THE INSTALLable EQUILIBRIUM - the opening of gyms in Portugal during COVID-19

Posted by Luis Cordeiro on
THE INSTALLable EQUILIBRIUM - the opening of gyms in Portugal during COVID-19

If there are difficult binomials to manage, one of them is that which concerns the decisions of the various countries regarding the greater or lesser confinement of their inhabitants.
What is the point at which widespread and prolonged containment can lead to worse health situations than those directly associated with the pandemic itself?
When can economic shutdown lead to an economic crisis that could lead to more starving people dying than from Covid-19?
What is the impact on the mental health of the world population as a result of the containment measures imposed?

Pandemics

We know that Covid-19 is a disease caused by the SARSCoV-2 virus and that the proximity of people facilitates contagion. That is why we speak of the famous necessary social distancing, a term that we abhor, since it has a highly negative charge in relation to a distancing that is only physical.
The Covid-19 is the most terrible pandemic since 1918, since the so-called "Spanish flu".

It is thought that this flu killed about 50 million people, mostly children, young people and very old people, but many of them were still healthy.

Over the years there have been several pandemics, in addition to those caused by the Spanish flu and now by SARS-CoV-2:


1889: Russian Flu (H2N2)
1900: former Hong Kong flu (H3N8)
1918: Spanish flu (H1N1)
1957: Asian Flu (H2N2)
1968: Hong Kong flu (H3N2)
2009: Swine Flu (Influenza A [H1N1] )

 Figure 1. Images captured in 1918 during the Spanish flu pandemic.

We know that SARS-CoV-2, the virus responsible for Covid-19, has stopped virtually all economic activity, launching the world into an unprecedented public health and economic crisis.
One obvious question: why were the same containment measures not taken in 2009 in the face of the influenza A (H1N1 influenza) pandemic?
In fact, like Sars-Cov-2, H1N1 was also transmitted by coughing and sneezing or by direct contact with an infected person and respiratory secretions.

But the H1N1 was twice less transmissible than the new coronavirus. The World Health Organization (WHO) points out that a person with H1N1 was capable of infecting 1.2 to 1.6 people.
This index, for Sars-Cov-2, varies widely from country to country, but a recent study, used as a reference by the Centers for Disease Control and Prevention in Europe, indicated a Covid-19 transmissibility rate of 2.79.
Scientist Neil Ferguson of the Imperial College of London in the United Kingdom, however, speaks at an index above 3.
Mortality rates also differentiate this Pandemic from influenza A.
The WHO estimates a global mortality rate associated with Covid-19 of 3.4%, but for example, in Bergamo, Italy, the mortality rate exceeded 12%.
This high rate cannot, however, be considered exact, as the amount of diagnostic tests done was very low, which probably inflated it a lot.
According to WHO's Van Kerkhove, the mortality rate for influenza A (H1N1) will be in the range of 0.02% and the actual mortality rate associated with Covid-19 is estimated to be between 0.5 and 1%.
One of the justifications for such a difference, says British scientist Spilki, is that Sars-Cov-2 seems to kill more directly than a virus like H1N1.
"Normally, a viral infection is associated with other elements, such as bacteria, which complicate the clinical picture. But evidence points to the new coronavirus being able to generate a serious illness on its own and lead the patient to death," he says.

Does that make this Pandemic more serious than Influenza A?

These two vectors, coupled with the increased transmissibility and lethality of Sars-Cov-2 - are reflected in the WHO official figures on the two pandemics.
One of the reasons why this Pandemic has more impact than the 2009 Pandemic is because people born between 1957 and 1968 had contact with two Pandemics created by the Influenza virus, which led to many of the people who in 2009 were between 41 and 52 years old being immunized.
This age range represented a large slice of the population and clearly contributed to a decrease in the number of infected people.

Figure 2: Photograph taken under a microscope of the Influenza H1N1 virus. The similarities for Coronaviruses are undeniable

Because they closed the Gymnasiums and Sports Centers


Gymnasiums, Fitness Centers, Sports Centers, Swimming Pools, etc..., are spaces where many people circulate and where the safety distances between people are very difficult to guarantee.

Figure 3: Situation in a gym that we are unlikely to see again in the near future..

On the other hand, many people touch the same places with their hands, without the possibility to properly sanitize and disinfect the spaces.
Imagine the following cases: door handles, taps, locker mixers, fitness machines, free weights, training mattresses, backrests, TRX, swimming pool teaching materials, and many others.

How many people touched these materials daily in the pre-covid period?

The answer is simple: many!

In addition to this there were group classes, dry and in a pool, with many people, and consequently very close to each other.

The accelerated respiratory rhythm, a consequence of physical exercise in these classes, leads to a greater amount of inspired air and frequency of breathing, which naturally implies a significant increase in the risk of infection, caused by the aspiration of droplets from the people closest to us.

In February 2020, more than 100 people were infected with the new coronavirus after a few dance classes in the city of Cheonan, South Korea, which proved that indoor physical activities pose a high risk of contagion. This study was published in the journal Emerging Infectious Diseases.

According to this study, at least 112 infections from the classes were registered in 12 different clubs. Of these 112 users, 82 were asymptomatic, or 73.2%. The instructors were responsible for more than half of the infections and although none had symptoms at the time, 8 of them tested positive for the virus. In total, there were 27 professionals.

The research concluded that the humid and warm atmosphere of the club's closed spaces, an environment created by the very air flow generated by intense physical activities, can cause a more concentrated projection of droplets in the air.

Curiously, no cases were recorded in classes with less than 5 participants. In the classes of the Pilates and Yoga modalities, no student contracted the disease, which leads us to the scientific theory that the activities of lower physical intensity do not cause the same transmission effect.

This study gives us important indicators that we have to retain, in the sense of the necessary and desirable reopening of Gymnasiums, Clubs and Sporting Centres, namely with regard to the type of activities that can start first and the necessary limitation of the capacity of the areas dedicated to physical exercise and changing rooms.


Because it is necessary to reopen the Gymnasiums, Gyms, Clubs and Sports Centers in General?


1) Public Health reasons:

Several scientific studies show that the mortality rate by OVID-19 is higher among people suffering from chronic health problems such as hypertension, diabetes or chronic obstructive pulmonary disease (COPD).

According to these studies, changes in metabolism caused by these diseases can trigger a series of biochemical events that lead to an increase in the amount of the ACE-2 gene, responsible for encoding a protein to which the SARS-CoV-2 virus binds to infect lung cells.

The increased expression of ACE-2 and other genes that facilitate the infection, causes this type of patients to have a greater amount of cells affected by the SARSCoV- 2 virus and, consequently, a more severe picture of the disease.

We also know that sedentary life is a direct cause of some of the health problems mentioned above, such as hypertension. This indicates to us that we will have to reopen the activity in a conscious and considered way, respecting new protocols of hygiene and disinfection and distance between people.

It should be noted that the largest cause of death in Portugal is stroke, and that on the other hand, we are one of the countries in the world with the highest stroke mortality rates.

Portugal has 42% of hypertensive adults and 20.4% of the obese population. According to the observatory of the Directorate General of Health (DGS), in 2015 15 people per day died from diabetes in Portugal.

We must also consider mental health issues, such as the prevention of depression, which can be greatly mitigated by regular exercise.


2) Economic reasons:


Focusing now more on Fitness, the latest Agap/Portugal Ativo barometer figures indicate that in 2019 nearly 500,000 people attended the gym. The 2018 turnover in the Fitness industry is estimated to be around £260,000. In 2019, the turnover will have been around EUR 290,000 M.

The Fitness industry provides direct employment for about 9,000 people and also provides work for about 12,000 instructors.

The State, in addition to receiving income from corporate income tax, VAT, personal income tax and TSU, relating to the business generated by Fitness and the salaries of its employees and service providers, also benefits from a saving in Social Security, derived from the increase the health of fitness practitioners, who will naturally reduce their need to use the services of the National Health Service (SNS) and the acquisition of reimbursed medication.

At a time when the State is greatly increasing its public spending, given the need to spend on NHS and support for Lay Off workers, maintaining a sector with such a closed economic impact seems impractical to us.

Conclusion

A CIMAI, as a long time partner of AGAP/Portugal Ativo, has prepared a Plan, exclusively dedicated to the sanitization and disinfection of sports spaces, with special focus on Fitness, regardless of the size and typology of the clubs.

We have over 32 years of experience in the development, manufacture and marketing of concentrated disinfectant products, all of which are registered/notified with the DGS.

We all know that the Fitness industry can only get out of this crisis without irreparable damage if it can get its customers/users to have confidence that they take minimal risk by using clubs again.

Failure to reopen near the clubs could be fatal to the entire fitness industry and its entrepreneurs.

The maintenance, hygiene and disinfection plans for the clubs will therefore all have to be redone and then carried out very rigorously, this being the only way to ensure the safety of employees and customers/users, and consequently gain their confidence, in order to bring them gradually to the clubs.

Pedro Mesquita

Chief Executive of CIMAI


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