What is COVID-19?
Coronavirus disease 2019 (Covid-19) is a disease caused by a virus (the severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) that progressed rapidly into a pandemic this year.1 First identified in Wuhan, the capital city of China’s Hubei province, it has now spread globally. It has led to the postponement of the Tokyo Olympic Games and countless other sports events.
COVID-19 can cause a cough, fever (temperature > 37.8° C), fatigue, shortness of breath, and other symptoms.2 It is highly contagious, which means that it easily spreads from person to person. It does so mainly by coughing, sneezing and close personal contact.
What are the consequences of COVID-19?
Lockdown and physical distancing
Most countries implemented varying levels of ‘lockdown’ measures, such as closing schools, universities, all non-essential workplaces, and enforcing ‘stay at home’ measures among citizens. These further included banning all social gatherings (including sports events) and advocating a policy of ‘social distancing’ (or physical distancing). There is a good scientific rationale for doing this.3Table 1 What are social distancing measures 4
- Advising the population to self-isolate at home if they or their family have symptoms
- Bans on social gatherings (including mass gatherings)
- Suspending flights and public transport
- Closure of “non-essential” workplaces (beyond the health and social care sector, utilities, and the food chain) with continued working from home for those who can
- Closure of schools, colleges, and universities
- Prohibition of all “non-essential” population movement
- Limiting contact for special populations (e.g., care homes and prisons)
Mental and psychological impact on all of us
We have all been affected by these measures that essentially aim at “flattening the curve”: slowing down the infection rate to allow medical facilities to cope with the number of COVID-19 patients. It is already almost a cliché to say: “How much has changed in a few weeks?” or “I hope you and your family are safe…?” or “Do you have lockdown blues/cabin fever like me?” Clichés or not—it is true!
We don’t necessarily say it to each other so much anymore, but we all feel it: everything is different. Everything will be different—for all of us, and it can make us sad, anxious, and unsure. Researcher have recently searched the medical literature and highlighted a number of stressors affecting people during quarantine.5 Many of these may also apply to the current lockdown measures: (1) duration of quarantine, (2) fears of infection, (3) frustration and boredom, (4) inadequate supplies, (5) inadequate information.
Changes to daily routines: training, competitions, and access to services
Part of “the previous normal” for athletes was daily (team) training sessions and travelling to training camps, matches, or competitions. The daily routine was eating a healthy athlete’s diet, sleeping well to recover well, and contact with others—on the sports field, in the massage room, and talking to teammates or friends over lunch. “The new normal” is Zoom or other videoconferencing contacts. Videoconferencing training sessions. Videoconferencing classes. Videoconferencing Pilates. Videoconferencing fatigue…
Competitions are important driving forces in the lives of athletes and provide the motivation and goals to focus training effort. Preparing for the big one: the Olympic Games, World Cups, Diamond Leagues, Premier League, Boston Marathon, Iron Man… This has all changed. With the lack of clarity over future competitions, the focus of training and staying at home has switched to the maintenance of fitness and focus on various other aspects.
Many athletes find it difficult to access sports medicine services. Regular clinics for non-urgent care have mostly been postponed or are taking place via teleconsultation.
A flood of information
“The new normal” is the flood of information packaged as ‘important facts’—real facts, fake facts, helpful facts, irrelevant facts, funny facts… An infodemic.6 This can be overwhelming and frustrating.
What can you do about all this?
Melissa Miller, a scientist at the Scripps Institution of Oceanography, works on research vessels that often cruise for months. She provides wonderful insights into self-isolation emphasising the importance of human contact, physical activity, sharing responsibilities, organising time, and the fact that ‘a good cry to release frustration is healthy’.7
Protect yourself and others
Wash your hands regularly with soap and water and for 20 seconds at a time. Wear cloth masks in public and when you are training.8,9 Keep proper physical distance—in public spaces and also when training. The recommended physical distance of 2 meters might be significantly more the faster you go: 10 m for runners and 20 m for cyclists or wheelchair athletes.
Keep a routine and stay in touch with loved ones, friends, and teammates
The ability to communicate with one’s family and friends is essential to ease the burden of quarantine or lockdown measures. Many teams motivate each other by staying in touch through WhatsApp groups and virtual training sessions. It is important to plan a daily and weekly routine and stick to it. Involve others to co-create enjoyable habits.
Stay healthy
Aspetar’s Covid-19 ‘Wellness Tips’ are: “Live smart, Eat smart, Train Smart”.10 (Figure 1) Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, provides excellence in clinical sports medicine care to all our patients. These are international and professional athletes, club athletes, recreational athletes, weekend warriors, and patients pursuing a more active lifestyle for health.
COVID-19 forced us to rethink how we do this. While continuing to provide on-site urgent care, we implemented a range of eHealth services to patients and clinicians: telephone follow- up consultations, telerehabilitation, online education, and webinars. Make sure to use opportunities in your area to access sport medical services.
Stay fit, avoid detraining, and work with your coach
It is important for professional athletes to minimise the effects of possible detraining. Maintain some form of fitness-, strength- and skills training if possible.11 This is athlete- and sport-specific—all athletes should work closely with their coach to plan and monitor their individual training programmes while in lockdown or quarantine.
Protect yourself from the flood of information
The Aspetar Covid-19 Evidence for Athletes Service is an initiative to help athletes to cope with the flood of information.12 We provide easy access on Aspetar’s website to evidence-based information and guidance on the COVID-19 pandemic to athletes and those involved in athlete (health)care.10 The evidence team behind this resource includes individuals from Aspetar, the Aspire Zone Foundation, and many collaborating international individuals and institutions.
The Aspetar COVID-19 Evidence for Athletes Service includes:
Athletes’ questions: We asked (and continue to ask) athletes and coaches what they want to know about the COVID-19 disease and pandemic. We catalogue these questions, rephrase them where necessary and synthesise the best evidence to answer them. These answers are easily accessible, with “bottom line” short answers and infographics.
Education material: This section contains education material (infographics, videos, leaflets, and blogs) which have been reviewed by Aspetar’s evidence team. Here is an example of a video: “What athletes should do about coronavirus (Covid-19)”. External collaborators also contribute education material.
Scientific papers: Scientific information relevant to sports practitioners, athletes, and coaches is identified, assessed, and linked to the website to facilitate its access.
Important resources: Important resources include institutional websites where you receive generic guidance and daily updates on the situation worldwide and in specific countries. Examples include public health institutions such as the World Health Organisation, Academic Institutions (e.g., The Centre for Evidence-Based Medicine at the University of Oxford), Sports Organisations and Scientific Repositories (e.g., Evidence Aid, BMJ, NEJM, The Lancet) providing up-to-date information on the COVID-19 pandemic.
Athletes’ stories: This part of the portal collects stories from athletes and we have included a dedicated email address for athletes to reach out and share their stories:
Repository of local and international news: We provide a repository of relevant local and international COVID-19 news relevant to athletes in this section.
References
- Bi, Q. et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect. Dis. S1473309920302875 (2020) doi:10.1016/S1473-3099(20)30287-5.
- Hull, J. H., Loosemore, M. & Schwellnus, M. Respiratory health in athletes: facing the COVID-19 challenge. Lancet Respir. Med. S2213260020301752 (2020) doi:10.1016/S2213-2600(20)30175-2.
- Lewnard, J. A. & Lo, N. C. Scientific and ethical basis for social-distancing interventions against COVID-19. Lancet Infect. Dis. (2020) doi:10.1016/S1473-3099(20)30190-0.
- Douglas, M., Katikireddi, S. V., Taulbut, M., McKee, M. & McCartney, G. Mitigating the wider health effects of covid-19 pandemic response. BMJ m1557 (2020) doi:10.1136/bmj.m1557.
- Brooks, S. K. et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395, 912–920 (2020).
- Zarocostas, J. How to fight an infodemic. The Lancet 395, 676 (2020).
- Miller, M. T. Self-Isolation? I’m an Expert. Scientific American Blog Network https://blogs.scientificamerican.com/observations/self-isolation-im-an-expert/.
- Greenhalgh, T. Masks for the public: laying straw men to rest. doi:10.22541/au.158809415.52483068.
- Greenhalgh, T., Schmid, M. B., Czypionka, T., Bassler, D. & Gruer, L. Face masks for the public during the covid-19 crisis. BMJ 369, (2020).
- Aspetar – Overview. Aspetar http://www.aspetar.com/Overview_Covid19.aspx?lang=en.
- Eirale, C. et al. Medical recommendations for home-confined footballers’ training during the COVID-19 pandemic: from evidence to practical application. Biol. Sport 37, 203–207 (2020).
- Dijkstra, H. P. et al. Can I trust the messenger and their advice? The Aspetar COVID-19 Evidence for Athletes Service | BJSM blog – social media’s leading SEM voice. https://blogs.bmj.com/bjsm/2020/04/20/can-i-trust-the-messenger-and-their-advice-the-aspetar-covid-19-evidence-for-athletes-service/.
Profile
Dr. Paul Dijkstra, Director of Education and Sports Medicine Physician, Sofie Nelis, physician and PhD candidate, and Dr. Marco Cardinale, Executive Director of Research and Scientific Support, have jointly written this blog for Aspetar.
¹ Aspetar, Qatar Orthopaeadic and Sports Medicine Hospital, in Doha, Qatar. Visit the Aspetar website to learn more about this unique institute.
Author Profile
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Dr. Paul Dijkstra, Director of Education and Sports Medicine Physician, Sofie Nelis, physician and PhD candidate, and Dr. Marco Cardinale, Executive Director of Research and Scientific Support, have jointly written this blog for Aspetar Qatar Orthopaedic and Sports Medicine Hospital, in Doha, Qatar. Visit the Aspetar website to learn more about this unique institute.
