 Good morning. My name is Charlie Huebner. I'm a vice president with the U.S. Olympic Paralympic Committee. Welcome to the more than 4,800 registrants of the Fourth Annual Injury Prevention Symposium. Thank you, Professor Barr, for kicking us off in such an eloquent and important way. We here in the United States are enamored with the incredible leadership by the Norwegians and not only sport but in medicine. So, again, thank you for kicking off this symposium. I'm here to moderate today. I've been told to not be sarcastic to keep my comments brief and short. We have some incredible content from some brilliant speakers throughout the world. I haven't had a haircut in about six weeks, so if I'm wearing my Team USA hat in a little while, my apologies. But you can also win this hat. Part of my job is to get you to participate virtually with us. I'm going to briefly provide bios of our speakers. You all have their detailed bios in your packets, but I'll provide high level brief bios of all our speakers. If you post questions, you can win. So I want to encourage you to post questions to our panelists. You can win a Team USA hat. You can win a We Are Team USA shirt. So participation is important. So we really encourage you to post questions to our panelists. We also have some great trivia questions that we'll be pulling on to see who are the experts in Olympic and Paralympic trivia and sports medicine trivia. And finally, I want to give a shout out to Max Baroso, who has joined us today. Shout out to you, Max. You want a T-shirt? We are Team USA. We will connect with you after the symposium and send you a T-shirt, but thanks for joining us. Now it is my great pleasure to introduce our brand new Chief Medical Officer for the US Olympic and Paralympic Committee, Dr. Jonathan Finoth. Jonathan joined us as the former medical director for the Mayo Clinic in Minnesota. He has worked in professional sports and he has worked in Olympic sports. Three different Olympic or Paralympic Games. He has played a leadership role in. I've done a little bit of my research for all my speakers today. I've done a little bit of research. Jonathan also performed in Oliver. He was the lead in Oliver in his junior high class. So please welcome Dr. Jonathan Finoth. Hello, everyone. My name is Jonathan Finoth. I'm the Chief Medical Officer for the US Olympic and Paralympic Committee. I'm going to be talking to you today about the US OPC's response to COVID-19. I'd like to thank Dr. Nabhan and Dr. Philippon for inviting me to speak with you on this. So all opinions, viewpoints, and recommendations contained in this presentation represent those of the author alone and do not represent the opinions, viewpoints, or recommendations of any organization with which the author may be affiliated, including, and without limitation, the US OPC. And I don't. My disclaimers from medical advisory boards and royalties, they are not relevant today. So first I'm going to give you an overview of the problem. I'll talk about the US OPC's response to that problem. And then I'll briefly discuss how we're planning reentry to both training and event planning and we'll draw some conclusions. So coronaviruses are a family of viruses that cause respiratory infections and they're found in both humans and animals. The current outbreak that's causing global pandemic is from a coronavirus called SARS-CoV-2. And it causes an infection called COVID-19. Most likely this was from a reservoir of viruses in bats and then through some type of animal vector was trained in humans. The first cases of COVID-19 were described on December 31st of 2019 by Chinese health officials and they noticed a mysterious pneumonia in 41 patients. In January of that same year, January 7th, they had identified the virus and it was subsequently named SARS-CoV-2. On January 11th, first death occurred. On January 20th, the first case on US soil was reported. By the 30th of that month, the WHO declared a global public health emergency. Between the time of the first cases reported on December 31st and February 29th, only 59 total cases had occurred in the United States. Over that 40-day time frame and the first death in the United States occurred. On March 11th, the WHO declared the outbreak a global pandemic so things had really accelerated. And by the 13th of March, the US had declared a national emergency. By March 26th, the US reported the largest number of COVID cases in the world at 82,004. On April 7th, we had the largest single-day death toll of any country at greater than 1,900 deaths in a single day. And COVID-19 became the most common cause of death in the United States. As of April 22nd, 2020, when I recorded this presentation, there were 2.7 million worldwide cases of COVID-19, 185,000 deaths in the world, and in the United States, 842,000 cases and nearly 47,000. It's pretty wild to look at how fast this spread. It took 67 days to go from one case to 100,000 cases, but from 100,000 to 200,000, it only took 11 days, and then from 200,000 to 300,000, 4 days, and from 1 million to 2 million. So it just ramped up quickly. Now, if we go back to that slide in March, remember at the very end of February, there were only 50-something cases in the United States and only a single death. So I started my job on March 2nd, but within a week and a half, the WHO had declared the outbreak of global pandemic, and by the 24th, the 2020 Tokyo Olympic and Paralympic Games had been postponed to 2021. So really dramatic changes within the first two weeks of my employment with the USOPC. So how did we handle it? Well, before I even got there, on January 30th, the USOPC had their first communication about COVID-19 to the NGBs, and the day after that, they established a COVID-19 working group that had four representatives, medical security risk and sports performance. But as of now, that has expanded to 23 members with representation that's broad from athletes and NGBs, the Paralympics, games operations, facilities, IT, legal, et cetera, et cetera. Essentially, this is affecting every aspect of our business. So when I arrived, within three days, we created an infectious disease advisory group of infectious disease specialists from around the country at top institutions, including the Mayo Clinic, Texas Children's Hospital, the Biocontainment Unit at University of Nebraska, and so on. We also were working closely with an official from the CDC. And we developed a workplace prepared in 2019 that the USOPC then implemented. And the first thing that we needed to do is educate our staff and communicate this to our staff and athletes so they understood what we were doing. And it was essentially all the different infection control procedures that you would expect, washing your hands, using hand sanitizer, proper cough etiquette. We had people self-monitoring for symptoms, both athletes and staff, twice daily. We were doing screening as they would come through at the security points. We discontinued any tours and visitors because we didn't want to have people coming into the center and exposing our staff and athletes to potential COVID infections. And we had to work remotely. We discontinued any international travel at that time and would only approve domestic travel if it was considered essential. And it had to be approved by our administration. We adopted an intensive facilities cleaning schedule. We did the screening process that I talked about, which was twice daily monitoring of symptoms, as well as screening as people came and went through and general infection control measures. In sports medicine, we also had a protocol. So essentially if an athlete felt sick, they would call sports medicine. We would take a history over the phone. Then we would don PPE and go over and escort the athlete from their room to the sports medicine center where we would complete a physical examination, do a biofire respiratory panel, which is a PCR panel for common respiratory pathogens and then also a COVID-19 PCR test. And then we would place them in quarantine until testing. So that is what we implemented. And then on March 16th, because of executive orders within the states where we have Olympic and Paralympic Training Centers, our venues had to close. But since this is also a residence for a lot of athletes, we did not kick them out. They got to stay in their home, which was the Olympic and Paralympic Training Center. They just couldn't train anymore. And some athletes chose to leave the facilities, but a lot stayed. So we ended up having 20 athletes in Colorado Springs with 50 staff. Lake Placid had 10 athletes with 15 staff and Chula Vista had 60 athletes with 30 staff. We had a total of 185 staff and athletes on these three facilities. And between March 16th and April 23rd, we had three confirmed COVID-19 cases in resident athletes. And there was one in an athlete offsite. So essentially, we had high density living. And despite that, we prevented any type of outbreak within our facilities. We had about 10 other athletes that we quarantined because of close sustained contact with the people who had tested positive for COVID-19. And none of them ended up testing positive. So I felt very, very positive with our response and the result of how we implemented our infection control procedures. Well, we shut things down. Everybody has been under shelter in place. But now everybody's talking about what do we do afterwards? The athletes want to get training. The coaches and the NGBs want to get ready for competitions. And so they've been asking us for guidance in terms of re-entering training and competition. And so we spoke with just experts all over the place, including the World Health Organization, the CDC, chief medical officers from a variety of organizations, athletes, NGBs, event planners. And just got a lot of information from all these individuals and developed one being an event planning document and the other one being a return to training document. A return to training document. And it has a preamble and it says that this is meant to be a guide used by sports as varied as archery and wrestling and locations as diverse as Minot and New York City. By athletes and organizations with vastly different resources. Because of that, the document can't be prescriptive. What it does is it presents all sorts of different considerations that you have to think about when you are planning your sports and region and resource specific returns training. We also talk a little bit about the ethical considerations. If you start training in that area and you do it too soon or you start doing group training, are you putting the community at risk by exposing a lot of people to potential infection? If you are using testing, is that going to deny people who are sick from being tested? If you're using PPE, are you taking that away from healthcare professionals? All of this has to be taken into consideration when you're creating your plan. The other thing is that while most of our athletes are young and healthy and probably will have mild symptoms, there are people that die from this. And our athletes also do have some risk factors. Some of them have diabetes and they may have hypertension and they may have asthma. So there are different things that they can have that predispose to worse disease. So until COVID-19 is either eradicated, a vaccine is found or a cure is found, there's no way of completely avoiding the potential of a fatal infection. And so this needs to be in the front of your mind when you're developing. So we had a three-phase, excuse me, a five-phased approach to return to training. Phase one is essentially your shelter-in-place. Phase two, you're allowed to go outside but you're not supposed to be training in groups and facilities aren't owned or aren't open. So at that point, you can do virtual coaching. You really need to be using your own equipment. And you need to do all of the difference infection control measures, including deep cleaning of your home environment. By phase three, you're allowed to do some small group training but the training facilities remain closed. And it's really important to choose a small group that consistently trains together so that you're not exposing people repetitively to different individuals that might increase their risk of getting an infection. You want to make sure that everybody has been screened for any signs or symptoms of COVID-19 and you want to do infection control measures. And then you still use your own equipment, no direct or indirect contact. So no wrestling, no using the same ball, no landing in the same high jump pit. So all of that has to be in place. But you can have a coach on site. They just have to do social distancing. By phase four, you can have a regular-sized group and the training facilities are open. You should still do infection control procedures and you should do self-monitoring for symptoms twice daily and try to avoid sharing equipment and clean equipment between use. But at this point, you're assuming that there is essentially no community transmission or extremely limited community transmission. And so direct or indirect contact is okay. Then phase five is where a vaccine or a cure has been developed and so you don't have any restrictions. But you still want to continue general infection measures because infections happen. I mean, you can have norovirus or get influenza. So you still want to do infection measures. And now we're starting to talk about reopening our Olympic and Paralympic training centers. So when it is deemed appropriate for our venues to open within the training centers, then we're going to have five days for our staff to get ready and do deep cleaning of the facilities. And then we're going to gradually introduce resident athletes based on their sport risk and the number of athletes. So we want to have low risk athletes in first and we want to have low numbers. So high risk are activities that have high contact. So a high risk that you're going to be transmitting disease and low risk is where you have no contract. They're individual sports like. So prior to arrival, the athletes will get an educational brochure explaining to them about the procedures and what infection control measures we have implemented upon arrival. They'll be checked for signs or symptoms of COVID-19. We'll have a thermal camera that will look at their temperature. If they are asymptomatic, they don't have a temperature, then they'll be entered into the facility. We'll put them into quarantine in their own room and we'll do two COVID-19 PCR tests separated by 24 hours. And if they have two negative tests, then they'll be introduced into the OPTC with their own room and they'll begin to train with other athletes that have passed those tests. So essentially we're trying to create an environment where none of the athletes have an infection. We'll follow rigorous infection control measures once they're inside, including in the cafeteria and in training. We'll also really create a barrier between our staff and the athletes because the athletes are getting tested and our staff are going to be coming on and off site. And so we have to really prevent transmission of those two populations. So in conclusion, COVID-19 hit us hard and fast. The response that we had was dynamic, multifaceted, and often related to rapidly changing public health mandates. We implemented a broad infection control strategy that I feel was very successful based on our limited number of cases in a high-risk population, not risk from a bad infection standpoint, but a risk from high-density living standpoint. And we have a very challenging path ahead with reentry post COVID-19 until we've got a vaccine or a cure or it just happens to die out. We are at risk for transmitting this disease. And so I think that we have a good plan in place, but there's no way of eliminating any type of risk. And I want you all to know that the USOPC is here to help you navigate these waters. This is very complicated, but we're there as a resource for you. So reach out to us if you have any questions. Thank you very much for your attention in answering your questions. Thank you.