In a world where government advice on COVID19 is drastically sparse, health and safety advisers are limited in what they can suggest and companies are seeking to take advantage of the knowledge gap, what should we be doing to keep our clients safe?
First things first, who am I and what right have I got to talk about gym hygiene post-COVID and why am I not another person throwing around conjecture? My name is Stephen Nash. I am the Managing director of Faultless Fitness Ltd and have worked in the capacity of Lead Exercise Physiologist here for the last 8 years. My second role is as a trainee Physician Associate (a medical role that sees me training and working alongside doctors and nurses as a general medical practitioner).
It is my dual exercise/medical role that I think uniquely places me in a position to be able to compare both the requirements of the fitness industry with the requirements of our clients and apply the knowledge gained from medicine to allow the safe running of my facilities. As of now, I have attempted to gain advice from health and safety consultants, looked at our “Industry leader recommendations” and talked with colleagues in other institutions and industries. I am still yet to feel secure or safe in the knowledge that, by following these limited recommendations, I am looking after my staff and client’s safety properly.
The problem with COVID19 in a gym environment
COVID19 is being painted as a semi-airborne virus. The reason I add the clarification is that it is being shown to normally spread through the large water droplets in our breath that can then either directly infiltrate another person’s airways within 8 feet or potentially contaminate surfaces around us for someone to later touch and infect themselves. Some evidence suggests that viral DNA can be found up to 8m away but whether this is live infectious virus or not is up for debate. One study suggests that transmission at 1m is likely a 13% chance whilst at 2m transmission risk is 3%.
Anecdotally, when thinking of a truly airborne virus we think of one that can travel through aerosol for meters and can potentially hang in the air for hours at a time like measles. However, in certain environments we can artificially aerosolise the COVID19, for instance by activating an oxygen mask on a patient over 5l/min, using dentist equipment and even CPR.
The good news is that at the moment 2m and heavy droplets seem to be working in our favour for social distancing working. If the virus was more virulent and had a larger radius we might be in even bigger trouble.
As an exercise physiologist, I am more than familiar with the high force expiratory ventilation we all face daily from people carrying out exercise in our facilities. It is why my facility has a policy of not allowing clients to attend training if they had symptoms of a cold prior to the discovery of COVID19. Clients become immunosuppressed acutely after training and mixed with the aerosol containing the cold virus by any infected client creates the perfect storm for transmission!
A gym environment is also high in traffic (even despite my gym being limited to 8 people in a group) especially in comparison to the days of being locked into one household in lockdown. This makes gyms the perfect vector for transmission post-lockdown.
Also, equipment comes in all shapes and sizes and isn’t easy to clean with difficult to reach places, plenty of porous surfaces and the number of people using it and a short turnaround between users. Then we also have touchpoints to enter, leave and dress in the facility!
With equipment in mind, let’s talk about the cardio equipment! How many cardio machines use fan resistance? How many of your cardio machines use belts? Think about the position of someone on a fan resisted rower breathing every breath large droplets straight into a turbine to then be aerosolised and blasted straight across the facility to hang for 3 hours or a client on a treadmill breathing straight onto a treadmill belt that shoots an air current and any water vapour meters behind it. Can you start to see the problem?
The Current Advice: are we thinking about this backwards?
The current advice seems to be prioritising limiting the number of people coming into the facility, clean the facility after every use, after every step, put up massive plastic (a substance the virus can be detected as living on for 3 days!) sheets that increase the surface area for the virus to land on and the likelihood that someone will brush against it creating indirect transmission opportunities. Not only this but creating little air chimneys that shoot air upwards into the air above clients to drop down wherever and on whoever outside of the little plastic chimney. Hygienic!
If we do get a COVID+ client then we have to immediately shut down and deep clean again. It doesn’t seem to be taken into consideration, or has been conveniently forgotten, that unlike with SARS, COVID19 patients are at peak infectivity in the first 3-5 days prior to the onset of symptoms! So, for 3-5 days a client has been rocking around generating live virus droplets in your facility for people to walk through and to be blasted around by your cardio equipment. You have cleaned every easily accessible surface but the client would have easily infected their average 3.5 people just from the direct transmission when walking past people in doorways let alone indirectly through the virus deposited on surfaces and in air.
This is why gyms and studios are likely to be considered super spreading environments. It is also why I feel the current advice by our industry leaders/demi-regulators is tantamount to slamming the stable door shut after the horse has bolted.
What High End Studios already do well:
Any high-end facility already does the following really really well:
- Maintain our equipment mechanically
- Maintain our equipment’s hygiene
- Maintain a high hygiene standard for floors and surfaces to limit staphylococcus and streptococcus infections
- Encourage clients to maintain their own hygiene and hygiene of the equipment they’re using
- Maintain high standards of hygiene in our washroom and shower facilities due to the risk of infection from legionella and reduce the risk of transmission of sewage.
- Encourage clients and staff not to present to sessions when ill from non-COVID infections to reduce transmission of seasonal infections.
- Keep the gym floor safe from debris and trip hazards etc.
As you can see, this isn’t our first rodeo! We have been fighting the spread of infection, perhaps unknowingly, for decades! So, what has changed that’s got the organisations, supposedly leading our industry from being able to provide any rational advice? The answer – aerosol and water droplet generated transmission of a new pathogen with no best practice to fall back on.
Identifying the real enemy:
Ok. So, it seems that what is causing gyms to not be safe is the fact we generate vastly more aerosol in gyms than anywhere else in public spaces. That means the real enemy is the aerosol generation. Someone then please needs to explain to me why there has been NO aerosol mitigation strategies put in place in any of the advice we have been given!
The most obvious element to all of this is that in order to be able to use a gym safely we have to reduce the capacity for COVID19 to spread in airborne water droplets and that could potentially become aerosolised.
With that in mind we have 2 options:
- Don’t let anyone in to use the facility (not particularly good for business) and unless we completely eradicate the virus impossible to sustain.
- Mandatory of antimicrobial masks.
Firstly, A decent well-fitted mask captures the large water droplets in the breath meaning that standard movement around the facility is less likely to create contaminated surfaces or person to person transmission. Secondly, masks drastically reduce the spread of aerosol as evidenced in the video above.
With this in mind, if the spread is down to <4 inches with mask use, does that mean that if mandatory use across the facility by staff and clients, we would be able to get within a meter to deliver coaching as required and potentially spotting?
Practical advice that should be considered by UK ACTIVE and CIMSPA:
First off, we will continue to do what we will always do. We will maintain a hygienic safe environment by regularly cleaning the equipment, surfaces, floors and touchpoints. We will also continue to encourage clients to maintain the hygiene of the equipment they use and as employees, we will clean in between as well. We will also have a cleaner who will clean the showers, and toilets as well as hoover and mop any debris in the facility.
What we will also do specifically to mitigate COVID19 is as follows:
- Client’s will be asked to wear brand approved masks in the facility at all times as a term of service.
- Staff will be asked (as it isn’t strictly categorised as PPE at this time it, unfortunately, cannot be enforced) to wear the same masks.
- Antiviral Fogger will be used after the last client has left every day to make sure that all places reachable by client-generated aerosol are reached by antiviral cleaning.
- Touch-points for client accessible doors will be wiped down after every session and left open where possible.
- Clients will wait in cars before entering the facility whilst previous class clears and classes will be limited to 8.
- Masks will be donned outside of facility and hands will be washed/sanitised upon entry.
- Masks can be removed for drinking but hands must be sanitised again after replacing mask.
I hope this helps anyone who is currently looking to set up guidelines for their facility or studio. I would also happily take questions from anyone at UK ACTIVE or CIMSPA on the guidelines I am proposing be used in all facilities and why they should be lobbying government to allow gyms to reopen with mask use. I will even help them do it!