Symptom Number and Reduced Pre-infection Training Predict Prolonged Return to Training after SARS-CoV-2 in Athletes: AWARE IV.

PURPOSE: To determine factors predictive of prolonged return to training (RTT) in athletes with recent SARS-CoV-2 infection. METHODS: Cross-sectional descriptive study. Athletes not vaccinated against COVID-19 (n = 207) with confirmed SARS-CoV-2 infection (predominantly ancestral virus and beta-variant) completed an online survey detailing the following factors: demographics (age, sex), level of sport participation, type of sport, co-morbidity history and pre-infection training (training hours 7 days pre-infection), SARS-CoV-2 symptoms (26 in 3 categories; "nose and throat", "chest and neck", and "whole body") and days to RTT. Main outcomes were hazard ratios (HR; 95%CI) for athletes with vs. without a factor, explored in univariate and multiple models. HR < 1 was predictive of prolonged RTT (reduced % chance of RTT after symptom onset). Significance was p < 0.05. RESULTS: Age, level of sport participation, type of sport and history of co-morbidities were not predictors of prolonged RTT. Significant predictors of prolonged RTT (univariate model) were (HR;95%CI): female (0.6;0.4-0.9; p = 0.01), reduced training in the 7 days pre-infection (1.03;1.01-1.06; p = 0.003), presence of symptoms by anatomical region [any "chest and neck" (0.6; 0.4-0.8; p = 0.004) and any "whole body" (0.6; 0.4-0.9; p = 0.025)], and several specific symptoms. Multiple models show that the greater number of symptoms in each anatomical region (adjusted for training hours in the 7 days pre-infection) was associated with prolonged RTT (p < 0.05). CONCLUSIONS: Reduced pre-infection training hours and the number of acute infection symptoms may predict prolonged RTT in athletes with recent SARS-CoV-2. These data can assist physicians as well as athletes/coaches in planning and guiding RTT. Future studies can explore whether these variables can be used to predict time to return to full performance and classify severity of other acute respiratory infection in athletes.

The incidence and transmission of SARS-CoV-2 infection in South African professional rugby players - AWARE II.

OBJECTIVES: To describe the incidence and transmission of SARS-CoV-2 infections in South African professional rugby union players in different phases of return-to-competition during a pandemic. DESIGN: Prospective cohort study. METHODS: Players reported their history of SARS-CoV-2 infection before/during a national competition, using an online questionnaire (physician verified). Three periods of return to training/competition after a nation-wide complete lockdown during a pandemic were studied: 1) non-contact training, 2) contact training, 3) competition. The total period was 184 days (20/07/2020-20/01/2021) including 45 matches. Outcomes were: 1) incidence of SARS-CoV-2 infection (I: per 1000 player days; 95%CI) in each period (calculated using a Poisson distribution), 2) player symptoms, 3) median days to return-to-training following SARS-CoV-2 infection, 4) method of transmission, and 5) percentage matches cancelled due to SARS-CoV-2 infections. RESULTS: 185 players had 42 physician verified positive SARS-CoV-2 infections (I = 1.23; 95%CI: 0.86-1.61). Incidences during the three periods were: non-contact training = 0, contact training (I = 1.04; 0.36-1.71; mostly forwards), and competition (I = 1.54; 1.00-2.10). 83 % of the infected players were symptomatic and 52 % of the 42 positive players had systemic symptoms. Median return-to-training was 14 days. 22 (52 %) SARS-CoV-2 infections were rugby-related: 13 off-field (31 %), 9 on-field (21 %). 11 % of matches were cancelled due to SARS-CoV-2 infections. CONCLUSIONS: As contact in rugby was introduced back into the game following lockdowns there was an increasing incidence of SARS-CoV-2 infection. On-field rugby activities were responsible for 21 % of SARS-CoV-2 infections and 11 % of matches had to be cancelled, indicating the need for risk mitigation strategies.

Medical care and first aid: an interassociation consensus framework for organised non-elite sport during the COVID-19 pandemic.

The cessation of amateur and recreational sport has had significant implications globally, impacting economic, social and health facets of population well-being. As a result, there is pressure to resume sport at all levels. The ongoing prevalence of SARS-CoV-2 and subsequent 'second waves' require urgent best practice guidelines to be developed to return recreational (non-elite) sports as quickly as possible while prioritising the well-being of the participants and support staff.This guidance document describes the need for such advice and the process of collating available evidence. Expert opinion is integrated into this document to provide uniform and pragmatic recommendations, thereby optimising on-field and field-side safety for all involved persons, including coaches, first responders and participants.The nature of SARS-CoV-2 transmission means that the use of some procedures performed during emergency care and resuscitation could potentially be hazardous, necessitating the need for guidance on the use of personal protective equipment, the allocation of predetermined areas to manage potentially infective cases and the governance and audit of the process.