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5.07.2020

Commentary on Reopening Combat Sports in the COVID-19 Pandemic

Let me preface this with a little about non-combat sports me. I’m a doctor. An internist by training who now does mostly palliative care with some bioethics. So I’m trained to be an adult person doctor either in the clinic or the hospital. I have focused my practice in palliative care, the area of medicine that deals with the quality of life and wellbeing in people who have advanced, life-limiting illnesses. I see a lot of suffering and I see a lot of death. Obviously from this blog I have substantial interest and experience in combat sports including Brazilian Jiu-Jitsu, Jeet Kune Do, Muay Thai, and Mixed-Martial Arts. Yes these two interests seem widely antithetical but I’m complex like that.

I am NOT an epidemiologist, infectious disease physician, or public health expert. So this is my opinion on medical topics that I have some familiarity with but I am NOT an expert on. Sadly I do not know of any of these specialists who also train in combat sports, who could likely give us better guidance. I will further caveat this with that ANYONE who trains has a secondary gain in their gyms and academies opening up again. We need to acknowledge this implicit bias exists in any conversation where those who participate have a deep-seated desire to get back on the mats and into the ring. I know I do. I want to train so bad I can taste it.

You may be familiar with Dr. Chris Moriarty’s Guidelines for Opening Up Jiu-Jitsu Academies During the COVID-19 Pandemic. It is an interesting read. Dr. Moriarty has certainly put a lot of thought into this. But if I agreed with everything he suggests I wouldn’t be writing a commentary. I do suggest reviewing this document as it is clear that the intent is to resume training in Brazilian Jiu-Jitsu as safely as possible. I cringe a little bit at the use of the word “Guideline” as typically in medicine these are based on research and consensus opinion by a large group of experts rather than one person. I believe he is spot on with this being a phased approach with different activities being acceptable at different times. Personally, I would suggest following your state’s reopening plan rather than the federal plan as your state is more likely to police, fine, or incarcerate you if the case of any intentional or accidental wrongdoing. Also even in neighboring states, such as Illinois and Indiana, can have massively differed. I plan a follow-up discussing my state of Illinois and Indiana’s plan at a later date.

I agree with Dr. Moriarty that the first part of returning to our academies will involve careful planning and continued social distancing which makes practice largely composed of solo drill and conditioning, due to social distancing and in a mask to limit transmission. We know little about how this novel coronavirus travels through the air so we do not know the optimal distance for avoiding this kind of transmission. For example with the guess that each student requires 64 square feet that means that a 1000 square foot space can only hold 15 students. That likely means longer hours of operation to accommodate everyone and a lot of cleaning between classes. This may be prohibitive in reopening smaller academies in a financially stable manner.

When COVID-19 initially hit we all were inundated with fever being a ubiquitous sign of this disease. We are learning that fever is not as common a presenting symptom as we thought. This means using the absence of fever as an objective marker of who is “safe” to train with is likely spurious and a waste of time and resources. I do agree that a checklist to limit risk makes a lot of sense but will be difficult to realistically implement. As a clinician working in an area with community spread and with active COVID-19 cases within our hospital walls I witness abundant accidental behavior in myself and others that increase the risk of transmission. We would rapidly violate the checklist for everyone if we were aware and honest about their daily activities. We are not.

I live and practice in a community where rapid testing is available. Turn around is about 24 hours. However we don’t have enough testing swabs and medium to test people once or twice per week. Besides no insurance is going to pay for testing this often. And the risks of repeated use of deep nasopharyngeal swab sampling have not been tested. In other words, imagine having someone shove an extra-long Q-tip into the back of your nose, roughly at a distance into our skull where your ears create a line twice per week. No thanks. In addition, we don’t know what immunity looks like and we don’t know the meaning of what positive serum antibodies actually is. Positive antibodies likely mean you are immune to the strain that caused the antibody reaction but for how long and how well to other strains is unclear. Furthermore you don’t have to be infected and immunity doesn’t mean you cannot transmit COVID-19, it could just be on your hands or equipment.

Many reopening plans have included the use of 50% capacity, arguably as a way to help continue social distancing. That makes sense for fitness gyms where limiting capacity limits population density using equipment hypothetically making it easier for people to spread out. However limiting capacity makes less sense for combat sports, the entire point of which is to interact at close range and as a consequence of this lead to the swap of sweat, tears, snot, spit, and other mucus.
Dr. Moriarty does a good job of saying if you have risk factors, live, or work with people who do (such as healthcare staff) then training may be out of the question for you. We don’t know how to best mitigate those risks but we do know distancing ourselves from others decreases the risk of transmission. It is up to all of us to ponder as individuals what our decisions can do once we have more autonomy to do so.

I do not believe that training is closed to us until a vaccine is developed (and not simply because the development of a coronavirus vaccine has never been done before). I am saying that we may be better served by adapting state reopening plans to the specific conditions that combat sports have and look at the best way to mitigate risk. Dr. Moriarty has several good ideas for decreasing risk, some of which I believe are less than realistically achievable. I encourage more discussion on this topic to get the best answer for returning to the martial arts that keep us fit, sane, and make us better people.

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