Friday, November 6, 2020
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The Villages

Group exercise can spread COVID-19

Dr. Gabe Mirkin

Tyler Amburgey was good enough to play on the United States National Hockey under-age-18 teams from 2007 to 2009, and then was a very talented player for the next eight years for six minor league hockey teams. One of his coaches said that he loved hockey, had a lot of skill as a strong skater, moved the puck well, and was a solid defenseman. However, he didn’t make it to the National Hockey League because he was frequently injured, needed five hip operations and had several serious concussions that affected his memory.

Hockey was his first love, so after he retired from professional hockey, he coached several youth hockey teams in Texas. This August, he felt sick for a few days, developed body aches, nausea, shortness of breath and headaches, and couldn’t sleep at night. On his last night, he took one sleeping pill and died in his sleep on August 29, 2020. The autopsy found that he died from COVID-19, and several players on the two teams he coached had positive tests for the disease. His death has been linked to an outbreak of more than 30 reported cases of COVID-19 across several youth hockey teams in the Dallas-Fort Worth area. He left a wife and young daughter. He was 29 years old.

Tyler Amburgey

Group Exercise Can Spread COVID-19
Many hockey, baseball, football, basketball and other sports games or whole seasons have been cancelled because of increased risk for COVID-19. When you exercise, you breathe harder, deeper and more frequently so you can bring increased amounts of virus into your nose and lungs (Environ Int, 2020;141:105794), and one infected player can spread the virus to everyone who shares their breathing space (Emerg Infect Dis, 2020;26:1059–66). Within five days after a hockey game in Tampa Bay, Florida, one player infected 14 others (Morbidity and Mortality Weekly Report, October 16, 2020;69(41);1492–1493). Eighteen members of the Yale University men’s hockey team tested positive for COVID-19 in mid-October (CNN, October 16, 2020). It usually takes about five days from exposure to the start of symptoms, with a range from two to 14 days. Hockey players may be more vulnerable than many other athletes because their games are played indoors, where there is less air circulation than in outdoor events.

Similar extensive outbreaks of COVID-19 have been reported in 57 infected dancers in a high-intensity fitness dance class (Emerg Infect Dis, 2020;26:1917–20) and five players in a game of squash (Epidemiol Infect, Mar, 2020;148:e120). Another documented report was in a choir in the state of Washington last spring in which 53 out of 122 members of the Skagit Valley Chorale contracted the virus and two died. Singing also requires deep breathing and the louder you sing, the more virus you spew into the air.

Winter Will Probably Increase Risk for COVID-19
Cold, dry air in hockey arenas may also be a factor. The common cold and flu are far more prevalent in the winter (J Exp Med, 224:251–56), and we can expect COVID-19 risk to increase in the approaching cold months. The emergence of the virus in Wuhan occurred in the winter (NEJM, 382:1199–2075). Indoor heating systems increase the spread of respiratory virus droplets (PLoS ONE, 2015;10:e0125874), cause dry air that can irritate nasal and lung membranes, and prolong the life of the virus on surfaces that you touch such as door handles and toilet flushers (Annual Review of Virology, Sept, 2020;7:83-101).

Messages from the Death of Tyler Amburgey
Be careful when you exercise in a group, particularly in the winter.
• Anything that makes you breathe deeper and more frequently can increase risk of spreading COVID-19.
• Indoor heating dries the air to reduce the amount of water in the air to crack your respiratory membranes to open the door for viral entry into cells.
• Lower humidity in wintertime increases spread of virus-infected respiratory droplets.

Dr. Gabe Mirkin is a Villager. Learn more at www.drmirkin.com

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