ABSTRACT #40

EVALUATING A COVID-19 SAFETY PROTOCOL FOR WILDERNESS MEDICINE EDUCATION

Adam Hill, Kaitlyn Votta, Ryan Lebuhn

PURPOSE AND GOALS: In response to the COVID-19 pandemic, educational institutions created safety protocols for in- person activities, yet guidance on wilderness medicine (WM) education is lacking. While protocols have shown variable impact in COVID-19 mitigation within summer camps and day camps, none have specifically evaluated WM- based endeavors. We describe a safety protocol implemented for a WM elective to limit the transmission of COVID- 19.

METHODS: Based on guidelines from the Centers for Disease Control and Prevention, the American Camp Association, and institutional guidelines, we implemented a COVID-19 safety protocol among instructors, residents, and medical students participating in a WM course over three 5-7 day in-person, outdoor-based sessions from 2020-2022. The protocol included 1) pre-course and daily symptom screening, 2) singleperson or “social bubble” tenting, 3) masks in enclosed areas, 4) hand hygiene, 5) mandatory vaccination (2021 and 2022 cohort), and 6) isolation or departure should a participant exhibit symptoms.

EVALUATION PLAN: Course participants completed a pre-course symptom screen, and symptoms were monitored daily during the course and for 14 days after. Post-course participant symptoms triggered a testing protocol. Positive cases were recorded and evaluated to determine rate of transmission within the course. Daily COVID-19 case counts for New York City during the 14 days prior to the course were obtained to ascertain background infection rates. Our primary outcome of interest was COVID-19 transmission rate amongst the study population.

SUMMARY OF RESULTS: A total of 42 people participated in the course during the study period. Average daily population case rates for 2020, 2021, and 2022 were 2, 16, and 18 per 100,000, respectively. There were no documented or suspected cases of COVID-19 transmission during the 3 evaluated cohorts. Two participants reported symptoms prior to the course, one with nasal congestion that resolved 1 week before departure and one with self-resolved gastrointestinal symptoms the day before departure. No symptoms were reported during or after the course by participants.

REFLECTIVE CRITIQUE: While the case transmission rate in our study population was zero, it is hard to draw any definitive conclusions as to the impact of the study protocol. The low rate of transmission in our population may have been due to small sample size, COVID-19 prevalence rates, vaccination rates, and other confounding factors. While two participants had pre-course symptoms, resolution at the time of the course makes transmission unlikely, although neither participant was tested on course arrival. We acknowledge that more frequent testing may have a role in future iterations of the protocol and improvements in quality and availability of rapid tests make this more feasible. Despite these limitations, our data suggests that with adherence to a rigorous protocol, in-person WM education is safe and COVID-19 transmission rates low.