Sports Medicine

Koichi WATANABE

Sports Medicine
SARS-CoV-2 and Exercise

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 Pathogens

Virus Bacteria Fungus Parasite

nm μm ｍｍ

Visible by microscope

Pathogens of Common Cold

Generally Rarely

• 30–50% • <5%
Human rhinoviruses (RVs) enteroviruses
• 5% • coxsackieviruses
respiratory syncytial (RS) • echoviruses
virus • bocavirus
• 10–15% • EBV
coronaviruses
• human metapneumovirus
• <5% (hMPV)
adenoviruses ･･･20–30%
• 5%
parainfluenza viruses
• 5–15%
influenza viruses

Terho Heikkinen, Asko Järvinen：The common cold. Lancet. 2003 Jan 4;361(9351):51-9.

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 Structure of corona virus

Genetic information is covered by envelope

This portion is attached to

the cell of the host

100nm
=0.1μm

Corona virus versus existence of human on the earth: A computationaland biophysical approach. Int J Biol
Macromolecules 161:271-281,2020 Fig 5

Infection:route
B A
Oral
Cavity

Blood
Body
fluid

Skin

Contact

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 Particles
No. Flight
Distance
Droplet
Speaking 0-210 Nuclei
Staying in the
air
Cough 0-3500 ～2m Dried pathogen
Droplets
usually lose
μm～mm
their
4500- pathogenesis
Sneeze ～8ｍ Except：TB,
1000000
Measles,
chickenpox etc
Aerosol
5μm>

PIV：Particle Image Velocimetry

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 Air-borne infection is major?

Calm, Windless condition

Droplets observed during exercise

Calm, Windless condition（定位置運動）

Saliva during Sweat

conversation Disseminated with
↓ Shivering
Wind speed: 3m/s :10.8km/h against

Saliva during
speaking Saliva Nasal discharge
↓ Visible・straight fall down 下

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 Coughing during exercise
Wind speed: 3m/s :10.8km/h against

Droplets equally fell

down regardless of
body position
(upright or crouching)
Droplets during exercise are
From cough or sneeze
During speaking
Involuntary shudder
Saliva
Nasal discharge
Sweat
All visible droplets by laser beam
whose size is above 1 um dropped
down to the ground.

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Inportance of facial mask

N95 type：
catch 1um particles over 95.0% Merit and Demerit

• Capture or Trap the particles

• No dissemination
• Merit?
• Gathering particles
• Merit/Demerit?
• Airway obstruction
• Heat accumulation
• Health risk
• Humid accumulation
• Merit?

https://www.3mcompany.jp/3M/ja_JP/

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 Is Mask beneficial for athlete?

Mask Faceshield

Exhaled air moves behind the head

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 Map showing the key location and features of the
mass gatherings.

Alqahtani AS et al: Burden of vaccine preventable diseases at large events.

Vaccine 33:6552-6563, 2015

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Health problems in recent mega sporting events

Infection
•2009 Universiade Games in Serbia
•Influenza pandemic
•2014 Asian Games in Incheong, Korea：Ebola出血熱
•2015 Universiade Games in Gwandju, Korea MERS
•2016 Summer Olympic Games in Rio, Brazil, Zika fever
•2017 Universiade Games in Taipei Dengue fever
•2018 Winter Olympic Gamaes in Peongchang, Korea Noro
Virus

Air pollution(PM2.5) and respiratory problems

•2008 Summer Olympic Games in Beijing China
•2012 Summer Olympic Games in London, UK
•2013 East Asian Games in China天津

Heat illness
•1984 Summer Olympic Games in Los Angels, USA
•2005 Universiade Games in Turkey

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 R0：Basic Reproductive Number
• R0：Basic Reproductive Number
• How many persons can be infected by one patient
• 1＞：to end of pandemic，
• = 1：continue pandemic，
• 1＜：to pandemic
• HIT：herd immunity Threshold=1-1/R0

R0 Mode of transmission HIT

Measles 12-18 By Droplets or Air 90%<

Mumps 5-7 By Droplets 80-85％

Rubella 5-7 By Droplets 80-85％

Poliovirus 5-7 By Fecus 80-85％

RS virus 1-2

Influenza 1-2 By Droplets

Rodpothong P, et al: Viral evolution and transmission effectiveness. World J Virol. 12; 1(5): 131-134,2012

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Case of Influenza pandemic

in Universiade Games in Serbia 2009
Poster in the athlete village Sequence of Events AUS athlete
• 29/06/09: Flight Sydney-Hong
Kong-London
• 30/06/09: Arrived 1150-Belgrade
• 30/06/09: Village 1300
• 30/06/09: Swimming training
• 30/06/09: Ate outside Village with
one athlete
• 30/06/09: Returned to Village-
reported symptoms 1945
• (immediately)
• 30/06/09: Polyclinic
• 30/06/09: Hospital VMA
• 30/06/09: Isolated close contact
• 30/06/09: Report of nasal swab -
positive
• 30/06/09: Report of nasal swab -
negative close contact

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 Announcement on 2009.7/7
• The World continues to see an increase in the H1N1 Influenza. There
are as of July 7, 2009, 100,000 cases worldwide and over 10,000
cases with four (4) deaths in the European Region (one of six regions
of the WHO). Serbia is in this region and has reported over twenty
(20) cases. There are multiples of this number of cases in the world.
Most people with minor symptoms of cough and fever are not tested.
At the World University Games Athletes‘ Village, we will have over
9,000 athletes from 121 countries. The Village contains fourteen
(14) new apartment buildings with large open areas for athletes to
walk, shop, eat and converse. There is one large cafeteria where all
athletes eat. There are 1-3 athletes per bedroom.
• We have three (3) confirmed cases of H1N1 Influenza and all
three(3) athletes came to Belgrade with the infection. We have no
confirmed cases of person to person transmission within the Village.
All three (3) athletes are in isolation units at the Serbian Military
Medical Academy. They are well enough to be released but are
retained in an effort to minimize spread within the Village.
• Our policy for H1N1 Influenza has been developed by the Working
Group of Serbia for infectious disease in cooperation with the WHO.
The FISU Medical Committee has added additional requirements in
an effort to control spread of the new virus within the Village.
• We have two (2) members from the WHO and one (1) member from
19 the European Communical Disease Center in Belgrade helping FISU

Announcement on 2009.7/11
• Three (3) new cases of H1N1 Influenza have been identified in
the Athletes‘ Village this evening.
• Two (2) of the athletes are female Table Tennis players from
Zambia. They are room mates and we believe at least one (1)
of these athletes acquired the infection while in Belgrade.
Both of the athletes are in the hospital and are doing well.
Their two (2) other roommates are quarantined and will be
tested with nasal swab on July 12, 2009.
• One (1) male French Water Polo player who had been in the
Village for ten days developed symptoms this morning and
tested positive for H1N1.
• This makes a total of six (6) cases that have been identified
since the Athletes‘ Village opened.

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 Plans by medical comitte of OC
1. Requesting all athletes and officials with any
symptoms of influenza not to enter the Village;
2. All with symptoms (cough, fever, shortness of breath)
to report to the Polyclinic immediately. Also use a
mask immediately;
3. Use well recognized health prevention strategies such
as washing hands frequently, not touching hands to
face and mouth, cover mouth when coughing, keep one
meter distance from anyone coughing and open
windows in the rooms;
4. Isolating all persons with symptoms of influenza until
results of the H1Nl nasal swab are available;
5. Isolating close contacts of those with proven H1Nl
Influenza either in the polyclinic or hospital with
positive cases for 72 hours and then testing close
contacts with nasal swabs. If they are negative and
they are asymptomatic, they can then leave
quarantine and compete.

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Plans by medical committe of OC

• Continue to obey safe health practices. This includes washing
hands frequently; keep your hands away from your mouth and
nose; do not cough directly on other people, step away and cover
your mouth; open windows in your room, etc.
• Please do not travel if you are feeling ill or have signs and
symptoms including fever, cough, shortness of breath, chills or
sore throat.
If you have any of the above symptoms, please report to the
polyclinic immediately.
• The World Health Organization (WHO) has not put any
restrictions on healthy people traveling regardless of your contact
history.
Therefore, close contacts of athletes proven positive for H1N1
Influenza will be allowed to travel if they are without symptoms.
• Report after Games
• How many of your athletes have developed symptoms as listed
above of H1N1 Influenza?
• Please tell us the day they became symptomatic, the day they
entered the Village and the day they left the Village.
• Did these athletes see a physician?
Were they admitted to the hospital?

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 Structure for infection control

Government Ministry

Public Health
Quarantine
Center
Hospitals

Organizing Committee
Operation center Designated
Hospitals
GOC
Surveillance

Clinic at
Polyclinic
venue

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Concept of risk assessment

by Indicator-based surveillance

OC: Unit for

Report by physicians at domestic
athlete village medical
planning

• Acute phase ( < 10 days) • From the point of view

Fever with 38℃< of public health
Suspicious for respiratory infection • Infection surveillance
Eg: sore throat, cough ,sputum
Suspicious for intestinal infection
Eg: watery stool, bloody stool, diarrhea, vomiting
• Syｓtemic eruption
• Los of consciousness or meningeal signs
Others

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 Infection control in the athlete village
• Immunization including medical staffs
• Checking immunization
• Vaccination
• How to protect athlete village
• Collaboration with Quarantine
• How to identify the infected person
• Collaboration among the surveillance center, polyclinic,
hospitals, health center and infection control center
• Assignment of infection control doctor
• Isolation and quarantine system in the athlete village
• Information center for infection prevalence

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Flowchart for infection prevention

in sports

Time
Infection Latency
course

Onset Dx・Tx Prevention

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 Diagnotic testing

Antibody：produced by hosts as an
immunological response
⇨means immunologic acquirement for the
pathogen post infection

Antibody Antigen：is expressed on the virus

⇨means existence of the virus
Easily detectable, wasting less time
Antigen False negative by small amount of pathogens

Virus Copy

PCR：polymerase chain reaction

gene information ⇨Methodology of gene copy
Only one fragment of virus can be detectable
Copy machine is not easily available= waste time and
places

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Washing：removing pathogens
Hand wash
Gurgling
Pathogen

Disinfectant
Some agent is not appropriate
for using body or mucus
Physical distance or barrior

Antibiotics Vaccines

In body
Immune function

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 persistence on inanimate surfaces
Alive time
Rhinovirus 2 168
HAV 2 1440
Coronavirus 3
Herpes simplex virus, 4.5 1344
Respiratory syncytial virus 6
Norovirus and feline calici virus (FCV) 8 168
Cytomegalovirus 8
Influenza virus 24 48
SARS associated virus 72 96
Rotavirus 144 1440
Adenovirus 168 2160
Echovirus 168
HBV 168<
HIV 168<
Papovavirus 192
Coxsackie virus 336<
Parvovirus 8760<

Kramer A, Schwebke I, Kampf G: How long do nosocomial pathogens persist on inanimate surfaces? A systematic
review. BMC Infectious Diseases 2006, 6:130

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First data on stability and resistance of SARS

coronavirus compiled by members of WHO laboratory
network
• Virus survival in stool and urine
• Virus is stable in feces(and urine) at room temperature for at
least 1-2 days.
• Virus is more stable (up to 4 days) in stool from diarrhea
patients (which has higher pH than normal stool).
• Disinfectants
• Virus loses infectivity after exposure to different commonly
used disinfectants and fixatives.
• Virus survival in cell-culture supernatant
• Only minimal reduction in virus concentration after 21 days at
4°C and -80°C.
• Reduction in virus concentration by one log only at stable room
temperature for 2 days. This would indicate that the virus is
more stable than the known human coronaviruses under these
conditions.
• Heat at 56°C kills the SARS coronavirus at around 10000 units
per 15 min (quick reduction).
• Fixatives (for use in laboratories only)
• SARS virus fixation (killing) on glass slides for
immunofluorescence assays in room temperature does not kill
virus efficiently unless the acetone is cooled down to -20oC.

https://www.who.int/csr/sars/survival_2003_05_04/en/

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 Sym
ptom
Virus in the Discharge（Scattering） Infectivity
body

Infected Onset

Body washing

Patient Sufferer

Disinfectant

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3～11 days Onset Symptom

Infected

Dx

Quarantine

PCR positive
Dx

Isolation,Tx

Virulence

Viral load

PCR ✕ ◎ 〇

Symptom ✕ 〇

• Return to Play(RTP) Virulence is the key

• Discharge: alive or dead?
• Symptomatic or Asymptomatic means whether the patient
has a capacity of scattering
• Sneezing
• Cough
• Talking

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Assignment 4
Please discuss about the possibility of COVID-19
infection in sports activity, and make your COVID-19
prevention plan

• Please make your essay by word file

• 1-2 page of A4 size
• Please make your file title as
Student Number_Your name_A4
• Submit to “MANABA”
• Deadline : by 31 July 2021

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