s the moderation point that interested me, and I thought I’d share. Thanks for reading!

fitness · illness

Viruses and politics in unusual places

I was hanging out recently in a virtual fitness world, chatting with strangers, as one does these days, when someone chimed in “No virus talk please.” This community is about fitness activity, not COVID-19. But of course COVID-19 is the reason many of us were there rather than outside. It struck me as odd not to talk about the very reason we were online rather than in person.

Yet, I understand the desire to take some time where we don’t think about the global pandemic of COVID-19. There have been evenings too where I’ve wanted a break from it all. But I would never insist that others give me that break. It’s my break to make.

Someone else chimed in and agreed with the “no virus talk” rule, adding that it was like the “no politics talk” rule that some groups have.

I get the “no politics” rule. There have been times when I haven’t wanted to know what someone’s politics are. I remember being part of a running group and being excited to find someone who ran at just my pace. While running we chatted about movies but I really didn’t want to have a political disagreement with my perfect running partner. I’m always reminded of Elaine on Seinfeld having a great new boyfriend and her dilemma about whether or not to find out his views about abortion.

But this virus is affecting all of our lives and while our response may be informed by our political instincts, the virus itself isn’t political. It’s interesting who thinks it’s a big deal and who thinks our response is overblown. See COVID-19 Carelessness: Which Canadians say pandemic threat is ‘overblown’? And how are they behaving in turn?

I hate it when people run together matters of public health and politics. And I love that in Ontario our Conservative Premier said he’d listen to the public health authorities and that this isn’t a time for politics.

Back to the virtual fitness world.

A nurse followed up saying that she was hanging in this virtual world before a very stressful 12 hour shift and if she wanted to talk about the virus she would.

Next up were two people hanging out virtually while waiting for COVID-19 test results. They said the same. We’re self isolating and worried and we’ll talk about it if we need to.

Others chimed in and said they were worried about sick family members.

We’re all doing the best we can in very hard times.

Just say no to calls for no virus talk.

Cheddar doesn’t know anything about the virus but he’s happy to have so many people at home.
fitness · illness

So-called “miracle cures” are back on the market: bogus treatments for real illness

Here’s the tl:dr version of my post today:

What are the top 10 cures for for COVID-19?

  1. there
  2. aren’t
  3. any.
  4. Anyone
  5. saying
  6. there
  7. are
  8. is
  9. a
  10. liar.

Every time illness breaks out, there are lots of enterprising charlatans out there, trying to take advantage of our vulnerability. So it is now with COVID-19. What are some of those unscrupulous blackguards peddling (either in goods or false rumors)?

First, there’s garlic.

Twitter post saying that 8 cloves of garlic boiled in water will treat COVID-19. It won’t.

Apparently, this rumor got so much traction that the WHO felt the need to add it to their page of debunked myths about the coronavirus:

WHO graphic showing garlic with faces, but which have no healing powers for COVID-19.
WHO graphic showing garlic with nice faces, but who have no healing powers for COVID-19.

And also: gargling salty water.

Disinformation posted on twitter, giving bogus info about salt water gargling and coronavirus.
Disinformation posted on twitter, giving bogus info about salt water gargling and coronavirus.

Gargling may make your sore throat feel better, but it’s not going to have any effect on the virus. None at all.

Here’s another: Chlorine dioxide. What is that? Factcheck.org, tells us more here and below:

Chlorine dioxide kits are sold online under various names — Miracle Mineral Solution, Miracle Mineral Supplement, Master Mineral Solution — but they are most often referred to as MMS.

These kits typically include a bottle of sodium chlorite and a bottle of an “activator” such as citric acid. When the two chemicals are mixed together, they make chlorine dioxide, a common industrial bleach used in the production of paper products, according to the federal Agency for Toxic Substances and Disease Registry.

But MMS hucksters sell the chemical solution as a cure-all for cancer, AIDS, autism and, now, the novel coronavirus.

Again, the WHO says no to bleach (either ingesting it or pouring it on one’s body) as a treatment for COVID-19 (or anything, for that matter).

Here’s yet another one: substances with the name chloroquine. This refers to an anti-malarial drug (which HASN’T been shown to be effective against COVID-19), but also to a solvent used to clean fish tanks. An Arizona couple heard a news story about the anti-malarial drug and thought the fish tank cleaner had the same substance; they decided to put some in liquid and drink it. The man died and the woman is in critical condition. You can read more about it here, and below:

“Given the uncertainty around COVID-19, we understand that people are trying to find new ways to prevent or treat this virus, but self-medicating is not the way to do so,” Daniel Brooks, Banner Poison and Drug Information Center medical director, said in the hospital’s statement. “The last thing that we want right now is to inundate our emergency departments with patients who believe they found a vague and risky solution that could potentially jeopardize their health.”

Then we have: the online swindlers who cook up bogus medical treatments and sell them to vulnerable people during times of outbreak and uncertainty. One such miscreant, Keith Lawrence Middlebrook, was arrested on Wednesday:

[Middlebrook] is charged with one count of attempted wire fraud, which carries a punishment of up to 20 years in prison.

In videos he posted this month to his 2.4 million Instagram followers, Middlebrook showed off nondescript white pills and a liquid injection he claimed would offer immunity and a cure, respectively.

“Not only did I make the cure, but this pill right here is the prevention,” he said in one video. “Meaning, if I walk into the Staples Center and everyone’s testing coronavirus positive, I can’t contract it. It’s impossible. … I have what makes you immune to the coronavirus.”

You might be thinking: Srsly? Who would believe that some guy would have found THE medical concoction that does double-duty as both prevention and cure for a brand-new virus? I mean, who could be that gullible?

We can. We can believe anything when we’re scared, when we or our friends/family are sick, and when there aren’t any current treatments out there.

So, what can we do while waiting for medical science to hurry up and help a planet out?

I have three suggestions:

Hang tight.
Hang tight.
Wash those hands!
Wash those hands!
when in doubt, zoom!
when in doubt, zoom!

Zoom with friends, family, coworkers, yoga classmates, neighbors, distant relatives, old prom dates, vacuum cleaner salespeople, former pets, future ex-in-laws, fellow ex-patriots, third-grade teachers, part-time hairstylists, amateur boxers, Irish stepdancers, out-of-work tour guides, licensed taxidermists, in-the-know gossip columnists, tree surgeons, romance novelists, new moms, old cowhands, child psychiatrists, or orchid enthusiasts. That’s a start.

Have you, dear readers, heard any rumors about cockamamie cures or treatments or preventatives for COVID-19? Please feel free to share them so we can all revel in their bogusness.

accessibility · disability · fitness · illness

Disability, Fitness, and COVID-19

by Jane S

Sometime in February, when it became clear that coronavirus wasn’t just going to be an outbreak limited to China and its neighbors, I got a lot more serious about going to the gym.

The logic was simple. I have cerebral palsy, a disability known to make pneumonia more dangerous by causing habitual shallow breathing, which reduces lung capacity. Less lung capacity means less reserve if you contract pneumonia. But this can be modified by exercise. As long as I was doing a lot of aerobic activity, my risk of severe illness should be about the same as that of a physiotypical 30-something.

Since avoiding the risk of infection entirely was impossible (even if I could have stayed home all the time, family members go out), it made sense to focus on harm reduction. Better a somewhat higher risk of an unpleasant illness than a lower risk of a dangerous one.

In March, my options for physical activity began to narrow. I stopped going to BJJ class because it didn’t seem like a good time to be getting into people’s faces. A week or two later, when students were sent home at my university, the rock wall was shut down. My main fun activities were gone — an unusually rainy March precluded outdoor cycling — but I could still exercise, maybe even train for a birthday challenge. Then, on March 15, my city ordered all gyms to close.

It’s an odd feeling when your main tool for staying healthy gets taken away in the name of public health. I felt a loss of control, combined with anger on behalf of others who would be harmed more than me. I could plunk down a hundred dollars on a mini-bike to use at home and set up Skype sessions with my trainer — not perfect but better than nothing. But that’s financially out of reach for many. Some people with disabilities need exercise equipment that costs thousands of dollars. Others can only swim. It wouldn’t have been too hard to set up designated fitness centers for such people, but no one thought of doing so. Even physical therapy offices closed.

The idea that an important aspect of pandemic preparedness is being overlooked is not just my intuition. Julie K. Silver, the Associate Chair of Physical Medicine at Harvard Medical School, writes in a BMJ opinion piece that it is crucial “to recognize that strategies that might help slow the spread of disease and perhaps reduce its overall incidence (i.e., social distancing and sheltering in place), could have the unintentional and harmful effect of decreased physical activity and contribute to cardiopulmonary deconditioning. In particular, the elderly, who are most vulnerable to pulmonary complications from coronavirus, may exhibit a decrease in their baseline cardiac and pulmonary fitness that could substantially impact their outcomes and increase morbidity and mortality.”

Some of the very people most at risk from COVID-19 — the elderly and those with heart disease and diabetes — are the ones most harmed by inactivity. And that doesn’t even begin to take into account questions of maintaining overall health and physical function. How many older people will become frail, possibly suffering fractures or losing the ability to do activities of daily living? How many will die from this?

There is still an opportunity to maintain vulnerable people’s health during this time. Some can take advantage of exercise videos or routines available on TV or online, or exercise outdoors while maintaining necessary distance. For others, cities and medical centers should try to provide individual or small-group telehealth sessions (hospitals may be overwhelmed, but the skills of physical therapists aren’t immediately relevant to treating COVID-19 patients) and set up in-person facilities for those for whom this is not enough. Getting through the pandemic with a minimum of harm to individuals and society will require a comprehensive approach that includes everyone.

Jane S. is an ecologist who teaches mathematical biology. She enjoys climbing, Brazilian jiu jitsu and any activity that involves thinking with your body. She also gets a kick out of using her powerchair to move heavy objects.

canoe · cycling · fitness · hiking · illness

Riding my bike and moving beyond bargaining

Last week, like many of us, I was bargaining.

Sure, #StayAtHome and #WorkFromHome but I can still ride my bike. I can still take walks with friends. I love the outside. It won’t be that bad. I was imagining canoe camping holidays even. Repeat: It won’t be that bad. I was still thinking about me and my life, not exclusively but my plans revolved around making work at home work for me, the daily work of my leadership role in the university, family responsibilities, and seeing how much of my exercise routine I could keep.

I blogged about that here and here and here.

And then I read this, To tackle coronavirus, walk – and act– this way by André Picard in the Globe and Mail. Who is André Picard? His official bio says, André Picard is the health columnist at The Globe and Mail and one of Canada’s top public policy writers. His latest book is MATTERS OF LIFE AND DEATH: Public Health Issues in Canada.”

To me, he’s the person whose voice I respect the most on matters of Canadian health policy. We were young journalists working together for Canadian University Press and though our careers have taken us in different directions, I’ve always found his voice to be wise and compassionate. You know you have those people in your life, who if they speak, you listen? André Picard is one of those people for me. His column was my wake up call.

André writes,

“People who are not sick and not recent travellers, can circulate freely. They can go for a walk. But should they? Ethically, is it right to go for a walk when we are being asked to keep our interactions to a bare minimum?

“We also have to start thinking seriously, and preparing ourselves mentally, for how long this could go on, and how long we can tolerate a new normal. Right now, we’re still in the bargaining phase: It’s okay to go for a walk, right? It’s okay to take the kids to the park, isn’t it? Are these attempts to eke out a little bit more normal in these extraordinarily abnormal times just a bargain with the devil?”

“In Canada, we’re on the brink of being too late to prevent those dire outcomes. It’s time to bring the hammer down, to move from polite entreaties to practice social distancing to firm orders to do so. This must be done with absolute clarity and a singular message. It doesn’t feel like time for a casual walk, or casual talk, anymore.”

In the past week, I went from thinking riding solo was okay to watching France, Italy and Spain ban recreational cycling. Why? Because if you get a mechanical failure, who is going to pick you up? Is that trip essential? Because you might have an accident and land in the hospital and you absolutely do not want to be taking medical attention away from a COVID-19 patient.

This week I’ve watched Nova Scotia moved to close all parks and ban recreational hiking. You can hike from your home only now. I just read that the UK is allowing people one bout of outdoor exercise a day. You can’t run in the morning and ride in the afternoon.

We’ve all watched people home from work taking over beautiful remote locations. Wales and Banff were both swamped with tourists. Go home, say the people who make these remote places home. We only have enough food supplies for locals and there isn’t room in the hospitals if you get sick. In my part of Ontario cottage country residents who aren’t year round residents have been asked to leave. The emergency rooms only have a few beds.

The world is getting smaller, fast. It’s time to stop bargaining and face the task at hand head on.

But it has its good moments, my smaller world. We took part in a neighbourhood art scavenger hunt today and drew a turtle to place in our window for local children to find.

I really appreciated these words from friend and award winning author Emma Donoghue about making a life in small places.

So there’s one focus right now and that focus is getting through this pandemic without overly taxing our health care system so it doesn’t collapse. We’re doing this so we won’t have sick people unable to get a respirator because they are all being used. I watched a thing last night about a 72 year old Italian priest who gave up his respirator to save a younger person. I don’t want doctors and patients to face those choices here.

Flattening the curve is a group project that requires our full on effort and attention. Today the Premier of Ontario announced (finally!) that all non-essential businesses are closed for two weeks. I hope that got everyone’s attention though I wish he’d done it two weeks earlier.

We are in this one together. We need to stay home, yes, but we also need to support vulnerable people and our essential workers. That’s nurses and doctors but also transit and grocery store workers.

But what about our mental health? Surely there is some need for exercise.

I think that’s right but what’s the smallest-cost-to-others way you can accomplish that? In places like France, Italy, and Spain you can still ride your bike to the grocery store. It’s recreational cycling that’s banned. You can still walk your dog. You can run within 2 km of your house.

We’re not there yet and if we all work together now maybe we won’t get there. I’m past bargaining but I’m still hoping. And me, I’m riding inside on my trainer in the virtual world of Zwift. When it’s nicer I will ride outside but short distances near my house, I think. Long rides are for later.