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      Return to training in the COVID‐19 era: The physiological effects of face masks during exercise

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          Abstract

          COVID‐19 outbreak has a profound impact on almost every aspect of life. Universal masking is recommended as a means of source control. Routinely exercising in a safe environment is an important strategy for healthy living during this crisis. As sports clubs and public spaces may serve a source of viral transmission, masking may become an integral part of physical activity. This study aimed to assess the physiological effects of wearing surgical masks and N95 respirators during short‐term strenuous workout. This was a multiple cross‐over trial of healthy volunteers. Using a standard cycle ergometry ramp protocol, each subject performed a maximal exercise test without a mask, with a surgical mask, and with an N95 respirator. Physiological parameters and time to exhaustion were compared. Each subject served his own control. Sixteen male volunteers (mean age and BMI of 34 ± 4 years and 28.72 ± 3.78 kg/m 2, respectively) completed the protocol. Heart rate, respiratory rate, blood pressure, oxygen saturation, and time to exhaustion did not differ significantly. Exercising with N95 mask was associated with a significant increase in end‐tidal carbon dioxide (EtCO 2) levels. The differences were more prominent as the load increased, reaching 8 mm Hg at exhaustion (none vs N95, P = .001). In conclusion, in healthy subjects, short‐term moderate‐strenuous aerobic physical activity with a mask is feasible, safe, and associated with only minor changes in physiological parameters, particularly a mild increase in EtCO 2. Subjects suffering from lung diseases should have a cautious evaluation before attempting physical activity with any mask.

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          Most cited references24

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          Psychophysical bases of perceived exertion

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            Respiratory virus shedding in exhaled breath and efficacy of face masks

            We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
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              Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

              Summary Background Since the coronavirus disease 2019 outbreak began in the Chinese city of Wuhan on Dec 31, 2019, 68 imported cases and 175 locally acquired infections have been reported in Singapore. We aimed to investigate options for early intervention in Singapore should local containment (eg, preventing disease spread through contact tracing efforts) be unsuccessful. Methods We adapted an influenza epidemic simulation model to estimate the likelihood of human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a simulated Singaporean population. Using this model, we estimated the cumulative number of SARS-CoV-2 infections at 80 days, after detection of 100 cases of community transmission, under three infectivity scenarios (basic reproduction number [R 0] of 1·5, 2·0, or 2·5) and assuming 7·5% of infections are asymptomatic. We first ran the model assuming no intervention was in place (baseline scenario), and then assessed the effect of four intervention scenarios compared with a baseline scenario on the size and progression of the outbreak for each R 0 value. These scenarios included isolation measures for infected individuals and quarantining of family members (hereafter referred to as quarantine); quarantine plus school closure; quarantine plus workplace distancing; and quarantine, school closure, and workplace distancing (hereafter referred to as the combined intervention). We also did sensitivity analyses by altering the asymptomatic fraction of infections (22·7%, 30·0%, 40·0%, and 50·0%) to compare outbreak sizes under the same control measures. Findings For the baseline scenario, when R 0 was 1·5, the median cumulative number of infections at day 80 was 279 000 (IQR 245 000–320 000), corresponding to 7·4% (IQR 6·5–8·5) of the resident population of Singapore. The median number of infections increased with higher infectivity: 727 000 cases (670 000–776 000) when R 0 was 2·0, corresponding to 19·3% (17·8–20·6) of the Singaporean population, and 1 207 000 cases (1 164 000–1 249 000) when R 0 was 2·5, corresponding to 32% (30·9–33·1) of the Singaporean population. Compared with the baseline scenario, the combined intervention was the most effective, reducing the estimated median number of infections by 99·3% (IQR 92·6–99·9) when R 0 was 1·5, by 93·0% (81·5–99·7) when R 0 was 2·0, and by 78·2% (59·0 −94·4) when R 0 was 2·5. Assuming increasing asymptomatic fractions up to 50·0%, up to 277 000 infections were estimated to occur at day 80 with the combined intervention relative to 1800 for the baseline at R 0 of 1·5. Interpretation Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections. We therefore recommend immediate deployment of this strategy if local secondary transmission is confirmed within Singapore. However, quarantine and workplace distancing should be prioritised over school closure because at this early stage, symptomatic children have higher withdrawal rates from school than do symptomatic adults from work. At higher asymptomatic proportions, intervention effectiveness might be substantially reduced requiring the need for effective case management and treatments, and preventive measures such as vaccines. Funding Singapore Ministry of Health, Singapore Population Health Improvement Centre.
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                Author and article information

                Contributors
                danyep@gmail.com
                Journal
                Scand J Med Sci Sports
                Scand J Med Sci Sports
                10.1111/(ISSN)1600-0838
                SMS
                Scandinavian Journal of Medicine & Science in Sports
                John Wiley and Sons Inc. (Hoboken )
                0905-7188
                1600-0838
                30 September 2020
                : 10.1111/sms.13832
                Affiliations
                [ 1 ] Internal Medicine “B” Department Rambam Health Care Campus Haifa Israel
                [ 2 ] Department of Gastroenterology Rambam Health Care Campus Haifa Israel
                [ 3 ] Department of Cardiology Rambam Health Care Campus Haifa Israel
                [ 4 ] Department of Nephrology Rambam Medical Center Haifa Israel
                [ 5 ] Department of Cardiology Shamir Medical Center Zerifin Israel
                [ 6 ] Sackler School of Medicine Tel‐Aviv University Ramat‐Aviv Israel
                [ 7 ] Department of Anesthesiology Rambam Health Care Campus Haifa Israel
                [ 8 ] Ruth and Bruce Rappaport Faculty of Medicine Technion Haifa Israel
                [ 9 ] Medical Intensive Care unit Rambam Health Care Campus Haifa Israel
                Author notes
                [*] [* ] Correspondence

                Danny Epstein, Internal medicine “B” department, Rambam Health Care Campus, HaAliya HaShniya St. 8, Haifa, 3109601, Israel.

                Email: danyep@ 123456gmail.com

                Author information
                https://orcid.org/0000-0001-7032-7007
                Article
                SMS13832
                10.1111/sms.13832
                7646657
                32969531
                b8402ec8-c49f-4fc5-a166-b6fee1f83d92
                © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                : 07 July 2020
                : 10 September 2020
                : 11 September 2020
                Page count
                Figures: 2, Tables: 1, Pages: 6, Words: 8036
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                corrected-proof
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.3 mode:remove_FC converted:06.11.2020

                Sports medicine
                coronavirus disease 2019,face masks,personal distancing,physical activity,sport
                Sports medicine
                coronavirus disease 2019, face masks, personal distancing, physical activity, sport

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