Confluence of Preventable Factors Led to Outbreaks in Chicago, Hawaii

On February 24, the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report published two reports outlining case studies of COVID-19 outbreaks at fitness centers.

These outbreaks occurred in Honolulu, Hawaii in June, and Chicago, Illinois, in August. According to the reports, these incidents are the result of several, preventable factors.

Chicago, Illinois

In Chicago, 55 people were sickened when several people who had symptoms of—or had tested positive for—COVID-19 attended multiple fitness classes in one week. Specifically, two people who developed symptoms several days before the week of the outbreak attended five classes that week. The building likely had inadequate ventilation, and participants wore masks infrequently. According to the analysis, odds of infrequent mask use were over four times higher in those infected with COVID-19.

Honolulu, Hawaii

In Hawaii, the outbreak started with an infected instructor who taught a high-intensity cycling class—before his symptoms emerged—in a small, 400 square foot studio with doors closed. During the class, the instructor was talking loudly, and no one wore a mask. All 10 class participants were infected, as well as an instructor at another facility.

The second infected instructor passed COVID-19 onto others, including one personal training client during a session—neither the instructor nor client wore masks—and nine participants plus one caregiver across several kickboxing classes in which only two participants wore masks.

Several preventable factors contributed to these outbreaks.

1. Poor or inadequate ventilation. In Chicago, the classes took place in a building not originally designed for fitness classes. In Hawaii, the classes took place in a small studio with fans blowing air away from an infected person towards uninfected people, none of whom wore masks.
2. Infrequent and inadequate mask use. The IHRSA Active and Safe Guidelines recommend staff wear masks at all times, which—at the time of the outbreak—was not observed in Hawaii. Following the outbreak, Hawaii updated their mask guidelines.
3. Non-adherence to COVID-19 screening. In Chicago, people who would not have passed a basic screening for COVID-19 attended class. It is not clear whether the facility conducted the screening or whether the participants did not adhere to it.

What the CDC Reports Mean for Gyms and the Public

In both reports, the CDC says “ To reduce SARS-CoV-2 transmission in fitness facilities, staff members and patrons should wear a mask, and facilities should implement engineering and administrative controls including improving ventilation, enforcing physical distancing and consistent and correct mask use (even during high-intensity activities), increasing opportunities for hand hygiene, and reminding all patrons and staff members to stay home when ill. Conducting exercise activities entirely outdoors or virtually could further reduce SARS-CoV-2 transmission risk.”

The good news for the health and fitness club industry is that the Active & Safe Guidelines are closely aligned with CDC’s recommendations. In the U.S., 803 health and fitness facilities have made the Active & Safe Commitment. These clubs have implemented safety precautions that include:

• Enforcing a mask policy,
• Appropriate physical distancing,
• Enhanced measures to optimize ventilation and filtration,
• Employee and member health monitoring, and
• Regular member communication.

Mask Policy in Place and Enforced

At a minimum, Active & Safe clubs enforce all local mask ordinances and guidelines in their facility. Members are required to wear a mask or cloth face covering upon entering and exiting the club, and while moving between areas within the club, and anytime they can’t maintain physical distancing. Depending on the state, members may or may not be allowed to remove the mask during exercise, but staff are always required to wear a mask or face covering in the facility.

Physical Distancing

To facilitate and support appropriate physical distancing, these clubs employ and enforce measures including but not limited to signage, floor markings, physical distancing of at least 2 metres/6 feet (or a distance as stipulated by local guidelines). Longer distances will be considered for certain situations, including group exercise, during periods of high community spread, or high intensity exercise.

Enhanced Measures to Optimize Ventilation and Filtration

The club has ensured that HVAC systems meet all local requirements and standards, and the club has taken additional measures to maintain safe humidity levels (40-60%), regular air exchange, ventilation, and purification. Monitoring records to show evidence of implementation of these measures.

Employee and Member Health Monitoring

The club has implemented daily health screening protocols for both employees and members. Screening options could include self-screen prior arriving to the facility, and/or temperatures and symptoms screening prior to entering the facility.

Regular Member Communication

All policies and protocols are clearly communicated with members across a variety of mediums so they understand and actively participate in appropriate COVID-19 mitigation measures.

Fitness Centers Still Not a Primary Source of COVID-19 Transmission

These reports detail two outbreaks, both attributable to preventable and uncommon situations in fitness centers. Currently, available evidence suggests fitness centers implementing appropriate safety protocols are not high risk venues for COVID-19 transmission. According to the Illinois Department of Public Health, just 1.71% of COVID-19 cases were attributed to gyms and fitness centers. In Honolulu, there has been just one cluster of 25 cases reported in fitness centers since November 4th, representing less than 1% of total cases in that time period.

Contact tracing in other states shows that cases attributed to categories containing fitness centers appear to make up a small proportion of total outbreaks.

The industry recognizes that risk for COVID-19 is not—and cannot be—zero. However, many in the industry have been closely following the CDC guidelines outlined in these reports, and fitness facilities are communicating risks, guidelines, and protocols with their members.