COVID-19: Sport Medicine Advisory Committee Update (May 21)

ADVISORY ON COVID-19

UPDATE #17  –  May 21, 2020

Please consult this article again as new updates will be published (Visit INS Quebec’s website if you wish to consult previous updates)

Also, be sure to refer to your provincial, regional and municipal Health authorities as measures and restrictions currently vary across Canada

Disease Update

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

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

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

General Statement on COVID-19 testing:

In Canada, indications for conducting testing for COVID-19 have changed over the course of the pandemic, as case definitions have evolved, and testing kits have become more available. The high-performance sport sector in Canada is considering testing of high-performance athletes in controlled, ‘bubble’ environments. Questions and considerations regarding athlete testing are under review and will inform a thoughtful, and planned response to the potential use of testing as one of numerous mitigation strategies used by an NSO in their return to training planning.

What is COVID-19 testing?

The most common test to confirm the diagnosis of COVID-19 is PCR testing of nasopharyngeal and/or throat swabs, combined with relevant clinical findings. The Public Health Agency of Canada has recommended using multiple samples over multiple days in those whose symptoms are strongly suggestive of COVID-19 yet return an initial negative test. In general, PCR tests for other respiratory viral infections tend to have a high sensitivity and specificity, although there is limited data specific to COVID-19.

As of May 20, 2020, two serology tests have been approved for use in Canada. At this stage the availability is limited to in Lab use and the reliable (approved) tests are not widely available for community screening. There is still significant debate on how long and to what level a person who has been infected with COVID 19 will maintain immunity or protection from a new infection. At this stage routine serology testing, specifically to enable return to group training or competition, is not recommended. As with everything in this pandemic this may change, and we will continue to monitor for any developments relevant to sports

What are issues with COVID-19 testing?

  • There are at least 500 COVID -19 tests available around the world of which 19 are of sufficient sensitivity and specificity to be licensed for use in Canada.
  • Even with the most reliable tests there are issues with timing of testing, methods of taking samples and viral shedding that may result in negative results in people who are asymptomatic yet may actually be infected.
  • At present testing of asymptomatic individuals using nasal swabs (PCR tests) as a screening tool is not recommended to be used routinely as a method for clearing an individual for return to play or joining a training group. Research confirms that presently the most sensitive screen is a combination of daily symptom checks, testing of any symptomatic individuals, placing individuals with suspected COVID-19 infections in isolation until test results are available, isolation of any confirmed positive individuals and tracing of all contacts. Management of any positive cases must follow local public health regulations and guidelines.

When should a test be considered or used in a high-performance sport environment?

  • The Canadian high-performance sector has considered the appropriate use of testing for high-performance athletes in controlled, ‘bubble’ environments. At this point, the position is to support testing for COVID-19 for athletes, coaches, staff, etc. in the daily training environment who are symptomatic only and not as a pre-entry screening measure. The fundamental principle underlying this approach is to protect the health and safety of athletes, coaches, staff, their families, facility staff and communities.

What are the considerations being undertaken in Canada for implementation of testing for high-performance athletes?

The decision to engage in testing of high-performance athletes in Canada is complex and consideration is being given to resource implications in the following areas:

  • Expertise – testing will be carried out through the local health authority or with their approval in a designated area conforming to regulations including proper training of individuals involved in the performance of the test, cleaning of the test space and managing of the results of said testing per PHAC regulations.
  • PPE – Use of personal protective equipment for all sample collection (e.g.) gloves, gowns, masks, eye protection. Safe handling of potentially contaminated equipment or surfaces in the patient environment, and respiratory hygiene/cough etiquette.
  • Testing Isolation – A designated room is required for testing. This room must not be used for other purposes and must be a room that can be fully sanitized between each athlete test. There must be an entry point to this room that is separate from the exit.

These considerations are being addressed in a High-Performance Athlete Testing Protocol.

Return to training protocol after symptomatic diagnosis is being researched and additional information and plan for how to return a high-performance athlete to training will be published in the near future. This is an area of developing information and best practices are in their infancy.

NSO decisions to engage in athlete COVID-19 testing should be made in consultation with a Team CMO and/or a CMO member of SMAC.

Training

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

Return to Training in Clubs and Groups

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

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

Canadian Centre for Ethics in Sport (CCES)

CCES has discontinued in-person testing at this stage but whereabouts are still required as before. This is fully explained in the CCES link HERE

Sports and Institutes

At this stage all Canadians remain under national and provincial public health guidance and as such all institutes and public training facilities remain closed at this time. The timing and level of operations possible will be dependent on the local restrictions in place at the time and vary from one institute to another. A summary of present status is below.

INS Québec

Offering virtual services and in negotiation with Public Health on potential opening of the facility although no specific dates are known at this time.

CSIO

  • The Government of Ontario has approved, in principle, group training for professional and high-performance sports that meet requirements set out by the separate Ministries of Health, Labour, and Sport.
  • CSIO is working with its partner sports to submit proposals specifying adequate traffic control, distancing, and hygiene / disinfection protocols to resume group training for a number of sports at several venues, to begin as approvals are granted.

CSIO Services:

  • Remote services continue to be offered to affiliated athletes pending any re-opening.
  • When S&C space re-opens, it will be for targeted partner sport groups. Open / drop-in training hours will not yet resume.
  • Other IST services (medicine, therapy, nutrition, mental performance, physiology, biomechanics) services will continue to be available remotely only for the time being.

CSI Calgary

CSI pacific is still closed and are offering virtual services as per previously. Currently they are preparing a return to sport document with their building partners and hoping for opening early to mid-June in collaboration with public health officials.

CSI Pacific

CSI Calgary facility / indoor training remains closed at this time. There is a Phase 1 Return to Indoor Train/Play/Work ready for when the government allows opening.

Mental Health Update

The Psychology of Return to Group Training

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

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

1.Come back to training with no issues- let’s get back at it!

  • These individuals have not been significantly impacted and are ready to start training.
  • Need to manage these individuals’ expectations regarding the “new normal” and be clear on risk mitigation procedures to which they must adhere.

2.     Fearful and anxious of contamination or second wave

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

3.     Personally, impacted by COVID-19 or experienced secondary trauma

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

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

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

Assess individual needs and different levels of comfort for returning to group training

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

Attend to anxiety that may be produced by perceived disadvantages and/or fear of contamination

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

Manage frustration that may come with new ‘risk mitigation’ training protocols

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

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

Nutrition

Combating the COVID-19 Cravings & How to Manage Stress Eating During the Pandemic

It is without question that we are all dealing with at least some form of stress right now, so it’s no surprise that we may be faced with stress/emotional eating. It IS a real thing and it is NOT your fault!

In acute times of stress, we release cortisol and during prolonged stress, which is what we are now experiencing, can elevate cortisol levels, which can increase hunger. This coupled with the challenge of being in close proximity to the kitchen: pantry and fridge, can make it even more difficult to stop the endless grazing! People manage stress differently; some like to bake and try new recipes, (which also makes it a challenge to be disciplined enough not to indulge on the sweet new creations!) and some people may eat less. If you are skipping meals, you could be more prone to emotional eating or even binge-eating in the evening.

Here are some other factors that may contribute to mindless (over) eating/snacking:

  1. How you manage stress
  2. Your Surroundings
  3. Schedules! (or lack there-of!)
  4. Food Availability
  5. And…your emotions!

Below are some strategies that will help you ward off the endless grazing and get back to better eating habits.

1.MANAGING STRESS:

  • Keep active!!
  • Don’t sit longer than 3 hours at a time
  • Call an old friend
  • Try a new or old skill

2. YOUR SURROUNDINGS:

Get out of the kitchen! Try to set up your workout and space in a designated area AWAY from the pantry and FRIDGE!

3.SCHEDULES:

…Are so important! Try to stick to your daily scheduled/plan just as you would if you were in regular training, with your pre-prepped scheduled meal and snack times! Pack your lunch/snacks and recovery foods the night before as you would have when you were leaving the house! Finding a sense of normalcy

will help you keep regular eating habits. Ensure you are still eating every three to four hours to ensure you are getting sufficient nutrients to manage your health.

4. FOOD AVAILABLITY:

What foods are stocked in your home have a significant impact on our food choices. Don’t Stockpile Food! A good rule of thumb: use what you have at home before buying more! Allow yourself to buy ONE of your FAVOURITE treat items each weekly (or every other week) grocery shopping trip.

Planned snacks! Focus on high fiber high protein snacks to help you feel full longer to curb those cravings! STRIVE FOR 20g Protein 4-5 x/Day and a minimum of 25 g fiber!

Quick Basic Snack Ideas:

  • Handful of almonds/seeds
  • Easy protein balls (https://www.floridacitrus.org/oj/recipes/no-bake-orange-protein-balls/)
  • Greek/Skyr yogurt or Cottage cheese (add some canned, dried or fresh fruit!)
  • Trail mix: ½ c Chex or Cherrios with ¼ cup almonds and ¼ c dried fruit (stick to 1 cup serving) with some added Easter Treats (smarties) to satisfy the sweet tooth
  • Whole grain muffins/crackers/granola/granola bars
  • Veggie sticks with Tzatziki or nut/soy butters

Don’t forget to hydrate! It will also help to keep you from excess snacking! Beware of calorie dense fluids such as specialty coffees, alcoholic beverages. Instead try a ½ cup 100% Orange Juice with sparkling water or other homemade smoothies and flavored waters, along with decaf teas and coffee

To read the complete advisory, click here

 

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Posted on: April 30, 2020