Community Transmission of SARS-CoV-2 at Three Fitness Facilities — Hawaii, June–July 2020

Abstract

the Hawaii Department of Health was notified that a fitness instructor (instructor A) had experienced signs and symptoms compatible with coronavirus disease 2019 (COVID-19)* and received a positive reverse transcription-polymerase chain reaction (RT-PCR) test result for SARS-CoV-2, the virus that causes COVID-19. At the time, Honolulu County reported community transmission of a 7-day average of 2-3 cases per 100,000 persons per day (1). Before the onset of symptoms, instructor A taught classes at two fitness facilities in Honolulu, facilities X and Y. Twenty-one COVID-19 cases were linked to instructor A, including a case in another fitness instructor (instructor B). The aggregate attack rates in classes taught by both instructors <1 day, 1 to <2 days, and 2 days before symptom onset were 95% (20 of 21), 13% (one of eight), and 0% (zero of 33), respectively. Among the 21 secondary cases, 20 (95%) persons had symptomatic illness, two (10%) of whom were hospitalized. At the time of this outbreak, use of masks was not required in fitness facilities. To reduce SARS-CoV-2 transmission in fitness facilities, staff members and patrons should wear a mask (including during high-intensity exercise), and facilities should implement engineering and administrative controls including 1) improving ventilation; 2) enforcing consistent and correct mask use and physical distancing (maintaining 6 ft of distance between all persons, limiting physical contact and class size, and preventing crowded spaces); 3) reminding all patrons and staff members to stay home when ill; and 4) increasing opportunities for hand hygiene. Conducting exercise activities entirely outdoors or virtually could further reduce SARS-CoV-2 transmission risk. * Signs and symptoms included fever,