Fall is the time when nearly the entire Northern Hemisphere adopts climate conditions well-suited to rock climbing. While not necessarily the busiest season for guide services, there’s no doubt that the cool temperatures and low humidity levels make climbers yearn to be on the rock. As our interaction and timeline with COVID-19 progresses, organizations that guide clients in the mountains are adapting to changes in the landscape as well as renewed desire from the public for meaningful outdoor activities and instruction. Previous posts from the WMS have provided excellent recommendations not only for outdoor recreation guiding in general, but also for recreational rock climbing. The aim of this article will be to summarize current best practices and elucidate the confluence of the risks inherent in the vertical environment and those inherent to working with the guided public.

In reviewing multiple protocols and recommendations from different organizations, a couple of things are clear.

• COVID-19 will be with us for the foreseeable future, and precautions must be taken to prevent exposure, both for clients and staff. 
• There are many unknowns regarding SARS-CoV-2 and its transmission. While viral load needed for transmission, and conditions favoring transmission in the frontcountry are becoming more defined, little research has been conducted regarding the likelihood of transmission in an outdoor or specifically a vertical environment.
• Risk is inherent in mountain guiding and instruction, and risk to participants is impossible to eliminate. 
• Both clients and instructors are aware of risks in outdoor activities and must be engaged in mitigation. 
• A multi-pronged approach to hazard mitigation will be necessary both to prevent actual transmission of the virus, as well as to reassure clients and guides that climbing instruction under current conditions fits within their personal risk tolerance. 
  

• Given that the incubation time for COVID-19 is somewhere between three days and two weeks, the 14 days prior to a guided outing are an important time for clients to minimize exposures. A check in from the guide service at the two week mark can not only help remind participants to be aware of their actions. Avoiding illness will benefit both client and guide, since neither wants a cancelled trip. 

• Symptomatic individuals must be removed from programming. Full stop. Given the likelihood of false negatives early in the course of disease, it is reasonable to think that the client who shows up coughing with a runny nose, even if they have a negative COVID-19 test in the last 48 hours may still be positive for the virus and contagious. 

• Guiding and instruction may need to shift to shorter program formats for the time being. A client who is asymptomatic at the beginning of a week-long climbing expedition, but who becomes ill four days later in a remote location may deteriorate more rapidly than extrication can be arranged. 

• “High tech” solutions such as screening with pre-trip pulse oximetry and infrared thermometers are of limited utility and are likely impractical for risk mitigation. 

• During guiding and instruction, masks must be the norm when within range of droplet transmission (generally 6 feet). While the utility of certain types of masks such as buffs is unknown, the most important metric for a mask in the vertical environment is probably ease of use. The mask not worn because it was bulky or cumbersome to apply is certainly of no value. Extra masks should be carried by the guide

• The likelihood of transmission by contact with shared equipment or holds on a route is unknown and precautions must be taken. Hand sanitizer should be readily available to clients and guides in order to limit transmission from hand to eyes, nose and mouth.

• Cleaning every piece of equipment between clients, especially for programs providing tents, is likely not feasible. The best solution given current understanding of coronavirus longevity on fomites is to let equipment sit for 72 hours between clients or groups of clients. (A good resource for cleaning guidelines, compiled by the Association for Challenge Course Technology, can be found here).

• While many guide services have provided freshly prepared meals for clients on expeditions in the past, this should likely be the year of freeze-dried meals prepared by the clients, with hot water provided by the guide service as needed. 

• Emergency response procedures should be evaluated with an eye to the current reality. Hands-only CPR, with a mask on the patient might be the best we can do. For ski guiding, investing in a small BVM, given the importance of rescue breathing post avalanche burial, should be considered

The AMGA Responsible Return to Work page has several other resources that are worth reviewing when evaluating not only the medical considerations for guiding during COVID-19, but also the legal and insurance implications for doing so. In reviewing the documents, there were several consistencies that became apparent across the three components:

1. Industry collaboration is key. There’s no established playbook for how to conduct operations during a pandemic, and thus the steps taken by any individual guide service or employer will by default be compared against those of their industry competitors. 
2. Informed consent is the name of the game. Communicating the risks inherent in the activity, giving clients alternatives such as rescheduling trip dates, and explaining the precautions being taken will go a long way towards creating happy clients and limiting liability. These concepts should be familiar to medical providers. 
3. Plan your work and work your plan. There’s no room for continuing operations without a solid plan in place. Taking time to consider the impact of COVID-19 on all aspects of the guided activity will pay dividends in the long run. Once established the plan should be faithfully followed and reviewed regularly for opportunities for improvement. 

Anecdotal reports from around the mountain guiding community in the U.S. suggest that after a brief disruption, COVID-19 may be leading to increased demand for guiding and instruction as families look for adventure activities that are socially distanced, and individuals seek to build their skill base for future outdoor pursuits. While most significant adjustments are initially painful, some of the COVID-19 considerations may end up making us better guides and instructors. Greater efficiency at belay transitions in the multipitch environment will minimize exposure today and will gain our clients more climbing time. Thoughtfully considering this new threat will make us better risk managers. The immediate threat of this virus will eventually fade, but the lessons we learn and internalize now will make our industry better in perpetuity.