key: cord-315991-uecdbanf
authors: Hughes, David; Saw, Richard; Perera, Nirmala Kanthi Panagodage; Mooney, Mathew; Wallett, Alice; Cooke, Jennifer; Coatsworth, Nick; Broderick, Carolyn
title: The Australian Institute of Sport Framework for Rebooting Sport in a COVID-19 Environment
date: 2020-05-06
journal: J Sci Med Sport
DOI: 10.1016/j.jsams.2020.05.004
sha: 
doc_id: 315991
cord_uid: uecdbanf

Abstract Sport makes an important contribution to the physical, psychological and emotional well-being of Australians. The economic contribution of sport is equivalent to 2–3% of Gross Domestic Product (GDP). The COVID-19 pandemic has had devastating effects on communities globally, leading to significant restrictions on all sectors of society, including sport. Resumption of sport can significantly contribute to the re-establishment of normality in Australian society. The Australian Institute of Sport (AIS), in consultation with sport partners (National Institute Network (NIN) Directors, NIN Chief Medical Officers (CMOs), National Sporting Organisation (NSO) Presidents, NSO Performance Directors and NSO CMOs), has developed a framework to inform the resumption of sport. National Principles for Resumption of Sport were used as a guide in the development of ‘the AIS Framework for Rebooting Sport in a COVID-19 Environment’ (the AIS Framework); and based on current best evidence, and guidelines from the Australian Federal Government, extrapolated into the sporting context by specialists in sport and exercise medicine, infectious diseases and public health. The principles outlined in this document apply to high performance/professional, community and individual passive (non-contact) sport. The AIS Framework is a timely tool of minimum baseline of standards, for ‘how’ reintroduction of sport activity will occur in a cautious and methodical manner, based on the best available evidence to optimise athlete and community safety. Decisions regarding the timing of resumption (the ‘when’ ) of sporting activity must be made in close consultation with Federal, State/Territory and Local Public Health Authorities. The priority at all times must be to preserve public health, minimising the risk of community transmission.

On 12 January 2020, the World Health Organisation (WHO) reported a cluster of 41 confirmed cases 83 of viral severe acute respiratory syndrome in Wuhan, Hubei Province, People's Republic of China, 84 following a novel coronavirus outbreak in December 2019. [1] Coronaviruses, enveloped Ribonucleic 85 acid (RNA) viruses with surface spikes, are a group of viruses that affect both animals and humans, 86 (loss of smell) and ageusia (loss of taste). [52, 53] Less commonly reported symptoms include headache, 138 abdominal pain, nausea, vomiting and diarrhoea. [45, 50, 54] 139

In a review of clinical presentations from China, 81% of infected people have mild symptoms (no 140 respiratory distress), 14% have severe illness (dyspnoea, tachypnoea and hypoxia) and 5% have 141 critical illness (respiratory and other organ failure, septic shock). [55] The observed timeline of 142 symptoms and pathological changes in symptomatic individuals is an influenza like illness (fever, 143 cough and myalgia) in the first few days followed by respiratory symptoms (dyspnoea +/-hypoxia) in 144 the second week of the illness. The characteristic features on chest CT are bilateral, peripheral, 145 multifocal ground glass opacities. [56] These imaging findings can also be seen in asymptomatic and 146

pre-symptomatic individuals. The median time from onset of symptoms to intensive care unit (ICU) 147 admission in the critically ill is 10 days. [57] In most instances the cause of death is respiratory failure, 148 septic shock or myocardial injury and cardiac failure. [50] Hospitalisation and mortality rates increase 149 with age. 150

Case fatality rates (CFR) vary from country to country and are likely to reflect the extent of testing (if 151 only severe cases who present to hospital are tested CFR will appear higher), demographics (regions 152 with a higher proportion of elderly will have higher CFRs) and stress on the health systems (the size 153 of the outbreak versus the capacity to provide ventilatory support). 154

While people of all ages can be affected by COVID-19, children tend to have a milder illness, lower 155 rates of hospitalisation and asymptomatic carriage is not uncommon. [58] The proportion of infected 156 individuals who remain asymptomatic is not known as widespread population screening has not been 157 undertaken but reports vary from 18% to 79%. [59, 60] The proportion of asymptomatic carriage is likely 158 to be higher in a younger population. Unlike SARS-CoV which was most infectious approximately 159 one week after symptom onset, [61] the most infectious period for SARS-CoV-2 is the 48 hours prior to 160 onset of symptoms and the day of symptom onset. [62] It is estimated that 44% of infections are 161 transmitted prior to the onset of symptoms in the index case. [62] This has significant implications for 162 community transmission. Several risk factors, other than advanced age, have been found to be associated with severe disease 164 and death. These include; male sex and co-morbidities including diabetes, cardiovascular disease, 165 hypertension, respiratory disease and immunosuppression. [50, 61, 62] The laboratory findings associated 166

with an increased risk of severe disease and death were; leucocytosis, lymphopenia, elevated liver 167 enzymes, elevated inflammatory markers, elevated D-dimer, elevated troponin, eosinophilia and 168 abnormal renal function. [50] It has been postulated that more severe cases of COVID -19 may be 169 associated with hyperinflammatory syndrome characterised by a fulminant and fatal 170 hypercytokinaemia (cytokine storm) causing multi-organ pathology. [50, 63] 171

Reports of non-respiratory manifestations of COVID-19 are increasingly being described. While 172 pneumonia is still the most frequent serious manifestation, cardiomyopathy has been reported in one 173 third of critically ill patients in the United States of America. [47] Approximately one third of 174 hospitalised patients display neurological symptoms including headache, dizziness, agitation, 175 delirium, ataxia and corticospinal tract signs. [66] Neurological symptoms are more common in those 176 with severe respiratory disease. [48] Coagulopathies with thrombotic events and elevated phospholipid 177 antibodies have also been described. [49] 178

To date, there are no clinical data on possible long-term complications of COVID-19. Whether 179 individuals who have been infected and "recovered" have residual organ damage, in particular 180 respiratory or cardiac complications, is unknown at this time. The other current unknown is whether 181 infection confers immunity to future infection and if so, how long that immunity lasts. 182 183 PREVENTION 184 Pre-emptive low-cost interventions such as enhanced hygiene and social distancing measures reduce 185 numbers of cases through several mechanisms. Social distancing decreases the risk of transmission by 186 reducing incidence of contact while enhanced hygiene reduces disease transmission, if a contact occurs. [39] Education of the public and enhanced medical resources have also been shown to reduce 188 transmission. [39, 65, 66] 189

The Australian Governor-General declared a 'human biosecurity emergency period' on 18 March 2020 190 in response to the risks posed by This empowered the Australian Government to make 191 a series of decisions including prohibition of cruise ships, travel bans (domestic and international), 192 limiting gatherings to two persons (with exceptions for people of the same household and other select 193 groups), and closing a range of indoor and outdoor public facilities. [70] After peaking in Australia in 194 mid to late March 2020, the number of daily new cases of COVID-19 began to drop in response to In Australia, indications for conducting testing for COVID-19 have changed over the course of the 202 pandemic, as case definitions have evolved, and testing kits have become more available. [71, 72] Testing 203 availability was initially limited to patients with relevant symptoms who were returned overseas 204 travellers or known contacts of a COVID-19 case. Testing criteria have now broadened gradually, and 205

doctors should refer to current local health guidelines. [71] 206

There are currently two main types of tests available for SARS-CoV-2: 207  Nucleic acid detection tests: commonly referred to as polymerase chain reaction (PCR) tests 208 detects SARS-CoV-2 genetic material. The preferred test to confirm the diagnosis of COVID-19 is PCR testing of nasopharyngeal and/or 211 throat swabs, combined with relevant clinical findings. Despite the potential for faecal-oral 212 transmission [45, 46] , the role of faecal PCR testing remains unclear. 213

The absence of SARS-CoV-2 on a PCR test on a single occasion is insufficient to definitively rule out 214 COVID-19 infection. Public Health Authorities in Australia have recommended using multiple 215 samples over multiple days in those whose symptoms are strongly suggestive of 71] In 216 general, PCR tests for other respiratory viral infections tend to have a high sensitivity and specificity, 217 although there is limited data specific to COVID-19. See Appendix A for more detailed information 218 regarding testing for SARS-CoV-2. 219

Serology tests are available, including Point of Care (PoC) serology tests that can provide results from 220 venous or finger prick samples in 15-30 minutes. [71, 74] It is likely that antibodies take 5-10 days to 221 become detectable after infection, and around 30% of patients may not produce detectable levels at 222 all. [75] At present the sensitivity and specificity for serology testing is not well known. In addition to 223 false negatives, false positives may arise from exposure to other coronavirus strains. As serology is 224 testing for antibodies and not the presence of the virus, it does not provide clinically useful 225 information as to whether a patient could be infectious. [ Champions (individuals and teams). [84] The sport sector employs >220,000 individuals and engages 264 >1.8 million volunteers. The economic contribution is equivalent to 2-3% of Gross Domestic Product 265 (GDP). [85] Regular community-based sport participation in Australia generates an estimated $18.7B 266 value per annum in social capital including direct economic benefits. [86] Australia has enjoyed many 267 benefits as a result of a rich sporting culture. 268

Preventative measures taken in Australia and other countries, while required to limit the spread of 269 COVID-19, have impacted upon a range of work and social pursuits including sport activities. The Olympic Games and the international community". [87, 88] There is contested uncertainty about the likely course of the pandemic and the resulting timelines for 291 safe return to training and competition. In professional sport, loss of revenue from sponsorship, gate-292 takings and broadcast deals has resulted in job losses and reappraisal of operational imperatives. [116] It 293 is unclear what long-term effects there will be on other factors such as fan engagement, sport 294 participation, employment in the sport industry and athlete/staff welfare. Global and national 295 economic conditions will also have repercussions for sport. 296

The COVID-19 pandemic has impacted people in varying ways with many experiencing 300 deteriorations in mental health. [117, 118] Resumption of sport can significantly contribute to the re-301 establishment of normality in society, in a COVID-19 environment. Some established norms 302 associated with sport from sharing drink bottles, hugging and shaking hands to arenas packed with 303 spectators are the antithesis of social distancing. Sport organisations and participants will be faced 304 with complex decisions regarding resumption of training and competition in the current 305 circumstances. The AIS, in consultation with sport partners (NIN Directors, NIN Chief Medical 306

Officers (CMOs), National Sporting Organisation (NSO) Presidents, NSO Performance Directors and 307 NSO CMOs), has developed a framework to inform the resumption of sport. National Principles for 308

Resumption of Sport formed the foundation of 'the AIS Framework for Rebooting Sport in a COVID-309

19 Environment' (the AIS Framework). Given the recency of COVID-19 there is a paucity of 310 research, particularly in athletic populations. The AIS Framework is based on current best evidence, and guidelines from the Australian Federal Government extrapolated into the sporting context by 312 specialists in sport and exercise medicine, infectious diseases and public health. The AIS Framework 313 will be regularly updated to reflect the evolving scientific evidence about COVID-19. The AIS 314

Framework is a timely tool of minimum baseline of standards, for 'how' reintroduction of sport 315 activity will occur in a cautious and methodical manner, based on the best available evidence to 316 optimise athlete and community safety. The principles outlined in the AIS Framework apply to high 317 performance/professional, community and individual passive (non-contact) sport. Decisions regarding 318 the timing of resumption (the 'when') of sporting activity must be made in close consultation with 319

Federal, State/Territory and Local Public Health Authorities. The priority at all times must be to 320 preserve public health, minimising the risk of community transmission. Resumption of sport and recreation activities can contribute many health, economic, social and cultural benefits to Australian society emerging from the COVID-19 environment. 2. Resumption of sport and recreation activities should not compromise the health of individuals or the community. 3. Resumption of sport and recreation activities will be based on objective health information to ensure they are conducted safely and do not risk increased COVID-19 local transmission rates. 4. All decisions about resumption of sport and recreation activities must take place with careful reference to these National Principles following close consultation with Federal, State/Territory and/or Local Public Health Authorities, as relevant. 5. The AIS 'Framework for Rebooting Sport in a COVID-19 Environment' provides a guide for the reintroduction of sport and recreation in Australia, including high performance sport. The AIS Framework incorporates consideration of the differences between contact and non-contact sport and indoor and outdoor activity. Whilst the three phases A, B and C of the AIS Framework provide a general guide, individual jurisdictions may provide guidance on the timing of introduction of various levels of sport participation with regard to local epidemiology, risk mitigation strategies and public health capacity. 6. International evidence to date is suggestive that outdoor activities are a lower risk setting for COVID-19 transmission. There are no good data on risks of indoor sporting activity but, at this time, the risk is assumed to be greater than for outdoor sporting activity, even with similar mitigation steps taken. 7. All individuals who participate in, and contribute to, sport and recreation will be considered in resumption plans, including those at the high performance/professional level, those at the community competitive level, and those who wish to enjoy passive (non-contact) individual sports and recreation. 8. Resumption of community sport and recreation activity should take place in a staged fashion with an initial phase of small group (<10) activities in a non-contact fashion, prior to moving on to a subsequent phase of large group (>10) activities including full contact training/competition in sport. Individual jurisdictions will determine progression through these phases, taking account of local epidemiology, risk mitigation strategies and public health capability. a. This includes the resumption of children's outdoor sport with strict physical distancing measures for non-sporting attendees such as parents. b. This includes the resumption of outdoor recreational activities including (but not limited to) outdoor-based personal training and boot camps, golf, fishing, bush-walking, swimming, etc. 9. Significantly enhanced risk mitigation (including avoidance and physical distancing) must be applied to all indoor activities associated with outdoor sporting codes (e.g. club rooms, training facilities, gymnasia and the like). 10. For high performance and professional sporting organisations, the regime underpinned in the AIS Framework is considered a minimum baseline standard required to be met before the resumption of training and match play, noting most sports and participants are currently operating at level A of the AIS Framework. 11. If sporting organisations are seeking specific exemptions in order to recommence activity, particularly with regard to competitions, they are required to engage with, and where necessary seek approvals from, the respective State/Territory and/or Local Public Health Authorities regarding additional measures to reduce the risk of COVID-19 spread. 12. At all times sport and recreation organisations must respond to the directives of Public Health Authorities. Localised outbreaks may require sporting organisations to again restrict activity and those organisations must be ready to respond accordingly. The detection of a positive COVID-19 case in a sporting or recreation club or organisation will result in a standard public health response, which could include quarantine of a whole team or large group, and close contacts, for the required period. 13. The risks associated with large gatherings are such that, for the foreseeable future, elite sports, if recommenced, should do so in a spectator-free environment with the minimum support staff available to support the competition. Community sport and recreation activities should limit those present to the minimum required to support the participants (e.g. one parent or carer per child if necessary). 14. The sporting environment (training and competition venues) should be assessed to ensure precautions are taken to minimise risk to those participating in sport and those attending sporting events as spectators (where and when permissible). 15. The safety and well-being of the Australian community will be the priority in any further and specific decisions about the resumption of sport, which will be considered by the COVID-19 Sports and Health Committee. All community and individual sport participants, parents/guardians of participants, coaches, 353 spectators, officials and volunteers (collectively termed community sport members) and sport 354 organisations must play a role help slow the spread of COVID-19. The safe reintroduction of 355 community and individual sport requires thorough planning and safe implementation. 356

Prior to the resumption of community sport, it is important for sports clubs/groups to safely prepare 358 the sporting environment. A thorough risk assessment must be carried out and preparation will be 359 specific to the sporting environment. A resumption of sport activity should not occur until appropriate 360 measures are implemented to ensure safety of community sport members. 361

Education of community sport members about COVID-19 risk mitigation strategies is crucial. 363

Education will help to promote and set expectations for the required behaviours prior to 364 recommencing activities. Improved health literacy including awareness of self-monitoring of 365 respiratory symptoms (even if mild). Community sports may benefit from consulting with local 366

Government and Public Health Authorities on education materials and options available. 367

Possible education measures include: 368  Provide education material for community sport members to promote required behaviours (e.g. -What is the strategy to ensure that social distancing of at least 1.5m is maintained by 428 community sport members attending training or competition? 429 -What strategies can be used to communicate/inform community sport members of preventive 430

-What is the strategy to reduce in-person contact between athletes and other personnel? 432

-What is the strategy to manage increased levels of staff/volunteer absences? 433 -What is the strategy to reduce risk to vulnerable groups? 434

Proposed criteria for resumption of sporting activity 435 Initial resumption of community and individual sport will be governed by public health policy and 436 Relaxing/increasing restrictions may be required in response to fluctuating numbers of COVID-19 443

An initial resumption of sporting activity is dependent on several factors: 445  A sustained decrease in COVID-19 transmission 446

 Healthcare system capacity 447  Community sport clubs/groups and individuals making their own risk assessment guided by 448 their Local Public Health Authorities (i.e. community sports clubs and individuals cannot 449 restart sport before permitted by Local Public Health Authorities but may decide to delay a 450 restart due to their own circumstances / risk assessment). 451

Three levels (Levels A, B, C) of sporting activities are recommended in the context of a COVID-19 452 environment (Table 1) . For each level, permitted activities, general hygiene measures, and spectators, 453 additional personnel considerations are provided as recommendations before the resumption of 454 community or individual sport. A more detailed description of the sport-specific activities has been 455 developed in conjunction with medical staff working within sport (Table 1) . 456 457 <Insert There should be no unnecessary body contact (e.g. hand shaking, high fives). 473 Community sport organisations should minimise unnecessary huddles of spectators. Spectators 474 should be encouraged or directed to spread out and maintain social distance. 475 Consideration should be given as to whether it is appropriate to serve food and drink at community 476 events, as this will likely encourage spectators to come into close proximity with each other. 477 Hand hygiene stations should be placed in high traffic areas and entry/exit points. 478 479 Progression from Level A to Level B sporting activities will be considered when the local effective 480 reproduction number (R t ) has remained <1 for two incubation periods (i.e. four weeks) as determined 481

by Public Health Authorities. [36, 119] 482

When sport activity has been at level B for a further two incubation cycles without an increase in R t , 483

progression to Level C sporting activities can be considered, as determined by with Public Health 484

Authorities. The timing of the progression from Level B to Level C may be influenced by any 485 evidence of transmission issues within the sporting cohort. 486

Community sport members and individuals should not return to sport if in the last 14 days they have 489 been unwell or had close contact with a known or suspected case of COVID-19. In an environment of 490 community transmission of COVID-19, any individual with respiratory symptoms (cough, sore throat, 491 fever or shortness of breath), even if mild, should be considered a possible case of COVID-19. All 492 community sport members must be made aware not to attend sport environments if they are unwell 493 and should use a cautious approach. Anyone who is unwell should be referred to a doctor in 494 accordance with local Public Health Authority guidelines. An athlete with a possible case of COVID-495 19 should refrain from training (even at home) until they have been cleared to do so by a doctor, given 496 the potential for worsening illness. 497

It should also be considered that anyone returning to sport and exercise after a period of social 498 isolation and not exercising regularly may be at an increased risk of injury. Clubs and individuals 499 should apply a graded return to mitigate injury risk, understanding that a sudden increase in training 500 load will predispose to injury. [120] 501

Vulnerable groups 502 Vulnerable groups such as para-athletes and others with medical conditions may be at increased risk. 503

Those with concomitant medical conditions need individualised management in consultation with 504 their regular treating doctor(s) prior to return to training environments. Considerations include 505 increased susceptibility to respiratory infections, unique equipment (e.g. wheelchairs) that requires 506 cleaning, accessibility of medical resources, risk of medical sequalae from COVID-19, and access to 507 alternate training options. 508

Athletes/other personnel with concurrent medical conditions including; respiratory or cardiac disease, 509 hypertension, diabetes [121, 122] , obesity [54] and immunosuppression due to disease or medication may be 510 at increased risk. Other groups that require special consideration include; individuals over 70 years of 511 age, carers for or a household contact of a vulnerable person, athletes with suboptimal access to 512 medical care (e.g. remote) and Aboriginal and Torres Strait Islander Communities. There are two separate points to consider for athletes and other personnel who have been infected 522 with COVID-19, prior to returning to sport: 523  Ensure they no longer pose any infection risk to their community and 524  Ensure they have sufficiently recovered to safely participate in exercise (specifically for 525 athletes and other personnel undertaking physical roles). 526

In both instances, clearance from their doctor is required. 527

Athletes and other personnel who have recovered from COVID-19 must satisfy the Communicable 528

Disease Network of Australia (CDNA) criteria to ensure they are no longer infectious. [72] 529

While there is increasing research on the multi-organ nature of COVID-19 in the acute phase, there is 530 currently limited research on medium to long-term complications. Long-term decreased exercise 531 capacity has been noted following previous coronavirus infections (SARS and MERS). [123] Athletes 532 and volunteers/officials with physical roles may be at increased risk of health complications after 533 COVID-19 and warrant multidisciplinary specialist medical assessment before resuming high exertion 534 activities. [124, 125] They should be instructed to see their local doctor for a full medical review. An 535 outline of the recommended assessment process following a COVID-19 case is illustrated in Table 2. <Insert High performance/professional athletes are 'returning to work' and safe resumption of sport in a 544 COVID-19 environment will be a complex process. For high performance/professional sporting 545 organisations, the 'AIS Framework' is considered a minimum baseline of standards required to be met 546 before the resumption of training and match play. 547

The AIS Framework provide minimum baseline of standards for 'how' high performance/professional 548 sport activities can be reintroduced based on the best available evidence to ensure the safety of 549 athletes/other personnel and the wider community ( Figure 5 ). If sporting organisations are seeking 550 special exemption to recommence activity, they are required to demonstrate to the respective 551

State/Territory and/or local Public Health Authorities that they meet the 'AIS Framework' 552 requirements and are also taking additional measures to prevent the spread of COVID-19. Federal, 553

State/Territory and Local Public Health Authorities must be closely consulted in decisions regarding 554 the resumption of ('when') high performance/professional sport activities. All individuals and sport 555 organisations must follow directions of the Local Public Health Authorities. 556 (Table 3) . For each level, permitted activities, general hygiene measures, and medical 673 servicing considerations are provided as minimum baseline of standards required to be met by high 674 performance/professional sport before the resumption of training and competition. A more detailed 675 description of the sport-specific activities has been developed in conjunction with medical staff 676 working within sport (Table 3) . 677

Progression from Level A to Level B sporting activities will be permitted when the local effective 679 reproduction number (Rt) has remained <1 for two incubation periods (i.e. four weeks) as determined 680

by Public Health Authorities. [36, 119] 681

When sport activity has been at level B for a further two incubation cycles without an increase in R t , 682

progression to Level C sporting activities can be considered, in consultation with Public Health 683

Authorities. The timing of the progression from Level B to Level C may be influenced by any 684 evidence of transmission issues within the sporting cohort. The assessment process will depend on multiple factors including medical resources, athlete risk 698 factors and sport-specific risk factors. It may be appropriate for an initial screening to be conducted Vulnerable groups such as para-athletes and others with medical conditions may be at increased risk. 720

Those with concomitant medical conditions need individualised management in consultation with 721 their regular treating doctor(s) prior to return to training environments. Considerations include 722 increased susceptibility to respiratory infections, unique equipment (e.g. wheelchairs) that requires 723 cleaning, accessibility of medical resources, risk of medical sequalae from COVID-19, and access to 724 alternate training options.

Athletes/other personnel with concurrent medical conditions including; respiratory or cardiac disease, 726 hypertension, diabetes [121, 122] , obesity [54] and immunosuppression due to disease or medication may be 727 

There will be athletes/other personnel who have been infected with COVID-19 wanting to return to 739 the sport environment. Some individuals may have been infected and not be aware (asymptomatic or 740 minimally symptomatic cases that did not meet testing criteria at the time of illness). Athletes/other 741 personnel who have recovered from COVID-19 must satisfy the Communicable Disease Network of 742

While there is growing research on the organ systems affected by COVID-19 in the acute phase, there 744 is currently limited research on medium to long-term complications. Long-term decreased exercise 745 capacity has been noted following previous coronavirus infections (SARS and MERS). [123] Athletes 746 and other personnel with physical roles may be at increased risk of health complications after 747 COVID-19 and warrant multidisciplinary specialist medical assessment before resuming high exertion 748 activities. [124, 125] Medical clearance of staff may be conducted by the sport, or by external doctors, depending on the individual sport organisation resources and policies. An outline of the recommended 750 assessment process following a COVID-19 case is illustrated in Table 2 In Australia, currently most respiratory tract infections will be tested for COVID-19. If an individual 764 is being tested for COVID-19: 765  They must immediately self-isolate and discontinue training until COVID-19 has been excluded 766 and they have been medically cleared by a doctor to return to the training environment 767  Isolation of close contacts will be a decision for medical staff, based on case specific details 768

Definition of close contacts: 769  "Face-to-face contact in any setting with a confirmed or probable case, for greater than 15 770 minutes cumulative over the course of a week, in the period extending from 48 hours before onset 771 of symptoms in the confirmed or probable case, or  Sharing of a closed space with a confirmed or probable case for a prolonged period (e.g. more 773 than 2 hours) in the period extending from 48 hours before onset of symptoms in the confirmed or 774 probable case 775  Contact is considered to have occurred within the period extending 48 hours before onset of 776 symptoms in the patient, until the patient is classified as no longer infectious by the treating team 777 (usually 24 hours after the resolution of symptoms)". [72] and key surfaces before/after every patient. 794  For manual therapy treatment or massage, it is recommended that the athlete and therapist wear a 795 face mask. The therapist must wash their hands before and after treatment, and the athlete should 796

shower before and after treatment.

symptoms/illness must be tested for COVID-19 and cleared by a doctor. 799  Unwell athletes should be instructed to see a doctor and must not receive any other type of 800 medical servicing such as assessment for injury (unless urgent) or manual therapy until cleared to 801 do so. 802

Detailed description of medical service considerations pertaining to Level A, B, C sporting activity is 803 illustrated in Table 3 all sectors of society, including sport. In a COVID-19 environment, sport has an important role to play in restoring normality. Sport Organisations and athletes will be faced with complex decisions 821 regarding resumption of training activities in the current circumstances. 'The AIS Framework for 822

Rebooting Sport in a COVID-19 Environment' is based on current available evidence, extrapolated 823 into the sporting context by specialists in sport and exercise medicine, infectious diseases and public 824 health. The AIS Framework provides a timely tool for sport organisations to guide the cautious and 825 methodical resumption of sport activity (the 'how') . Decisions regarding resumption of sporting 826 activity must be based on objective medical information regarding the transmission of Federal, State/Territory and Local Public Health Authorities must be closely consulted in decisions 828 regarding the timing of resumption of sport (the 'when'). The AIS Framework will be updated to 829 reflect the evolving evidence regarding COVID-19. While navigating the return to sport, 830 organisations must ensure that the health and wellbeing of athletes and other personnel informs 831 decision making. The overriding priority for sport, however, must ensure that any return to activity 832 does not endanger public health.  The overriding priority for sport, however, is to ensure that any return to activity does not 881 endanger public health. 882 

Activity that can be conducted by a solo athlete or by pairs where at least 1.5m can always be maintained between participants. No contact between athletes and/or other personnel. Examples for all sports -general fitness aerobic and anaerobic (e.g. running, cycling sprints, hills) . Strength and sport-specific training permitted if no equipment required, or have access to own equipment (e.g. ergometer, weights) . Online coaching and resources (e.g. videos, play books).

As per Level A plus: Indoor/outdoor activity that can be conducted in small groups (not more than 10 athletes and/or other personnel in total) and with adequate spacing (not more than 1 person per 4m 2 ). Spitting and clearing of nasal/respiratory secretions on ovals or other sport settings must be strongly discouraged.

Communal facilities can be used after a sport-specific structured risk assessment and mitigation process is undertaken. 'Get in, train and get out' -be prepared for training prior to arrival at venue (minimise need to use/gather in change rooms, bathrooms). Minimise use of communal facilities (e.g. gym, court) with limited numbers (not more than 10 athletes/staff in total). Have cleaning protocols in place for equipment and facilities.

Hand hygiene (hand sanitisers) on entry and exit to venues, as well as pre, post and during training. Thorough full body shower with soap before and after training (preferably at home). Where possible maintain distance of at least 1.5m while training. No socialising or group meals.

No spectators unless required (e.g. parent or carer). Separate spectators from athletes. Spectators should maintain social distancing of at least 1.5m.

Running, resistance training (solo), skills training (solo). Passing, kicking, catching drills. No tackling or grappling. Small groups (not more than 10 athletes/staff in total).

Outdoor range and solo only. Full training indoor or outdoor range, with limited numbers / appropriate distancing between athletes.

Solo training drills only-land based, in own pool or openwater. General fitness, strength work.

Swimming (own lane). In pool solo technical drills or group technical drills without physical contact. No lifting, holding.

Outdoor training sessions on own, with coach, or with 1 training partner (no sharing of equipment e.g. javelin, discus, high-jump mats, pole vault, shot put, hammer, starting blocks).

Full training. Avoid running in slipstream of others.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, handballing, ball handling skills (e.g. handball against wall, bouncing, ball recovery work).

Controlled kicking, marking and handball drills. No tackling/wresting, contact, body on body drills. Small groups (not more than 10 athletes/staff in total) for both education and training.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).

Full training on court, singles or doubles.

Running/aerobic training (solo), resistance training (solo), skills training (solo).

Full training with small numbers (not more than 10 athletes/staff in total). Laser Run practice in small groups, respecting distance on shooting bench.

Running/aerobic training (solo), resistance training (solo), simulation work at home if available.

Full training.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo), including shooting (outdoor or own ring only) or ball skills e.g. against a wall to self.

Skills using netball passing, shooting, defending. Small group training (not more than 10 athletes/staff in total) based on skills with set drill, but no close contact/defending/attacking/match play drills.

Para-athletes require individualised consideration and assessment through all Levels (A, B, C) of a return to sport. Some para detailed planning and consultation with their regular treating medical team prior to a return to formal training, or progression throu (e.g. wheelchairs, prostheses) will require regular cleaning (for all levels). For more information, refer to the 'AIS Framework for Rebooting Sport in a COVID-19 Environment' document. For more sport specific guidelines for Levels A, B, C, refer to the relevant sport heading in this document.

Ergometer if access to own at home. Cycling (solo), running (solo), resistance training (solo). On-water single.

Skill drills using a ball, kicking and passing. No rucks, mauls, lineouts or scrums, no tackling/wresting. Small group (not more than 10 athletes/staff in total) sessions.

Solo or double handlers (if allowed by State regulations) only.

Full training.

Aerobic/resistance training (solo), technical skills (solo)e.g. standing/holding and dry firing. Mental skills traininge.g. concentration/reaction time, visualisation, arousal control). Live fire on home ranges only (no club range access).

Continuation of athlete-led preparation at home. Coach-led training including live fire in small groups at authorised venues (i.e. clubs/ranges).

Outdoor and solo only, or indoor only if have own facilities. Full training with appropriate distancing between athletes.

Running/aerobic training (solo), resistance training (solo), skills training (solo).

Small group (not more than 10 athletes/staff in total) skills training.

Aerobic and resistance training (solo), climbing solo/pairs on own wall or outdoors (if allowed by local Government). Solo hang board training.

Full training. Cleaning of indoor walls required between athletes/groups.

Solo or with 1 training partner only. Full training.

In-water training (solo) in own pool or open-water. Use of communal pool with limited numbers, 1 athlete per lane. Table Tennis Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).

Full training on court, singles or doubles. Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).

Small group (not more than 10 athletes/staff in total) skill sessions only. No matches.

In-water training (solo) if access to own pool only, or openwater.

Use of communal pool with limited numbers and distance maintained. Swimming, throwing (passing/shooting) drills.

No full contact/defending drills, wrestling.

Resistance training, technical work at home (no indoor sporting facility / gym access allowed).

Full training with limited numbers to avoid congestion.

Aerobic training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).

Non-contact shooting, dribbling drills. Other non-contact technical /skill drills. Small groups (not more than 10 athletes/staff in total).

Aerobic training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).

Non-contact passing drills on court. Other non-contact technical /skill drills. Small groups (not more than 10 athletes/staff in total). Reduced aerobic capacity and increased respiratory distress. Potential persisting restrictive lung patterns and reduced diffusion capacity. These respiratory long-term complications been reported follow previous coronavirus epidemics (SARS, MERS) in non-athlete populations.

[126]

Clinical assessment Graded exercise testing, VO2 max testing FBE, CRP, spirometry, lung ultrasound, chest x-ray, CT chest Respiratory review Cardiovascular Cardiomyopathy [47] Myocarditis [127] Pericardial effusion [130] Arrythmias [45, 127] Autoimmune mimicry of vasculitis and thrombosis [49, 129] A return to exercise with underlying cardiac complications could be contraindicated for some. [123] Return to contact sports / trauma could be contraindicated for some. Persisting inflammatory states.

Clinical assessment 12-lead ECG, troponins, coagulation profile, CRP, echocardiogram, cardiac MRI D-dimer, ferritin, C-reactive protein, erythrocyte sedimentary rate Cardiology review Neurological

Multiple symptoms and signs have been described. [66] Guillain-Barré syndrome [132] Elevated D-dimer [131, 132] Stroke [135] Encephalopathy [136] Currently unclear as the neurological sequalae from mild to moderate cases is yet to be elucidated. Post-viral fatigue is known to occur following other viral infections [139] and may occur with COVID-19.

Monitoring of self-report measures, fatigue symptoms and training loads.

Mental health Symptoms of depression [140] Potential increased risk of post-traumatic Clinical assessment and anxiety [140] Both were more common in patients with less social support [139] stress disorder (PTSD), depression, anxiety. [123] Persistent depression and anxiety have been reported following previous coronavirus epidemics in non-athletic populations.

Screening questionnaires Psychology review and psychiatrist review 1331 1332 1333 

Activity that can be conducted by a solo athlete or by pairs where at least 1.5m can always be maintained between participants. No contact between athletes and/or other personnel. Examples for all sports -general fitness aerobic and anaerobic (e.g. running, cycling sprints, hills). Strength and sport-specific training permitted if no equipment required, or have access to own equipment (e.g. ergometer, weights). Online coaching and resources (e.g. videos, play books).

As per Level A plus: Indoor/outdoor activity that can be conducted in small groups (not more than 10 athletes and/or other personnel in total) and with adequate spacing (not more than 1 person per 4m 2 ). Some sharing of sporting equipment permitted such as kicking a football, hitting a tennis ball, use of a skipping rope, weights, mats. Non-contact skills training. Accidental contact may occur but no deliberate body-contact drills. No wrestling, holding, tackling or binding.

As per Lev Full sporti size matches). rugby scru For larger separation For some operation

No sharing of exercise equipment or communal facilities. Apply personal hygiene measures even when training away from group facilities -hand hygiene regularly during training (hand sanitisers) plus strictly pre and post training. Do not share drink bottles or towels. Do not attend training if unwell (contact doctor). Spitting and clearing of nasal/respiratory secretions on ovals or other sport settings must be strongly discouraged.

Communal facilities can be used after a sport-specific structured risk assessment and mitigation process is undertaken. 'Get in, train and get out' -be prepared for training prior to arrival at venue (minimise need to use/gather in change rooms, bathrooms). Minimise use of communal facilities (e.g. gym, court) with limited numbers (not more than 10 athletes and other personnel in total). Have cleaning protocols in place for equipment and facilities.

Hand hygiene (hand sanitisers) on entry and exit to venues, as well as pre, post and during training. Thorough full body shower with soap before and after training (preferably at home). Where possible maintain distance of at least 1.5m while training. No socialising or group meals.

Return to cleaning m Limit unne

All consultations undertaken via telehealth unless face to face is considered urgent Avoid all routine and non-essential manual therapy. Five Moments for Hand Hygiene must be used to minimise the risk of transmission between health professionals and patients. Hygiene practises to include no bed linen except single use towels, cleaning treatment beds and key surfaces after each athlete. Minimum contact of non-essential surfaces to occur and hands on treatment should be kept to essential only.

History taking, or full consultations should be conducted via telehealth if practical. Face to face consults should be conducted from at least 1.5m apart when possible, and hands on treatment should be for essential conditions only. A single source therapist is recommended. During any essential manual therapy, it is recommended that the athlete and practitioner wear a face mask. All nonessential athletes and other personnel should avoid the treatment area, and the number of people in treatment areas should be kept to a minimum, following social distancing guidelines. 

World Health Organisation. Novel Coronavirus -China

Travellers give wings to novel coronavirus (2019-nCoV). J 892 Travel Med

International travel health: SARS (Severe Acute Respiratory 894 Syndrome)

European Centre for Disease Prevention and Control. MERS-CoV worldwide overview

An outbreak of COVID 19 caused by a new 898 coronavirus: what we know so far

World Health Organisation

Herd immunity -estimating the level required to halt the COVID-19 1010 epidemics in affected countries

Clinical characteristics of 138 hospitalized patients with 2019 novel 1016 coronavirus-infected pneumonia in Wuhan, China

Detection of SARS-CoV-2 in Different Types of Clinical Specimens

Characteristics and outcomes of 21 critically ill patients with COVID-19 1019 in Washington State

Neurologic Manifestations of Hospitalized Patients With Coronavirus 1021 Disease

Coagulopathy and Antiphospholipid Antibodies in Patients with Covid-19

Clinical, laboratory and imaging features of COVID-1027 19: A systematic review and meta-analysis. Travel medicine and infectious disease

Self-reported olfactory and taste disorders in SARS-CoV-2 1030 patients: a cross-sectional study

Olfactory and gustatory dysfunctions as a clinical presentation of 1032 mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European 1033 study

Characteristics of and important lessons from the 1037 coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 1038 cases from the Chinese Center for Disease Control and Prevention

Radiological findings from 81 patients with COVID-19 pneumonia in 1040

China: a descriptive study. The Lancet Infectious Diseases

Clinical course and outcomes of critically ill patients with SARS-CoV-2 1042 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The 1043 Lancet Respiratory Medicine

SARS-CoV-2 infection in children

Estimating the asymptomatic proportion of coronavirus disease 2019 1047 (COVID-19) cases on board the Diamond Princess cruise ship

Universal Screening for SARS-CoV-2 in Women Admitted for Delivery

Clinical progression and viral load in a community outbreak of 1052 coronavirus-associated SARS pneumonia: a prospective study

Baseline Characteristics and Outcomes of 1591 Patients Infected 1057 With SARS-CoV-2 Admitted to ICUs of the Lombardy Region

Clinical Characteristics of Patients Who Died of Coronavirus Disease 1059 2019 in China

COVID-19: consider cytokine storm syndromes and immunosuppression

Neurologic Features in Severe SARS-CoV-2 Infection

Association of Public Health Interventions With the Epidemiology of the 1068 COVID-19 Outbreak in Wuhan, China. JAMA, 2020. 1069 69. Parliment of Australia. COVID-19 Human Biosecurity Emergency Declaration Explainer

World Health Organisation, Laboratory testing for coronavirus disease 2019 (COVID-19) in 1085 suspected human cases

Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered 1087 patient cohort and their implications. medRxiv, 2020. 1088 76. World Health Organisation

Presumed Asymptomatic Carrier Transmission of COVID-19

National COVID-19 Clinical Evidence Taskforce. Caring for people with

World Health Organisation, Clinical management of severe acute respiratory infection (SARI) 1100 when COVID-19 disease is suspected. 2020. 1101 82

International Olympic Committee. Joint statement from the international olympic committee 1118 and the tokyo 2020 organising committee

Game Zero?' Soccer Game Attended by 40,000 Fans Likely Made This Italian 1126 City a Coronavirus Epicenter

Canberra Capitals move one step closer toward WNBL title with thrilling Game 1129 1 win over Southside Flyers

Official Release: NBA to suspend season following Wednesday's games

Premier League and British football shuts down 1146 until April due to coronavirus -as it happened

ABC News. New Zealand cricket team to return home, postponing ODI series with Australia

Super Rugby suspended due to coronavirus, Jaguares-Highlanders cancelled

Update on COVID-19: Hyundai A-League to play matches behind closed doors

A-league to end quickly behind closed doors

Football: Euros and Copa America moved to 2021 due to coronavirus chao

FFF Media. FFA to postpone remaining matches in the Hyundai A-League season due to 1180 COVID-19

-organising-committee-and-tokyo-metropolitan-government-announce-new-dates-for-1192 the-olympic-and-paralympic-games-tokyo-2020. 1193 112. Battett, D. UPDATE: Pay cut deal ensures 'certainty' in AFL industry: AFLPA

ABC News. NRL players lose five months' pay as part of new deal during coronavirus 1200 pandemic

CA announces staff cutbacks due to coronavirus

Article: A wake up call: the effects of Coronavirus on the sports industry

The differential psychological distress of populations affected by the COVID-1209 19 pandemic

Prevalence and Factors Associated with Depression and Anxiety of 1211 Hospitalized Patients with COVID-19. medRxiv

The reproductive number of COVID-19 is higher compared to SARS 1213 coronavirus

Are patients with hypertension and 1218 diabetes mellitus at increased risk for COVID-19 infection? The Lancet Respiratory 1219 Medicine

Long-term clinical outcomes in survivors of coronavirus outbreaks 1223 after hospitalisation or icu admission: A systematic review and meta-analysis of follow-up 1224 studies

Respiratory health in athletes: facing the 1226 COVID-19 challenge. The Lancet Infectious Diseases

The resurgence of sport in the wake of COVID-19: cardiac considerations 1228 in competitive athletes

Clinical characteristics of 24 asymptomatic infections with COVID-19 screened 1232 among close contacts in Nanjing

Findings of lung ultrasonography of novel corona virus pneumonia 1236 during the 2019-2020 epidemic

LONG-TERM CLINICAL OUTCOMES IN SURVIVORS OF 1238 CORONAVIRUS OUTBREAKS AFTER HOSPITALISATION OR ICU ADMISSION: A 1239 SYSTEMATIC REVIEW AND META-ANALYSIS OF FOLLOW-UP STUDIES. medRxiv

Cardiovascular Considerations for Patients, Health Care Workers, and 1242 Health Systems During the Coronavirus Disease 2019 (COVID-19) Pandemic

COVID-19) CT Findings: A Systematic Review 1245 and Meta-analysis

The use of anti-inflammatory drugs in the treatment of people with severe 1247 coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from 1248 China

Guillain-Barré Syndrome Associated with SARS-CoV-2

Unique epidemiological and clinical features of the emerging 2019 novel 1252 coronavirus pneumonia (COVID-19) implicate special control measures

Large-Vessel Stroke as a Presenting Feature of Covid-19 in the 1256 Young

Impact of COVID 19: perspectives from gastroenterology

Kidney disease is associated with in-hospital death of patients with 1262 COVID-19

Management of chronic (post-viral) fatigue syndrome. The Journal of the 1264 Royal College of General Practitioners

5 Moments For Hand Hygiene

Figure 1: History of Coronavirus epidemics over the past two decades

A series of pneumonia cases of unknown cause with clinical presentations resembling viral pneumonia emerged in Wuhan, Hubeiin Province, People's Republic of China

Cluster of respiratory infections in Wuhan reported to World Health Organisation (WHO) China Country Office

First death of COVID-19 in People's Republic of China

WHO first reported a cluster of cases in Wuhan, Hubeiin Province, People's Republic of China[9] People's Republic of China shared the genetic sequence of

First case of COVID-19 outside of China

Australian Federal Government list 'human coronavirus with pandemic potential' in the Listed Human Disease under the Biosecurity Act 2015, enabling the use of enhanced border measures

Lock down in Hubei province, People's Republic of China[18] 628 confirmed COVID-19 cases People's Republic of China and 17 deaths

Australian Federal Government increased level of travel advice for Wuhan and Hubei Province in People's Republic of China to 'level 4 -do not travel

First case of COVID-19 in Australia

Australian Federal Government advice return travellers who have been in the Hubei province, People's Republic of China must self-isolated at home for 14 days

WHO declared COVID-19 as a global health emergency

Australian Federal Government closed borders for non-citizens and non-residents arrivals from People's Republic of China

Global COVID-19 cases >11,900 and >250 deaths (in People's Republic of China

First death of COVID-19 outside People's Republic of China

COVID-19 cases in the Diamond Princess cruise ship docked Yokohama

First cases of community transmission of COVID-19 in Australia

Global COVID-19 cases >145,400 and >5

French Government bans gatherings of >100 people

New Zealand Government impose mandatory 14-day self-isolation for all returning travellers

Australian Federal Government impose mandatory 14-day self-isolation for all returning travellers

Australian Government banned international cruise ship arrivals for 30 days

WHO launches SOLIDARITY trial (international clinical trial to help find an effective treatment for COVID-19

Australian Federal Government impose a limit of <100 people for non-essential indoor gatherings and <500 people for outdoor gatherings, and call to limit non-essential domestic travel

Australian Federal Government border closure to all non-citizens and non-residents[31] 22 March 2020 Most Australian State and Territory governments advised against non-essential interstate travel

Australian Federal Government impose a ban on all overseas travel 'level 4 -do not travel

Global COVID-19 cases >423,100 and >19,000 deaths

Australian Federal Government impose mandatory 14 day supervised self-isolation at designated facilities (e.g. a hotel) for all returning international travellers

The United States is the new epicentre of the COVID-19

Global COVID-19 cases >3,230,400 and >228

Figure 3: New and cumulative confirmed COVID-19 cases by notification date in Australia

Groups of single sculls. Rugby League Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, passing, ball skills (e.g. against wall) to self. Skill drills using a ball, kicking and passing. No tackling/wresting. Small group (not more than 10 athletes/staff in total) sessions. Rugby Sevens Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, passing

Non-contact skill drills using a ball, kicking and passing, small groups (not more than 10 athletes/staff in total) only. No rucks, mauls, lineouts or scrums, no tackling/wresting. Rugby Union Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, passing

wheelchairs, prostheses) will require regular cleaning (for all levels)

On-water single. Group resistance training sessions and outdoor group ergometer training placed at least 1.5m apart (not more than 10 athletes/staff in total). Groups of single sculls. Full trainin Rugby Sevens Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, passing

Non-contact skill drills using a ball, kicking and passing, small groups (not more than 10 athletes/staff in total) only. No rucks, mauls, lineouts or scrums, no tackling/wresting. Full trainin Sailing Solo or double handlers (if allowed by State regulations) only. Full training. Full trainin Shooting Aerobic/resistance training (solo), technical skills (solo)-e.g. standing/holding and dry firing

Continuation of athlete-led preparation at home. Coach-led training including live fire in small groups at authorised venues (i.e. clubs/ranges)

Full trainin Skateboarding Outdoor and solo only, or indoor only if have own facilities. Full training with appropriate distancing between athletes. Ful Softball Running/aerobic training (solo), resistance training (solo), skills training (solo)

Running/aerobic/agility training (solo), resistance training (solo), skills training and shooting drills (solo) at home or outdoor (no indoor sporting facility access allowed). No ball handling drills with others.Non-contact skills using basketball -passing, shooting, defending, screens and team structure (offence and defence). Small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), technical training (solo). Bag work if access to own equipment, without anyone else present.Shadow sparring allowed. Non-contact technical work with coach, including using bag, speedball, pads, paddles, shields. No contact or sparring.

Running/aerobic training (solo), resistance training (solo), on-water training (solo).Full training.

Running/aerobic training (solo), resistance training (solo), skills training (solo).Nets -batters facing bowlers. Limit bowlers per net. Fielding sessions-unrestricted.No warm up drills involving unnecessary person-person contact.No shining cricket ball with sweat/saliva during training.

Solo outdoor cycling or trainer, resistance training (solo). Avoid cycling in slipstream of others-maintain 10m from cyclist in front. Avoid packs of greater than two (including motorcycle derny).

On-land training only (solo Non-contact skills training drills in small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo).Non-contact skill training drills -passing, shooting, headers. Small groups (not more than 10 athletes/staff in total).

Solo or pairs only (if permitted by local Government). Full training.

Resistance training, skills training solo and outside of gym only.Rhythmic -skills at home. Trampoline -off apparatus skills, drills at home only.Small groups only -1 gymnast per apparatus (including rhythmic and trampoline). Disinfecting high touch surfaces as per the manufacturer's guidelines.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).Skill drills -passing, shooting, defending. No contact drills. Small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), technical training (solo)-e.g. mirror work.No contact / bouts. Non-contact shadow training. Non-contact technical work with coach.

Running/aerobic/agility training (solo), resistance training (solo), technical training (solo)-e.g. mirror work.No contact / bouts. Shadow sparring. Non-contact technical work with coach, including using pads, paddles.

A maximum of 2 people are allowed per green at any one time.All players are to use separate mats and jacks (or ensure that the same player on each rink places mats or places/rolls jacks).Other bowls equipment cannot be shared between players (e.g. bowls, cloths, measures) . Coaching should be limited to no more than a coach and one other person at the time and all practicing physical distancing of 1.5m during the coaching session.No barefoot bowls activity.A maximum of 10 persons is allowed per green at any one time. Bowling Clubs may need to have a booking system in place to facilitate (Levels A and B). Bowling Clubs with more than one green need to ensure that compliance is achieved in respect to social gathering restrictions.

Running/aerobic training (solo), resistance training (solo), skills training (solo).Swimming -Use of communal pool with limited numbers, 1 athlete per lane.

Running/aerobic/agility training (solo), resistance training (solo), skills training and shooting drills (solo) at home or outdoor (no indoor sporting facility access allowed). No ball handling drills with others.Non-contact skills using basketball -passing, shooting, defending, screens and team structure (offence and defence). Small groups (not more than 10 athletes/staff in total). Non-contact skills training drills in small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo).Non-contact skill training drills -passing, shooting, headers. Small groups (not more than 10 athletes/staff in total).

Solo or pairs only (if permitted by local Government). Full training. Full trainin

Resistance training, skills training solo and outside of gym only.Rhythmic -skills at home. Trampoline -off apparatus skills, drills at home only.Small groups only -1 gymnast per apparatus (including rhythmic and trampoline). Disinfecting high touch surfaces as per the manufacturer's guidelines.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).Skill drills -passing, shooting, defending. No contact drills. Small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), technical training (solo)-e.g. mirror work.No contact / bouts. Non-contact shadow training. Non-contact technical work with coach.

Running/aerobic/agility training (solo), resistance training (solo), technical training (solo)-e.g. mirror work.No contact / bouts. Shadow sparring. Non-contact technical work with coach, including using pads, paddles.

A maximum of 2 people are allowed per green at any one time.All players are to use separate mats and jacks (or ensure that the same player on each rink places mats or places/rolls jacks). Other bowls equipment cannot be shared between players (e.g. bowls, cloths, measures). Coaching should be limited to no more than a coach and one other person at the time and all practicing physical distancing of 1.5m during the coaching session. No barefoot bowls activity.A maximum of 10 persons is allowed per green at any one time.Bowling Clubs may need to have a booking system in place to facilitate (Levels A and B). Bowling Clubs with more than one green need to ensure that compliance is achieved in respect to social gathering restrictions. 

Para-athletes require individualised consideration and assessment through all Levels (A, B, C) of a return to sport. Some para-athletes wil detailed planning and consultation with their regular treating medical team prior to a return to formal training, or progression through Le Small group (not more than 10 athletes/staff in total) skills training.

Aerobic and resistance training (solo), climbing solo/pairs on own wall or outdoors (if allowed by local Government). Solo hang board training.Full training.Cleaning of indoor walls required between athletes/groups. In pool water training if access to own pool (consider using swim tether) or open-water only. Consider use of wind trainer and treadmill for those in quarantine (who are medically well).

Avoid cycling in slipstream of others-maintain 10m from cyclist in front Avoid packs of greater than two. Avoid packs of greater than 2 running. Maintain social distancing while running. Use of communal pool with limited numbers, 1 athlete per lane, consider one lane between athletes.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).Small group (not more than 10 athletes/staff in total) skill sessions only. No matches.

In-water training (solo) if access to own pool only, or openwater.Use of communal pool with limited numbers and distance maintained. Swimming, throwing (passing/shooting) drills. No full contact/defending drills, wrestling.

Resistance training, technical work at home (no indoor sporting facility / gym access allowed).Full training with limited numbers to avoid congestion. Full trainin

Aerobic training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).Non-contact shooting, dribbling drills. Other non-contact technical /skill drills. Small groups (not more than 10 athletes/staff in total).

Aerobic training (solo), resistance training (solo), skills training (solo) at home or outdoor (no indoor sporting facility access allowed).Non-contact passing drills on court. Other non-contact technical /skill drills. Small groups (not more than 10 athletes/staff in total).

Running/aerobic/agility training (solo), resistance training (solo), balance training (solo).Use of institute gym facilities and indoor ice surfaces in small groups (<10 total athletes/support staff). Use of acrobatic facilities such as trampoline, bungee and water ramp in small groups with 1 athlete at a time and at least 1.5m distancing to support staff. Limited on snow training dependent on travel restrictions. Small groups widely spaced, no communal living. Full training with small numbers (not more than 10 athletes/staff in total).

Running/aerobic training (solo), resistance training (solo), skills training (solo).Nets -batters facing bowlers. Limit bowlers per net. Fielding sessions-unrestricted.No warm up drills involving unnecessary person-person contact.No shining cricket ball with sweat/saliva during training.

Running/aerobic training (solo), resistance training (solo), simulation work at home if available.Full training. Full trainin

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo), including shooting (outdoor or own ring only) or ball skills e.g. against a wall to self.Skills using netball passing, shooting, defending. Small group training (not more than 10 athletes/staff in total) based on skills with set drill, but no close contact/defending/attacking/match play drills.

Running/aerobic/agility training (solo), resistance training (solo), skills training (solo) including kicking, passing, ball skills (e.g. against wall) to self.Skill drills using a ball, kicking and passing. no tackling/wresting. Small group (not more than 10 athletes/staff in total) sessions.Full trainin 1336 1337