Coronavirus and the CrossFit Community: A Call to Action

Photo courtesy: Julie Foucher

[Editor’s Note: In an effort to highlight Dr. Foucher-Urcuyo’s calls to action, we have placed them at the beginning of this OpEd. Please read the article in its entirety, though, to fully understand the situation we face as a community.]

Calls to Action

Affiliate Owners: Whether mandated or not, I strongly encourage you to close your doors for a period of time. If you do so, continue to employ your trainers to work on projects that will expand offerings for your members – hold video workouts via live stream, create a home workout program, or start a podcast for your community. Yes, taking such action comes with a tremendous amount of uncertainty, but with the information we have right now, I believe it is the right thing to do.  We will get through this together, and CrossFit HQ has already voiced their commitment to support affiliates through these challenging times.

Affiliate Members: Even if you feel well, you may still be acting as an asymptomatic carrier of the virus and you play an important role in containing its exponential spread. Practice social distancing NOW. This means staying at home and not going out other than for essential reasons such as work (if not possible to work from home), medical care, or to restock food and supplies. Practice essential hygiene measures such as washing your hands, avoiding touching your face, and cleaning surfaces. If you are able, please continue paying your affiliate membership. We’re all going to go through financial hardship, but have some compassion for your box owner and trainers and continue to support your community so it can thrive again in person when the time is right. 

CrossFit Games Athletes: The CrossFit community looks to you as role models, and will follow your lead. Please use your platforms to lead by example and encourage social distancing. Consider hosting a free live virtual bodyweight workout that community members can follow along with.

Introduction

When asked by trainers or affiliate owners for his advice for success, CrossFit founder Greg Glassman has been known to reply with three things: “Care, care, and care.”

Many of us start CrossFit because of the effectiveness of its workouts, but we stay because of the community. We are a community of people who understand the value of hard work, are not afraid to face challenges head-on, and genuinely care for the people sweating next to us. We face challenges together every day, and we are there for one another in the darkest of times.

When the man who is 90lbs overweight gathers the courage to walk in the doors of an affiliate, the CrossFit community is there to receive him with open arms and encouragement. 

When an affiliate member is diagnosed with cancer, the CrossFit community is there to support her through treatment and recovery.

When natural disasters devastate entire boxes, the CrossFit community is there to help them rebuild.

When I tore my Achilles during the 2015 Central Regional, the CrossFit community was there to lift me back up during one of the most vulnerable moments of my life. 

When one of our men or women in uniform sacrifices their life fighting to protect our safety and freedom, the CrossFit community is there to pay its respects.

Today, we are facing one of the biggest global challenges of our lifetimes, and the CrossFit community NEEDS to be there.

The Coronavirus Reality 

The coronavirus is spreading across the world, and it’s spreading quickly. We’ve now exceeded 200,000 people infected and 8,000 lives lost due to COVID-19, the disease caused by the coronavirus SARS-CoV-2.

Some countries, like China, are seeing the number of cases plateau after months of diligent and coordinated efforts. Others, like Iran and Italy, have seen the number of cases rise at an exponential rate, with a trajectory that their health care systems can no longer sustain. There are not enough resources to provide treatment for every patient who needs it, and doctors are being forced to make difficult life-and-death decisions about who to help.

The rest of the world is not far behind – Spain, Germany, France, the UK, and the United States are following the same trajectory as Iran and Italy, just a week or two behind. If action is not taken now, we can expect to face these difficult decisions ourselves and lose a significant portion of our populations in the near future.

Source: ft.com

As a physician currently working in a health care system in an area of the U.S. where spread of the coronavirus is just starting to accelerate, it feels like we are watching a nightmare play out before our eyes, knowing that we are about to live through it ourselves in a matter of days to weeks. 

Tension is high, protocols are changing by the hour, and our workforce is already emotionally exhausted from anticipation before the real challenge has even begun. 

From Unknown Challenge to Action Plan 

So, what can we do? What can the CrossFit community do now to prevent this nightmare from becoming a reality all around the globe?

Actually, a lot.

First, let’s review what we know about how the virus works, and how it seems to affect different populations. 

So far, the major mode of transmission of the coronavirus is thought to be person-to-person through respiratory droplets. This means droplets from your nose or mouth can infect others in close contact after you cough or a sneeze. The virus also has the ability to live on certain surfaces for hours to days, and touching a contaminated object before touching your mouth or nose could also potentially result in infection. The average incubation time, or time from infection to the onset of symptoms, is about 5 days, but may be up to 14 days. Those who are symptomatic seem to be the most contagious, but because of the lack of testing there are also likely a large number of people without symptoms who are unknowingly transmitting the disease as well.

Once infected, about 80% of individuals seem to do very well, ranging from having no symptoms at all to mild symptoms of fever, cough or shortness of breath not requiring significant medical intervention. About 14% of those infected have severe disease, and about 6% have critical illness – meaning respiratory failure, septic shock and/or organ failure (think: on a ventilator in the Intensive Care Unit). Individuals at highest risk of severe or critical disease and death are those who are over the age of 60 and who have at least one underlying chronic disease such as hypertension, diabetes, cardiovascular disease, lung disease, or cancer. Death rates overall are estimated between 0.6-2.0%, which is 6 – 20 times higher than influenza. Death rates from COVID-19 increase substantially, however, to above 8% for those with chronic conditions and 15-20% for those over 80 years old. Children seem to be protected, as most are asymptomatic or have mild symptoms.

So, how does all of this create the perfect storm that has led to the reality we have today? 

Overall the virus seems to be easily transmitted, with each infected individual spreading it to an average of 2-3 others. Much of this transmission may be occurring through people who are healthy or who have mild symptoms, but because of the lack of widespread testing, they don’t know they are infected. Ultimately, this leads to the rapid and exponential spread of the virus we’ve observed in various locations around the world. 

If we don’t take action, the virus will continue to spread exponentially for months. Once COVID-19 outpaces available resources, it will undoubtedly result in the collapse of health care systems and an increase in death rates. When our resources are exhausted by caring for patients with COVID-19, we will not have the reserve to provide vital medical care that will continue to be needed for things like accidents, strokes, heart attacks, or appendicitis in the rest of our populations.

Social Distancing and “Flattening the Curve” 

Social distancing is the tried-and-true, research-backed method of increasing the physical space between people in order to reduce the spread of an infectious disease. It’s a method that is already working for the coronavirus in several countries that have implemented strict quarantine rules. Those that implemented such rules early on like Hong Kong and Singapore are reaping the benefits, and countries such as South Korea that were a little later to the party are now starting to slow the spread of the virus. Other countries, including Italy and Spain, are now under strict quarantine rules but perhaps waited too long. Their health care systems are paying the price.

The goal of social distancing is not to reduce the spread of illness – at this point it’s too late for that, and the coronavirus will still likely affect a large portion of our population over the coming months. Instead, the goal is to slow the spread so that we have adequate resources within our healthcare system to provide care for those individuals who contract severe or critical disease and increase their chances of survival. 

This phenomenon is known as “flattening the curve” and is illustrated in the diagram below: 

Source: https://www.nytimes.com/2020/03/11/science/coronavirus-curve-mitigation-infection.html

Over the past week we’ve seen the cancellation of Sanctionals, other large sporting events, travel, conferences, schools, and meetings. In many places, the closure of restaurants and bars, gyms, and recreation facilities has followed suit. Mandatory quarantine has recently been implemented across France and in some counties in California. These measures are all being taken in order to “flatten the curve” and bend our current trajectory to hopefully look more like South Korea in a few weeks than Italy or China. Due to the primary mode of transmission by respiratory droplets, improving cleaning and sanitation efforts is not sufficient to prevent spread – we must physically distance ourselves from each other. The trajectory of infection is steeply increasing day by day, but we have the potential to influence the next chapter in this story. Will we act now to “flatten the curve” and potentially reduce the death toll by a magnitude of 10 or 20? Every day that we wait to take social distancing seriously is another day closer to making Italy’s nightmare our reality.

The CrossFit Community: Leaders and Advocates for Health

Over the past few days, many CrossFit affiliates have made the difficult decision to close their doors, or have been forced to do so by government mandates. The economic impact of these closures on affiliate owners and trainers is not taken lightly, but I believe we have a role to play as leaders and advocates for health in each of our communities. 

Yes, I said we are leaders and advocates for health in each of our communities. 

Whether you realize it or not, if you are consistently showing up to your affiliate and working hard to improve your fitness, people around you notice. If you are packing your lunch every day with meat and vegetables, nuts and seeds, some fruit, little starch, and no sugar, your coworkers are paying attention. Don’t underestimate the degree to which people in your life who may not do CrossFit look to you for guidance and direction when it comes to fitness and health.

This is an opportunity that we as a CrossFit community have to do the right thing, and lead from the front. Yes, as a group we are more likely to fare well when infected with the coronavirus and be part of the 80% with mild disease. The hard work we put in in the gym every day and the attention we give to fueling our bodies with real food tends to stave off the chronic diseases that would put us in that higher risk category. After all, one of the reasons we work so hard for our fitness is to create a buffer against sickness that protects us in this exact, unanticipated situation. On the whole, I think we are going to be okay, but we are not immune. I would venture a guess that there are members of every box who are older or who have comorbidities from diabetes, to asthma, to cancer that put them at higher risk, and each of us goes home to parents, grandparents, and other community members who are vulnerable. Making the right choice to distance now will protect our communities and our loved ones. 

This solution is not hard, and if we all do it together we will have a much bigger impact than any of us can have alone. You do hard things every day. Doing Fran is hard. Coming into the gym and pushing yourself on the days you don’t feel like working out is hard. Counting your macros is hard. Saying “no” to the refined sugar that’s always around is hard. Doing a hero workout to memorialize a service member whose life ended too early is hard. 

Distancing yourself physically from others for a few weeks is not hard.

Work from home. Spend time with your family. Sleep for 9 hours. Do some bodyweight workouts. Catch up on projects you’ve been putting off. Take time to slow down and allow your body and mind to recover.

From one member of the CrossFit community to another, I urge you to do your part. Take steps now to protect our vulnerable populations, first responders, and health care workers. After all, the more people with chronic disease we save from the coronavirus, the more people we’ll have to welcome into our affiliates with open arms, ready to change their lives so that they, too, can build a buffer against sickness for when the next threat comes along. 

Affiliate Owners: Whether mandated or not, I strongly encourage you to close your doors for a period of time. If you do so, continue to employ your trainers to work on projects that will expand offerings for your members – hold video workouts via live stream, create a home workout program, or start a podcast for your community. Yes, taking such action comes with a tremendous amount of uncertainty, but with the information we have right now, I believe it is the right thing to do.  We will get through this together, and CrossFit HQ has already voiced their commitment to support affiliates through these challenging times.

Affiliate Members: Even if you feel well, you may still be acting as an asymptomatic carrier of the virus and you play an important role in containing its exponential spread. Practice social distancing NOW. This means staying at home and not going out other than for essential reasons such as work (if not possible to work from home), medical care, or to restock food and supplies. Practice essential hygiene measures such as washing your hands, avoiding touching your face, and cleaning surfaces. If you are able, please continue paying your affiliate membership. We’re all going to go through financial hardship, but have some compassion for your box owner and trainers and continue to support your community so it can thrive again in person when the time is right. 

CrossFit Games Athletes: The CrossFit community looks to you as role models, and will follow your lead. Please use your platforms to lead by example and encourage social distancing. Consider hosting a free live virtual bodyweight workout that community members can follow along with.

If there’s anything the CrossFit community knows how to do, it’s face an unknown challenge while supporting and caring for one another. Here’s our opportunity to shine. 

Julie is eternally grateful for the collective input from CrossFit physicians around the world in the writing of this article. 

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