Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes

Abstract

The COVID-19 pandemic brought the global world of sports to a staggering halt. In unprecedented fashion and with few exceptions, professional leagues, mass participation endurance events, and youth sport around the globe went silent. In the face of a rapidly evolving health crisis, the decision to cancel or postpone sporting events was a logical and necessary step. COVID-19 is a highly contagious, potentially fatal virus that is transmitted primarily through contact with aerosolised or surfacedwelling respiratory secretions, a process that requires close human contact. 1 Competitive sport as we know it, from athletes 'elbowing' one another for position on the pitch to arenas packed with fans, may be the quintessential antithesis of social distancing. There is concern that the Champions League match between Atalanta and Valencia in Milan may have influenced the trajectory of COVID-19 cases in Europe. 2 In the absence of a vaccination or curative intervention, physical distancing emerged as the key step to slow or stop the spread of COVID-19. Thus, the decision to turn off the lights and to silence competitive athletics represented a logical, essential and highly visible component in the global fight against COVID-19. This has been an unusually quiet time for the sports medicine community. Athletic training rooms have gone dark, and many clinicians have been repurposed to meet the needs of patients with COVID-19. Fortunately, this will not last forever. The great American poet Robert Frost once said, 'In three words I can sum up everything I've learnt about life. It goes on', and indeed, there are early signs of progress in the fight against COVID-19. As rates of new infection begin to plateau and even decline in some countries, there

Infographic. Graduated return to play guidance following COVID-19 infection

“…Niall Elliott , 1,2 Rhodri Martin, 3,4 Neil Heron, 5,6 Jonathan Elliott , 7 Dan Grimstead, 3 Anita Biswas 8…”

“…With risk of cardiological, renal, respiratory and haematological complications, [1][2][3][4][5] it is best practice to follow steady resumption of training, paying attention to physical and psychological factors after COVID-19 infection.…”

Infographic. Clinical recommendations for return to play during the COVID-19 pandemic

“…1 Numerous authors have attempted to address return to play given the importance and complexity of the issue, with notable attention on possible cardiac implications. [2][3][4][5][6]…”

Return to sports after COVID-19: a position paper from the Dutch Sports Cardiology Section of the Netherlands Society of Cardiology

“…Different proposals regarding the resumption of sports and exercise after COVID-19, e.g. from the Ameri-can College of Cardiology's Sports and Exercise Cardiology Council, have recently been published [1,2]. Based on different categories of disease severity, in this point-of-view article we offer the (sports) cardiologist or sports physician in the Netherlands a practical guide to pre-participation screening (PPS), and clinical management strategies in competitive (elite) athletes and highly active individuals >16 years of age after COVID-19.…”