The not so long and winding road back to sport after COVID-19.
Updated: Jun 13, 2020
The recent announcement that the latest round of Premier League football testing for COVID produced no new positive tests has reiterated that a return to sport in the UK is not too far away. The most recent round of testing, coupled with encouraging tests from the previous rounds, the Championship as well as League 1 and League 2 mean that we can all look forward to watching our favourite sports again sooner rather than later, albeit, from the comfort of our sofas. Sports stadiums in the UK, indeed, most of the world, are likely to take a good deal longer to be opened to the public due to the obvious difficulties posed by social distancing and risks of cross-contamination amongst groups of people within a stadium. For the armchair sports fan, it will feel like Christmas day.
However, what of the smaller sports teams and venues looking to re-establish themselves in training and competition? All of the country’s sports teams and institutions closed their doors some 10 weeks ago resulting in tens of thousands of the population being without their personal physical sporting fix. Many people have wisely used this difficult lockdown to get fitter, starting a training program and improving their overall wellbeing. So whether you are hoping to return to International elite competition, the camaraderie of Sunday league football, or simply channel your new-found fitness enthusiasm into a formalized running club, you will want to know when these normalities can occur.
Why not, then, look to some of the UK’s international sporting allies for advice? After all, many countries have already paved the way for a return to sport after the COVID crisis. Germany has already undertaken several rounds of Bundesliga football in the men’s and women’s game. NRL has returned to Australia, while New Zealand will imminently recommence their rugby union participation with the Aotearoa games. With New Zealand particularly, pioneering the way in COVID management, they have today denounced themselves COVID-free with suggestions that there may even be fans permitted at the games played.
So what measures have these forward-thinking countries taken to allow for a speedy return to sports and what lessons can be learned to allow for our own sports to return in the UK?
In Germany recreational sports and activities have been permitted to return under limited conditions and only outdoors. As mentioned, the German top-flight football league, the Bundesliga, have been playing for several weeks now. To enable this to have happened, all players had to be quarantined in isolation-style camps to ensure safety and reduce the risk of spread of viral matter.
New Zealand has offered possibly the most comprehensive and transparent documentation on how they’ve achieved their rapid return to sports. New Zealand has, critically, implemented contact tracing for anyone intending to return to sports. Contact tracing is a system which identifies all individuals that have come into contact with a person with a confirmed, probable or suspected case of COVID-19. The New Zealand government describe contact tracing as one of the single most fundamental precautions against the spread of the virus in the community.
This complex system is undertaken by the NZ Ministry of Health and shared amongst District Health Boards. Sports facilities, sports grounds and Sport, Play & Recreation providers must ensure they comply with requirements to keep records to enable the contact tracing system to be efficient.
Furthermore, any facility in NZ that opens for sports use should maintain a guest/participant register (including staff and contractors) to assist with the Ministry of Health’s efforts at contact tracing for COVID-19. The information collected on the register should include:
Time in (and where possible, time out)
It is with these key pieces of information that contact tracing can be performed successfully.
Currently, sports clubs and facilities are being advised on the following measures to reduce the risk of infection and spread:
Regular disinfecting of surfaces.
Encouraging good hand hygiene by allowing frequent hand washing with soap and water before thoroughly drying them.
Not having unwell people at your facility.
Meeting physical distancing requirements.
All Common sense really and, reassuringly, not too different from how we are behaving in the UK already.
There is a big focus on hand hygiene in the NZ guidelines too. Having worked at several sports facilities in my career, I can attest to the fact that sportspeople are not always the most cleanly or diligent when it comes to hand hygiene. I feel that a drive towards improving this will be key if a successful and safe return to sport is to be implemented. Here are some of the key points from the New Zealand legislature:
Good hand hygiene is the best tool against spreading germs when participating in sport or active recreation. Make sure that everyone who uses the facility to participate washes their hands with soap and water and thoroughly dry them before and after each activity.
Hand washing is the preferred option for good hand hygiene. However, hand sanitizer (containing at least 60% alcohol) should be provided as an acceptable alternative, especially where there are not sufficient hand washing facilities.
One of the possible obstacles in the way for the UK may be the acquisition of enough good quality hand sanitizer to open clubs throughout the country. The sanitizer has been at a premium in recent weeks and very difficult to get hold of. Then again, think back to the flour and toilet roll shortages which seem like a lifetime ago now and maybe there is light at the end of the tunnel for all hard-to-come-by items.
Furthermore, advice from NZ continues:
Communicate handwashing guidance to all members and visitors. The key message is that people need to wash their hands with soap and water and thoroughly drying them before and after activities.
Put up signs in shared facilities to remind people to wash their hands.
Make sure bathrooms are always stocked with soap and paper towels.
Provide hand sanitizer (containing at least 60% alcohol). Consider placing it at the entrance/exit and next to any shared equipment.
Other ways to keep our hands clean and prevent germs spreading include:
Encourage alternative greeting or end of game traditions (instead of hi-fives).
Where possible keep your entrance and exit doors to your facility open and avoid using your hands on high-touch surfaces, such as door handles, gates, and seats.
Participants must also bring their own clean towel to dry off any sweat while being active.
A special note is made in the guidance against the act of spitting. Spitting is already a criminal offence in New Zealand and is soon to be made illegal in the UK. Spitting obviously carries a high risk of viral spread and prohibiting spitting seems like a sensible idea.
NZ advise against bringing your own food and drink to a sports facility and instead suggesting that all nutrition and fueling should be undertaken at home. One personal water bottle is permitted and is not to be shared with anyone else.
Further advice is provided suggesting that participants and guests are to leave the facility after they have completed their exercise and not spend extended time in the clubrooms or at the facility.
What about sports or activities that require equipment then? NZ have provided clear advice around this too:
Participants at your facility must bring their own personal equipment (towels, water bottles, etc). Water bottles should be stored separately and clearly labelled to avoid mix-ups.
Implement sanitizing practices suitable for any shared equipment used at your facility. For example, for a group fitness class, you may like to incorporate the cleaning of the equipment as part of the class instruction just as you would the warm-up and cool-down routine.
Ensure that participants know to clean personal equipment before and after use.
Make sure shared equipment is cleaned before and after use with disinfectant, concentrating on points of contact.
At the grassroots level, the reality of using equipment is that it is usually shared equipment. For instance, there are few amateur hurdlers who own their own hurdles or American footballers in the UK who own their own protective equipment. Therefore:
If the equipment at your facility cannot be washed before and after each use, you need to implement other ways to prevent germs spreading. For example:
Rotating equipment to allow a withholding period between uses could allow the virus to die off from these surfaces.
Rock climbers may like to use climbing chalk that contains a sanitizer when participating.
In general, the advice is sensible and mainly surrounds reducing risk by minimising touching of surfaces or socialising for extended lengths with other sports club users. These are measures which are so simple to implement with the provision of such guidelines; leave doors open, do not permit showering, changing or eating on site and obviously, and most critically, do not allow any person with symptoms of illness to participate. COVID or no COVID, this is the best way to reduce infection risk of any kind.
And so to the UK and back to the EFL proposals. These documents are split into 3 different sections. The first discussing the protocols for return to training, the second discussing the return to contact training and the third examining a return to behind closed doors matches. Presumably, a fourth document is in the pipeline which will allow for open stadiums and the return of the fans too, but for now, let’s focus on what’s available to us.
The first document, the protocols, is very data-heavy with specific rules around documentation of people attending places of sport, registers and very importantly, each club must formulate their own operational policy for COVID. The club must appoint a COVID officer too to deal with everything around the virus. This should not, the document states, be a member of the medical team, moreover, a member of the health and safety team instead.
Testing takes high priority too with no player of staff member permitted to return to the training ground or facility without a proven negative test. A positive test would require a period of isolation for a minimum of 7 days and a negative retest is required to permit further participation.
Most of the EFL protocols follow very similar frameworks to those already discussed from abroad. Social distancing, hand washing and exposure among the key points for mention.
Use of medical equipment, recovery adjuncts and manual therapy is prohibited where possible and only to be used at a premium if absolutely necessary and approved by the club doctor. Where therapies are utilized on players, staff must ensure the use of designated PPE for their protection and the protection of the players.
Although the Australian slogan mentioned earlier: Get in; Train; Get out, is not documented in the same manner in the EFL protocols, the principles are very much evident in the UK document too. There is specific mention of players arriving dressed and ready to train, minimizing nutritional input at the training facility, restricting the presence of drinks bottles and leaving without showering or even removing strappings.
Congested training areas, opposed training and tackling are also prohibited in the EFL document. As with the Australian checklist, I think this will be a difficult-to-manage area of training, especially as larger numbers of athletes return.
The EFL have included an operational risk assessment document which will help other clubs, not just those involved in football, with the planning and undertaking of similar risk assessments. There is also a COVID symptom example screening questionnaire. These are available on the EFL website or by clicking this link:
The second document highlights the return to contact training which, for sports such as netball, rugby, football and martial arts, will be a critical part of returning to the sports. All of the same principles apply from the first document as well as the planning, in detail, of sessions proving the mitigation of close contact, large group, interaction, wherever possible from the coaches. This is suggested by commencing contact training in small groups or clusters to begin with. This must be done outdoors and no indoor training is currently permitted within the EFL document.
The third document is somewhat more aimed towards stadium staff and action plans. Along with players and coaches, a behind-closed-doors game would warrant the attendance of dozens, if not hundreds, more staff. This, obviously increases the risk of adding viral matter into a confined area as well as the introduction of ‘foreign’ staff and elements from the visiting team. Cross-contamination amongst home and visiting teams could cause an acceleration of the spread of the virus in new or less affected areas of the country or the world. Therefore the systematic protocols highlighted in the third document are essential for mitigating these risks. If you are involved in the planning of matches or managing stadia, rather than read my abridged version of this, I would strongly advise reading the full document here:
As the promising day goes by with negative testing results, innovation in track-and-trace and reducing numbers of hospital admissions, positive cases and ultimately deaths, the outlook is looking for optimistic for a return to sport in the UK. Over the next few weeks, we should see the return of one of the nation’s favourite pastimes. With the use of these documents and others like them from all over the world, I think we can use the global experience collectively to return to our beloved sports and recreation.
So keep yourselves active, keep yourselves fit, keep yourselves healthy because it should not be long before you can be pitting your physical skills against other real-life competitors.
Huw Roberts, Chief Physiotherapist, Backroom Medics, @HuwDRoberts