As states cautiously reopen, some studios are returning to classes as teachers and owners scramble to implement CDC guidelines and maintain a safe space for dancers to train. With this new normal, we are forced to come to terms with how we safely train, especially when masks and physical distancing are crucial and often required. While homemade masks are evidenced to be effective at reducing the amount of droplets a person may spread while talking or breathing normally, there are extra considerations that need to be implemented to keep ourselves and other dancers safe in the studio.
The Center for Disease Control and Prevention recommends wearing a homemade cloth mask to slow the spread of COVID-19, and some states, cities, and private businesses require mask usage. As masks become more common, some are questioning their safety and efficacy in sports.
Our understanding of the novel coronavirus is constantly developing. While there is an influx of misinformation, we do know that it is a respiratory (meaning: develops in the lungs) disease that spreads through droplets produced by sneezing and coughing. Additionally, there is mounting evidence that SARS CoV-2 can travel as an aerosol. Airborne pathogenic particles are smaller and can travel further than droplets, and often stay in the air for several hours. While this can be a scary thought, masks are shown to be effective at preventing or reducing the spread of aerosols and droplets—especially when they are form fitted. Masks that do not fit the face—such as a bandana that may be open on the bottom—will not be as effective. Face shields were once thought to be as effective as masks thanks to this article, but that is only true for pathogens spread solely through droplets. Masks are our best bet for returning to a sense of normalcy in everyday life while reducing the spread of COVID-19, and should be worn any time you encounter someone you don’t live with, especially in an enclosed space.
Pathogens can also be spread through heavy respiration, as seen in fitness classes and workouts, which may also cause the droplets and aerosols to spread further than the required social distance measure of six feet (there are a couple studies on this in runners). Coupling high aerobic activity with an enclosed space and an asymptomatic carrier, and the rate of infection increases (such as with some fitness classes in South Korea). If possible, consider increasing social distancing in your space to about 10 square feet per person and opening windows to increase airflow. Any activities that can be done outside should be done outside with proper social distancing and masks, as air conditioning systems can carry the virus (such as in this restaurant).
Without proper social distancing, face masks are not enough to prevent the spread of COVID-19.
Unfortunately, we do not currently have published and validated studies on respiratory levels as we work out in homemade masks. We do have some studies on surgical masks causing a decrease in oxygen uptake in medical professionals when worn for a prolonged period of time, and evidence that masks that imitate high altitudes decrease acute performance abilities.
However, as most homemade facemasks do not fit perfectly and do not create a seal around the mouth and nose, it is very unlikely they will cause carbon dioxide toxicity.Around 5% of the air we exhale is CO2, and without a tight seal on the masks it would be very difficult for the air we are inhaling to reach toxicity levels. As masks do change how we breath and our respiration rate (breaths per minute), our bodies will need to adjust when returning to activity. As you return, scale back your classes to allow the dancers to safely adapt to the masks and the uptick in intensity compared to working at home. If any dancer or teacher starts experiencing dizziness, headaches, or trouble concentrating allow them to sit down or go outside and remove their mask. Focus on technique in-studio, and consider offering an additional, virtual session for cardiovascular training.
In addition to being worn, a mask has to be handled correctly, especially when removing it. Improperly removing and disposing of a mask can make wearing the mask totally useless in the first place. Once a mask is on, it should stay on and not be touched (this can be really hard for kids!). When you do remove your mask, do not touch the front of it and immediately dispose of it or place it in a zipped plastic bag until it can be washed in hot water (you don’t want to deal with bacteria growing on your mask, too) and WASH YOUR HANDS. As athletes, we have one more thing to think about: SWEAT! As a mask—surgical or homemade—gets damp, it loses its microbial filtering properties and restricts airflow, meaning it is less effective at stopping the spread of droplets and aerosols. This is especially true for teachers and older students that may spend hours in the studio every night. If this is you, bring extra masks to safely change throughout the night, storing all used ones in a sealed bag until they can be washed. And again, WASH YOUR HANDS with each mask change.
The sheer amount of information we have to process through can be overwhelming. Take your time, and don’t rush your return to the studio. Allow fellow dancers the space and time they need to feel comfortable. Right now, the best thing we can do is to be flexible and understanding. No one knows how to respond to this, and all we can do is assume everyone is doing their absolute best for this situation—because they are!
Apolla is currently developing a mask to help address the needs of students and teachers returning to the studio—stay tuned!
Additional Resources for COVID-19 Response and Phased Reopening:
Aydin, O., Emon, M. A. B., & Saif, M. T. A. (2020). Performance of fabrics for home-made masks against spread of respiratory infection through droplets: A quantitative mechanistic study [Preprint]. Epidemiology. https://doi.org/10.1101/2020.04.19.20071779
Beder, A., Büyükkoçak, Ü., Sabuncuoğlu, H., Keskil, Z. A., & Keskil, S. (n.d.). Preliminary report on surgical mask induced deoxygenation during major surgery. 6.
Blocken, B., Malizia, F., van Druenen, T., & Marchal, T. (n.d.). Towards aerodynamically equivalent COVID19 1.5 m social distancing for walking and running. 12.
CDC. (2020, February 11). Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/hcp/using-ppe.html
Contributor, N. T. (2003, September 30). The effectiveness of surgical face masks: What the literature shows. Nursing Times. https://www.nursingtimes.net/clinical-archive/infection-control/the-effectiveness-of-surgical-face-masks-what-the-literature-shows-30-09-2003/
Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D., & Gruer, L. (2020). Face masks for the public during the covid-19 crisis. BMJ, 369. https://doi.org/10.1136/bmj.m1435
Jang, S., Han, S. H., & Rhee, J.-Y. (2020). Early Release—Cluster of coronavirus disease associated with fitness dance classes, South Korea. Emerging Infectious Diseases Journal, 26(8). https://doi.org/10.3201/eid2608.200633
Konda, A., Prakash, A., Moss, G. A., Schmoldt, M., Grant, G. D., & Guha, S. (2020). Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano, 14(5), 6339–6347. https://doi.org/10.1021/acsnano.0c03252
Lu, J., Gu, J., Li, K., Xu, C., Su, W., Lai, Z., Zhou, D., Yu, C., Xu, B., & Yang, Z. (2020). Early Release—COVID-19 outbreak associated with air conditioning in restaurant, Guangzhou, China. Emerging Infectious Diseases Journal, 26(7). https://doi.org/10.3201/eid2607.200764
Mahase, E. (2020). Covid-19: What is the evidence for cloth masks? BMJ, 369. https://doi.org/10.1136/bmj.m1422
Ong, S. W. X., Tan, Y. K., Chia, P. Y., Lee, T. H., Ng, O. T., Wong, M. S. Y., & Marimuthu, K. (2020). Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA, 323(16), 1610–1612. https://doi.org/10.1001/jama.2020.3227
Perencevich, E. N., Diekema, D. J., & Edmond, M. B. (2020). Moving Personal Protective Equipment Into the Community: Face Shields and Containment of COVID-19. JAMA. https://doi.org/10.1001/jama.2020.7477
Peters, D. M. D. (2020). COVID-19: Wearing masks and face coverings in the community. 5.
Restrictive breathing mask reduces repetitions to failure. (n.d.). The Journal of Strength & Conditioning Research. https://doi.org/10.1519/JSC.0000000000002648
Singhal, T. (2020). A Review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics, 87(4), 281–286. https://doi.org/10.1007/s12098-020-03263-6
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