Surfing in a Covid-19 Era Summary
As Surf community we want to know how to protect ourselves and how to protect others, most of all how we can continue to Surf. While information is rapidly evolving, here are some considerations.
Introduction
- There are estimated to be more than 30 million people who participate in surfing worldwide annually; however, many nations have banned surfing during national lockdown periods.
- Major national and international competitive surfing events, including World Tour WSL and 2020 Tokyo Olympics, were postponed due the COVID-19 pandemic.
- Surfing is, for the most part, a safe method of physical exercise due to the low injury-risk profile, low risk of infectious transmission, and high proportion of young participants.
Key message on Covid-19 & Surfing
- Surfers and surfing organisations should take note of the updated guidance for bystander rescue in the event of suspected drowning to minimise the risk of COVID-19 transmission.
- Surfers should start with a step-wise rehabilitation plan consisting of land-based activities prior to controlled environment outdoor water training, followed by the return to surf in the ocean environment as the last step.
- Surfers with multiple co-morbidities and surfers that suffered from moderate to severe COVID-19 should make a rehabilitation plan with their physician before returning to surf.
- Elite surfers and their corresponding medical teams should account for WADA recommendations in the treatment of COVID-19 and impact of competitive surfing.
Health Benefits of Surfing
Surfing has many positive health benefits, ranging from improved cardiovascular function, to serving as a form of therapy in various physical and mental health conditions ranging from stroke rehabilitation, to post-traumatic stress disorder
Low Risk of Infectious Transmission
Surfing is a very low risk activity from an infectious spread perspective, due to the low population density while surfing, the ventilation status of the ocean and beach environment, reduced verbal communication amongst other surfers, and limited close interaction with others in the water due to both surfing etiquette and board length imposed distance.
Changes to bystander rescue & CPR
The current COVID-19 Pandemic provides a challenge around optimal CPR including rescue breaths in the drowning victim.
Rescue breaths are an important part of CPR in drowning for the reversal of hypoxia in the drowning process. Furthermore in the context of Surfing, in offshore breaks or heavy line-ups, this is often the first possible in-water response to reverse the lack of oxygen and drowning process.
In this COVID era, ideally you want to have a family member/your room mate/ your friend who is in the same person bubble to provide ventilation to reduce risk of transmission or you may guide another family member / contact in bubble through the resuscitation.
Further reading on the risks of ventilations and proposed strategy in drowning victims in the era of COVID-19 can be found here: https://www.ilsf.org/2020/06/05/idra-ils-imrf-joint-position-statement-resuscitation-of-the-drowned-person-in-the-era-of-covid-19-disease/
Implications for Surfing after Covid-19 infection
Cardiovascular
SARS-CoV-2 may result in increased risk of myocarditis, tachyarrhythmias, ischemic cardiac conditions, cardiomyopathies, thrombosis, and heart failure. It is advised that exercise is avoided during the active phase of viral infection
Respiratory
Patients can sustain several respiratory sequelae post Covid-19 infection, including chronic cough, fibrotic lung disease, bronchiectasis and pulmonary vascular/thromboembolic disease. Gradual escalation of activity is recommended including pulmonary rehabilitation programs after infection.
Return to Sport
A period of abstinence from intense physical activity for at least two weeks after cessation of symptoms is recommended. Due to possible cardiorespiratory deconditioning, gradual, step-wise return to sport in a controlled, safe environment is recommended. Professional and recreational surfers with underlying medical conditions, which may impact severity of Covid-19 infection or who suffered from moderate to severe Covid-19 infection, should consult their physician for consideration of further testing prior to resuming vigorous exercise.
Impact on Injury Risk
Elite and recreational surfers may experience a decline in neuromuscular adaptations after any training cessation, resulting in accelerated muscle disease atrophy. Cardiopulmonary deconditioning may put those surfing after a Covid-19 infection at greater risk of adverse cardiac events and may pose additional risk of musculoskeletal injury.
Vaccine Reactions
Surfers who are symptomatic post vaccine administration should avoid participation in sport, especially if there are signs of chest pain, shortness of breath, dizziness, extreme fatigue, or in any other ways symptomatic. These symptoms should be reviewed by a healthcare professional before return to sport. SMI endorses vaccinations for Covid-19, for specific questions and different vaccines please refer to your national health authority and/or your own care provider.
Prescription and Banned Substances
Dexamethasone and Hydrocortisone, which are available options for COVID-19 therapy are currently listed on the World Anti-Doping Agency (WADA) lists of prohibited substances. Therefore, it would be prudent for these athletes to clarify this with their governing body and WADA if appropriate to ensure they are complying with the most recent guidance on anti-doping.
Implications for Surfing Organizations
Surfing organizations may consider additional guidelines to prevent infectious spread, while maintaining the ability to allow safe surfing activity to occur. For professional events, surf schools, ocean safety, and training organizations, consider implementing social distancing practices into activities, reducing class sizes, and implementing e-learning materials where possible. Develop infectious prevention, testing, and isolation strategies ahead of classes, courses, and events, including consideration of frequent PCR and rapid-antigen testing both prior to and during course activities. Outdoor training and sessions reduce likelihood of infectious transmission. Lastly, remember to follow and continually review local guidelines and regulations.
Surfing After a Covid-19 Infection
Due to the risk of lung scarring, myocardial inflammation, necrosis, ventricular dysfunction, and neuromuscular deconditioning, it is advised that exercise is avoided during the active phase of viral infection and that there is at least a two week symptom-free period before return to intense exercise. A physician check-up should occur after severe and complicated Covid-19 infections, in the case of infection with underlying pre-existing conditions, symptoms of fatigue during slow return to sport practices, or before returning to elite/competitive surfing.
