What athletes need to consider after a corona infection

Rubén Oliver 8. December 2020

Corona is paralysing the sports world… but are the measures justified? Isn’t the Covid19 infection harmless in the vast majority of cases? Why do professional athletes need to produce a negative test result before every event?

A corona infection should never be ignored. Firstly, because the chains of infection need to be contained. And secondly because the long-term effects on young athletes, too, should never be underestimated. For these reasons, no one should take the protective measures lightly, because protection concepts are only as good as their implementation.

And what are the possible risks for otherwise generally healthy competitive athletes? We don’t have much experience with this new disease yet, but the infection does not seem to be confined to the lungs alone. Various athletes complain about persistent fatigue and a loss of performance following mild coronavirus symptoms… but what is it really about? And is it dangerous?

The virus can infect various organs

Everyone knows that corona can possibly cause a lung infection. The virus enters the lung tissue via special receptors. Alongside coughing, it can result in pneumonia, which can lead to scarring and functional loss of the lung tissue. Bronchial hyperreactivity can also occur and the virus can affect other organs such as the heart, liver, kidneys, nervous system or cause the formation of thrombi in blood vessels.

The number of studies to date is not huge. A study by the Universitätsmedizin Frankfurt* involving hospitalised but also less symptomatic patients who had a cardiac MRI done after the corona symptoms disappeared surprisingly showed that the heart muscle was infected in 60 out of 100 patients. Another study by the Ohio State University** involving 26 college athletes with mild symptoms confirmed this trend. Blood tests also often show an increase in the same heart values as those for a heart attack. The exact meaning of these findings is still unclear as to whether it will just blow over or lead to a symptomatic heart muscle inflammation in some cases. However, the risk of such inflammations and the subsequent changes in the heart muscle is urging the heart specialists to exercise caution.

In addition to the long-term effects on the heart and lungs, persistent symptoms such as fatigue and reduced performance capability, which last for more than 28 days and are known as the so-called long Covid syndrome, are currently being investigated. A long-term course is expected for around 10% of people under 50 and the incidence of long-term effects is expected to be up to 20% for older people. These symptoms, known as ‘chronic fatigue’, have so far been known to occur with other viral infections such as Pfeiffer's glandular fever or chronic hepatitis C.

Caution should be exercised when returning to training 

Sport & Exercise Medicine Switzerland (SEMS), together with the University Hospital of Zurich and Swiss Olympic, have issued recommendations*** to clarify the situation for athletes before they return to training.

It can be summarised as follows: If a competitive athlete is tested positive for corona, they should observe an absolute sports ban during the 10 days of isolation, even if they do not develop symptoms. They should then undergo a medical check before they start training, during which blood tests and a cardiac current curve (ECG) are carried out when at rest. If lung symptoms persist, a lung X-ray and a lung function test are also required for clarification. In the case of inconspicuous findings, they can gradually increase their training until they are fully fit for the sport. If these tests show signs of disease, a special medical examination is required by a lung or heart specialist. Further imaging examinations such as computer tomography, cardiac ultrasound or an MRI can then be arranged.

Anyone who has experienced a mild or asymptomatic Covid infection should consider themselves lucky. A 10-day training restriction is a very manageable period of time in relation to the possible long-term consequences.


* Puntmann VO et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online July 27, 2020.

** Rajapal S el al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiol. Published online September 11, 2020.

*** Schmied CM et al. SARS-CoV-2 Return to training and competition Flowcharts (https://sems.ch/publikationen/covid-19flow-charts/)

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