Will COVID-19 affect horse sport? Yes, sadly, it will. Should we be worried? Yes, we absolutely should be.

As a physician with no tendency to panic about the type of media coverage of illness meant more to sell ads than inform the public (think “flesh-eating strep”), COVID-19 has me worried. And not just me. The American Academy of Orthopedic Surgeons canceled their annual meeting on March 10, and no one is more balls to the wall than orthopedic surgeons. Make no mistake, this is a deadly virus, and we should take it very seriously. In China, 15% of people who got the virus needed oxygen and hospitalization, and 5% needed to be intubated and put on a breathing machine. The statistics in Italy are even worse.

“I am not old. I don’t have any preexisting conditions. Why should I care?”

First, check your definition of old. (Mine keeps changing, and 52 is most definitely young these days!) Yes, this is most deadly for people over 60 and those with preexisting medical conditions; however, it is killing young, healthy people in their 30s. And even if you don’t die, 15% of people end up hospitalized, and 5% of people end up on breathing machines. Are you really willing to risk that?

Second, the “preexisting conditions” that increase your risk of death are common conditions like high blood pressure and diabetes. Tom Frieden, former director of the U.S. Centers for Disease Control and Prevention, told reporters on March 9 that 60% of U.S. adults have at least one underlying health condition.

Last, are you willing to infect and kill someone else? As a pediatrician specializing in the care of medically fragile children, this one hits close to my heart. So you don’t die—excellent. Are you willing to kill someone else’s husband or wife or grandparent? This virus can likely be passed before a person has any symptoms or when they have minimal symptoms, so if you are infected but asymptomatic, you could go to that horse show and talk to your best horse buddy and pass it to them, and then they could take it home and pass it to their spouse who is getting chemotherapy, or their grandparent or elderly parent.

“Just make sure to wash your hands frequently.”

Hand washing. I do NOT want to underestimate the importance of washing your hands, which absolutely helps prevent the spread of disease (see the CDC guidelines). Use soap or an alcohol-based hand sanitizer and rub for 20 seconds, or the time it takes to sing “Happy Birthday” twice, or, if you prefer:

“Tally-ho! Tally-ho! A hunting we will go,
Over hedge and stile we’ll hunt the fox for many a mile;
Tally-ho! Tally-ho! The pace is far from slow.
With horse and hound we cover the ground, Tally-ho! Tally-ho!

BUT (you knew there was a but), this virus is spread by droplets, so if your best horse buddy is infected but has few or no symptoms yet and is explaining to you vehemently why that dressage judge does not know what they are doing, and a miniscule piece of spit flies from her lips to yours, you just got COVID-19 despite having really clean hands.

“If you go out, wear a mask.”

You’ve got your mask on, and you and your infected best bud are now past how crappy the dressage judge is and are kvetching about the changes in flag rules, and a little bit of spit flies from her lips into your eye (which is a mucous membrane). Guess what? Coronavirus. Please stop buying up face masks, or you are going to need an appendectomy, and your surgeon is going to have to breathe into your open belly. If you are worried, do the smart thing and stay home.

“As it warms up, this will go away.”

Stop thinking this is influenza. Many viruses are around all year (think stomach flu). We have no idea yet whether COVID-19 cases will drop over the summer. Influenza is a virus in the Orthomyxoviridae family. COVID-19 is a virus in the Coronaviridae family. It is like comparing a Miniature Horse to a Thoroughbred. I own both, they both neigh, they both eat grain, but only one is going to jump an advanced oxer.

“Other people aren’t worried. Why should I be?”

Put your faith in the Centers for Disease Control and the World Health Organization, which declared COVID-19 a pandemic on March 11. Both organizations are staffed by brilliant physicians, statisticians and epidemiologists, as opposed to your Facebook friends, who may have little expertise.

Here’s a little bit more information to consider: It is highly contagious—more contagious than flu but less than measles—but you could be exposed and not get it. Close contact is six feet. Kids and teens are much less likely to get it than adults; no one is sure why. People are most contagious when they are sickest, but it does appear that it can be transmitted before someone is showing symptoms. This is also true of flu but was not true of SARS. Early symptoms may be mild enough that an infected person may not think they are sick—people have varying definitions of sick!

As an MD, I wash my hands before and after every patient visit with a medical-grade alcoholic-based sanitizer, but I still get stomach flu almost every year and occasionally strep throat. If you have been exposed and don’t get the virus, you will not carry it in your body or spread it. If you get the virus, it can take anywhere from two to 14 days to start to show symptoms. This is why quarantine is 14 days. Once you have had it, you are most likely immune and won’t catch it again, but some people have tested positive for weeks after being ill. However, shedding virus does not always mean people are still contagious. Basically, we don’t really know yet what the onset and duration of viral shedding are for this virus. There is a lot we just don’t know yet.

Stay home, people. Use the time to work on that dressage test or fine-tune your jumping. If it all comes to nothing (which I personally doubt), you will have missed a horse show, and you can feel free to laugh at me. At least we will all be there to laugh.

Helpful links:

Handwashing: https://www.cdc.gov/handwashing/when-how-handwashing.html

https://www.cdc.gov/coronavirus/2019-ncov/summary.html

https://www.who.int/news-room/q-a-detail/q-a-coronaviruses

Here’s a great article that puts this in a historic context: https://www.theatlantic.com/ideas/archive/2020/03/coronavirus-cancel-everything/607675/

This is an excellent article with chilling graphics on how fast this will spread and how social distancing can keep people alive: https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

Adrienne Classen, MD, is a pediatrician specializing in the care of children with chronic illness, medical fragility, school and mental health needs. The pediatric practice she started and ran for 13 years was named by the American Academy of Pediatrics as an Innovative and Promising Practice in Pediatric Medical Home Implementation. She and her husband Dale live on their farm in Thurmond, North Carolina, where they breed horses for upper-level three-day eventing. Before her practice became too busy, Adrienne evented through the  CCI3*-L level.