There’s been more than a year of intense scientific focus on COVID-19, and more than half of Americans have had at least one dose of a vaccine. So much has changed—do we still have to observe all the restrictions we did a year ago? Are group training rides okay? Do we still need to wear masks when working out outdoors? How does being vaccinated change things?
On April 27, the Centers for Disease Control and Prevention tried to answer some of those questions. The new guidelines are based on increasing numbers of Americans vaccinated, decreasing hospitalizations from Covid-19, and data that shows less than 10% of virus transmission occurred in outdoor settings. The CDC now says you don’t have to wear a mask when running or biking outdoors. By yourself. Or with members of your own household. Or attending a small (small is not defined) gathering of fully vaccinated people (gathering implies not breathing hard?). Which is pretty much what the vaccinated among us have already been doing.
While the CDC’s announcement is certainly encouraging in terms of our progress in battling the pandemic, there are so many asterisks and caveats it’s still hard to determine practical application of this information.
Dr. Andrew Getzin, head team physician for USA Triathlon, laid out the baseline facts from his perspective. “What we do know is that the overall health benefits of exercise are exceedingly high. Exercising outside always presents less risk than indoors; and if you can get vaccinated, do it. The very small risk of exposure while exercising should not prevent you from enjoying the huge benefits.”
Getzin has been reading the same science, the same studies that informed the CDC, and is comfortable extending the organization’s famously and necessarily uber-cautious recommendations. He said that going on an outdoor training ride with a fully vaccinated group, for example, presented “almost zero risk.” They can breathe hard, maskless, for an hour or two, often within 6 feet of each other with very little risk, according to Getzin. The universal vaccination status and outdoor droplet-dissipating environment are the mitigating factors in this instance.
But what if one member of the group brings along an unvaccinated friend? Well, the risk edges up. That’s because the vaccine protects those who have it from getting severely ill, but it’s still not known whether vaccinated people can carry and transmit the virus to the unvaccinated.
“Again, it’s relative risk,” Getzin said. “They’re outside, where it’s known that viral load dissipates quickly, so while being unvaccinated in this scenario increases risk slightly, it’s still low. If the person is not vaccinated and vulnerable to a bad outcome, it might be prudent to eliminate any potential exposure [pass on the group ride]. Also, if there’s high Covid prevalence in the community, an unvaccinated person might be at higher risk.”
The CDC’s recommendation for outdoor exercise over indoor comes in part from their 2020 work with the NFL, Getzin pointed out. Despite several hours of close physical contact, without masks, during games, no viral transmission was found. Indoor contact sports were another story. “The majority of cases come from asymptomatic spread where people are inside for more than 15 minutes,” Getzin said.
As eagerly as we ditch the mask outdoors, face coverings remain a part of life, even for the fully vaccinated. Our theoretical fully vaccinated training group may ride maskless, but they should keep a mask handy for the post-ride restaurant stop, errands, or the possibility of encountering a crowd.
Vaccinated or no, Getzin agreed not much has changed indoors—masks, distancing, wiping down surfaces. There’s been no recorded virus transmission in water, neither chlorinated nor fresh, so whatever risk there is at the pool comes from close contact in the locker room. At an indoor pool, masks should be worn by all users in the locker room, and at the outdoor pool changing facility if it’s crowded. And the indoor spin class? With warmer weather, it seems easy to find a more appealing alternative than sweating fully masked through a 90-minute session.
There’s lab science and there’s social science. Emerging from pandemic restrictions is scary for some, there’s nothing outward that announces your vaccination status, and there’s plenty of room for interpretation in the CDC’s guidelines—what’s a small group? Is a rave a gathering? There’s something to be said for allaying people’s fears, Getzin said: “If you’re running in Central Park on a Sunday, it might be a good idea to mask up, not because you’re at risk of transmission but just to send the message of safety.”
Getzin’s take, that vaccinated people can work out outdoors much as they did in those far-off pre-Covid days with very little risk, is welcome news indeed. But other health professionals look at the same data, the same studies, and see the list of unknowns—how long do vaccines provide immunity? Are they effective against all the variants? Can a vaccinated person still carry and transmit the virus? No vaccine is 100% effective, and no environment is 100% safe—what about that sliver of risk?
“In general, the same behaviors that have been recommended—mask wearing, staying 6 feet apart, exercising outdoors whenever possible, washing hands frequently—are still things you can do to engage in exercise safely,” said Dr. Regina Davis Moss, Associate Executive Director of the American Public Health Association.
Davis Moss recommended double masking when working out indoors, particularly when doing strenuous exercise like running on the treadmill, spinning, or rowing. This is, she admitted, a challenge, which is why people should try to do high-intensity exercise outdoors. But being outdoors is not a free pass, she said. Given the scenario of two fully vaccinated friends running together outdoors, one Getzin characterized as low risk, Davis Moss pointed out the compromises—you’re closer than 6 feet, breathing hard for an extended period of time. “All those factors add to your risk.”
Davis Moss is a public health expert; her approach is to identify risk, and encourage the safest possible behaviors for everyone. Getzin is dealing with a largely healthy, low-risk group of people who are itching to lay down a brick workout. “They have different goals,” said infectious disease specialist and runner Dr. Dimitri Drekonja, Associate Professor of Medicine at the University of Minnesota.
Like Getzin, Drekonja reads the science and is comfortable being a step ahead of the CDC. “It’s pretty clear working out outdoors is extremely safe,” he said recently by phone. “Breathing heavily increases risk, but whatever virus you may have dissipates pretty quickly in the breeze. The example often used is bikers drafting in a line, breathing heavily for an hour or more. Could you get sick from being downwind of someone who wasn’t vaccinated? Yes, you could. But is it rare? Absolutely.”
While masks are still an important and effective way to protect yourself and others, Drekonja said, the game changers are being vaccinated and training outdoors. “If you and your friends have all been vaccinated, it’s totally reasonable to be working out outdoors together,” he said. “Group runs, group rides. It’s not perfect, it’s not bulletproof, but few things are.”
As we navigate this stage of the pandemic, there’s a lot of room for personal interpretation and responsibility. The upcoming rave, for example. Would that be considered a small gathering? Your call.