Sports Medicine
https://doi.org/10.1007/s40279-020-01288-7
COMMENTARY
Sports Health During the SARS-Cov-2 Pandemic
Toomas Timpka1,2
© Springer Nature Switzerland AG 2020
Key Points
Sports organisations must adopt pandemic strategies that
are unmistakeably communicated to their memberships.
Temporary frameworks for sports practices should be
developed that harmonise with prevailing social distancing and quarantine regulations.
Sports medical researchers and practitioners should
cooperate with sports organisations and public health
agencies to build trust and resilience and safeguard
sports participation at all levels.
1 Introduction
In December 2019, the Chinese city of Wuhan reported
an outbreak of SARS-Cov-2 (severe acute respiratory syndrome coronavirus-2) infection that causes the Covid-19
disease, an atypical pneumonia [1]. Modelling analyses per
late January 2020 showed that the outbreak was no longer
contained within Wuhan, and that other major Chinese cities sustained localised outbreaks [2]. Cases were thereafter
exported across China, as well as internationally. In early
March 2020, the World Health Organisation proclaimed that
the outbreak had developed to a pandemic. The pandemic
caused by SARS-cov-2 has had a major impact on sports,
from the cancellation of major events and championships
[3] to small sports clubs being forced into bankruptcy [4].
* Toomas Timpka
toomas.timpka@liu.se
1
Athletics Research Center, Linköping University,
581 83 Linköping, Sweden
2
Department of Public Health and Statistics, Region
Östergötland, Linköping, Sweden
The aim of this commentary is to examine the consequences
of the SARS-Cov-2 pandemic for sports and provide recommendations for response measures from the sports
community.
1.1 SARS‑Cov‑2 and Covid‑19
The SARS-Cov-2 is not the first coronavirus to generate concern [5]. Healthcare systems across the world have had to
manage SARS in 2003–2004 and MERS (Middle Eastern
Respiratory Syndrome), which has been ongoing since 2012.
Infection with SARS-Cov-2 is established in the upper airways which at times can lead to very high virus production.
The body responds first via the innate immune system and
subsequently via the adaptive immune system, whereby the
virus is eliminated from the body. However, SARS-Cov-2
may enter the lower respiratory tract, reach the furthest alveoli, damage the alveolar epithelial barrier, and allow fluid
flow across the interstitial barrier, thus decreasing oxygenation [6]. When the immune system responds, there is a risk
of a cytokine storm syndrome that may cause acute respiratory distress, systemic inflammation, multi-organ failure,
and sometimes death [7, 8].
The median incubation time for Covid-19 is 4–6 days
(2–14 days) [9]. The main symptoms among adults are fever,
a new persistent dry cough, shortness of breath, and occasionally loss of sense of smell. No specific symptoms can
distinguish Covid-19 from other common respiratory tract
infections, e.g. influenza. Asymptomatic cases or cases with
only mild symptoms, e.g. slight cough and sense of illness,
may also occur [10]. From early Chinese cohorts of symptomatic patients, the majority have been reported to suffer
mild progression of the disease (> 80%), 14% severe (dyspnea, decreased oxygen saturation), and 5% a life-threatening
condition [11].
Diagnosis of Covid-19 has thus far (early April 2020)
been confirmed by polymerase chain reaction (PCR) analysis of secretions from the nasopharynx (or pharynx) [5].
Reliable serological tests are expected to soon be ready for
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T. Timpka
widespread use [12]. These tests will be able to detect past
SARS-Cov-2 infection, which will be important for identifying individuals who have been infected, and to follow
the evolution of the pandemic. The impact on the lungs can
in most cases be demonstrated by computerised tomography. There are currently only experimental pharmacological
treatments available for Covid-19. Remdesivir is a nucleotide analogue inhibitor of the virus’s RNA-dependent RNA
polymerases. It has a wide spectrum of antiviral activity
against RNA viruses, including SARS-Cov and MERS-Cov
[13, 14]. The malaria and rheumatism drug, chloroquine
phosphate, demonstrates in vitro activity against SARSCov-2, and unverified reports from China also indicate
in vivo efficacy in humans [15].
1.2 Public Health Response
It is predominantly people greater than 70 years of age and
individuals with chronic conditions who are at risk of developing severe Covid-19 disease [11]. Children and young
people are reported to contract SARS-Cov-2 infections and
transmit the virus, but they seldom suffer a serious course
of illness [16]. The progress of a pandemic is essentially
hard to forecast due to lack of knowledge about the infectious agent and population response behaviours [17, 18].
This implies that the planning of response measures must
be dynamically adapted to surveillance reports on the disease and immunity status in the population that the measures are intended for [19, 20]. SARS-Cov-2 is transmitted
through droplets from coughs and sneezing and contact with
infectious secretions [9]. The most important measure to
prevent virus transmission is, therefore, thoroughness with
personal hygiene, i.e. washing hands frequently and carefully, coughing and sneezing in the arm-fold, use of hand
sanitizer, and, in certain contexts, use of face masks [21].
The second main preventive measure is social distancing,
which ranges from keeping at least a 2-m person-to-person
distance to cancellations of sports events, school closures,
and household quarantine [22]. The national public health
agencies choose social distancing regulations based on an
overall assessment of how critical certain activities are for
society as a whole and whether motivation to comply with
the rules can be assumed. The concept of ‘proportionate
universalism’ is generally applied [23], i.e. that population
health interventions are seen as universal, not targeted, with
a scale and intensity that is proportionate to the level of
collateral disadvantage caused in the community. During
the SARS-Cov-2 pandemic, effectively all population-level
interventions include the recommendation that social contacts with the elderly, and especially the senior elderly, are to
be reduced to an absolute minimum. Domestic and international travel are also generally discouraged, especially to and
from metropolitan areas with ongoing disease transmission.
2 Recommendations for Sports Health
During the SARS‑Cov‑2 Pandemic
Sports organisations should develop a pandemic response
strategy that addresses the needs of its athletes and
coaches, while complying with the regulations and recommendations issued by the government and national
public health agency. For a society to function during a
pandemic, its members need to trust their fellow citizens
as well as the government institutions that are issuing
regulations [24]. If sportspeople do not believe that most
others are going to play by the temporary restrictive rules,
they are unlikely to adhere to them. The pandemic strategy
of a sports organisation must therefore be unmistakeably
communicated to its memberships. Swedish Athletic’s
Covid-19 website [25] is an example of a platform used
to communicate a temporary framework for sports practice and competitions to a sports community. The website
presents links to national government and public health
agency regulations, contact information to managers at the
federation office, and recommendations specific for athletics. It is updated hourly by the chief information officer,
and its contents are discussed every second day within a
multi-disciplinary pandemic task force at the federation.
The temporary frameworks for organised sports practice
and competitions must be developed based on the social
distancing and quarantine protocols activated during the
pandemic. Furthermore, novel arrangements of informal
physical exercise for children which conform to prevailing
social distancing regulations need to be created. The main
principles for the temporary frameworks are that activities
should be performed outdoors in small groups and that
physical contact is avoided as far as possible. The regulations for football (soccer) practice issued by the Norwegian Football Association demonstrate these principles
[26]: maximum 5-person groups, an adult to be present in
each group, 2-m person-to-person distance, no physical
contact, and balls should not be handled or headed and
should be washed after each session. At sports facilities,
the sharing of locker rooms by large groups should be
avoided and easy access to handwashing facilities provided. In individual sports, virtual competitions can be
arranged using Internet resources [27], with athletes participating at the same time and different locations, or at the
same location and different times.
Regarding individual athletes, the risk of developing
Covid-19 can be reduced by regular sleep, eating a wellbalanced diet, and staying well hydrated, to maintain the
capacity of the immune system [28]. A proper intake of
fruit and vegetables (7–8 portions per day) is beneficial,
since these foods contain polyphenols and flavonoids
that support immune function [29]. Athletes with asthma
Sports Health During the SARS-Cov-2 Pandemic
should use their prescribed medications meticulously to
reduce the risk for a more serious course of illness. There
are as yet no clinical studies of Covid-19 among athletes.
In most cases, young people appear to cope well with
Covid-19, and the symptoms improve over the course of a
week [16]. However, if return-to-sports is made too soon,
there is a risk of heart and lung complications [11, 30].
Taking at least 10 days of complete rest from exercise
is required, or rest for a minimum of 7 days from when
symptoms stop [31]. The period of rest should be followed
by stepwise return-to-play with careful evaluation before
proceeding to the next level.
The SARS-Cov-2 pandemic is challenging for the elite
athlete, considering both the risk of infection and the fact
that season’s goals and aims must be abandoned. The rulesof-play may also have changed, e.g. with regard to how
final league tables are determined and qualifying for major
championships, such as the Olympic Games, is decided.
Individual-level health monitoring can, therefore, be considered among elite athletes during the pandemic period.
High levels of stress have a negative effect on mood and
can also reduce the capacity of the body to resist infection
[32]. Continuing training can help to relieve some pressures.
Season targets should be re-evaluated and new realistic goals
determined as soon as possible. Sponsorship and other financial support contracts should then be re-negotiated accordingly. In Swedish Athletics, weekly surveillance of athletes
listed for the national team (n = 190) was initiated in March
2020. The monitoring uses web-based self-reports of Covid19 symptoms, if any individuals in the athlete’s household
or training group have symptoms, and a mood assessment.
During the first weeks of monitoring, participation has been
satisfactory (about 75%). The collected data are used by the
national team coach and medical team for planning of supportive interventions in different areas and at individual and
group levels.
3 Conclusions
In societies world-wide, the SARS-Cov-2 pandemic has serious effects on morbidity and mortality. In response, societies have restricted social contacts and redirected health
service resources to Covid-19 patients. Sports communities
are not excluded from the negative consequences of the pandemic. In athletes, Covid-19 can not only cause disruption
of training and competition programmes, but also can cause
more significant health issues [6, 7, 30]. Athletes not contracting the disease are impacted by the pandemic through
cancellation of competitions and loss of incomes. In April
2020, most professional sports have been locked down and
thousands of community sports clubs need immediate support to avoid bankruptcy. These collateral consequences of
the pandemic will influence sports participation for a long
period of time and require effective countermeasures. To
withstand the pandemic, sports organisations should cooperate with national public health agencies, epidemiologists,
and sports medical researchers and practitioners to build
trust and resilience, protect the elderly and other vulnerable
groups, and safeguard sports participation at all levels.
Author Contributions TT conceived the article, conducted the data
collection and wrote the commentary.
Funding No sources of funding were used to assist in the preparation
of this article.
Compliance with Ethical Standards
Conflict of Interest Toomas Timpka declares that he has no conflicts of
interest relevant to the content of this article.
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