In the Midst of the COVID-19 Pandemic, Should Surfers Continue to Surf?

Introduction: 

On January 31^st, 2020, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC) due to the international novel virus known as SARS-CoV-2 , or COVID-19.³ This declaration supported closure of  all non-essential services, including hotels, schools, and restaurants. In many countries, non-essential workers were mandated to stay home in lockdown and non-essential travel was restricted in order to prevent the spread of the virus. Parks, pools, gyms and even the oceans were closed in many counties. Many members of the community flocked to sidewalks and local parks for recreational activity, continuing to walk and bike, trying to get outside, while maintaining social distancing recommendations. Many swimmers, surfers, and ocean-goers, questioned why they were not allowed into the water when others were permitted to carry on exercising outdoors. While there are risks of exercising outdoors during the viral pandemic, heading to the oceans poses its own specific concerns that may increase the likelihood of contacting the pathogen. 

Discussion:

In the eras of Hippocrates and Celsus, texts often reported the healing properties of the ocean.⁴ While physicians have turned away from dated seawater remedies for common ailments, surfers and ocean-goers have claimed to feel a sense of serenity, peace, and decreased levels of stress from entering the ocean. Patients with cystic fibrosis have fewer hospitalizations when they have been surfing, clearing their lungs from the thick respiratory secretions that block their airways.⁵ So, why is it that when a virus that primarily impacts the respiratory system emerges, people are being told to stay out of the water, if the ocean does indeed have healing properties?

There are many factors that are still unknown about COVID-19. A major factor was that the virus was not initially described to have airborne transmission. This thought changed when a study in the New England Journal of Medicine stated that it could stay aerosolized for up to 3 hours.⁶ With this discovery, dental procedures, intubations for elective surgeries, and laparoscopic procedures were halted due to the increased risk of transmission to those medical providers. Unlike healthcare professionals, surfers are not staring over the mouths of another surfer; however, this aerosolized virus may come from a simple sneeze or a cough in the water. The virus has the potential to stay airborne and travel more than 6 feet due to the ocean breeze.^7-9 While there are no officially described cases of this phenomenon, scientists warn against taking that chance, recommending that surfers and ocean-goers avoid their normal sea activities.

Many maneuvers in surfing lead to swallowing ocean water, even simply dismounting at the end of a wave. The fluid enters the surfer’s oropharynx and then can be expelled through coughing or spitting out the water. Should this surfer carry the virus, the viral particles can be shed through the water. Thus, if many surfers in a lineup still spread the prescribed distance away from each other, there is still the possibility for viral transmission within the ocean water. It is still currently unknown how long the virus stays active while in water, though some studies show that it can survive in freshwater longer than saltwater.¹⁰ Nevertheless, COVID-19 has the potential to enter a surfer’s mouth, nose, and eyes via seawater or ocean breeze.

Many surfers will not surf after a recent rainstorm due to the storm run-off that dumps into the surf break. Many have reported getting sick after post-storm surfing, and have related the illness to the contaminated ocean water. In addition, a good deal of sewage systems dump directly into the ocean. During the COVID-19 pandemic, this may become problematic for surfers because the Centers for Disease Control and Prevention (CDC) has detected COVID-19 in sewage and feces.^8,9 However, the risk of fecal transmission is unknown, but is expected to be low as compared to other similar coronaviruses, such as severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS).^6,11 The CDC also stated that COVID-19 may be found in sewage systems, which could include sewage run-off into the ocean.^10,12 During the SARS epidemic, the virus was detected in untreated sewage for up to 2 weeks and even in sewage aerosols.¹³

Conclusions:

While it may be frustrating to many members of the surfing community, the most impactful way we can contribute to the public health effort is to maintain social distancing by staying off of the beaches and out of the ocean. In this time of surfing abstinence, surfers can turn to watching surfing movies, perusing surf clips online, and training on dry-land. In order for this pandemic to level off and not overwhelm the hospital systems, we all have to do our part, and continue to do so until deemed safe by public health experts. Even with the proposed oceanic healing properties, a lot is still unknown about COVID-19. We do not know whether the spread could come from the ocean breeze, respiratory secretions in the seawater, sewage run-off, or the exposed surfer further down the lineup. COVID-19 has left us with many unknowns, so in the end it is best to err on the side of caution and keep yourself and your surfboard at home. 

Acknowledgments: 

Surfer’s Medical Association

Author Contributions:

Mary Showstark, James Meiling, George Raum, and Barbara Kozminski each participated in the study concept and design, acquisition of the data, analysis of the data, drafting of the manuscript, critical revision of the manuscript and approval of final manuscript.

Financial/Material Support Statement:

None

Disclosure Statement:

Mary Showstark and Barbara Kozminski both currently serve on the board of Surfer’s Medical Association (SMA). Because of their SMA positions, they have been receiving many emails asking about the respiratory health benefits of surfing and continuing to surf during the COVID-19 pandemic. 

References:

1. Hines M. Florida begins reopening beaches amid coronavirus crisis, and people are enthusiastically flocking. USA Today. Available at: https://www.usatoday.com/story/travel/news/2020/04/18/coronavirus-florida-beaches-reopen-big-crowds-during-pandemic/5159264002/. Accessed April 21, 2020.
2. Rojas R, Cooper M. Georgia, Tennessee and South Carolina move to reopen as hot spots emerge. The New York Times. Available at: https://www.nytimes.com/2020/04/20/us/coronavirus-us-hot-spots-reopening.html. Accessed April 21, 2020.
3. Gallegos, A. WHO declares public health emergency for novel coronavirus. Medscape Medical News. Available at: https://www.medscape.com/viewarticle/924596. Accessed April 21, 2020.
4. Braun A. The historic healing power of the beach. The Atlantic. Available at: https://www.theatlantic.com/health/archive/2013/08/the-historic-healing-power-of-the-beach/279175/. Accessed April 21, 2020.
5. Winner C. Marine microbes vs. cystic fibrosis: scientist seeks medicines from nature. Oceanus Magazine. 2012. Available at: https://www.whoi.edu/oceanus/feature/marine-microbes-vs-cystic-fibrosis/. Accessed April 21, 2020.
6. Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J of Med. 2020;382(16):1564-7.
7. Prodanovich T. Coastal breeze can carry COVID-19 more than 6 feet, says virus expert. Surfer. Available at: https://www.surfer.com/features/coastal-breeze-can-carry-covid-19-more-than-6-feet-says-virus-expert/. Accessed April 21, 2020.
8. Xia R. Coronavirus at beaches? Surfers, swimmers should stay away, scientist says. Los Angeles Times. Available at: https://www.latimes.com/california/story/2020-04-02/coronavirus-ocean-swimming-surfing-safe-beaches-los-angeles. Accessed April 21, 2020.
9. Robbins G. UC San Diego virus expert pleads with surfers to stay out of the ocean to avoid coronavirus. The San Diego Union-Tribune. Available at: https://www.sandiegouniontribune.com/news/science/story/2020-03-31/uc-san-diego-atmospheric-chemist-pleads-with-surfers-and-beach-walkers-to-stay-home. Accessed April 21, 2020.
10. Day, K. COVID-19 and beach water quality: updates from the research community. Surfrider Foundation. Available at: https://www.surfrider.org/coastal-blog/entry/covid-19-and-beach-water-quality-updates-from-the-research-community. Accessed April 21, 2020.
11. Hindson J. COVID-19: faecal-oral transmission?. Nat Rev Gastroenterol Hepatol. 2020 [Epub ahead of print].
12. Centers for Disease Control and Prevention. Water and COVID-19 FAQs. Available at: https://www.cdc.gov/coronavirus/2019-ncov/php/water.html. Accessed April 20, 2020.
13. Yeo C, Kaushal S, Yeo D. Enteric involvement of coronaviruses: Is faecal-oral transmission of SARS-CoV-2 possible?. Lancet Gastroenterol Hepatol.2020;5(4):335-7.

Authors/Affiliations:

Mary Showstark, MPAS, PA-C; Yale University School of Medicine Physician Assistant Online Program; New Haven, CT, USA

James Meiling, DO; Medical City Weatherford, Weatherford, TX, USA

George Raum, BA; Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA

Barbara Kozminski, MD; University of Washington, Seattle, WA, USA

Corresponding Author:

Mary Showstark, MPAS, PA-C
Address: Yale University School of Medicine Physician Assistant Online Program; 100 Church Street South, Suite A230, New Haven, CT 06519, USA
Phone Number: (475) 331-5101
Email: mary.showstark@yale.edu