Update #16: Advisory on COVID-19

Wednesday, May 20, 2020
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UPDATE #16 | 20 May 2020

Advisory on COVID-19

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

NOTE: THERE WILL BE A SUBSEQUENT ADVISORY ON COVID-19 PROVIDED ON 21 MAY, 2020 AT 4:00 PM EDT.
 

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.

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.
 
Institutes and Training Facilities

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.
 
INSQ
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 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.
 
CSI Pacific
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.
 

 
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.

Testing for COVID-19
  A subgroup of the Sport Medicine Advisory Committee has created enhanced testing and monitoring protocols for returning sports which may include testing through the Canadian Sport Institutes or local testing centers. The plan will be released in a special SMAC update on May 21 2020.
 
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. 
 

AN UPDATE WILL BE PROVIDED EVERY SECOND WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

_________________________________________________________________________________________

UPDATE #15 | 6 May 2020

Advisory on COVID-19

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Disease Update
The number of confirmed cases of COVID-19 is over 3.7 million with 1,242,000 recovered and 258,295 deaths. There are documented cases in over 213 countries or territories.  Mortality rate worldwide is at 6.93%. We are continuing to see prolonged second waves in countries that had relaxed their restrictions including Singapore and are monitoring this 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 62,000 cases, 4,000 deaths and 27,000 (43%) recovered. Of the 31,000 presently active cases in Canada 97% are classified as mild. Several provinces have gone more than 14 days without any new cases, and this has prompted government officials to start to come out with plans for loosening 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.

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 has been addressed in earlier releases). In addition we would recommend taking this opportunity to also work on mental resilience and mental training.

Institutes and Training Facilities
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. As information changes it will be updated.

Return to Training in Groups
As many are aware several countries especially in Asia and Europe have begun to allow training and return to sport. Many of these countries are at a different point on the curve in terms of when cases started and spread of the virus in their local areas. The SMAC is gathering these protocols and reviewing and integrating them with the Return to Sport Task Force that has been created (meetings started this week). Any decisions regarding return to group training would ultimately be in conjunction with provincial / local health authorities, provincial / local government bodies, your sports associations as well as OTP, CPC and COC.
It cannot be emphasized enough that groups, teams or sports should go through this risk assessment process carefully in planning for the safety of their athletes, coaches and the larger population in general when the return is possible. Ultimately local health officials will need to be on board as different provinces, regions and cities are affected differently with COVID-19 and as a result may have unique policies regarding gatherings of individuals that will determine when and how group training may resume in different regions.

Testing for COVID-19
A subgroup of the Sport Medicine Advisory Committee is creating testing and monitoring protocols for returning sports which may include testing through the Canadian Sport Institutes or local testing centers. More information will be forthcoming as this work is completed. This will be integrated into the recommendations from the above Task Force.

Mental Health Update
Psychosocial Phases of the COVID-19 Pandemic
The COVID-19 pandemic, and its impact on society as a whole and on sport more specifically, is nothing like a crisis we know; it is unprecedented. The Psychosocial Phases of Disaster model (see Figure 1) is helpful to understand the phases through which populations go when facing a global crisis or pandemic. The model can assist us in anticipating needs and providing appropriate support and resources as we move across each phase. While there are typical collective responses to a pandemic, there are also individual differences, leading people to respond in unique ways to challenges, restrictions, and disruptions. These differences must be taken into consideration in the development and provision of support and resources throughout any pandemic.

Figure 1. Psychosocial Phases of Disaster (adapted from Zunin & Meyers, 2000)
NOTE: The intensity and duration of these phases vary and may also overlap. People and subgroups may experience different phases at any one time.

Following is a brief summary of each phase, with examples of how they may be currently manifesting themselves in the sport context. It is beneficial for us to reflect on each phase to be able to recognize when we may be progressing or regressing from one phase to the next. Identifying examples supporting our experiences in each phase can foster not only self-acceptance and self-compassion, but also self-awareness to recognize specific needs we may have to effectively cope and overcome challenges. Take some time to contemplate the phase that best characterizes you and your NSO at the moment within this COVID-19 pandemic.
Heroic Phase

In the immediate aftermath, the heroic phase prioritizes survival and promotes safety of others.
The community focuses energy and activities into assisting others, providing emergency responses, and attending to impacts of the disruptions. 
Sport context examples: Getting teams/athletes back to Canada, national team athletes reaching out to youth to help them through challenges, health prioritized over all else.

Honeymoon Phase

This phase is characterized by optimism in the community/individuals and formal assistance becomes readily available. 
Community bonding occurs as a result of sharing the experience and giving/receiving support.
Mental health supports are visible and seen as helpful, they are more readily accepted, and provide a foundation for the future. The difficulty of what is to come becomes apparent and fatigue sets in.
Sport context examples: #ONETeamCanada, posting group workouts, optimism through social media, concerns about access to training and future.

Disillusionment Phase

In this phase, the reality of the disruption sets in (economic impacts, strenuous rebuilding process). 
Fatigue sets in, symptoms related to stress intensify, and hope decreases.
Complaints related to abandonment, unfairness, and incompetence become vocalized. 
Sport context examples: Frustration that the ‘goal post’ continues to move (no training for weeks, now months), anxiety about job security, fatigue and decreased motivation with modified training routines.

Recovery and Reconstruction Phase

This phase involves rebuilding what was lost and there is an ongoing need to readjust and grieve losses.
The repair and mitigation efforts initiated in the early phase become apparent and impact personal growth. 
There is an ability to see opportunities and re-examine life priorities, and confidence is built by building relationships and overcoming challenges.
Sport context examples: Reintegrating into group and center training, crafting new training and competition goals and plans, grieving lost opportunities, restructuring given economic impacts. 

It is possible that many of us are currently oscillating between the ‘honeymoon’ and ‘disillusionment’ phases. With disillusionment comes accumulating fatigue, frustration, impatience, boredom, and decreased motivation. Therefore, mental health must be regularly monitored at this time, and mental performance skills (e.g., goal-setting, stress management, mindfulness, self-talk) should be used to cope with unproductive thoughts, emotions, and behaviors. Uncertainty about the future may persist, however, it is important that we keep in mind that reconstruction and recovery are around the corner, if not already initiated.
Discussions regarding group-based training, use of training facilities, and new training and competition plans are imminent or already underway. All of this may be generating mixed emotions, which are normal in these circumstances. Regardless of the phase in which we find ourselves, it is vital that we continue to respect regulation and restrictions.
In summary, while we all have different coping mechanisms and timelines to work through challenges during this pandemic, it is essential that be proactive about protecting our mental health throughout each phase to help flatten the mental illness spike that may emerge without a preventative approach.  We also must maintain hope, optimism, social connection, and support, and adopt a growth mindset to foster resilience and maintain mental health during the Recovery and Reconstruction phase. If you would benefit from further support, please consider this resource document ( GamePlan Resource).

AN UPDATE WILL BE PROVIDED EVERY SECOND WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

_________________________________________________________________________________________

UPDATE #14 | 29 April 2020

Advisory on COVID-19

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Disease Update
The number of confirmed cases of COVID-19 is over 3.1 million with 975,000 recovered and 219,287 deaths. There are documented cases in over 213 countries or territories.  While some countries have slowed the doubling rate of new cases and deaths, other areas in the world are seeing these rates continue to accelerate. We are continuing to see prolonged second waves in countries that had relaxed their restrictions and are monitoring this 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 50,000 cases, 2859 deaths and 19,000 (38%) recovered. Of the 28,000 presently active cases in Canada 97% are classified as mild. At present our doubling time has prolonged to every 16 days. Although the curve continues to flatten in Canada there remains a lot of risk involved in relaxing restrictions too early and we can only reemphasize that in Canada there are limited resources available and asymptomatic spread is occurring. Continue to assume all others you may encounter may have COVID and act with that in mind and continue to maintain physical distancing vigilance. Many provinces are starting to prepare plans for staged relaxation of restrictions as is considered safe in their specific area. 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.

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 has been addressed in earlier releases). In addition we would recommend taking this opportunity to also work on mental training.

Institutes and Training Facilities
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. As information changes it will be updated.

Return to Training in Groups
At a Town Hall call involving NSOs and national sport partners on 27 April a Risk Assessment Tool for Sport that will allow groups and teams to assess risk and mitigation of this risk was presented in a draft form. The SMAC group, in concert with COC, CPC and OTP are finalising this tool (to be made available on 1 May 2020) and will continue to collect information from WHO and other countries to create the best path forward for returning to training.

Despite a number of nations returning to group training this week, in Canada physical distancing measures remain in force and we are thus not able to start group training at this point in time. Any decisions regarding return to group training would ultimately be in conjunction with provincial / local health authorities, provincial / local government bodies, your sports associations as well as OTP, CPC and COC.

It cannot be emphasized enough that groups, teams or sports should go through this risk assessment process carefully in planning for the safety of their athletes, coaches and the larger population in general when the return is possible. Ultimately local health officials will need to be on board as different provinces, regions and cities are affected differently with COVID-19 and as a result may have unique policies regarding gatherings of individuals that will determine when and how group training may resume in different regions.

Mental Health Update
Leading mental health authorities and advocacy groups are calling for an increase in mental health resources to cope with the threat of an “echo pandemic”, the significant rise in mental health issues in those significantly affected by COVID-19. The Canadian Sport community is not immune to this echo pandemic, and to help flatten the mental health spike, a preventative and proactive approach must be taken. To help mitigate the ill-effects of stress, protect mental health and promote mental fitness, it is recommended that we practice psychological hygiene as part of the daily routine. The following are some activities to be considered.
Emotional Tolerance
We must remember that emotions are an integral part of the human experience; they are there to protect us, guide us and help us recognize what we need. We should accept that our emotions are real and valid responses to this abnormal event. By understanding our emotions and core needs, we are able to increase our emotional tolerance. Valuable steps in this process include:

  • Naming the emotion we are experiencing (e.g., I feel anxious and overwhelmed) and recognizing it as normal and valid (e.g., just my emotions doing their job in these times of uncertainty)
  • Accepting the emotion as a normal aspect of our experience (e.g., It’s understandable that I have heightened level of anxiety given the current situation)
  • Identifying needs by exploring what the emotion is revealing or why it is important (e.g., I want to be safe and need to take necessary precautions) 

Stress Management
COVID-19 is an unprecedented event. As such, there is no rule book to follow and it is inevitable that stress and anxiety levels rise given the uncertainty and unpredictability of the situation we are facing. However, it is important to remember that not all stress is bad; it depends on our perspective, competencies, and support. Adversity is part of high performance sport, therefore, athletes, coaches, and IST members can use existing skills to manage challenges and the unknown. COVID-related stress management tips include:

  • Protective physical and psychological factors 
    • Engaging in physical distancing 
    • Washing hands and wearing a mask and gloves when out in public
    • Staying home, especially if sick
    • Reducing information by taking breaks from watching or listening to news
    • Maintaining a sense of balance by pairing intense information processing with light activities (e.g., watching or reading something amusing, playing a game). 
  • Stress management 
    • Identifying stressors and focusing on the knowledge and skills we have to manage them – keeping our confidence greater than our fears
    • Connecting with others and expressing worries and concerns to feel supported
    • Taking care of our body by exercising, eating and sleeping well, and limiting our alcohol intake
    • Spending time outdoors to benefit from mother nature’s healing effects
    • Doing breathing / relaxation exercises 
    • Having fun and staying stimulated by trying out new activities / hobbies

Mindfulness
Mindfulness is deep awareness of the present moment. It reflects our ability to BE.HERE.NOW with an accepting, nonjudgmental attitude. Mindfulness helps us to embrace all human experiences, regulate emotions, improve focus and sleep, and boost immunity. A daily dose of mindfulness training can make a world of difference.  

  • Try the mindfulness app “Calm” for free for one month by clicking here

Gratitude and Growth
To help balance the part of the brain that becomes activated when exposed to perceived threat and danger (the amygdala), we can even out the input by focusing on what is good. This can be done by scanning the world around us for three good things and writing those things down at the end of each day. This activity has shown to improve levels of optimism, happiness and subjective well-being. 

We can also mitigate the stress response by adopting a “challenger” mindset and looking for opportunities for growth and learning that comes with the challenge we are facing. For example, this quarantine is a great opportunity to build mental fitness and resilience skills, which can help enhance sport performance when back to training and competition.
Take a proactive and preventative approach and practice psychological hygiene on a daily basis. 

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

 

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

___________________________________________________________________________________________________

UPDATE #13 | 22 April 2020

Advisory on COVID-19

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Disease Update
The number of confirmed cases of COVID-19 is over 2.5 million with 690,000 recovered and 177,608 deaths. There are documented cases in over 213 countries or territories.  While some countries have slowed the doubling rate of new cases and deaths (now at approx. 10 days in Canada), other areas in the world are seeing these rates continue to accelerate. We are continuing to see prolonged second waves in countries that relaxed their restrictions. Canada’s health officials are monitoring this closely as this will have an impact on how other countries, including Canada, manage restrictions and relaxations in the future. A number of European countries have started to relax movement restrictions (including small group activities) this week, however it remains too early to see what the impact of this is at this stage.

In Canada we have over 38,000 cases, 1,834 deaths and 13,000 (34%) recovered. Of the 23,000 presently active cases in Canada 97% are classified as mild. In Canada the testing rate has increased with approx. 6.4% of tests returned as positive. Of the positive cases 77% have no known contact. Although the curves continue to flatten in Canada there remains a lot of risk involved in relaxing restrictions too early and we can only reemphasize that in Canada there are limited resources available and asymptomatic spread is occurring. Continue to assume all others you may encounter may have COVID and act with that in mind and continue to maintain physical distancing vigilance. Despite media reports of some sports or leagues discussing June restarts, this is not imminent in Canada. It remains too early for us to start training in groups or shared facilities as the risks of transmission and becoming infected are still very high. It will remain entirely dependent on Local, Provincial and National public health regulations as to when small group in-person training will again be possible. 

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 has been addressed in earlier releases). If you do have symptoms you should not train until you have contacted your Team Physician, CMO, CSI physician or Family physician to avoid any potential severe and long term complications etc.

Institutes and Training Facilities
At this stage all Canadians remain under national and provincial public health guidelines and as such all institutes and public training facilities remain closed for the foreseeable future.

Return to Training in Groups
As weather improves and as a result of physical distancing measures, COVID-19 pandemic infection rates in some parts of t he country are starting to improve. Many athletes and teams are looking forward to restart training in small groups, with the goal of competing foremost in many minds.

In Canada, as physical distancing measures remain in force, we are not currently ready to start group training at this point in time, and all decisions regarding this would ultimately be in conjunction with provincial / local health authorities, provincial / local government bodies, your sports associations as well as OTP, CPC and COC .

To assist with planning a future restart to training, the SMAC COVID Response Group is working on a Risk Assessment Tool to help guide National Sport Organizations, coaches, teams, and athletes. Aspects that will be considered in the risk assessment tool for your sport include travel arrangements for athletes to the group training venue, as well as mitigation factors that each team/sport will need to evaluate and plan for including:

  • Understanding the current local, provincial, and national COVID-19 situation
  • Emergency preparedness and response plan in case of the occurrence of COVID-19 cases in the training group
  • Logistical coordination
  • Stakeholder coordination and risk communications
  • Isolation capacity of the local community in case an outbreak spreads to that community
  • Specific measures that need to be in place for training to minimize any risk of COVID-19 in the training group

It cannot be emphasized enough that groups, teams or sports should go through this risk assessment process in planning for the safety of their athletes, coaches and the larger population in general. Ultimately local health officials will need to be on board as different provinces, regions and cities are affected differently with COVID-19 and as a result may have unique policies regarding gatherings of individuals that will determine when and how group training may resume in different regions.

The risk assessment tool will be provided next week to NSOs in consultation with CMOs.  A Town Hall will be convened on Monday April 27 th at 11 am Pacific Time / 2 pm Eastern Time to discuss the Risk Assessment Tool. A meeting invitation will be extended by OTP to COPSIN Network representatives, NSO CEO/HPDs COC, CPC and Sport Canada.

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.  

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

___________________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Disease Update
The number of confirmed cases of COVID-19 is over 2 million with 490,000 recovered and 128,000 deaths. Physical distancing and self-isolation are in place in over 50 countries and affect over 2.3 billion people.  While some countries have slowed the doubling rate of new cases and deaths, other areas in the world are seeing these rates accelerate. We are starting to see some second waves in countries that had relaxed their restrictions and are monitoring this closely as this will have effects on other countries including Canada in the future.

In Canada we have over 27,000 cases, 903 deaths and 8,250 recovered. Of the 18,000 presently active cases in Canada 97% are classified as mild. Many of the deaths are from nursing home outbreaks and this has prompted many to consider relaxing their physical isolation and hygiene measures. Although the curves are starting to flatten there is a lot of risk involved in relaxing restrictions and we can only reemphasize that in Canada there are limited resources available and asymptomatic spread is occurring so please continue to assume all others have COVID and act responsibly. Despite media reports of some sports or leagues discussing June to re-start, this is not imminent in Canada. The IOC, IPC and the IFs continue to work on confirming a revised qualification schedule for Tokyo and winter competition calendar. It remains too early for us to start training in groups or shared facilities as the risks of transmission and becoming infected are still very high.

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 year (the rationale has been addressed in earlier releases). If you do have symptoms you should not train until you have contacted your Team Physician, CMO, CSI physician or Family physician to avoid any potential severe and long term complications etc.
 
A recent study by a Belgian and Dutch group looked at air flow and particles when exercising. On the basis of these lab controlled (no prevailing wind etc) results the scientist advises that for walking the distance of people moving in the same direction in 1 line should be at least 4–5 meters, for running and slow biking it should be 10 meters and for hard biking at least 20 meters. Also, when passing someone it is advised to already be in a different lane at a considerable distance e.g. 20 meters for biking.

Institutes and Training Facilities
At this stage all Canadians remain under national and provincial public health guidance and as such all institutes and public training facilities remain closed for the foreseeable future.

 

Mental Health

COVID-19 has led to changes to our daily routine, a constant influx of information, and uncertainty about the future. As a result, the COVID-19 Mental Health and Mental Performance Taskforce Group is seeing a range of reactions by the sport community including increased anxiety and stress, fluctuating motivation, concerns about training and deconditioning, fear of prolonged isolation and lack of connection, but also positive adaptation and resilience. In addition to taking care of our physical health, it is equally important to protect our mental health, promote well-being, and build mental fitness and resilience. Sport medicine providers should anticipate the need for additional mental health support for athletes, coaches and staff during these times of uncertainty and can refer to the following resource guide for those who would benefit from additional support ( Mental Health Resource ).
 
Additionally, athletes, coaches, and support staff are invited to reach out to their Mental Performance Consultants (MPC) to discuss a plan to strengthen their mental performance and resilience. Those who do not currently have an MPC can consult the Canadian Sport Psychology Association (CSPA) website ( https://www.cspa-acps.com ) for registered MPCs across the country. 

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

 

___________________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Within Canada the number of cases continues to rise across the country, but the rate of new cases appears to be slowing in most regions although at different rates. Despite this, areas or clusters of sustained infections and rising hospitalisations are still occurring. In Canada the overall “doubling time” is now between 4 and 5 days. This is in large part due to the efforts of everyone to stay at home and of the social distancing since 12 March. Interesting, of the present confirmed cases 79% have no known contact which reinforces the previous recommendations of “Act as if you are infected and treat anyone you come into contact with as if they are infected”. It is also important to understand that 63% of all confirmed cases in Canada are between the ages of 20 and 59 (28% of all cases between 20 – 39) no one is immune!

There is increasing evidence that people who are infected will transmit the virus even before they show any symptoms. (This is one of the reasons for Dr. Tam suggesting that masks be worn when social distancing cannot be guaranteed - to minimize asymptomatic spread.) If you do wear masks it is very important that you are fully versed in how to put them on and take them off to stop contaminating your own hands (Link to Canada govt website). https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks.html

Although certain countries in Europe and Asia are considering relaxing isolation restrictions in the near future, it is still far too early in Canada for us to start to follow suit. We need to keep on with the social isolation, hygiene and distancing measures to ensure the gains made so far are effective and sustained. It is still not safe to look for loopholes to restart group training. It remains essential for everyone for all of us to avoid training in teams/crews/ pools etc, using shared equipment of public facilities as per the previous statements.

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 year. (Rationale has been addressed in earlier releases.) If you do have symptoms you should not train until you have contacted your Team Physician, CMO, CSI physician or Family physician to avoid any potential complications etc.

Anti-Doping
As noted previously in the CCES advisory, the CCES has suspended testing at this time. There may, however, still be independent agencies that are doing testing on behalf of IFs or leagues. It is important to keep your whereabouts current. Links to useful information re CCES, their contacts and useful Q&As in case you are approached for testing are included below.
 
The CCES’ Notice:  https://cces.ca/news/cces-testing-program-hold
The CCES will advise when the suspension is lifted. The timeline obviously is dependent on how the situation unfolds.

WADA published a helpful Q&A for athletes: https://www.wada-ama.org/sites/default/files/resources/files/covid-19_qaforathletes_en_0.pdf

Athletes can keep reaching out to us for any questions or support they need. Depending on how much info you want/can provide, you can either provide  info@cces.ca  as the general contact, but here are some more specific contacts. All are monitored during this time:

Whereabouts support: whereabouts@cces.ca
Report Doping: intelligence@cces.ca
E-learning support: onlinelearning@cces.ca
Substance inquiries: substances@cces.ca
TUE questions and applications: tue-aut@cces.ca

Nutrition
Scientific evidence currently shows  no indication that COVID-19 is a foodborne illness . Evidence does, however, show that the virus can be transmitted via contact (with an infected person, surface or object) or droplets (from and infected individual coughing, sneezing or talking). 

According to the  Centers for Disease Control and Prevention (CDC), the transmission of the virus is far more likely to spread through  respiratory droplets  from an infected person and much  less  likely via surfaces or food.
       
TIPS FOR SAFE GROCERY SHOPPING                                                                                          
While grocery chains have  ramped  up cleaning and sanitation measures to keep customers safe, it is essential that we also maintain proper hygiene when grocery shopping. 

When at the store, touching surfaces and objects such as shopping carts, freezer door handles, and grocery items are inevitable.

Use disinfecting wipes to wipe down baskets and shopping carts, freezer door handles. (Discard used wipes immediately after use and wash your hands when possible.)  Health Canada has published a list of hard surface disinfectants that are likely to be effective for use against COVID-19.

Keep your distance (2 m)! Follow the one-way signs in the aisles. 

Opt OUT OF RECEIPTS!

Latex gloves are not durable and designed for everyday activities, like grocery shopping. They can rip easily and making them ineffective to protect you. Gloves require proper discarding and frequent changing after use. They should be reserved for our front-line workers. You can use your own gloves (and wash after use) or simply practice good hand hygiene and use a hand sanitizer (with 70% alcohol) as you leave the store and wash your hands immediately when you get home after your grocery trip.

Visit stores during less busy hours. 

Bag your groceries yourself to minimize touching by the store clerk or use the self checkout.
It is advised NOT to use your own re-usable bags. Use single use bags and discard after use and wash hands thoroughly after touching.

AT HOME
Currently, there are no documented cases of COVID-19 that were infected by viral transmission through food . However, the New England Journal of Medicine states that the virus can remain viable on hard surfaces, such as:

Plastic and steel, for up to 3 days 
Cardboard, for 24 hours
Copper, for four hours

This makes food packaging potentially a risk particularly if that packaging has the virus on it then one touches their own mouth, nose, or possibly their eyes. This is not thought to be the main way the virus spreads because of poor survivability of these corona viruses on surfaces. There is likely very low risk of spread from food products or packaging.

BEST PRACTICE RECOMMENDATIONS

Set aside non-perishable groceries in a place in your point of entry in your home (i.e garage) for 72 hrs. before using them to allow for the virus to become inactive. 
Set up a cleaning station to avoid contaminating your food or other surfaces in the house. 
Consider disinfecting packaging with common EPA-registered household disinfectants OR discard the packaging and re-package in your own clean bags or containers.

HOW SHOULD I CLEAN MY FRESH PRODUCE?
YOU DO NOT need to sanitize your fruits and vegetables! Simply washing under running water for 20 seconds is sufficient. The US Food and Drug Administration (FDA) doesn’t recommend using soap and water when cleaning because these are  not approved or labelled  by the FDA for use on foods due to the risk of soap residues remaining and causing gastrointestinal discomfort.
You may consider using a scrub brush to cleanse your produce better. Don’t forget to  clean  the scrub brush thoroughly with soap and water after each use. 

FOOD SAFETY                                                                                                                           
Food safety, personal hygiene and equipment cleaning should always be a priority when handling food. This is particularly true in the case of fresh fruits and vegetables. Corona viruses are killed by  common cleaning and disinfection methods  and by cooking food to  safe internal temperatures . Check out the Canada.ca/Public-health site to learn more about  food safety .

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

_________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

WHO/Public Health
Presently we have over 8,600 confirmed cases with > 100 deaths or 3 per 1 million population in Canada which continues to rise. Canada’s death rate is at approximately 1% of confirmed cases.
Canada is still in the early phase of the rapidly rising epidemic curve, as is the USA where the peak is expected to be approximately mid April. Although the peak in Canada is likely to be less severe than US our peak may be delayed by a few weeks. This may be due to the early effect of our isolation efforts which we will not see for another week or two or the viral strain. This means that social isolation efforts will likely need to continue at least through sometime in May (this is all theoretical mathematical modeling at present). On a positive front there are some very early indications that the social distancing and other measures in Canada may be working.

Worldwide there appear to be 3 or 4 different strains of the COVID-19 virus with varying severity that have yet to be confirmed. Italy has an 11% mortality rate and similar to Spain, with a Strain that appears to have originated from Wuhan. In Germany the mortality rate is closer to 0.8% and this strain likely originated from Shanghai. Which strain has infected Canada is yet to be determined and may be different from cluster to cluster, but we still need to make every effort across Canada to restrict transmission no matter which strain we have in our region.

We are presently observing a low but steady trend of local transmission cases from China, Japan, Singapore as restrictions are relaxed. This second “wave” is a concern and will also determine how long we need to enforce self-isolation measures.

IOC/IPC
We are grateful to have confirmed dates from the IOC/ IPC and Tokyo 2020 for the Games. This now enables everyone to begin focused planning and fill any “gaps” in training / acclimatisation plans that became evident for this year. IOC and IPC are working closely with the IFs regarding re scheduled seasons and new qualifying events etc. We encourage all NSFs to work closely with your coaches, ISTs and CMOs to make any adjustments to any plans that were in place for 2020 as needed and to follow your IFs re any new qualification processes etc.

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 year (the rationale has been addressed in earlier releases).

It is probable that athletes may not be able to resume “normal” training for 2-3 months given the epidemic predictions and this will need to be integrated into any YTP planning etc (remember China is now only 3 months post initial isolation measures) but this does not mean that we cannot take full advantage of this opportunity to address any performance gaps or biomechanical deficiencies etc.

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.

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

_________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

Yesterday the IOC and Tokyo 2020 made the official announcement that the Games would now be postponed to 2021 which will allow athletes to have some certainty and reduce their training.
 
 
Hygiene and Social Precautions:

  • All Canadians should stay at home, work from home, and exercise at home to the extent this is possible. The actual regulations may be different from Province to Province but the essential principle is the same.
  • Maintain a distance of 2 metres from other people.
  • There is a preferred hierarchy for handling coughs and sneezes.
  • Best practice is to expel respiratory droplets into disposable tissue, dispose of it safely, then immediately wash or sanitize hands.
  • Expelling respiratory droplets onto a flexed elbow is better than no protection or an unprotected hand but it is non-optimal, as virus then remains on either the clothing or skin of the elbow depending on attire, either of which then need to be washed.
  • For protection of others – assume you are infected and behave as such.
  • For your protection – assume all others are infected and behave as such. 

 
 
Updated Government of Canada Recommendations:

  • All Canadians are being urged to stay at home where at all possible.
  • All non-essential travel outside Canada is to be avoided, the US border is closed to non-essential traffic. All Canadians currently abroad are urged to return to Canada ASAP.
  • All travellers returning from any destination outside of Canada are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation). 

 
KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19

 
 
Exercise and Daily Training Environment:

At this time, all athletes (Summer and Winter sports) are strongly recommended to reduce training regimens, and instead exercise moderately in isolation from others to maintain general health, work on stability, core strength, fundamental movement quality, and so on.

 
Under the guidance of their NSO coaches, athletes should seek out specific support services to manage transitions in exercise, nutrition, and health needs. The first recommended contacts for physical and mental health issues should be NSO Physicians and NSO Mental Performance / Sport Psychology providers. Athletes who do not have access to NSO health professionals can obtain advice from relevant professionals at COPSIN Institutes and Centres as listed in the link below.

Canadian Centre for Ethics in Sport (CCES) Update:

  • The CCES has significantly reduced operations, testing only where necessary and possible. (Read our updated advisory note here: https://cces.ca/news/updated-cces-statement-regarding-covid-19).
  • CCES is following guidance from public health officials and any decision to test is being taken with full consideration for the health of athletes, sample collection personnel and public health.
  • During this time athletes are still subject to the CADP.
  • Athletes who are part of the CCES’ or their international federation’s Registered Testing Pool should complete their whereabouts as best they can before the deadlines.
  • Athletes are reminded to verify the status of medications using the Global DRO (www.globaldro.com) and to submit an application for a Therapeutic Use Exemption if prescribed a prohibited substance.
  • The CCES’ athlete services team are also available to provide support for online learning.

AN UPDATE WILL BE PROVIDED EVERY WEDNESDAY AT 4:00 PM EDT OR AS REQUIRED.

_________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

The number of confirmed cases of COVID-19 is over 350,000 globally, with approximately 100,000 recovered and over 15,000 deaths. The number of new cases continues to increase rapidly. Over 32,000 new cases were reported in the world yesterday, with the largest surges seen in USA, Italy, and Germany. 

In Canada, the numbers continue to rise quickly, with nearly 1,500 confirmed cases, 20 deaths. The Public Health Agency of Canada still states that the overall risk of infection in Canada is low, but the caseload has risen dramatically in the last week. There were 142 new cases reported on March 22, after two days of having had nearly 250 new cases per day. Continuing to slow the spread of this disease must be our current national and global priority.

Yesterday the COC and CPC made the difficult decision not to send a team to Tokyo in 2020 to minimize the risk to athletes who feel they need to continue training for July 2020 and to minimize the risk to their families and community.

Hygiene and Social Precautions:

  • All Canadians should stay at home, work from home, and exercise at home to the extent this is possible.
  • Maintain a distance of 2 metres from other people.
  • There is a preferred hierarchy for handling coughs and sneezes.
  1. Best practice is to expel respiratory droplets into disposable tissue, dispose of it safely, then immediately wash or sanitize hands.
  2. Expelling respiratory droplets onto a flexed elbow is better than no protection or an unprotected hand but it is non-optimal, as virus then remains on either the clothing or skin of the elbow depending on attire, either of which then need to be washed.
  • For protection of others – assume you are infected and behave as such.
  • For your protection – assume all others are infected and behave as such.

Updated Government of Canada Recommendations:

  • All non-essential travel outside Canada is to be avoided, the US border is closed to non-essential traffic. All Canadians currently abroad are urged to return to Canada ASAP.
  • All travellers returning from any destination outside of Canada are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation).

KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19

Sports and Institutes:

  • COPSIN is fully supportive of the decision made by COC and CPC yesterday not to send athletes to the Tokyo Summer Games if they occur this year.
  • At this time, athletes are strongly recommended to reduce training regimens aimed at peak performance capacity at Tokyo 2020 Summer Games, and instead exercise moderately in isolation from others to maintain general health, work on stability, core strength, fundamental movement quality, and so on.
  • Under the guidance of their NSO coaches, athletes should seek out specific support services to manage transitions in exercise, nutrition, and health needs. The first recommended contacts for physical and mental health issues should be NSO Physicians and NSO Mental Performance / Sport Psychology providers. Athletes who do not have access to NSO health professionals can obtain advice from relevant professionals at COPSIN Institutes and Centres as listed below:

CSI Pacific

CSI Calgary

CSC Saskatchewan

CSC Manitoba

CSI Ontario

INS Québec

CSC Atlantic

  • Athlete Services and Game Plan Manager – Meaghan Donohue (506-453-4500)

 
Training and Training Environments :

  • It is currently recommended that all Canadians should stay at home and exercise at home to the extent that is possible.
  • Canadians who should be self-isolating for reasons of recent travel, any symptoms of illness, or contact with ill persons should NOT exercise in outdoor environments; they must remain at home.
  • Athletes with symptoms of illness are advised not to exercise and seek medical advice.
  • Athletes are strongly recommended to reduce training regimes for the purposes of performance gains related to Tokyo preparation.
  • For a home based program athletes should work specifically with their HPD and team Coaches for your needs.
  1. You should be exercising alone in open spaces or in your house as per current recommendations.
  2. Spacing of 2 metres between people must be maintained.
  3. Do not share equipment; each athlete must use their own equipment.
  4. If training in indoor environments, wash or disinfect your hands before and after touching any equipment or surfaces. Disinfect all touched surfaces with EPA-approved disinfectants (70% alcohol, quaternary ammonium chlorides, 4% hydrogen peroxide).

Mental Health:

Athletes are encouraged to seek out their NSO MPC/Sport Psychologist or speak with a CMO (see below for contact details) to address any mental health needs. Additional mental health support services include:

  1. Referrals can be made online, by email, or by phone:
  2. Online at www.ccmhs-ccsms.ca/refer
  3. By email at INFO@CCMHS-CCSMS.CA
  4. Contact Poppy DesClouds, MPC, CCMHS Care Coordinator at 613-454-1409 ext. 2090

The National Sport Partners have initiated a COVID-19 Mental Health Task Group that will coordinate sharing of best practice within the community of Mental Performance Consultants (MPCs) and Sport Psychologists. National initiatives will be driven by the Task Group, if needed, in response to NSO-driven requests and needs. For more information speak to your NSO or COPSIN MPC/Sport Psychologist or Chief Medical Officer (see below for contact details).

Nutrition for Athletes in Isolation
While athletes may find themselves in isolation during the Covid-19 pandemic, it is important to keep nutrition top of mind.  Work directly with your team or institute nutritionist and follow these quick tips to ensure that you’re tailoring your nutrition to best suit your current needs and to maintain the training gains you’ve had all year long, while keeping your health optimized.

  • KEEP TO A REGULAR EATING SCHEDULE: This will prevent boredom and mindless eating, which can lead to excess unwanted (and needed) calories! Ask yourself Are You Hungry first, if YES, then PLAN what you will have, and listen to satiety cues and stop when you’re full!
  • KEEP THE FIBRE UP!: If you’re moving less overall due to confined spaces, be sure to get adequate amounts of daily soluble and insoluble fiber to keep the bowels moving while also helping you to feel fuller longer; preventing the late night Netflix munchies.
  • STAY HYDRATED: Dehydration can increase levels of stress hormones, something we all don’t need more of right now.  Drink 2-4 L of fluid such as water, carbonated water, tea, coffee, milk, or small amounts of 100% juice. If your first urine after waking up is the colour of lemonade, you’re doing well. Limit Alcohol!
  • REDUCE OVERALL ENERGY INTAKE: Depending on what types of at home training you’re doing, it is most likely that your total volume and intensities will be decreased from normal training loads.  It will be individual but can average a reduction from 500-1000 calories/day, mainly from starchy and simple carbohydrates (Grains and Fruits) and fats. See example below. TIP: reduce your usual plate/bowl size to reduce overall portions and limit snacking.
  • KEEP PROTEIN HIGH!: It is important to continue with your regular protein needs, as this will help to minimize any lean muscle mass loss during reduced strength training. Focus on high quality proteins: Poultry, meat, fish (canned or dried!), eggs, dairy (and lactose free dairy), soy (edamame), and quinoa (good sub when there is no rice!). 
  • CONTINUE WITH YOUR REGULAR NUTRITION SUPPLMENTATION PROTOCOL: This means if you were taking for ex. iron, Vitamin D, B12 etc. for clinical deficiencies, DONT FORGET TO CONTINUE THEM!

Canadian Centre for Ethics in Sport (CCES) Update:

  • The CCES has significantly reduced operations, testing only where necessary and possible. (Read our updated advisory note here: https://cces.ca/news/updated-cces-statement-regarding-covid-19)
  • CCES are following guidance from public health officials and any decision to test is being taken with full consideration for the health of athletes, sample collection personnel and public health.
  • During this time athletes are still subject to the CADP.
  • Athletes who are part of the CCES’ or their international federation’s Registered Testing Pool should complete their whereabouts as best they can before the deadlines.
  • Athletes are reminded to verify the status of medications using the Global DRO (www.globaldro.com) and to submit an application for a Therapeutic Use Exemption if prescribed a prohibited substance.
  • The CCES’ athlete services team are also available to provide support for online learning.

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

_________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

As of March 21 the number of confirmed cases of COVID-19 is over 285,000 globally, with approximately 91,000 recovered and over 11,800 deaths. The largest surges in cases continue to be in Europe (with Italy, France, Germany and Spain being hardest hit) and Iran. The USA has also reported accelerated numbers of new cases. Of note there have been more cases in Canada than in Japan at this point.

In Canada, the numbers are rising at an accelerated rate, with over 1,000 confirmed cases, and 12 deaths. The Public Health Agency of Canada still states that the overall risk of infection in Canada is low, but the entire nation needs to work together to “flatten the epidemic curve” through minimising spread is key.

Hygiene and Social Precautions:

  • All Canadians should stay at home, work from home, and exercise at home to the extent this is possible.
  • Maintain a distance of 2 metres from other people.
  • There is a preferred hierarchy for handling coughs and sneezes.
  1. Best practice is to expel respiratory droplets into disposable tissue, dispose of it safely, then immediately wash or sanitize hands.
  2. Expelling respiratory droplets onto a flexed elbow is better than no protection or an unprotected hand but it is non-optimal, as virus then remains on either the clothing or skin of the elbow depending on attire, either of which then need to be washed.
  • For protection of others – assume you are infected and behave as such.
  • For your protection – assume all others are infected and behave as such.

Updated Government of Canada Recommendations:

  • All non-essential travel outside Canada is to be avoided, the US border is closed to non- essential traffic. All Canadians currently abroad are urged to return to Canada ASAP.
  • All travellers returning from any destination outside of Canada are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation).

KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19

Sports and Institutes:

  • The IOC and IPC are working daily with International Sport Federations to develop fair alternate qualifying processes. 
  • INS, CSIO, CSIC, CSCS, CSCM, CSIP and CSCA are all physically closed but are providing remote services as many staff are working from home. Contact your regional institute or centre as below for details on accessing service. These are left here for rapid access.
  • If you as an athlete are not formally affiliated with an institution then your first choice of medical contact should be your personal or family physician, your sport’s team physician or IST lead. If they are not available or you do not have any of these then you may seek advice from the CMO of your region’s closest Canadian Sport Institute (see contact information below).
  • Services currently available at Canadian Sport Institutes and Centres:

CSI Pacific

  • All CSI Pacific staff are working remotely and at present, providing only remote support and services to their sporting partners.
  • As the Camosun Athletic and Exercise Therapy Clinic is closed, Medical and Paramedical providers are also only able to provide remote services at this time. If an athlete would like a medical consultation, please contact CSI Pacific CMO Dr. McCluskey at pmccluskey@csipacific.ca
  • If an athlete would like a physiotherapy consultation, please email Sue Lott at suzyqlott@gmail.com.
  • If you would like a Strength and Conditioning Consult, please contact your sport’s CSI Pacific Strength and conditioning lead.
  • If you would like a Physiology consult, please consult your sports physiology lead.

CSI Calgary

  • Physicians are available for in-person clinical appointments by contacting our Medical Coordinator at 587-830-2240 or mcosh@csicalgary.ca. General advice and/or follow-up appointments can also be arranged remotely via telephone pending each athlete’s unique situation.
  • Athletes in need of sport therapy services should contact their team therapist directly by email or telephone to schedule in-person or virtual rehabilitation. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number / email address above.
  • Strength and conditioning staff are also available for in-person or remote consultation, please contact your coach directly by email or phone. 

CSC Saskatchewan

  • Nutrition and mental training, and strength and conditioning contact your service provider via email, or Travis Laycock at travis.laycock@sasktel.net or the Athlete Services Manager Kia Schollar at kschollar@sasksport.ca
  • Game Plan and mental health services contact Lisa Hoffart (Game Plan Advisor) lhoffart@mygameplan.ca
  • CSCS/Sask Sport offices are closed to the public, but can be reached via email at mdezell@sasksport.ca or cell phone at 306-281-5814. 

CSC Manitoba

  • Nutrition and Sport Psychology services continue as usual. Please contact your service provider or the Athlete Services Manager, Scott Sywy (scott@cscm.ca) for access.
  • Strength & Conditioning services are being provided over video link. National Team and NSO identified athletes are being provided with equipment for home use following an assessment of needs and space constraints. Please contact your service provider or the Athlete Services Manager, Scott Sywy (scott@cscm.ca) for more information.
  • Lab/Physiological testing is available to athletes on a 1-to-1 basis, provided they have adhered to any quarantine or self-isolation protocols following travel or potential exposure. To discuss specific circumstances, please contact our Physiologist, Jeremie Chase (jeremie@cscm.ca).

CSIO – switchboard 416-596-1240

  • Physicians are available for remote consultation by contacting our Medical Coordinator at 647-725-4105 or sportmedicine@csiontario.ca. We are actively contacting everyone who had an existing physician appointment when we closed.
  • Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number or email address above.
  • Strength and conditioning staff at CSIO also remotely communicating with the athletes they normally train, are available for remote consultation, and can be contacted directly by email or phone.

INS Québec

  • Physicians are available for remote consultation either by contacting them directly or through our medical secretary who is working remotely too 514-255-1000 ext 301 or email: medical@insquebec.org. All athletes who had an appointment were contacted either by phone or email.
  • Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the medical secretary at the number / e-address above.
  • Strength and conditioning staff are also available for remote consultation. They are working on developing home programs, implementing web sessions (for small groups) and we are exploring equipment loan programs.

CSC Atlantic

  • CSCA staff is all working remotely. All performance services experts are prepared to assist athletes and coaches as required.  
  • All Game Plan services are available as well as inquiries regarding specific challenges that athletes are facing through this period of uncertainty. 

Additional Information

  • As noted before athletes should not seek on-site medical attention for respiratory conditions (cough, fever, runny nose, sore throat) at CSI clinics if they are feeling ill. Consult with local public health authorities or CMOs by telephone or email to discuss treatment, isolation or the need for testing.
  • Over the last 48 hours there have been multiple closures and restrictions on public gatherings, restaurants, bars, casinos, gyms, libraries, etc. across the country. This varies by region. Check the provincial links here (PROVINCIAL LINKS) or your own city links for details and specifics.

 
Caution re: Anti-Inflammatory Medications / NSAIDS:

  • There have been some suggestions published in recent medical literature that people with suspected COVID-19 should avoid non-steroidal anti-inflammatory drugs (so-called NSAIDs such as: ibuprofen / Advil / Motrin; naproxen / Aleve; diclofenac / Voltaren; ASA / Aspirin; others) for symptoms and use acetaminophen / Tylenol instead.
  • While some authorities including WHO are questioning the evidence on this issue, we believe it is presently prudent to avoid NSAIDs, and recommend that if symptomatic relief of fever or aches and pains is required, you should use acetaminophen (e.g. Tylenol or other brands thereof), not NSAIDs.

Training Environments:

  • It is currently recommended that all Canadians should stay at home and exercise at home to the extent that is possible.
  • Canadians who should be self-isolating for reasons of recent travel, any symptoms of illness, or contact with will ill should NOT train in outdoor environments; they must remain at home.
  • Athletes with symptoms of illness are advised not to exercise and seek medical advice.
  • If it is not possible to train at home, then training in outdoor or indoor fitness facility environments must follow practices that maintain distance and hygiene:
  1. Avoid crowded spaces; no spaces should contain more than 50 people.
  2. Avoid public transit if possible. Walk, ride a bike, or use a private vehicle if possible.
  3. Spacing of 2 metres between people (equivalent to 4 m2 of space per person in indoor environments) must be maintained.
  4. Do not share equipment; each athlete must use their own equipment.
  5. If training in indoor environments, wash or disinfect your hands before and after touching any equipment or surfaces. Disinfect all touched surfaces with EPA-approved disinfectants (70% alcohol, quaternary ammonium chlorides, 4% hydrogen peroxide).

Mental Health:

  • The National Sport Partners have initiated a COVID-19 Mental Health Task Group that will coordinate sharing of best practice within the community of Mental Performance Consultants (MPCs) and Sport Psychologists. National initiatives will be driven by the Task Group, if needed, in response to NSO-driven requests and needs. For more information speak to your NSO or COPSIN MPC/Sport Psychologist or Chief Medical Officer (see below for contact details).
  • Athletes can reach out to mental health professionals or mental performance consultants through their NSO or at regional institutes by email.

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

________________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

As of March 19 the number of confirmed cases of COVID-19 is over 220,000 globally, with approximately 85,000 recovered and over 9,000 deaths. The largest surges in cases continue to be in Europe with Italy, France, Germany and Spain being hardest hit. There are 171 countries reporting cases. Of note significantly, there are NO new local cases reported in China.The WHO has declared COVID-19 as a pandemic.

In Canada, the numbers are rising at an accelerated rate, with over 725 confirmed cases, with 9 deaths. The Public Health Agency of Canada still states that the overall risk of infection in Canada is low, but the entire nation needs to work together to “flatten the epidemic curve” through minimizing spread is key. All Canadians are requested to stay home and work from home, practice social distancing (2m distance) if at all possible.

The existing strong advice on the importance of hand and facial hygiene and “social distancing” still holds.

Updated Government of Canada Recommendations:

  • All non-essential travel outside Canada is to be avoided, the US border is closed to non-essential traffic.
  • All Canadians currently abroad are urged to return to Canada ASAP.
  • All travellers returning from any destination outside of Canada are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation).
  • As the possibility of coming in contact with someone with confirmed COVID 19 increases, we have included this link from the Public Health Agency of Canada (PHAC) on self monitoring and isolation.
  • If you have symptoms (fever, cough, runny nose, sore throat) when attempting to board a plane to return to Canada you will not be allowed on the flight.
  • Airlines are reducing capacity and flights (e.g. - Air Canada is operating at 50% of normal capacity), such that it may be difficult to return to Canada later.
  • As of 18 March, international arrivals by air (excluding USA, Caribbean, and Mexico) will only be through Toronto, Montreal, Calgary or Vancouver.
  • There is enhanced screening and advice on self-isolation at all airports (see the infographic below).

KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19

Sports and Institutes:

  • The IOC and IPC are working daily with International Sport Federations to develop fair alternate qualifying processes. 
  • INS, CSIO, CSIC, CSCS, CSCM, CSIP and CSCA are all physically closed but are providing remote services as many staff are working from home. Contact your regional institute or centre as below for details on accessing service.

CSI Pacific

  • All CSI Pacific staff are working remotely and at present, providing only remote support and services to their sporting partners.
  • As the Camosun Athletic and Exercise Therapy Clinic is closed, Medical and Paramedical providers are also only able to provide remote services at this time. If an athlete would like a medical consultation, please contact CSI Pacific CMO Dr. McCluskey at pmccluskey@csipacific.ca.
  • If an athlete would like a physiotherapy consultation, please email Sue Lott at suzyqlott@gmail.com
  • If you would like a Strength and Conditioning Consult, please contact your sport’s CSI Pacific S&C lead
  • If you would like a Physiology consult, please consult your sports physiology lead.

CSI Calgary

  • Physicians are available for in-person clinical appointments by contacting our Medical Coordinator at 587-830-2240 or mcosh@csicalgary.ca. General advice and/or follow-up appointments can also be arranged remotely via telephone pending each athlete’s unique situation.
  • Athletes in need of sport therapy services should contact their team therapist directly by email or telephone to schedule in-person or virtual rehabilitation. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number / email address above.
  • Strength and conditioning staff are also available for in-person or remote consultation, please contact your coach directly by email or phone. 

CSC Saskatchewan

  • Nutrition and mental training, and strength and conditioning contact your service provider via email, or Travis Laycock at travis.laycock@sasktel.net or the Athlete Services Manager Kia Schollar at kschollar@sasksport.ca
  • Game Plan and mental health services contact Lisa Hoffart (Game Plan Advisor) lhoffart@mygameplan.ca
  • CSCS/Sask Sport offices are closed to the public, but can be reached via email at mdezell@sasksport.ca or cell phone at 306-281-5814. 

 

CSC Manitoba

  • Nutrition and Sport Psychology services continue as usual. Please contact your service provider or the Athlete Services Manager, Scott Sywy (scott@cscm.ca) for access.
  • Strength & Conditioning services are being provided over video link. National Team and NSO identified athletes are being provided with equipment for home use following an assessment of needs and space constraints. Please contact your service provider or the Athlete Services Manager, Scott Sywy (scott@cscm.ca) for more information.
  • Lab/Physiological testing is available to athletes on a 1-to-1 basis, provided they have adhered to any quarantine or self-isolation protocols following travel or potential exposure. To discuss specific circumstances, please contact our Physiologist, Jeremie Chase (jeremie@cscm.ca).

CSIO – switchboard 416-596-1240

  • Physicians are available for remote consultation by contacting our Medical Coordinator at 647-725-4105 or sportmedicine@csiontario.ca. We are actively contacting everyone who had an existing physician appointment when we closed.
  • Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the Medical Coordinator at the number or email address above.
  • Strength and conditioning staff at CSIO also remotely communicating with the athletes they normally train, are available for remote consultation, and can be contacted directly by email or phone.

INS Québec

  • Physicians are available for remote consultation either by contacting them directly or through our medical secretary who is working remotely 514-255-1000 ext 301 or email: medical@insquebec.org. All athletes who had an appointment were contacted either by phone or email.
  • Therapy staff are checking in with athletes in their caseload on a regular basis by remote means to check their exercise programs, progressions, and how they are doing. Athletes needing to hear from a therapist should contact the medical secretary at the number / email address above.
  • Strength and conditioning staff are also available for remote consultation. They are working on developing home programs, implementing web sessions (for small groups) and we are exploring equipment loan programs.​

CSC Atlantic

  • CSCA staff is all working remotely. All performance services experts are prepared to assist athletes and coaches as required. 
  • All Game Plan services are available as well as inquiries regarding specific challenges that athletes are facing through this period of uncertainty. 

Additional Information

  • NSOs determine optimal adapted training environments and strategies to support athlete training and overall well-being. NSOs are encouraged to contact CSIs/CSCs to communicate required initiatives or support to meet athlete needs.
  • As noted before athletes should not seek on-site medical attention for respiratory conditions (cough, fever, runny nose, sore throat) at CSI/CSC clinics if they are feeling ill. Consult with local public health authorities or CMOs by telephone or email to discuss treatment, isolation or the need for testing.
  • Over the last 48 hours there have been multiple closures and restrictions on public gatherings, restaurants, bars, casinos, gyms, libraries, etc. across the country. This varies by region. Check the provincial links here (PROVINCIAL LINKS) or your own city links for details and specifics.

 
Caution re: Anti-Inflammatory Medications / NSAIDS

  • As reported by WHO and in the British Medical Journal published 17 Mar, people with suspected COVID-19 should avoid non-steroidal anti-inflammatory drugs (so-called NSAIDs such as: ibuprofen / Advil / Motrin; naproxen / Aleve; diclofenac / Voltaren; ASA / Aspirin; others) for symptoms and use acetaminophen / Tylenol instead. 
  • The use of NSAIDs may lead to more serious symptoms of respiratory or septic complications and cardiovascular complications. 
  • If symptomatic relief of fever or aches and pains is required, use acetaminophen (e.g. Tylenol or other brands thereof), not NSAIDs.

Training Environments :

  • NSOs should withhold athletes/coaches/staff with symptoms from attending training.
  • Medical advice recommends that self-isolation includes staying at home and avoiding all mass gatherings and public transport. Training outside (e.g. running) is permissible in isolation; avoiding social gatherings or training groups.
  • Spacing of 2 metres or greater for exercising athletes (equivalent to 4m2 = 45ft2 floor space per athlete in indoor spaces) is recommended and should be adopted by NSOs in terms of athlete and equipment spacing.
  • If training facilities are still accessible NSOs should check with facility cleaning services regarding cleaning fluids and enhanced practices to ensure optimal effectiveness of products, and to ensure that cleaning is directed at surfaces frequently touched by hands rather than floors and walls, etc.
  • NSOs should strongly review training in public venues that they cannot control for enhanced hygienic practices or social spacing appropriate to athletes. Consider off-hour use and NSO involvement in monitoring of cleaning.

Mental Health:

  • It is important to attend to the mental health of athletes whose training or qualification for 2020 Summer Games may have been interrupted by this pandemic.
  • Athletes can reach out to mental health professionals or mental performance consultants through their NSO or at regional institutes by email.
  • Please see the linked infographic from Game Plan for additional advice below.

CANADIAN NATIONAL TEAM ATHLETE MENTAL HEALTH RESOURCE GUIDE

 

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

 

_______________________________________________________________________________________

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

As of March 17 the number of confirmed cases of COVID-19 is over 183,000 globally, with approximately 80,000 recovered and over 7,100 deaths. The largest surges in cases continue to be in Europe with Italy, France, Germany and Spain being hardest hit. There are 161 countries reporting cases. The WHO has declared COVID-19 as a pandemic.

In Canada, the numbers are rising, with over 440 confirmed cases, with 4 deaths in a nursing home in BC and 1 death in ON. The Public Health Agency of Canada still states that the overall risk of infection in Canada is low, but the entire nation needs to work together to “flatten the epidemic curve” (slow the rate of transmission so that at its peak, the case load will not overwhelm our health care system’s capacity).

The existing strong advice on the importance of hand and facial hygiene and “social distancing” still holds.

Updated Government of Canada Recommendations:

  • All non-essential travel outside Canada is to be avoided.
  • All Canadians currently abroad are urged to return to Canada ASAP.
  • All travellers returning from any destination including USA are required to self-isolate for 14 days from the date of return (see the infographic below for specific information on what is involved in self-isolation).
  • Canadian borders are now closed except to Canadian citizens, permanent residents, and USA citizens.
  • If you have symptoms (fever, cough, runny nose, sore throat) when attempting to board a plane to return to Canada you will not be allowed on the flight.
  • Airlines are reducing capacity and flights (e.g. - Air Canada is operating at 50% of normal capacity), such that it may be difficult to return to Canada later.
  • As of 18 March, international arrivals by air (excluding USA, Caribbean, and Mexico) will only be through Toronto, Montreal, Calgary or Vancouver.
  • There is enhanced screening and advice on self-isolation at all airports (see the infographic link below) 
  • All Canadians are requested to stay home and work from home, practice social distancing (2m distance) if at all possible.

KNOW THE DIFFERENCE: SELF-MONITORING, SELF-ISOLATION, AND ISOLATION FOR COVID-19

Sports and Institutes:

  • The IOC remains committed to the Games in Tokyo going ahead on time and is addressing the qualification system through the International Sport Federations.
  • See the IOC communiqué
  • Tokyo 2020 Qualifying and test events continue to be cancelled.
  • The IOC and IPC are working with International Sport Federations to develop fair alternate qualifying processes.
  • INS, CSIO, CSIC, CSIP, CSCS, CSCM and CSCA are all closed. Many staff are working from home. Contact your regional institute or centre by email for details.
  • Athletics Canada closed both its East and West Hubs on 16 March 2020.
  • There was one confirmed positive case at the Cross Country World Cup event in Québec City. It was a foreign national who immediately isolated on arrival, but the Canadian team members have been advised to undergo 14 days of self-isolation after leaving Québec City.
  • As noted before athletes should not seek on-site medical attention for respiratory conditions (cough, fever, runny nose, sore throat) at CSI clinics. Consult with local public health authorities or CMOs by telephone or email to discuss treatment, isolation or the need for testing.
  • Over the last 48 hours there have been multiple closures and restrictions on public gatherings, restaurants, bars, casinos, gyms, libraries, etc. across the country. This varies by region. Check the provincial links here (PROVINCIAL LINKS) or your own city links for details and specifics.

Training Environments :

  • NSOs should withhold athletes/coaches/staff with symptoms from attending training.
  • Medical advice recommends that self-isolation includes staying at home and avoiding all mass gatherings and public transport. Training outside (e.g. running) is permissible in isolation; avoiding social gatherings or training groups.
  • Spacing of 2 metres or greater for exercising athletes (equivalent to 4m2 = 45ft2 floor space per athlete in indoor spaces) is recommended and should be adopted by NSOs in terms of athlete and equipment spacing.
  • If training facilities are still accessible NSOs should check with facility cleaning services regarding cleaning fluids and enhanced practices to ensure optimal effectiveness of products, and to ensure that cleaning is directed at surfaces frequently touched by hands rather than floors and walls, etc.
  • NSOs should strongly review training in public venues that they cannot control for enhanced hygienic practices or social spacing appropriate to athletes. Consider off-hour use and NSO involvement in monitoring of cleaning.

Mental Health:

  • It is important to attend to the mental health of athletes whose training or qualification for 2020 Summer Games may have been interrupted by this pandemic.
  • Athletes can reach out to mental health professionals or mental performance consultants through their NSO or at regional institutes by email.
  • Please see the linked infographic from Game Plan for additional advice below.

CANADIAN NATIONAL TEAM ATHLETE MENTAL HEALTH RESOURCE GUIDE

 

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

 

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

 

Travel Advisories

All countries recommend no travel and require 14 day self-isolation upon return.

 

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

_______________________________________________________________________________________

March 15th, 2020

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

There are over 162,410 cases worldwide, 5,985 deaths and over 75,000 recovered. The largest surges in cases continue to be in Europe with Italy, France, Germany and Spain being hardest hit. There are 141 countries reporting cases. The WHO has declared COVID-19 as a pandemic.

In Canada the numbers have started to rise with now over 250 cases. We now have 11 recovered and still only one death of an elderly person in BC

As an update the federal government has recommended that Canadians overseas return to Canada as some countries are closing their borders to international flights. They also recommend to “avoid non essential travel outside Canada until further notice” https://travel.gc.ca/travelling/advisories

Although Olympic & Paralympic travel to training venues is a NSO-based decision (and may be viewed as ‘essential’), it is recommended that consideration be given to being stranded in a foreign country with insurance that may not cover travel or medical expenses. Medical access in the COVID pandemic may also be limited.

Travel for training or competition other than compulsory Paralympic or Olympic qualification in 2020 should not be considered for at least 30 days. Updates will be provided should this time period change.
There are no restrictions or policies about travel within Canada at this time.

In all cases you should contact your team CMO or CSIO CMO/ team physician for advice and coordination.

In terms of self-isolation for anyone returning from outside of Canada, as of March 13, 14-Day self-isolation should be implemented for athletes returning to Canada from all international destinations. Self-monitoring should be emphasized for all athletes returning from international destinations. Please consult with CMOs to discuss travel dates that may be of concern.

Athletes should not seek medical attention for respiratory conditions (cough, fever, runny nose, sore throat) at CSI clinics. Consult with local public health authorities or CMOs by telephone.

Training Environment:

  1. NSOs should withhold athletes/coaches/staff with symptoms from attending training.
  2. Medical advice recommends that self-isolation includes staying at home and avoiding all mass gatherings and public transport. Training outside (e.g. running) is permissible in isolation; avoiding social gatherings or training groups.
  3. NSOs are recommended to work with CSI/CSCs and/or other training facility owners to determine hygienic training environments inclusive of modified training numbers, enhanced spacing of equipment, increased hand-washing, and increased sanitizing approaches.

NSOs should be mindful of municipal or provincial regulations regarding limits to mass gatherings.
Psychological factors are playing a large role in this pandemic and we encourage those that are concerned to contact their team physician, CMO or mental health team. Link is American but a good reference on social distancing and isolation.

https://www.apa.org/practice/programs/dmhi/research-information/social-distancing

It cannot be emphasized enough to continue to be diligent in self care including hand washing, use of hand sanitizer and cough etiquette.

 

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

 

Updated links from the Government of Canada and WHO

https://www.canada.ca/en/public-health/services/diseases/coronavirus-disease-covid-19.html#faq
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
Provincial Information

 

Travel Advisories

All countries recommend no travel and require 14 day self-isolation upon return.

 

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

_________________________________________________________________________________________

March 13, 2020

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

At this point there are over 134,824 cases worldwide, 4,284 deaths and over 70,000 recovered. There are 123 countries reporting cases. The WHO has declared COVID-19 as a pandemic.

In Canada the numbers remain small at 157 cases and one death and now 9 recovered. The risk level remains low and in the last day many provinces have changed or implemented travel restrictions. The table below list the latest info for travelers returning from outside Canada. There are no restrictions or policies about travel within Canada at this time.

People who are currently abroad: The international situation is rapidly evolving and most people are returning to Canada as quickly as possible. Please consult with Chief Medical Officers (CMOs) regarding appropriate self-isolation and/or hygiene practices upon return.

People looking to travel: The current trend is to avoid non-essential travel, and especially international travel. Please consider international or domestic travel carefully and consult with CMOs and investigate regional or provincial travel advisories.

Staging of events:  Numerous organizations are canceling sporting events out of an abundance of caution. We recommend that you contact public health officials if you are considering canceling or postponing upcoming sporting events and/or limit/restrict spectators.  

PROVINCIAL AND TERRITORIAL SELF-ISOLATION POLICIES

In all cases if you have symptoms or have questions you should contact your team CMO or CSIO CMO/ team physician.
For guidance on what self isolation entails please see the attached guidance below. 

HOME ISOLATION FACT SHEET

It can not emphasized enough to continue to be diligent in self care including hand washing, use of hand sanitizer and cough etiquette.

All sports in consultation with their CMO/team physicians need to do a risk assessment of their training facilities for the risk of community transmission and increased facility hygiene and disinfection processes.

INSURANCE: Based on the experience of certain sports, there is a growing risk that, in light of risks due to the COVID-19 virus, personal insurance coverage may no longer cover athletes when traveling abroad. You are therefore strongly encouraged to contact your insurance provider prior to athlete travel to confirm insurance coverage. 

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

 

Travel Advisories

China, Iran, Italy: Level 3 – Avoid non-essential travel

Do not travel to these areas at this time unless such travel is absolutely required for Olympic or Paralympic qualification. If you must go, use hyper-vigilant hand and face hygiene.

Japan, South Korea: Level 2 – Practice special precautions

In this context, with no available vaccine, this means to be hyper-vigilant about routine hygiene (see Level 1), and restrict travel to venues required for competition, training or accommodation. Avoid busy public places if possible.

France, Germany, Hong Kong, Singapore, Spain: Level 1 – Practice usual precautions

This includes proper hand hygiene (washing with soap for 20 seconds or use of hand disinfectants with >60% alcohol), covering coughs and sneezes with tissue that is then disposed of and hands cleaned, and avoiding contact with face, nose, or eyes with unclean hands, as well as frequent wiping of equipment and objects touched by hands.

 

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca
Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca
Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org
Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca
Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca
Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

________________________________________________________________________________________

March 11th, 2020

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

At this point there are over 121,000 cases worldwide, 4,373 deaths and over 65,000 recovered.

Some European countries and the US have had increased new cases in the last week. The US presently does not have any restrictions. There is a link below to the latest numbers and locations in the US of cases. Many competition and training opportunities are to be evaluated on a case by case basis and in consultation with the CMO’s listed below.

LiveScience: Coronavirus in USA

Cancellation of events are multi factorial and not necessarily related to COVID-19 medical precautions. The WHO will be publishing recommendations for mass events shortly and we will update as this is released.

WHO, IOC and IPC are all emphasizing that the games are still on schedule and they are working with IFs on any affected qualification routes and impacted test events.
In Canada the numbers remain small at 93 cases and one death. The risk level remains low and no specific measures for travel, participation in sporting events or training are in place. While a COVID-19 outbreak is not unexpected in Canada, our public health system is prepared to respond. PHAC, along with provincial, territorial and community partners, continues to reassess the public health risk, based on the best available evidence as the situation evolves.
Air Canada Update

WHO COVID-19 Update#15 10.03.2020
WHO Coronavirus Myth Busters

 

AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

 

Travel Advisories

China, Iran, Italy: Level 3 – Avoid non-essential travel

Do not travel to these areas at this time unless such travel is absolutely required for Olympic or Paralympic qualification. If you must go, use hyper-vigilant hand and face hygiene.

Japan, South Korea: Level 2 – Practice special precautions

In this context, with no available vaccine, this means to be hyper-vigilant about routine hygiene (see Level 1), and restrict travel to venues required for competition, training or accommodation. Avoid busy public places if possible.

Hong Kong, Singapore, France, Germany, Spain: Level 1 – Practice usual precautions

This includes proper hand hygiene (washing with soap for 20 seconds or use of hand disinfectants with >60% alcohol), covering coughs and sneezes with tissue that is then disposed of and hands cleaned, and avoiding contact with face, nose, or eyes with unclean hands, as well as frequent wiping of equipment and objects touched by hands.

 

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

 

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca

Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca

Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org

Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca

Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca

Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

_______________________________________________________________________________________

March 8th, 2020

SPORT MEDICINE ADVISORY COMMITTEE UPDATE:

The travel advisory remains the same as per below
 
At this point there are over 111,000 cases worldwide, over 80% in Mainland China.
 
Some European countries and the US have had increased new cases in the last week.
 
Japan has enacted a shutdown of schools and workplaces and their numbers have stabilized, now number 10 on the list of countries with most cases. The measures seem to indicate that this approach can be successful.
 
WHO has recommended avoidance of all cruise ship travel at this point.
 
In Canada the numbers remain small at 62 cases and no deaths. The risk level remains low and no specific measures for travel, participation in sporting events or training are in place beyond good hand washing and covering coughs or sneezes.
 
AN UPDATE WILL BE PROVIDED EVERY 48 HOURS AT 4:00 PM EST.

Travel Advisories:

China, Iran, Northern Italy: Level 3 – Avoid non-essential travel

-   Do not travel to these areas at this time unless such travel is absolutely required for Olympic or Paralympic qualification. If you must go, use hyper-vigilant hand and face hygiene.

Japan, South Korea: Level 2 – Practice special precautions

-   In this context, with no available vaccine, this means to be hyper-vigilant about routine hygiene (see Level 1), and restrict travel to venues required for competition, training or accommodation. Avoid busy public places if possible.

Hong Kong, Singapore: Level 1 – Practice usual precautions

-  This includes proper hand hygiene (washing with soap for 20 seconds or use of hand disinfectants with >60% alcohol), covering coughs and sneezes with tissue that is then disposed of and hands cleaned, and avoiding contact with face, nose, or eyes with unclean hands, as well as frequent wiping of equipment and objects touched by hands.

 

Further Questions:

Further information about COVID-19 may be obtained from your NSO Chief Medical Officer or Team Physician, or the Chief Medical Officers of the Sport Medicine Advisory Committee.

 

Dr. Mike Wilkinson, Canadian Olympic Committee: mwilkinson@olympic.ca

Dr. Andy Marshall Canadian, Paralympic Committee: amarshall@paralympic.ca

Dr. Suzanne Leclerc, Institut National du Sport du Québec: sleclerc@insquebec.org

Dr. Doug Richards, Canadian Sport Institute Ontario: drichards@csiontario.ca

Dr. Brian Benson, Canadian Sport Institute Calgary: bbenson@csicalgary.ca

Dr. Paddy McCluskey, Canadian Sport Institute Pacific: pmccluskey@csipacific.ca

 

General Information

This joint message is from the Own the Podium led Sport Medicine Advisory Committee comprised of Chief Medical Officers from the Canadian Olympic Committee, the Canadian Paralympic Committee, and the Canadian Olympic and Paralympic Sport Institute Network (COPSIN). It is meant to guide National Sporting Organizations (NSOs) in decision-making with respect to travel to competitions within and outside Canada. Information has been obtained from the World Health Organization, Government of Canada and Australian Institute of Sports websites. Other references are listed in this document. This advisory will be updated regularly and distributed to NSOs and other high performance sport partners.

The outbreak of severe respiratory illness related to the new coronavirus (COVID-19) continues to have an expanding impact internationally. The World Health Organization (WHO) provides regular updates which guide our recommendations. The latest WHO statements can be found at WHO website on Coronavirus disease (COVID-19) outbreak.

COVID-19 is a virus in the coronavirus family. Coronaviruses in this family are responsible for illnesses that range from the common cold to more serious illnesses such as Severe Acute Respiratory Syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV). COVID-19 is a new virus and so health officials are still learning about its impact and severity. At this time, it appears to cause an illness similar to the flu with the most common signs of infection being fever, cough and shortness of breath. In severe cases patients can develop pneumonia, severe respiratory distress, kidney failure and death.

 

Epidemiology: The numbers

The reports from China suggest that with COVID-19:

  • 1% have no symptoms
  • 81% have mild symptoms
  • 14% have severe symptoms that cause them to miss work or go to the hospital
  • 5% have severe symptoms that lead to ICU admission, including a fatality rate of 2.3%
  • The fatality rate is highest in those that are elderly and have other medical conditions
  • The estimate of risk to athletes (i.e., younger and healthier) is thought to be similar to the risk of health care workers; 0.3% fatality rate

Wu and McGoogan JAMA 2020-02-24 Characteristics of and Lessons from COVID-19 in China

The number of cases in Canada is small. At this time the risk of contracting COVID-19 in Canada is very low.

 

Clinical Course

It appears that COVID-19 is more contagious than the typical influenza virus.

The virus is transmitted primarily through respiratory droplets. Those that are experiencing symptoms are more likely to spread the illness than those that have the illness but do not have symptoms. There is ongoing research to determine if there are other possible modes of transmission such as fecal or air.

The estimated incubation period (time from initial expose to onset of symptoms) is between 1-14 days but is about five days on average. Symptoms can persist for longer than three weeks, although the duration of illness will be highly variable.

 

Prevention

Recommendations for protecting yourself and preventing spread of this illness include frequent hand washing and covering both your nose and mouth when coughing. Try to cough or sneeze into your arm, away from others, or into tissue paper (to be disposed in toilet). Wash your hands immediately afterwards. You should avoid close contact with anyone showing symptoms of respiratory illness.

Research on respiratory infections in travelling sporting teams suggests that the most likely pattern of spread occurs within a team, rather than from external sources. When an unwell team member joins the team, due to regular close physical contact between team members, the infections can spread readily (Valtonen et al, 2019). Consideration should be given for delaying travel for team members who are unwell.

 

What to do if you think you have COVID-19

Because the early symptoms of COVID-19 are similar to other respiratory illnesses, if you have any of the common symptoms (fever, cough and shortness of breath) you should contact your doctor’s office and arrange to have a consultation.

 

Treatment:

At this time, there is no specific treatment for COVID-19. The goals of medical management are to identify other treatable causes of illness (such as influenza), manage any complications from COVID-19 and provide advice on how to limit the transmission from known cases.

There are efforts internationally to produce a vaccine and to identify if any of the currently available antiviral medications are effective and safe. An update is expected to be released in mid-2020. A vaccine will likely take longer as it will have to go through longer clinical trials to confirm safety and efficacy.

 

Travelling to sporting events

We recommend that you check for up-to-date travel advisories from the Government of Canada at: Government of Canada COVID-19 Travel Advice.

 

On Airplanes:

Vigilant hand and face hygiene should be practiced. Stay hydrated.

The European Centre for Disease Control (EDCD) has published research into the risk of contracting Infectious Diseases on Aircraft. While there are currently no data available on the transmission risk for COVID-19 during airline travel, we look to the risk related to similar diseases, such as influenza and SARS. The ECDC concluded that the quality of evidence to assess the risk of transmission of influenza onboard an aircraft is not adequate. SARS transmission has been documented from airline travel with transmission most likely from those who are severely ill or those experiencing rapid deterioration, usually in the second week of their illness.

 

On Return from Travel:

The Government of Canada advises that any travelers from the above countries should be vigilant for symptoms that may indicate a respiratory illness consistent with COVID-19 (fever, cough, shortness of breath) and report these symptoms immediately to their physician and avoid contact with others until they have been cleared to do so. What this means for sports is, if team members returning to Canada from the countries listed become unwell in the two weeks after return to Canada, they may need to be quarantined and tested for COVID-19. This should be taken into account when planning training camps and competition preparation.

Athletes and coaches who are currently unwell with fever, cough or shortness of breath should delay their flight and seek medical review. If you become unwell during your flight you should notify the flight attendants, place a P2 or N95 face mask on and seek medical review as soon as practical on arrival.

 

Face Masks:

Face masks are most effective in preventing transmission when worn by people who are unwell. If you are well, masks only need to be worn by those who have close contact with those who are unwell (i.e., recommended for health care workers). Correct fitting of face masks is most important to their effectiveness. A good resource is the Australian New South Wales Health web site (How to Fit a Face Mask).

 

Considerations for Athletes, Coaches, Sport Organizations & Event Producers:

Athletes and Coaches:

Prior to travelling overseas for training camps and competitions

  • The risks associated with travel and competitions vary with multiple factors including location, age and origin of participants, indoor vs outdoor venues, and contact vs non-contact sports, among others. Check with your team physician, NSO CMO, or SMAC CMO for detailed consideration of these issues.

 

  • Make an appointment with your team physician or regular doctor prior to departure to ensure that your vaccinations are up-to-date and that you will have enough of your regular medications, with the appropriate documentation, for your entire trip and at least an additional week. Vaccinations need to be administered well in advance of travel to be effective.

 

 

  • It is best to have contingency travel plans in place with the ability to change flights if needed.

 

  • There is no need to alter your exercise or training if you are feeling well, nor do you need to wear a mask in public.

 

National Sporting Organizations (NSOs):

  • Where travelling to places with an elevated risk, NSOs are urged to have a team doctor travel with the team. Other health professionals should not be expected to coordinate or provide medical care.

 

  •  Having appropriate travel insurance for your team that can be relied upon in the event a medical evacuation is necessary.

 

  •  When planning training camps, consider factors such as ease of access to medical resources and the prevalence of infection rates in neighbouring countries.

Sporting Events in Canada:

  •  There have been very few cases of COVID-19 diagnosed in Canada. There is currently no indication for event organizers to delay or postpone sporting events in Canada.

 

  •  For international athletes travelling to compete in Canada, only the Government of Canada should provide details the current travel restrictions in place. At present, the Government of Canada is asking only those that have returned from the Hubei province in the last 14 days should self-isolate for 14 days and contact your local health authority within 24 hours of arriving in Canada. There are no other recommendations. Event organizers should not impose additional restrictions on international athletes. All travelers that have symptoms of fever, cough and shortness of breath should be advised to have a physician assessment.

 

  •  Mass gathering and sporting events can pose additional infection control challenges in general. If there is concern regarding your event, please discuss with your Chief Medical Officer who can help put in place risk mitigation strategies in conjunction with your local public health unit if required.

 

Other Resources:

 

 

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