COVID-19 and Elite Sport
Earlier in the week I attended a webinar run by the Royal Society of Medicine on COVID-19 implications on elite sport. Given that the target audience is medics associated with sport, I feared that there would be lots of medical jargon, but actually it was in plain English and fascinating.
There were three speakers:
Dr Abosede Ajaya - Consultant in Emergency Medicine & Sports Physician - Imperial Healthcare NHS Trust - Team GB & England Rugby Sevens Doctor
Dr Moiz Moghal - Consultant in Sport & Exercise Medicine - CMO for GB & England Hockey
Dr Charlotte Cowie - Head of Medicine, The Football Association
Each of the speakers talked through their approach to getting the teams back into training, and for football in particular, back into playing.
Each sport has a unique set of challenges and each shared their sport’s thought process and approach to the return to training. There were some similarities in approach and differences.
What was common was the 5 step approach for returning to full elite sport:
Each of the sports are at different points, with football ahead of the others. Football is at step 3, soon to move to step 4.
Rugby
Rugby stated that there are two inter-linked factors determining the return to Rugby Union in England:
COVID-19 Prevalence - levels of community transmission
Rugby COVID-19 Exposure - nature, frequency and duration of close and face to face contact events in rugby matches and training.
Step 1 - socially distanced Gym / Field based conditioning
To do this they carefully defined who would be involved:
Defined athlete population
Minimal support staff
Strict social distancing at all times
A Covid-19 officer and Medical Covid-19 lead undertook:
A risk assessment
Screening, which included temperature checks
Defined training venue hygiene and cleaning standards
Clear medical protocols including who was in each group to minimise transmission risk
Step 2 - Training for the team or in groups
They then moved on to gym & field training with minimum of 2m social distancing.
They used GPS data available from training and matches to inform their risk assessment. To mitigate the risk further they have started regular screening and ensured they minimise any time spent within 2m.
Step 3+ Competition
When it comes to planning for competing again their risk assessment takes into account the different parts of the venues and how access should be limited.
But it isn’t just about physical risk. They are also considering:
The impact of uncertainty
The psychological impact on players
Financial impact on players, clubs, governing body etc
Ability to still undertake periodisation based training
Hockey
Hockey have set out the following priorities in designing their plan:
Prioritise health, wellbeing and social responsibility
Follow government guidelines
Minimise and prevent the spread of COVID-19
Minimise the risk of contracting COVID-19
Prepare to excel in 2021
One of the unique challenges that hockey face that football and rugby do not, is that they train at a site which is also used by other sports and members of the public. That brings a different dimension to risk.
They then set out a plan that took them through to stage 2.
Throughout they have:
Done temperature checks
Completed symptoms questionnaires
Followed an approach where you are only in the training group for the minimum amount of time required.
Ensured social distancing except in understood circumstances
Followed good hand hygiene
Careful cleaning of kit
No use of indoor gym
Used a person-first approach
Worked hard to meet the mental health needs of all players and staff, recognising the range of emotions possible due to the virus and lost opportunities.
Return to training
This was a transition period where they were training at home through active engagement in a structured physical programme.
Stage 1 - Light skills based sessions in small groups
There was a definite emphasis on focusing on skills and technique coaching in this early phase. Groups were kept small in different sections of the pitch. Social distancing was maintained at all times with no physical contact at any point.
This lasted 2 weeks
Stage 2 - Training
Hockey planned this over two phases. Starting with small groups with opposing activity increasing in numbers over three weeks. Social distancing to be maintained at all times other than in specified parts of pre-defined exercises. All the while monitoring the wellness of the athletes to ensure they don’t over train. Groups were arranged to ensure they didn’t mix outside of their group.
Then a couple of weeks of high intensity (where appropriate /possible), small-sided activity with game strategies. This was also the start of whole squad return to relatively normal training, with the training load being determined by diagnostic data.
Importantly, through all these phases, the athletes had the ability to opt in or out of training. Athletes were also not allowed to train if their household included someone being shielded.
Football
The start of the plan for football was focused on the fact that elite sports people can’t work from home. Add to this the highly controlled training environment that you create with elite sport.
In assessing when it was appropriate to return to training and to progress through the five stages, football assessed against a number of criteria, including:
Screening availability
Hygiene and social distancing
The end to end journeys involved for all. For example, the entourage that often follows matches & training would need to remain at home with only essential people travelling. They’d minimise the amount of equipment being brought.
Amount of contact involved. Interestingly, GPS data from training and matches shows that there are surprisingly few times when people are within 2 metres of another player and the duration is very short. Reduce that to 1m and the number of incidents goes down further.
Then there are also considerations such as fixtures, financial pressure, political pressure etc
The guidelines were reviewed against each part of the football landscape with Premier league and the English Football League being prioritised.
Other sports
I imagine that other sports are going through similar processes with the risk profiles being subtly (or not so subtly) different due to amount of contact, nature of sport, use of equipment, funding and whether the sport is an indoors or outdoors, to name a few aspect.
I’d be fascinated to see more of this.
I’m a swimmer, I can only imagine the frustrations that Swim England are facing at the moment getting the sport back up and running. Swimming is an interesting sport in that it is generally non-contact, often indoors, but there is also a growing open water element. So it’s not a single environment to be considered.
Also, swimming means something very different to each participant. It’s a sport with high levels of participation across the population. For some it’s social, for some it’s accessible and good to keep in shape. For some it’s about competing indoors. For some it’s about wild swimming in lakes, rivers etc. There are also those, like me, who like to swim for many hours and cross channels and complete other endurance feats.
Let’s start with pool swimming.
Swimming
Pool swimming
The pools shut on 20th March and have remained shut ever since. The only people who have been able to swim in a pool are those who own their own pool or endless pool, or those who have become creative with large paddling pools and tethers.
There was hope that the announcements regarding further relaxation of rules on 4th July would mean that swimming pools could re-open, but they were specifically called out as remaining closed. Not even open air pools would open.
The government did declare that open water swimming was a form of exercise that was ok in the first relaxation of rules around 25th May. I personally found this pretty concerning. The water is far from warm in May and is not the best time for pool swimmers to switch to open water. Not all open water venues have safety cover (e.g. rivers) and so risking undoing years of work on safety and drowning prevention programmes.
It may well be a way to get some metres in, but it doesn’t make up for technique work or speed work that has been lost. I hope that those chasing Olympic dreams have access to an endless pool.
Open water swimming
Whilst most organised lakes have re-opened with new Covid safe procedures in place, most events have been cancelled. The British Long Distance Swimming Association (BLDSA) cancelled their entire 2020 calendar. Other individual events like the Jubilee 10k have also been cancelled.
Recreational open water swimming is booming and I hope that some of the pool swimmers who have ventured over and are now enjoying warmer open water will stick with the sport when the pools are open again.
One of the bigger challenges, as I see it, is that unless you go to one of the lakes with strict social distancing and time caps, you are at risk of areas where there is over crowding (it’s hard to ignore the images of over crowded beaches and other water based beauty spots on warm days), meaning that meaningful training for endurance events is not as straight forward as it once was.
Which brings me on to channel swimming
Channel Swimming
I normally run training for aspiring channel swimmers (or those training for other events of equivalent difficulty). Whilst open water swimming became an approved exercise form in May, other restrictions meant that I felt unable to run training in Dover. Having read the government’s phased approach to lifting the lockdown restrictions, I assessed that the earliest that I would be able to restart training was step 3 - 4th July.
As mentioned earlier, most UK based endurance swims have been cancelled for 2020. The BLDSA cancelled their season very early on. Swim England cancelled all of their events calendar (pool and open water) for 2020. Looking further afield, New York Open Water were also quick to realise that the 2020 season should be cancelled. Catalina Channel Swimming Federation also went on to cancel the entire 2020 season.
At this time, the two English Channel organisations have not cancelled the season, though currently restrictions from the UK government prevent the boats from going out, so it’s not clear whether there will be a season or not.
It’s pretty tough for those with events this year. It’s long acknowledged that channel swimming is 80% mental and 20% everything else. That 20% is still pretty big and the vast majority of swimmers would have had their training significantly compromised. Ideally, you’d have a blend of pool training and sea swimming - both of which are compromised at this point. Add to this the fact that the 80% will be more challenging this year with all the heightened fears and uncertainties compounded by the impact on the mental state of not being able to train sufficiently.
If you then consider risk, it is likely that the risk of an adverse event has gone up this season. Risks associated with over crowding on beaches. Health risks to those who have had Covid-19, whether they realise it or not. Risks of people taking on such an extreme event and being under prepared.
I am surprised, and concerned, that the organisations seem to be thinking about ‘how they can operate’ rather than considering social responsibility and the health & wellbeing of the swimmers. I’m sure there are many conversations going on in virtual board rooms, so perhaps the perception is not accurate.
Graphically, I’ve represented pool swimming, open water swimming and channel swimming on the 5 step diagram. With pool swimming it is completely unclear when any of the steps will happen. Any meaningful competitions in open water swimming have been postponed until 2021. To me it looks like channel swimming is moving through the steps very fast and without the ability for some swimmers to train adequately in the pool or for long enough in open water. Arguably it’s less risk for relays than soloists but I struggle to see how you can social distance on a small channel boat.
It’s definitely something that I’ll be watching with much interest.
