COVID-19: temporary and non-permanent repercussions on professional athletes.

Before going into the discussion, with particular reference to what may be the possible psycho-physical repercussions following a positive Covid-19 affecting professional athletes, some distinctions are necessary. The effort of a cyclist is different, for example, from that of a tennis player, a volleyball player or a football player. But even within the same sport, whether it is goalkeepers or players who move freely, the greatest difference lies in the physiological demands.
There is also the “disease” variable. Starting to tackle individual examples, the player Dybala contracted the virus without needing to be hospitalized, while Fernando Gaviria, a Colombian cyclist, found himself hospitalized for several weeks in a hospital in February. It is therefore clear that the pathogen creates a different response in each individual. The results, when and if present, are always different, but substantially, based on the scientific data provided today, there are no particular problems and repercussions in the professional sports world, with particular consequences that could compromise the future of athletes.

Most athletes who turned out to be infected (about 70%) were asymptomatic: they found they contracted the disease only after a routine swab, as required by current regulations.
Then there are the symptomatic, with modest symptoms ranging from loss of smell to low-grade fever, with or without cough, to get to high fever with initial respiratory failure. The probability of recovery strictly linked to the timeliness of the diagnosis and the therapeutic aids put in place.
There is no current reliable scientific literature, if by literature we mean studies supported by validated numbers and comparative evaluations, which can give indications on how the body of an athlete affected by covid-19- can react to the resumption of competitive activity.

Too little is known about the effects of this coronavirus that we have been facing for a year now and it appears that, to date, there are no real reliable data about the reactions of the bodies of top athletes. It is clear that the fact that the lack of data can be seen as an extremely positive aspect, as no side effects or pathologies have appeared, which could have had an influence on the sporting activity carried out.
With particular reference to the world of football, at the moment I am not aware of any concrete claims to be attributed to “permanent disability due to illness” resulting from the Covid 19 disease. Many precautionary claims have been filed but most of them were closed without sequelae. Even those cases which show some small consequences would fall within the expected 25% deductible.

Regarding the insurance matter, we can only take into consideration the illness policy: Covid 19 cannot be considered an accident in the context of private insurance, which provide for different regulations than those provided by Inail.
We know the common effects of the Covid 19 disease, such as pulmonary intestinal disease or embolism. The less common consequences are cardiac arrhythmias and strokes. These aspects and pathologies have rarely affected people under the age of thirty who appeared to be in good health, without pathologies. The major authors agree on the current lack of scientific literature.

All sports that require prolonged aerobic efforts such as cycling, running, cross-country skiing and even those that require efforts for prolonged times, even if not continuous such as rugby, football and tennis must take into account the possible lowering of the immune defenses, both for athletes who have already had the Coronavirus, and for all the others who compete when the virus is still present. During an intense effort, breathing is forced, the air reaches all the alveoli in depth and we cannot exclude that the inhalation of infected air reaches deeper, giving rise to deep interstitial pneumonia, which leads to a more demanding prognosis.

On the topic of “consequences”, most authors point out that some temporary effects may be present because the body of a high-level athlete is subject to decidedly demanding performances which require careful medical monitoring even if the player is already in perfect health. To be clear, we speak of the body of a highly performing athlete where the level of cardio-pulmonary activity is higher: the greater the stress, the higher the frailty. This is why resuming athletes who have been Covid + will need more attention from the medical staff. Surely in this period of resumption of activity there is the possibility of comparing the cardio pulmonary tests done at the beginning of the season with the current ones and, from here, to obtain the first indications. From the first data provided as regards the Italian football championship, there are no alterations or discrepancies in the tests.

Covid 19 is mainly manifested in a respiratory distress that originates mainly from the suffering of the interstitial tissue of the lungs, i.e. the elastic structure that allows the lungs to expand to receive oxygen, which can be complicated by the suffering of the arterial microcirculation inflamed by the immune reaction. This can lead to micro-embolisms. For overtly ill patients of any degree, if they are over the age of thirty, some temporary problems may even remain: a profound fatigue and increased muscle stress which can also be quite persistent. This condition could take several weeks to have a complete resolution. It follows that both performance and training capacity may not be adequate. Endurance athletes are therefore the ones who will suffer the most. From common sense and the history of other viral diseases, it is conceivable that Covid 19 can also leave a greater sense of fatigue for a determined period of time, which can also last months.

If it is true that data from all over the world, starting from China to the observations of the Italian Higher Health Institute on deaths in Italy indicate that the presence of cardiovascular comorbidities (hypertension or ischemic heart disease in the head) represent factors of specific risk in terms of mortality for patients hospitalized for Covid-19. It is equally undeniable that the infection directly induces a series of alterations in blood clotting. It is no coincidence that the data from the Higher Health Institute on deaths in Italy say that acute myocardial damage was observed in 11.6% of the deceased patients, confirming the cardiovascular involvement of the infection.
At a statistical level the only problems appear to be mainly of a psychological nature. They are not permanent after-effects, also considering that psychological diseases are never covered by an illness policy.

Many Premier coaches have found that 50% of their boys no longer sleep well. Brighton coach Graham Potter has picked up on some sleep issues: the interruption of the championship, the cancellation of the actual training and, in many cases, the isolation of the players, appears to have determined high psychological problems.
Prof. Craig Duncan, a scholar of sports performance who works for many football federations, reports as follows: “The real blow, for them, is that this time it is not an injury which brings with it an “expiration” date, i.e. a recovery and a return to activity but a disease which causes the end of the routine, i.e. that healthy succession of connected events such as nutrition, training “. Therefore, the fundamental activities of a typical day are missing.

At the City of Guardiola the work of Dr. David Young, appears to have increased: “We monitor even the smallest change. Which means receiving every day information from the players about their conditions: physiological and, if you like, spiritual. Those who pretend to be very well usually hide some more fear. In short, seeing black where white dominates, suspecting apparently less worrying cases “, says Young.

But we can only focus on what we see. The consequences of such a long and unexpected “lockdown” on sports professionals are unknown. The advice is not to focus on returning as: “This only adds anxiety to anxiety”, acknowledges Dr. Peter Olusoga of the University of Sheffield, called by some clubs to give an opinion (including United).

But that’s what almost everyone does: “Only in this case the questioning of the future is weighed down by an event that no one had ever experienced before”. Indeed two events: “The pandemic and the prolonged stop”.
To conclude, it is clear that to date, there are no data that can suggest concerns, with particular reference to any “permanent after-effects” that may be relevant when issuing a private insurance to cover professional athletes. Covid 19 disease certainly cannot fall within personal accident policies.

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