SIGN UP FOR THE CERTIFICATE IN TEAM SPORTS PHYSICIAN - ESSENTIAL CONCEPTS
join nowThe outbreak of the SARS-CoV-2 (COVID-19) virus at the end of 2019 has triggered a series of events that will presumably change many of the things we consider as normal in our everyday life. Due to the virus’ high infectivity (1), many countries have stopped their activities in order to mitigate its spreading and to avoid overloading the capacity of the health system.
Most leagues and sports competitions have been interrupted or cancelled since early March 2020. While the authorities decide how and when training and competitions will be resumed, sport health departments have been working on specific guidelines, such as the ones published in the Sports Health magazine (2). These publications intend to guide these entities for the possible different scenarios. They seek to reduce the players’ and club employees’ risk of infection, and in case they become ill, to know how to act and advise available treatments, as well as the appropriate time to get back to work after the infection.
Although athletes have a lower risk of developing severe symptoms as a result of COVID-19, since they do not suffer from associated comorbidities, such as hypertension or obesity (3), prevention strategies are necessary for several reasons. In the first place, to prevent them from becoming a medium for the transmission of the virus, in order to reduce the risks of infecting the population which are more susceptible such as the elderly or immunosuppressed people. People with no symptoms, those who are incubating the virus and do not show symptoms, are the most difficult cases because they may spread the virus without knowing it (4). If a young athlete gets infected, as a result he may suffer mild symptoms or no symptoms at all, which may increase the risks of infecting other people. This is why it is important to follow the guidelines to mitigate the possibility of infecting other people.
On the other hand, if athletes get ill, they will interrupt their training and this will affect their fitness (2). Even though there is no high risk, some authors think the virus could have some adverse effects on organs, such as the heart, the lungs, the liver, the kidneys, the blood and the immune system (5,6), which suggest to be cautious when it comes to making decisions that minimize the possible effects of the virus. Regarding this, the following prevention measures may help reduce the infection risk:
The virus incubation period is 14 days approximately, and the most common symptoms include fever, fatigue, dry cough and myalgia (12). Furthermore, some patients may show an alteration in biochemical parameters, such as increased lactate dehydrogenase, ferritin or interleukin-6 (12,13), which may cause a hyper-inflammatory response. However, the risk of developing severe symptoms which requires hospitalization for people between 18 and 45 years old is low (less than 10%) (14). Therefore, an athlete with no risk factors associated and infected with the virus may probably experiment an illness similar to the flu (2). Thereby, the main advisable measure is coping with the symptoms and resting (2).
This way, if the athlete is positive or is suspected to have the disease, home lockdown is advised, as long as the symptoms are not severe.
Authorities suggest discontinuing the lockdown based on two strategies, depending on the availability of resources. In case a test can be done, the lockdown could be interrupted, as long as the following criteria are met:
In case there are no tests available, the following criteria should be met:
The psychological impact this pandemic may have on athletes is still unknown. If we combine the social alarm and uncertainty with the suspension of competitions or the delay in the celebration of the Olympic Games, considering these people have set their minds on that objective for years, the result is a pile of emotions that may cause stress or anxiety. That is why, doctors and psychologists working in clubs or entities should anticipate and provide tools that help control this new reality.
When the health authorities decide to ease restrictions and allow athletes to go back and practice their sports activity, sports clubs need to follow preventive protocols and monitor the risks to prevent another outbreak of the virus. If an athlete has any symptoms related to COVID-19, the teammates, trainers and workers that have interacted physically with him, should start a lockdown period until the case is confirmed. If the athlete is positive for COVID-19, the lockdown should be maintained during 14 days (2). On the contrary, if the result is negative for COVID-19, they could go back to work as usual.
On the other hand, it would be interesting to implement daily temperature control measures in the training premises gateways, as fever monitoring could reduce the occurrence of the disease (15).
Nowadays the goal is still to mitigate the pandemic curve and avoid making prompt decisions that take us back to the starting point. That is why sports authorities should keep focusing on preserving both the athletes’ and the overall society’s health, as well as anticipating action plans that allow getting back to work in the safest way and always taking into account the recommendations made by the health authorities.
Adrián Castillo
REFERENCES
An article published in The Orthopaedic Journal of Sports Medicine —in which members of the club’s medical services participated— now suggests to consider the detailed structure of the area affected, and treating the extracellular matrix as an essential player in the prognosis of the injury.
