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Updated: November 25, 2020

What is the current evidence regarding precautions for engaging in water sports during the COVID-19 pandemic?

Summary

The following is a brief summary of evidence sources from trusted sources that provide high quality information on the precautions people should take when engaging in water sports during the COVID-19 pandemic. One rapid review and five national guidelines were used in the creation of this REAL note. For additional information about each of the sources, see the Table below. For additional information about each of the sources, see the Table below.

National guidance from three different countries – Canada, United States (US), and United Kingdom (UK) —concluded that there is no evidence of COVID-19 transmission in properly treated pool water [1,3,4,6]. The concentration of chemicals used in the water is a key contributing factor [3]. Three guidance documents agree that a threshold of chlorine is needed to minimize the spread of COVID-19 through water. The Life Saving Society Canada (LSSC) suggests in its guidance on Cleaning, Decontamination, and Safe Water Management of Aquatic Facilities that indoor pools should have between 1.0-3.0 mg/l of chlorine or 2.5-4.0 mg/l of bromine to adequately treat the pool and to minimize transmissions of COVID-19 through water [3]. In its Pools, Hot Tubs and Water Playgrounds guidance, the Centers for Disease Control and Prevention (CDC) recommends at least 1ppm of chlorine (1 mg/L) to ensure water safety in indoor pools [4]. The Pool Water Treatment Advisory Group guidance, Swimming pool technical operation after Covid-19 shutdown, agrees with these recommended chemical concentrations [6]
 
The Life Saving Society Canada (LSSC)’s Guide to Reopening Pools and Waterfronts suggests aquatic facilities ensure a limit of 6 individuals per swimming lane to practice effective social distancing at all times [2]. The New South Wales Critical Intelligence Agency in its Hydrotherapy and COVID-19 guidance recommends the following precautions for safe pool use: 1) ensure physical distancing; 2) frequent testing of pool water for recommended pH levels; 3) undertake frequent cleaning and disinfecting of objects, surfaces and equipment; 4) swimmers to showering before and after use of pool and screening for respiratory symptoms; and 5) where possible, increase ventilation of indoor spaces via circulation of outdoor air. Regular pool rules should also be enforced (i.e., swimmers should not spit, cough, urinate or blow their nose in the water) and use of equipment (i.e., snorkels which dispel the contents of the user’s mouth) should be avoided [1,2]. By contrast, the Canadian Underwater Games Association states in its guidance that there is no evidence suggesting the use of snorkels in water can increase COVID-19 transmissions [5]. The CDC states that the use of personal water equipment is recommended but discourages individuals from sharing items that are difficult to clean, sanitize, or disinfect or that are designed to come in contact with the face (i.e., snorkels, goggles, nose clips, etc.) [4]
 
To summarize, although treated pool water is safe for swimming during COVID-19, further research is needed to guide safe practices regarding water sports during the pandemic. Current guidance, as above, supports the adoption of the precautionary principle for water sport activities that involve equipment such as snorkels to minimize the risk of transmission.

Evidence

What‘s Trending on Social Media and Media

On June 8, 2020, CTV News released a news article on the safety of swimming in pools during COVID-19. The risk of contracting the virus from the pool water itself is likely very low. The exposure to water would weaken the virus, reducing the ability to cause infection. Also, the chlorine normally found in public pools would be severe enough to kill the virus. The risk isn’t so much from the water, but rather to people crowding together in an enclosed space. For this reason, it’s advised to social distance and keep all surfaces as clean as possible. 
 
The City of Ottawa is helping residents understand new recreational program guidelines. Public and lane swimming, as well as swimming lessons, can continue under new regulations, but with limited numbers and under a reservation system. Mask needs to be worn throughout the facility and on the pool deck but removed when entering the water. Find the article here published on October 4th, 2020. 

Organizational Scan

According to the Center for Disease Control and Prevention, there is no evidence that the COVID-19 virus can be transmitted to humans through water. Disinfecting pools using chlorine or bromine should inactivate the virus, however social distancing should be maintained both in and out of the water and masks should only be removed when in the water [7].  
The City of Toronto released their guidelines for how swimming pools and splash pads can safely re-open. This document covers information related to mask use at pools, and other precautionary measures related to indoor and outdoor pools in the City of Toronto. 
 

Review of Evidence

Resource Type/Source of Evidence Last Updated
Hydrotherapy and COVID-19
— New South Wales Critical Intelligence Agency, COVID-19 Critical Intelligence Unit
Rapid Review

This guidance recommends the following precautions: 1) physical distancing; 2) frequent testing of pool water for pH levels; 3) frequent cleaning of objects, surfaces and equipment; 4) people using the pool should shower before and after use and be screened for respiratory symptoms; and 5) increasing ventilation of indoor spaces via circulation of outdoor air.

Last Updated: June 16, 2020
Guide to Reopening Pools and Waterfronts
— LSSC: The Lifesaving Society of Canada
National Guidance

LSSC suggests that reopening pools during the pandemic can be safe. At this time there is no evidence that COVID-19 can survive in treated water. Everyone should wear masks at all times except when in the water. Using private water equipment is recommended, however public equipment provided by the facility should be disinfected between each use. Effective physical distancing is described as having a maximum of 6 swimmers per lane. Swimmers are also requested not to spit, cough, urinate or blow their nose in the water. Using equipment (i.e., snorkels, which dispel the user’s mouth’s contents) should be avoided.

Last Updated: April 28, 2020
Cleaning, Decontamination, and Safe Water Management of Aquatic Facilities
— LSSC: The Lifesaving Society of Canada
National Guidance

The LSSO notes the lack of evidence supporting the spread of COVID-19 through treated water. To maintain a safe water environment, indoor pools should have 1.0-3.0 mg/l of chlorine or 2.5-4.0 mg/l of bromine. Aquatic facilities should also clean frequently touched surfaces with appropriate disinfectants to minimize the chances of COVID-19 surviving inside the aquatic facility.

Last Updated: November 4, 2020
Pools, Hot Tubs and Water Playgrounds
— CDC: Centers for Disease Control and Prevention
National Guidance

The CDC is not aware of any scientific reports of SARS-CoV-2 spreading through the water in pools, hot tubs, or water playgrounds. Proper operation of public pools, hot tubs, and water playgrounds and disinfection of the water (with chlorine or bromine) should inactivate the virus.    The CDC discourages individuals from sharing items that are difficult to clean or that are designed to come in contact with the face, items include snorkels, goggles, nose clips, etc. 

Last Updated: September 30, 2020
Canadian Underwater Games Association: Snorkels
— Canadian Underwater Games Association (CUGA)
National Guidance

The CUGA has found no research showing the use of snorkels in water increasing the risk of COVID-19 transmission. They reference the CDC guideline regarding COVID-19 transmission being minimal in treated pool water due to the nature of chlorine/bromine. 

The CUGA suggests each individual to use personal equipment and avoid sharing with others.  

Last Updated: June 18, 2020
Swimming pool technical operation after Covid-19 shutdown
— The Pool Water Treatment Advisory Group
National Guidance

This UK-based independent, non-commercial membership organization recommends that with adequately disinfected pool water, the main risk of COVID-19 transmission is through airborne transmission. Free chlorine and pH values should inactivate the virus within 15-30 seconds. Ideally, a chlorine residual between 1.5 and 3 mg/l is effective at a pH between 7.0 - 7.4.     Pool operators should test the pool water for free and combined chlorine levels and pH frequently. Testing the pool is recommended before use and every two hours following. 

Last Updated: November 4, 2020
Pools, Hot Tubs and Playgrounds
— CDC: Centers for Disease Control and Prevention
Organizational Scan Last Updated: November 25, 2020
Swimming & Splash Pads
— City of Toronto
Organizational Scan Last Updated: November 25, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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