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Recommendations for return to sport during the SARS-CoV-2 pandemic

July 2020
BMJ Open Sport & Exercise Medicine 6(1):e000858

DOI:10.1136/bmjsem-2020-000858

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CC BY-NC

Authors:

Herbert Loellgen

Deutsche Gesellschaft für Sportmedizin und Prävention (Deutscher Sportärztebund) e.V.

Norbert Bachl

University of Vienna

Theodora Papadopoulou

Ministry of Defence uk

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In this viewpoint we make specific recommendations that can assist and make the return to sport/exercise as safe as possible for all those impacted – from the recreational athlete to the elite athlete. We acknowledge that there are varying rules and regulations around the world, not to mention the varying philosophies and numerous schools of thought as it relates to return to sport/exercise and we have been cognisant of this in our recommendations. Despite the varying rules and circumstances around the world, we believe it is essential to provide some helpful and consistent guidance for return to training and sport for sport and exercise physicians around the world at this most difficult time. The present viewpoint provides practical and medical recommendations on the resumption to sport process.

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LöllgenH, etal. BMJ Open Sp Ex Med 2020;6:e000858. doi:10.1136/bmjsem-2020-000858 1

Open access Viewpoint

Recommendations for return to sport

during the SARS- CoV-2 pandemic

Herbert Löllgen,1 Norbert Bachl,1,2,3,4 Theodora Papadopoulou,1,4,5,6

Andrew Shak,7,8 Graham Holloway,5 Karin Vonbank,9 Nigel Edward Jones,5,10,11

Xavier Bigard,1,4,12 David Niederseer ,13 Joachim Meyer,14

Borja Muniz- Pardos ,15 Andre Debruyne,1,4 Petra Zupet,1,4,16

Jürgen M Steinacker ,1,4,17 Bernd Wolfarth,4,18 James Lee John Bilzon ,4,5,19

Anca Ionescu,1 Michiko Dohi ,4,20 Jeroen Swart ,4,21

Victoriya Badtieva ,4,22,23 Irina Zelenkova,15,22 Maurizio Casasco,1,4,24

Michael Geistlinger,4,25 Luigi Di Luigi ,4,26 Nick Webborn,27,28 Patrick Singleton,29

Mike Miller,29 Fabio Pigozzi,1,4,30,31 Yannis P Pitsiladis 1,4,32

To cite: LöllgenH, BachlN,

PapadopoulouT, etal.

Recommendations for return

to sport during the SARS-

CoV-2 pandemic. BMJ Open

Sport & Exercise Medicine

2020;6:e000858. doi:10.1136/

bmjsem-2020-000858

For numbered afliations see

end of article.

Correspondence to

Dr Yannis P Pitsiladis;

Y. Pitsiladis@ Brighton. ac. uk

employer(s)) 2020. Re- use

permitted under CC BY- NC. No

commercial re- use. See rights

and permissions. Published by

BMJ.

ABSTRACT

In this viewpoint we make specic recommendations that

can assist and make the return to sport/exercise as safe

as possible for all those impacted – from the recreational

athlete to the elite athlete. We acknowledge that there

are varying rules and regulations around the world, not to

mention the varying philosophies and numerous schools

of thought as it relates to return to sport/exercise and

we have been cognisant of this in our recommendations.

Despite the varying rules and circumstances around the

world, we believe it is essential to provide some helpful

and consistent guidance for return to training and sport

for sport and exercise physicians around the world at

this most difcult time. The present viewpoint provides

practical and medical recommendations on the resumption

to sport process.

BACKGROUND

The COVID-19 pandemic and the restrictive

measures adopted internationally in order to

contain the virus has led to a disruption of

organised sport at all levels. During the lock-

down period, outdoor exercise was forbidden

or partly restricted in some cases without

access to sports facilities including gyms or

sports centres. As the number of infections

and hospitalisations decreased, the strict lock-

down was gradually lifted. Team sports have

commenced reintroducing their training

routines in groups, and the Bundesliga reac-

tivated the professional league behind closed

doors on 16 May 2020 despite serious concerns

raised by some in the scientific community.1

Additional sporting competitions such as

boxing, Ultimate Fighting Championship

and Formula 1 are also scheduled to resume.2

It is worth noting that social distancing is

possible in some sports (eg, tennis, swimming,

athletics and golf) whereas this is not always

possible in other cases (eg, football, rugby,

basketball, cycling and boxing), and careful

measures of hygiene and control are espe-

cially needed for these more at risk sports to

regulate the safety of sport resumption and to

avoid possible infections. For more thorough

information about the risk factors and symp-

toms to be considered to make the return to

sport as safely as possible, consult Carmody

et al3 and Nieß et al.4 The present viewpoint

provides practical and medical recommenda-

tions on the resumption to sport process.

GROUP IDENTIFICATION

During the resumption to sport process, the

following groups must be distinguished (indi-

viduals below refer to both leisure time and

professional athletes or persons starting new

with regular physical activities). This group

classification is a more developed version of

that recently published by Phelan et al.5:

1. Individuals without symptoms and signs

that never have been tested positive for se-

vere acute respiratory syndrome coronavi-

rus 2 (SARS- CoV-2).

2. Individuals with a positive SARS- CoV-2 test

without any COVID-19 symptoms but iso-

lating at home (quarantine) under close

medical observation (telephonic or video).

3. Individuals who experienced COVID-19

with mild symptoms, only needing outpa-

tient treatment and quarantine for 14 days.

4. Individuals with moderate symptoms but

had inpatient treatment due to an in-

creased risk derived from pre- existing con-

ditions (eg, asthma, diabetes).

5. Individuals with severe symptoms, inpa-

tient treatment, including intensive care

without artificial respiration.

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2LöllgenH, etal. BMJ Open Sp Ex Med 2020;6:e000858. doi:10.1136/bmjsem-2020-000858

Open access

6. Individuals with severe symptoms, inpatient treatment

in intensive care and on artificial respiration.

It is imperative that a medical examination is performed

in cooperation with a respiratory physician and/or cardi-

ologist, if suspicious findings of the pulmonary and/or

cardiovascular systems arise.

RECOMMENDATIONS FOR INDIVIDUAL GROUPS

Group 1

In individuals without symptoms and signs of COVID-19

and without any pre- existing medical condition(s), risk

stratification to safely resume to sport has to be evalu-

ated through questionnaires compiling data related to

personal and medical history, close contact with people

with positive SARS- CoV-2 test, or contact with people of

high risk of having been infected without being tested

positive, or in so called hotspots. The individual has to

confirm being free of any symptoms and this must be

documented. Exercise testing is likely to be necessary in

some sports due to the expected detraining after lock-

down,6 and exercise testing must be performed according

to the latest COVID-19/SARS- CoV-2 health and safety

regulations.

Group 2

Resumption after 14 days quarantine. Examinations

ought to include medical history, physical examination,

12- channel ECG, lung function assessment with typical

respiratory signs and symptoms, and ECG stress test.5 7–9

Echocardiography if clinically indicated.

Group 3

Resumption after a quarantine period of 2 weeks and

strict social distancing for another 2 weeks.

A medical examination by a sport and exercise medi-

cine physician with medical history, physical examination,

blood test focused on critical markers (eg, C- reactive

protein, high sensitivity troponin- I, natriuretic peptides),

and resting ECG (eg, changes of Q- wave, ST- stretch,

T- wave).8 Additional lung function assessment and stress

test with ECG, blood gas analysis and spiroergometry as

well as echocardiography are recommended if symptoms

have involved respiratory or cardiac impairment. Return

to regular sport is possible 3–4 weeks after beginning of

the symptoms under medical surveillance for 6 months

after return to sport if any symptoms are present but not

limiting return to sport.

Group 4

Same procedure as for group 3 but including compulsory

ergometry with blood gas analysis and/or spiroergom-

etry.3–5 10 Chest X- ray examination and depending on

the findings obtained during the inpatient stay, high-

resolution CT of the thorax in the most severe cases always

in consultation with a lung specialist. Cardiac examina-

tions depending on medical history, symptoms and signs,

cardio- MRI after consultation with a cardiologist. Return

to sport will vary from 2 to 6 months depending on the

severity of respiratory (lung) and/or cardiac (myocar-

ditis) involvement.

Groups 5 and 6

Following SARS- CoV-2 discharge, rehabilitation is recom-

mended. A complete pulmonary and cardiological

examination is necessary (‘cardiac markers’ such as high

sensitivity troponin- I or natriuretic peptides) including

resting ECG, lung function, echocardiography, stress test

with ECG and blood gas analysis.8 10–13 Return to sport

will be after several months depending on the severity

and completeness of recovery.

Depending on previous findings in heart rate, CT of

the thorax and cardiac MRI examination in consultation

with a respiratory physician and cardiologist, hospital

discharge can take place. A final medical check and

sports statement is mandatory.

Resumption of sport can occur 10–14 days after

complete recovery from SARS CoV-2 infection for

athletes included in groups 1 and 2. In patients with more

severe organ involvement, pneumonia, myocarditis or

neurological signs, an individualised plan is necessary.4 5

Testing for SARS CoV-2 can be carried out to support a

return to play decision but is not essential unless stipu-

lated (eg, National/International Sports Federation,

Government).

CONCLUSIONS

An adequate assessment of the resumption of sporting

activity is based on a case- by- case decision that must

consider the individual situation of the athlete including

pre- existing conditions, the type of sport and the risk

of infection from other athletes (eg, increased risk in

contact/team sports). The recommendation to return to

play will be based on the results of the examination and

individual assessment in consultation with the sport and

exercise medicine physician, specialists in pulmonary

medicine and sport cardiology (or extended multidisci-

plinary team), coaches and training specialists. After a

contact ban, an athlete should be provided with recom-

mendations on sports resumption that are in accordance

with national and regional guidelines. After a longer

period of interruption in sport caused by more severe

health issues, increases in training should be gradual and

individualised by monitoring signs and symptoms of the

health issue.

Author afliations

1European Federation of Sports Medicine Associations (EFSMA), Lausanne,

Switzerland

2Institute of Sports Science, University of Vienna, Vienna, Austria

3Austrian Institute of Sports Medicine, Vienna, Austria

4International Federation of Sports Medicine (FIMS), Lausanne, Switzerland

5British Association of Sport and Exercise Medicine, Doncaster, UK

6Defence Medical Rehabilitation Centre, Loughborough, UK

7South Tyneside NHS Foundation Trust, Sunderland, UK

8Newcastle Thunder Rugby, Newcastle, UK

9Department of Pneumology, Pulmonary Function Laboratory, Medicine Clinic

(KIMII), University of Vienna, Vienna, Austria

10British Cycling, Manchester, UK

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Open access

11University of Liverpool, Liverpool, UK

12Union Cycliste Internationale (UCI), Aigle, Switzerland

13Heart Centre, University of Zurich, Zurich, Switzerland

14Lung Center, Clinic Bogenhausen, Munich, Germany

15GENUD (Growth, Exercise, Nutrition and Development), University of Zaragoza,

Zaragoza, Spain

16Institute of Medicine and Sports, Ljubljana, Slovenia

17Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm,

Germany

18Department of Sport Medicine, Humboldt University and Charité University School

of Medicine, Berlin, Deutschland, Germany

19Department for Health, University of Bath, Bath, UK

20Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan

21UCT Research Unit for Exercise Science and Sports Medicine, University of Cape

Town (UCT), Cape Town, South Africa

22I.M. Sechenov First Moscow State Medical University (Sechenov University),

Moscow, Russian Federation

23Moscow Research and Practical Centre for Medical Rehabilitation, Restorative

and Sports Medicine, Moscow Healthcare Department, Moscow, Russian Federation

24Italian Federation of Sports Medicine (FMSI), Rome, Italy

25Unit International Law, Department of Constitutional, International and European

Law, University of Salzburg, Salzburg, Austria

26Unit of Endocrinology, Department of Movement, Human and Health Sciences,

University of Rome “Foro Italico”, Rome, Italy

27School of Sport and Service Management, Eastbourne, UK

28School of Sport, Exercise and Health Sciences, Loughborough University,

Loughborough, UK

29World Olympians Association, Lausanne, Switzerland

30University of Rome “Foro Italico”, Rome, Italy

31FIFA Medical Center of Excellence, Villa Stuart Sport Clinic, Rome, Italy

32Collaborating Centre of Sports Medicine, University of Brighton, Eastbourne, UK

Twitter David Niederseer @DavidNiederseer

Contributors All authors contributed signicantly to merit publication and in

accordance with the BJSM instructions to authors.

Funding The authors have not declared a specic grant for this research from any

funding agency in the public, commercial or not- for- prot sectors.

Competing interests None declared.

Patient consent for publication Not required.

Provenance and peer review Not commissioned; externally peer reviewed.

Open access This is an open access article distributed in accordance with the

Creative Commons Attribution Non Commercial (CC BY- NC 4.0) license, which

permits others to distribute, remix, adapt, build upon this work non- commercially,

and license their derivative works on different terms, provided the original work is

properly cited, appropriate credit is given, any changes made indicated, and the

use is non- commercial. See:http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

ORCID iDs

DavidNiederseer http:// orcid. org/ 0000- 0003- 3089- 1222

BorjaMuniz- Pardos http:// orcid. org/ 0000- 0002- 9191- 9033

Jürgen MSteinacker http:// orcid. org/ 0000- 0001- 8901- 9450

James Lee JohnBilzon http:// orcid. org/ 0000- 0002- 6701- 7603

MichikoDohi http:// orcid. org/ 0000- 0002- 1126- 7849

JeroenSwart http:// orcid. org/ 0000- 0001- 7098- 0313

VictoriyaBadtieva http:// orcid. org/ 0000- 0003- 4291- 679X

LuigiDi Luigi http:// orcid. org/ 0000- 0002- 2522- 126X

Yannis PPitsiladis http:// orcid. org/ 0000- 0001- 6210- 2449

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Aug 2023
J CARDIOVASC MED

Introduction: Data regarding echocardiographic findings during follow-up of asymptomatic or pauci-symptomatic coronavirus disease 2019 (COVID-19) are scarce in pediatric patients. The aim of the present study is to assess post-COVID-19 sequelae through echocardiography in children who have experienced mild SARS-CoV-2. Methods: This single-center, retrospective, observational study enrolled a cohort of 133 pediatric outpatients, born between 2005 and 2022, with a history of asymptomatic or paucisymptomatic SARS-CoV-2 infection, who underwent transthoracic echocardiographic (TTE) evaluation at an outpatient pediatric clinic in Northern Italy. Results: The percentage of the pediatric activity of the clinic which was focused on post-COVID evaluation was not negligible, representing almost 10% of the ∼1500 pediatric patients examined from 1 January 2021 to 31 August 2022. According to ACEP classification, children enrolled in this study had previously experienced in 72.9% (97) asymptomatic COVID-19 and nearly 27% (36) a mild illness. Clinical and instrumental examinations did not show any relevant abnormality in the functional [left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), pulmonary artery systolic pressure (PASP)] or structural [interventricular septum diameter (IVSd), left ventricular internal diameter (LViD, end-diastolic volume (EDV), left atrium volume (LAV)] parameters examined related to SARS-CoV-2 infection in the total of 133 children. Conclusion: According to our results, children who experienced an asymptomatic or mild SARS-CoV-2 infection should not be systematically investigated with second-level techniques, such as TTE, in the absence of clinical suspicion or other risk conditions such as congenital heart diseases, comorbidities or risk factors.

Considerations after lockdown and overcoming COVID-19: a systematic review for returning to safe physical exercise practice

Article

May 2023
SCI SPORT

Objective: This systematic review aims to understand the problems associated with lockdown and the various conditions of Covid-19 infection and to help prepare athletes and exercise enthusiasts for the safe resumption of sport in a manner that promotes wellness, healthy competition, and a sports industry that survives the current situation. This systematic review was carried out, following the recommendations of the currently pre-established reporting elements for systematic reviews and meta-analyses. The following databases were consulted: ISI Web of Science (WOS), Scopus and Google Scholar. This review includes a total of 19 articles. News: The results are presented based on three predominant themes: (1) psychological impact produced by SARS-CoV-2; (2) post-Covid-19 cardiac abnormalities and (3) protocols for an adequate return to physical practice. Prospects and projects: Most of the protocols shown by the various papers are consistent in terms of duration and number of phases. Based on this, the safe return to practice protocol can be divided into four stages of seven days in each phase in order to progress according to the symptoms perceived. In each phase, the physiological demand and efforts necessary to cover the proposed activities are increased until optimal physical condition is recovered.

Cardiopulmonary examinations of athletes returning to high-intensity sport activity following SARS-CoV-2 infection

Article

Full-text available

Dec 2022

After SARS-CoV-2 infection, strict recommendations for return-to-sport were published. However, data are insufficient about the long-term effects on athletic performance. After suffering SARS-CoV-2 infection, and returning to maximal-intensity trainings, control examinations were performed with vita-maxima cardiopulmonary exercise testing (CPET). From various sports, 165 asymptomatic elite athletes (male: 122, age: 20y (IQR: 17-24y), training:16 h/w (IQR: 12–20 h/w), follow-up:93.5 days (IQR: 66.8–130.0 days) were examined. During CPET examinations, athletes achieved 94.7 ± 4.3% of maximal heart rate, 50.9 ± 6.0 mL/kg/min maximal oxygen uptake (V̇O2max), and 143.7 ± 30.4L/min maximal ventilation. Exercise induced arrhythmias (n = 7), significant horizontal/descending ST-depression (n = 3), ischemic heart disease (n = 1), hypertension (n = 7), slightly elevated pulmonary pressure (n = 2), and training-related hs-Troponin-T increase (n = 1) were revealed. Self-controlled CPET comparisons were performed in 62 athletes: due to intensive re-building training, exercise time, V̇O2max and ventilation increased compared to pre-COVID-19 results. However, exercise capacity decreased in 6 athletes. Further 18 athletes with ongoing minor long post-COVID symptoms, pathological ECG (ischemic ST-T changes, and arrhythmias) or laboratory findings (hsTroponin-T elevation) were controlled. Previous SARS-CoV-2-related myocarditis (n = 1), ischaemic heart disease (n = 1), anomalous coronary artery origin (n = 1), significant ventricular (n = 2) or atrial (n = 1) arrhythmias were diagnosed. Three months after SARS-CoV-2 infection, most of the athletes had satisfactory fitness levels. Some cases with SARS-CoV-2 related or not related pathologies requiring further examinations, treatment, or follow-up were revealed.

Clinical practice Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC)

Article

Full-text available

Jun 2020

Regular exercise has multiple benefits for physical and mental health, including the body's ability to combat infections. The current COVID-19 pandemic and the social distancing measures employed to curtail the impact of the infection are likely to reduce the amount of usual physical activity being performed by most individuals, including habitual exercisers. The uncertainties relating to the impact of the SARS-CoV-2 virus on the heart may cause increased anxiety, particularly in athletes who need to sustain a vigorous exercise regime in order to maintain their skills and fitness in preparation for return to competition after a short retraining period. The aim of this document is to provide practical answers to pertinent questions being posed by the sporting community, in an attempt to offer reassurance, promote safe participation in exercise during as well as after the COVID-19 pandemic and provide a framework of management for physicians caring for athletes.

The Stanford Hall consensus statement for post-COVID-19 rehabilitation

Article

Full-text available

May 2020

The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death. Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress. Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments. There is a clear need for guidance on the rehabilitation of COVID-19 survivors. This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical. A chair combined recommendations generated within teams. A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence. Authors scored their level of agreement with each recommendation on a scale of 0–10. Substantial agreement (range 7.5–10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors. This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.

The Spectrum of Cardiac Manifestations in Coronavirus Disease 2019 (COVID-19) - a Systematic Echocardiographic Study

Article

Full-text available

May 2020

Background: Information regarding the cardiac manifestations of COVID-19 is scarce. We performed a systematic and comprehensive echocardiographic evaluation of consecutive patients hospitalized with COVID-19 infection. Methods: 100 consecutive patients diagnosed with COVID-19 infection underwent complete echocardiographic evaluation within 24 hours of admission and were compared to reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function, valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second exam was performed in case of clinical deterioration. Results: Thirty two patients (32%) had a normal echocardiogram at baseline. The most common cardiac pathology was RV dilatation and dysfunction (observed in 39% of patients), followed by LV diastolic dysfunction (16%) and LV systolic dysfunction (10%). Patients with elevated troponin (20%) or worse clinical condition did not demonstrate any significant difference in LV systolic function compared to patients with normal troponin or better clinical condition, but had worse RV function. Clinical deterioration occurred in 20% of patients. In these patients, the most common echocardiographic abnormality at follow-up was RV function deterioration (12 patients), followed by LV systolic and diastolic deterioration (in 5 patients). Femoral vein thrombosis (DVT) was diagnosed in 5 of 12 patients with RV failure. Conclusions: In COVID-19 infection, LV systolic function is preserved in the majority of patients, but LV diastolic and RV function are impaired. Elevated troponin and poorer clinical grade are associated with worse RV function. In patients presenting with clinical deterioration at follow-up, acute RV dysfunction, with or without DVT, is more common, but acute LV systolic dysfunction was noted in ≈20%.

Nowhere to hide: The significant impact of coronavirus disease 2019 (COVID-19) measures on elite and semi-elite South African athletes

Article

Full-text available

May 2020
J SCI MED SPORT

Objective To describe the perceptions of South African elite and semi-elite athletes on return to sport (RTS); maintenance of physical conditioning and other activities; sleep; nutrition; mental health; healthcare access; and knowledge of coronavirus disease 2019 (COVID-19). Design Cross-sectional study Methods A Google Forms survey was distributed to athletes from 15 sports in the final phase (last week of April 2020) of the level 5 lockdown period. Descriptive statistics were used to describe player demographic data. Chi-squared tests investigated significance (p < 0.05) between observed and expected values and explored sex differences. Post-hoc tests with a Bonferroni adjustment were included where applicable. Results 67% of the 692 respondents were males. The majority (56%) expected RTS after 1-6months. Most athletes trained alone (61%; p < 0.0001), daily (61%; p < 0.0001) at moderate intensity (58%; p < 0.0001) and for 30-60 min (72%). During leisure time athletes preferred sedentary above active behaviour (p < 0.0001). Sleep patterns changed significantly (79%; p < 0.0001). A significant number of athletes consumed excessive amounts of carbohydrates (76%; p < 0.0001; males 73%; females 80%). Many athletes felt depressed (52%), and required motivation to keep active (55%). Most had access to healthcare during lockdown (80%) and knew proceedings when suspecting COVID-19 (92%). Conclusions COVID-19 had physical, nutritional and psychological consequences that may impact on the safe RTS and general health of athletes. Lost opportunities and uncertain financial and sporting futures may have significant effects on athletes and the sports industry. Government and sporting federations must support athletes and develop and implement guidelines to reduce the risk in a COVID-19 environment.

Position stand: return to sport in the current Coronavirus pandemic (SARS-CoV-2 / COVID-19)

Article

Full-text available

May 2020

When can professional sport recommence safely during the COVID-19 pandemic? Risk assessment and factors to consider

Article

Full-text available

May 2020

COVID-19 for the Cardiologist: A Current Review of the Virology, Clinical Epidemiology, Cardiac and Other Clinical Manifestations and Potential Therapeutic Strategies

Article

Full-text available

Apr 2020

The coronavirus disease-2019 (COVID-19), a contagious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), has reached pandemic status. As it spreads across the world, it has overwhelmed healthcare systems, strangled the global economy and led to a devastating loss of life. Widespread efforts from regulators, clinicians and scientists are driving a rapid expansion of knowledge of the SARS-CoV2 virus and the COVID-19 disease. We review the most current data with a focus on our basic understanding of the mechanism(s) of disease and translation to the clinical syndrome and potential therapeutics. We discuss the basic virology, epidemiology, clinical manifestation, multi-organ consequences, and outcomes. With a focus on cardiovascular complications, we propose several mechanisms of injury. The virology and potential mechanism of injury form the basis for a discussion of potential disease-modifying therapies.

Return to sports after COVID-19 infection

Article

May 2020
EUR HEART J

The cardiovascular effects and long-term consequences of COVID-19 are currently unclear. The question of eligibility for sport and the point of return to sport following both asymptomatic and symptomatic COVID-19 with or without suspected involvement of the myocardium is currently becoming more and more important in leisure as well as in competitive sports. Fortunately, from previous studies and registries of acute myocarditis, it has been known that athletes with a complete recovery have a very good prognosis. Nevertheless, to optimize counselling and treatment of athletes in the future, prospective data collection on the current corona pandemic is urgently needed. To this end, the non-evidence-based recommendations for a return to sports presented herein might serve as a first guideline.

A Game Plan for the Resumption of Sport and Exercise after Coronavirus Disease 2019 (COVID-19) Infection

Article