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Abstract
In an effort to reduce transmission and number of infections of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) virus, governments and official bodies around the world have produced guidelines on the use of face masks and face coverings. While there is a growing body of recommendations for healthcare professionals and the wider population to use facial protection in “enclosed spaces” where minimal distancing from other individuals is not possible, there is a dearth of clear guidelines for individuals undertaking exercise and sporting activity. The present viewpoint aims to propose recommendations for face coverings while exercising during the COVID-19 pandemic that consider physical distancing, the environment, the density of active cases associated with the specific sports activity, and the practical use of face coverings in order to reduce potential viral transmission. Recommendations are provided on the basis of very limited available evidence in conjunction with the extensive collective clinical experience of the authors and acknowledging the need to consider the likelihood of the presence of the SARS-CoV-2 in the general population. We recommend that face coverings should be used in any environment considered to be of a high or moderate transmission risk, where tolerated and after individual risk assessment. In addition, as national caseloads fluctuate, individual sporting bodies should consider up to date guidance on the use of face coverings during sport and exercise, alongside other preventative measures.
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1 Somerset NHS Foundation Trust, Taunton, UK
2 University of Zaragoza, GENUD (Growth, Exercise, Nutrition and Development) research group, Zaragoza, Spain (GRID:grid.11205.37) (ISNI:0000 0001 2152 8769)
3 World Rugby, Dublin, Ireland (GRID:grid.497635.a) (ISNI:0000 0001 0484 6474)
4 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.497635.a); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of Vienna, Institute of Sports Science, Vienna, Austria (GRID:grid.10420.37) (ISNI:0000 0001 2286 1424); Austrian Institute of Sports Medicine, Vienna, Austria (GRID:grid.10420.37)
5 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.10420.37); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); British Association Sport and Exercise Medicine, Doncaster, UK (GRID:grid.497632.d); Defence Medical Rehabilitation Centre (DMRC), Loughborough, UK (GRID:grid.497632.d)
6 British Association Sport and Exercise Medicine, Doncaster, UK (GRID:grid.497632.d)
7 British Association Sport and Exercise Medicine, Doncaster, UK (GRID:grid.497632.d); British Cycling and University of Liverpool, Liverpool, UK (GRID:grid.10025.36) (ISNI:0000 0004 1936 8470)
8 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.10025.36); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Union Cycliste Internationale (UCI), Aigle, Switzerland (GRID:grid.497632.d)
9 University of Vienna, Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic (KIMII), Vienna, Austria (GRID:grid.10420.37) (ISNI:0000 0001 2286 1424)
10 University of Zurich, Department of Cardiology, University Hospital Zurich, University Heart Centre, Zurich, Switzerland (GRID:grid.7400.3) (ISNI:0000 0004 1937 0650)
11 German Respiratory Society (DGP), Berlin, Germany (GRID:grid.489525.7) (ISNI:0000 0000 9320 5144); Lung Center Bogenhausen-Harlaching, Munich Clinic, Munich, Germany (GRID:grid.489525.7)
12 German Respiratory Society (DGP), Berlin, Germany (GRID:grid.489525.7) (ISNI:0000 0000 9320 5144); German Center for Lung Research, LMU Klinikum, Institute and Clinic for Occupational, Social and Environmental Medicine, Comprehensive Pneumology Center, member DZL, Munich, Germany (GRID:grid.452624.3)
13 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.452624.3); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761)
14 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.497632.d)
15 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.497632.d); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Ulm University Hospital, Division of Sports and Rehabilitation Medicine, Ulm, Germany (GRID:grid.410712.1)
16 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Humboldt University and Charité University School of Medicine, Department of Sports Medicine, Berlin, Germany (GRID:grid.7468.d) (ISNI:0000 0001 2248 7639)
17 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); British Association Sport and Exercise Medicine, Doncaster, UK (GRID:grid.497632.d); University of Bath, Department for Health, Bath, UK (GRID:grid.7340.0) (ISNI:0000 0001 2162 1699)
18 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.7340.0)
19 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Japan Institute of Sports Sciences, Sport Medical Center, Tokyo, Japan (GRID:grid.419627.f)
20 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); UCT Research Unit for Exercise Science and Sports Medicine, Cape Town, South Africa (GRID:grid.497632.d)
21 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of the Witwatersrand, Centre for Exercise Science and Sports Medicine, Johannesburg, South Africa (GRID:grid.11951.3d) (ISNI:0000 0004 1937 1135)
22 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Ministry of Health of Russia, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation (GRID:grid.415738.c) (ISNI:0000 0000 9216 2496); Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation (GRID:grid.415738.c)
23 University of Zaragoza, GENUD (Growth, Exercise, Nutrition and Development) research group, Zaragoza, Spain (GRID:grid.11205.37) (ISNI:0000 0001 2152 8769); Moscow Research and Practical Centre for Medical Rehabilitation, Restorative and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation (GRID:grid.11205.37)
24 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.11205.37); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); Italian Federation of Sports Medicine (FMSI), Rome, Italy (GRID:grid.498572.5) (ISNI:0000 0001 0395 9784)
25 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of Salzburg, Unit International Law, Department of Constitutional, International and European Law, Salzburg, Austria (GRID:grid.7039.d) (ISNI:0000000110156330)
26 University of Rome “Foro Italico”, Rome, Italy (GRID:grid.412756.3) (ISNI:0000 0000 8580 6601); FIFA Medical Center of Excellence, Villa Stuart Sport Clinic, Rome, Italy (GRID:grid.412756.3)
27 University of Rome “Foro Italico”, Rome, Italy (GRID:grid.412756.3) (ISNI:0000 0000 8580 6601)
28 International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of Rome “Foro Italico”, Rome, Italy (GRID:grid.412756.3) (ISNI:0000 0000 8580 6601)
29 University of Brighton, School of Sport and Service Management, Eastbourne, UK (GRID:grid.12477.37) (ISNI:0000000121073784)
30 FIMS Collaborating Centre of Sports Medicine, Centre for Exercise Sciences and Sports Medicine, Rome, Italy (GRID:grid.12477.37)
31 University of Brighton, Centre for Stress and Age-related Disease, Brighton, UK (GRID:grid.12477.37) (ISNI:0000000121073784)
32 World Olympians Association, Lausanne, Switzerland (GRID:grid.12477.37)
33 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.12477.37); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of Rome “Foro Italico”, Rome, Italy (GRID:grid.412756.3) (ISNI:0000 0000 8580 6601); FIFA Medical Center of Excellence, Villa Stuart Sport Clinic, Rome, Italy (GRID:grid.412756.3)
34 European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland (GRID:grid.412756.3); International Federation of Sports Medicine (FIMS), Lausanne, Switzerland (GRID:grid.497632.d) (ISNI:0000 0001 0941 5761); University of Rome “Foro Italico”, Rome, Italy (GRID:grid.412756.3) (ISNI:0000 0000 8580 6601); FIMS Collaborating Centre of Sports Medicine, Centre for Exercise Sciences and Sports Medicine, Rome, Italy (GRID:grid.412756.3); University of Brighton, Centre for Stress and Age-related Disease, Brighton, UK (GRID:grid.12477.37) (ISNI:0000000121073784)