Downloadable Version | Memo to Certified Agencies | Sample Policies | Vaccine Position Statement

Updated July 30, 2020

The United States Lifesaving Association has received many inquiries regarding lifeguard operations amidst the COVID-19 epidemic. Lifeguards, like other public safety providers, want to know how to protect themselves and how to protect others, including co-workers, family, and the general public. While information is rapidly evolving, here are some considerations.

As a result of the AIDS crisis, many years ago, medical aid training programs and medical aid providers adopted the concept of universal precautions. The Occupational Safety and Health Administration explains it this way: "According to the concept of Universal Precautions, all human blood and certain human body fluids are treated as if known to be infectious for HIV, HBV, and other bloodborne pathogens."

The concept of universal precautions is addressed in Open Water Lifesaving – The United States Lifesaving Association Manual, and should be part of every lifeguard agency’s practices. It does not ensure prevention of disease transmission, but lessens the likelihood. Universal precautions should include at a minimum – gloves, N95 mask, and eye protection.

There are several aspects of COVID-19 that complicate things. Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention (CDC) told National Public Radio in April that as many as 25% of those with the virus have no symptoms. Some have suggested this number is even higher. Therefore you and people you come in contact with could have the virus and may be contagious without knowing it.

Another complicating factor is that the virus can spread through vapor in someone’s breath, through coughing, sneezing, and so forth. This is the primary reason that social distancing has been encouraged. And the virus can live on various surfaces—think door handles, for example—for a significant period of time.

All of these are good reasons to follow the common admonitions to wash your hands regularly with soap for a minimum of 20 seconds, avoid touching your face, and avoid being in close proximity to others. Some of this can of course be a challenge in the beach environment.

There are some bits of news lifeguards might see as positive. In early April, the CDC released a study among persons of all ages in 99 counties in 14 states (California, Colorado, Connecticut, Georgia, Iowa, Maryland, Michigan, Minnesota, New Mexico, New York, Ohio, Oregon, Tennessee, and Utah).

The study found that during March 1–28, 2020, the overall laboratory-confirmed COVID-19 associated hospitalization rate was 4.6 per 100,000 for the entire population; but that rates for younger people were substantially lower. For example, hospitalization rates were just 0.1 per 100,000 population in persons aged 5–17 years and 2.5 per 100,000 in those aged 18–49 years. (They were far higher at 17.2 per 100,000 population in adults aged ≥85 years.)

Most beach lifeguards probably fall into the 16-49 year age range, wherein this preliminary study suggests that the chance of a serious bout of COVID-19 that requires hospitalization is limited. That, of course, does not mean you can’t become sick, perhaps quite sick, and in any case it appears that it may be possible for people with no symptoms to be carriers who can infect others.

The study also found that 89% of hospitalized patients had one or more underlying conditions. The most common of these conditions were hypertension, obesity, chronic lung disease, diabetes mellitus, and cardiovascular disease. Among patients aged 18–49 years, obesity was the most prevalent underlying condition. Lifeguards tend to be an unusually healthy group who are probably much less likely than the general population to have conditions such as these.

Even so, as summer has progressed, a number of lifeguard agencies have had major outbreaks that have caused them to have to keep lifeguards off duty while they quarantine. Why might this be? Recent data suggests that outdoor transmission is fairly limited, so lifeguards who follow appropriate guidelines are probably quite unlikely to contract the novel coronavirus while outdoors at work. On the other hand, many anecdotal reports of transmissions among lifeguards, some of which have infected significant numbers of guards, appear to stem from large, off-duty social events among co-workers.

So what should you do as a lifeguard or lifeguard administrator? Here are some suggestions:

• Follow the directives of your employing agency, which should be informed by and consistent with the directives of state and local public health authorities.
• Use social distancing at work, avoiding large meetings, close training, and close proximity to others (example: one guard per stand/tower).
• Wear a simple, fabric mask covering your nose and mouth whenever you will be within six feet of others.
  
• Practice good personal hygiene, including regular hand washing. If access to running water is limited, use hand sanitizer.
  
• Use universal precautions when providing medical aid. Avoid mouth-to-mouth or mouth-to-mask resuscitation. Use a bag-valve-mask or positive pressure ventilator, in either case with a HEPA or N95 filter.
  
• Regularly clean the surfaces with which you, your fellow lifeguards, and the public come in contact.
• Avoid touching other people, including your fellow lifeguards, unless necessary.
  
• Consider regular temperature checks by lifeguards.
• Lifeguards should avoid off-duty social events, especially with large numbers of other people and especially indoors. Lifeguard administrators should actively discourage these activities.
• If you feel ill, advise your supervisor.
• If a lifeguard tests positive, any lifeguards who have had close contact (see below) to that guard, either on or off duty, should quarantine for 14 days or until they test negative. If a guard tests positive the guard should not return to duty until 10 days after the positive test date and at least three days after recovery from symptoms and fever if symptomatic. The CDC says close contact includes: You were within six feet of someone who has COVID-19 for at least 15 minutes; or, you had direct physical contact with the person (touched, hugged, or kissed them); or, you shared eating or drinking utensils; or, they sneezed, coughed, or somehow got respiratory droplets on you.

The COVID-19 pandemic is an experience that humanity has not faced in over 100 years. How it will be resolved is yet to be known. What is known is that public safety providers like lifeguards have a unique role to play, which can, in some cases, increase exposure. With prudent precautions, the risks can be limited.

This document was coauthored by Peter Wernicki M.D., Medical Advisor of the USLA and a member of the American Red Cross Scientific Advisory Council and B. Chris Brewster, Chair of the USLA National Certification Committee.

Sources:

• www.npr.org/sections/health-shots/2020/03/31/824155179/cdc-director-on-models-for-the-months-to-come-this-virus-is-going-to-be-with-us
• www.cdc.gov/mmwr/volumes/69/wr/mm6915e3.htm
• www.medrxiv.org/content/10.1101/2020.04.04.20053058v1
• www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html