What investigations should we consider including in a post-COVID-19 pre-competition medical assessment?

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Reflecting infection rates among the general public, an increasing number of elite and professional players are being found to have contracted COVID-19. Given that various cardiorespiratory complications have been reported following infection, it is suggested that a comprehensive cardiovascular and respiratory assessment should be carried out prior to return to play. What this assessment should involve, and which players should have this assessment, is not known. The aim of this study from the British Journal of Sports Medicine is to try to evaluate the utility of some of these screening tests.

It has been suggested that players who have contracted COVID-19 may be at an increased risk of a variety of adverse health outcomes. It has been documented among patients who have been hospitalised that this infection, in addition to causing an acute respiratory syndrome, can cause myocarditis, myocardial damage, acute coronary syndromes, arrhythmias and thromboembolic diseases. As a result of these potential problems it has been suggested that before resuming activity, players should have a medical assessment to try to determine whether it is safe to return to training and competition. It is currently not clear whether those who have had less severe symptoms, or indeed have been asymptomatic, are also at risk of these cardiorespiratory complications nor what the ideal pre-competition assessment should look like.

This study included a small sample of male professional players, some of whom who had tested positive for SARS-CoV-2 but who were either asymptomatic or who experienced mild symptoms. None of the players in this group had suffered from a more significant illness. A total of 30 male professional players were included in the study, 18 whom had tested positive for COVID-19. To be included in the COVID-19 group a player needed to be negative for IgM class antibodies and have positive IgG class antibodies. Tests were done at least 15 days from clinical resolution. Players who were IgM positive were required to self-isolate and have a further test. Data obtained during the post-infection assessment was compared with the player’s own pre-infection baseline and with data from the control group of players who had not contracted the virus. The screening assessment included a clinical history, antigen swabs, blood tests, spirometry, resting/stress-test ECG with oxygen saturation monitoring, echocardiogram, Holter and chest CT.

The main finding of the study was that there was no significant difference between the COVID-19 positive and COVID-19 negative players in terms of the data from spirometry, stress-test ECG and ECHO. Players in the COVID-19 positive group showed a statistically significant reduction in almost all spirometry parameters after infection. It should be noted that there was also a reduction among the COVID-19 negative group and that the other respiratory tests were normal. As a result it was suggested that this finding was more likely to relate to a period of de-training, rather than the effects of the infection.

The results of this study are somewhat reassuring and suggest that an extensive cardiovascular and screening battery may not be needed for all players following COVID-19 infection. The study’s authors recommend that a standard pre-competition medical assessment should be completed and that additional tests should be arranged on a case by case basis, for example where there is documented evidence of myocardial damage. It is however important to recognise that the study included a very small sample only and that further data is needed.

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References
1. Gervasi SF, Pengue L, Damato L, et al Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection? British Journal of Sports Medicine Published Online First: 05 October 2020. doi: 10.1136/bjsports-2020-102789

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bassam gwhrh
18 October 2020 5:00

Frequent examination and constant monitoring are among the most important reasons why the injury does not return