Another great informative study from S. Korea – at a gym! – today TX opens up gyms – https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article

“Vigorous exercise in confined spaces should be minimized during outbreaks.

…On February 25, a COVID-19 case was detected in Cheonan, a city ≈200 km from Daegu. In response, public health and government officials from Cheonan and South Chungcheong Province activated the emergency response system. We began active surveillance and focused on identifying possible COVID-19 cases and contacts. We interviewed consecutive confirmed cases and found all had participated in a fitness dance class. We traced contacts back to a nationwide fitness dance instructor workshop that was held on February 15 in Cheonan.

Fitness dance classes set to Latin rhythms have gained popularity in South Korea because of the high aerobic intensity (2). At the February 15 workshop, instructors trained intensely for 4 hours. Among 27 instructors who participated in the workshop, 8 had positive real-time reverse transcription PCR (RT-PCR) results for severe acute respiratory syndrome coronavirus 2, which causes COVID-19; 6 were from Cheonan and 1 was from Daegu, which had the most reported COVID-19 cases in South Korea. All were asymptomatic on the day of the workshop. By March 9, we identified 112 COVID-19 cases associated with fitness dance classes in 12 different sports facilities in Cheonan (Figure). All cases were confirmed by RT-PCR; 82 (73.2%) were symptomatic and 30 (26.8%) were asymptomatic at the time of laboratory confirmation. Instructors with very mild symptoms, such as coughs, taught classes for ≈1 week after attending the workshop (Appendix). The instructors and students met only during classes, which lasted for 50 minutes 2 times per week, and did not have contact outside of class. On average, students developed symptoms 3.5 days after participating in a fitness dance class (3). Most (50.9%) cases were the result of transmission from instructors to fitness class participants; 38 cases (33.9%) were in-family transmission from instructors and students; and 17 cases (15.2%) were from transmission during meetings with coworkers or acquaintances.

Among 54 fitness class students with confirmed COVID-19, the median age was 42, all were women, and 10 (18.5%) had preexisting medical conditions (Appendix Table 1). The most common symptom at the time of admission for isolation was cough in 44.4% (24/54) of cases; 17 (31.5%) case-patients had pneumonia. The median time to discharge or end of isolation was 27.6 (range 13–66) days after symptom onset.

Before sports facilities were closed, a total of 217 students were exposed in 12 facilities, an attack rate of 26.3% (95% CI 20.9%–32.5%) (Appendix Table 2). Including family and coworkers, transmissions from the instructors accounted for 63 cases (Appendix Figure 2). We followed up on 830 close contacts of fitness instructors and students and identified 34 cases of COVID-19, translating to a secondary attack rate of 4.10% (95% CI 2.95%–5.67%). We identified 418 close contacts of 34 tertiary transmissions before the quarantine and confirmed 10 quaternary cases from the tertiary cases, translating to a tertiary attack rate of 2.39% (95% CI 1.30%–4.35%).

The instructor from Daegu who attended the February 15 workshop had symptoms develop on February 18 and might have been presymptomatic during the workshop. Evidence of transmission from presymptomatic persons has been shown in epidemiologic investigations of COVID-19 (4,5).

Characteristics that might have led to transmission from the instructors in Cheonan include large class sizes, small spaces, and intensity of the workouts. The moist, warm atmosphere in a sports facility coupled with turbulent air flow generated by intense physical exercise can cause more dense transmission of isolated droplets (6,7). Classes from which secondary COVID-19 cases were identified included 5–22 students in a room ≈60 m2 during 50 minutes of intense exercise. We did not identify cases among classes with <5 participants in the same space. Of note, instructor C taught Pilates and yoga for classes of 7–8 students in the same facility at the same time as instructor B (Figure; Appendix Table 2), but none of her students tested positive for the virus. We hypothesize that the lower intensity of Pilates and yoga did not cause the same transmission effects as those of the more intense fitness dance classes.”

Since no guidelines being well advertised and no phase in quarantine being proposed these are the following notes from all the data and studies we have read….The goal is to reduce your exposure to the virus in order to not get you infected. Being in the presence of Zero covid-19 virus likely impossible unless you quarantine with restrictions.

Everyone must weigh their risk/reward – those with multiple comorbidities should note their risk is much higher. Key comorbidities: Hypertension, Obesity, Diabetes, and other immune compromise issue. IF you only have 1 or none of those you are in good shape for not dying – multiple comorbidities you will have to go to highest level of protections – suggest quarantine. In regards to age – one could be a 60 old who is much healthier than a 30 year old. Personal assessment is needed – however the data is clear which is not much different than other issues (e.g. respiratory or circulatory disease) – the older you are the more the chances you are going to die. See the table below from CDC data.

Suggestive Protective Guidelines in Order

1. Reduce exposure time particularly if indoors. Hypothesis is most infections are actually coming from someone you know as most are indoors and talking with friends/relatives. In general someone doesn’t talk a long time with a stranger. Reducing meeting/talking with someone under 2 min would be advisable. The kitchen staff in the Chinese restaurant did not get sick – they typically don’t talk or stay in the main restaurant area but do deal with all the dishes etc…
2. Wear a mask….very controversial for some reason – but think of it as a seat belt. Is the inconvenience worth not getting this virus even if it doesn’t impact you – who wants to be the carrier – and until more is known you probably don’t want to get it if you don’t have to.
3. IF you must meet/talk to people for extended period then doing it outdoors during a sunny breezy day is advisable. IT IS A FACT that UV does disrupt viruses. IF the sunlight is strong enough that’s another issue – but these suggestion is about reducing risk. The dilution of the air and the UV light will likely be beneficial to reduce the viral load. An alternative to this is to go to places that have a fresh air HVAC unit along with UV light filtration system. These systems do exist and should be promoted as BEST protections for restaurants, stores, or any gathering places.
4. Proper hygiene (wash hands, clean surfaces, etc..) will support your immune system so not tackling multiple issues e.g. common cold, rotavirus, etc…

Socializing or working out in a gym without fresh air HVAC and UV filtration seems very high risk to me. Same with restaurants – is the benefit there vs. takeout given the risk?

We did drop below 1000 deaths in the US – 808. In fact even Brazil (456) update is small so likely it is a Sunday effect.

NY leading the way still (183)

Country charts – the death chart looks really good. No significant reporting other than East and West Coast and cook county IL. Hopefully this means we are doing much better treating the disease.

Even though Russia confirm cases keep growing their deaths stay low. What are they doing? Is it as simple as stating false reporting? Why would they do that?

France 7 Day MA deaths jumped up….