Number Of Acute Symptoms In Athletes With SARS-CoV-2 Associated With Prolonged Return To Full Performance

OBJECTIVE: The study aims to identify factors associated with prolonged time to return to full performance (RTFP) in athletes with recent SARS-CoV-2 infection. METHODS: Prospective cohort study with cross sectional analysis. 84 athletes with confirmed SARS-CoV-2 infection assessed at a COVID-19 recovery clinic gave a history of: age, sex, type/level of sport, co-morbidities, pre-infection training hours and 26 acute SARS-CoV-2 symptoms from 3 categories (“nose and throat”, “chest and neck”, “whole body”). Data on days to RTFP were obtained by structured interviews. Factors associated with RTFP were: demographics, sport participation, history of co-morbidities, pre-infection training history, acute symptoms (type, number). Outcomes were: 1) days to RTFP [median (interquartile range-IQR)] in asymptomatic (n = 7) and symptomatic athletes (n = 77), and 2) hazard ratios (HR; 95%CI) for athletes with vs. without a factor (univariate, multiple models). HR < 1 was predictive of higher % chance of prolonged RTFP. Significance was p < 0.05. RESULTS: Days to RTFP were 30 (23-40) for asymptomatic and 64 (42-91) for symptomatic participants (p = 0.026). Factors associated with prolonged RTFP (univariate models) were: females (HR = 0.57; p = 0.014), endurance athletes (HR = 0.41; p < 0.0001), co-morbidity number (HR = 0.75; p = 0.001), respiratory disease history (HR = 0.54; p = 0.026). In symptomatic athletes, prolonged RTFP (multiple models that included significant co-variates) was significantly associated with increased total number of “all symptoms” (HR 0.91; p = 0.001), “whole body” (HR = 0.82; p = 0.007), “chest and neck” (HR = 0.85; p = 0.017) and “nose and throat” (HR 0.84); p = 0.013) symptoms. CONCLUSION: Larger number of total symptoms and specifically “whole body” symptoms during acute phase of SARS-CoV-2 infection in athletes, is associated with prolonged RTFP.