1. In this study, the vast majority of athletes exhibited mild or no acute COVID-19 symptoms, with only a small proportion experiencing persistent symptoms.
2. Current evidence does not suggest a causal relationship between COVID-19 and myocardial involvement.
Evidence Rating Level: 1 (Excellent)
Although the prevalence of COVID-19 among athletes is unknown, these low-risk individuals may still be at risk for post-acute complications which may in turn affect return to play protocols. Presently, there is a lack of understanding of the acute and post-acute COVID-19 manifestations in athletes. As a result, the objective of this study was to summarize the available evidence with respect to acute and post-acute COVID-19 infections in athletes.
Of 3344 identified studies, 43 (n=11 518) were included in the analysis from 2019 to January 2022. Observational studies were eligible if they included amateur, collegiate or professional athletes with COVID-19 who had symptoms/sequalae during and after the acute phase of infection. Studies that investigated the relationship between physical activity levels and COVID-19 symptoms were excluded. The primary outcome was acute and post-acute COVID-19 symptoms; the secondary outcome was myocardial involvement. The risk of bias was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Pooled estimates were obtained using random-effects models.
Results demonstrated that the vast majority of athletes (~94%) exhibited mild or no acute COVID-19 symptoms, with only a small proportion experiencing persistent symptoms (e.g. anosmia/dysgeusia, cough, fatigue, chest pain, headache). Furthermore, no causal relationship between COVID-19 and myocardial involvement was identified. However, the study was limited by the fact that most studies did not identify potential confounders. Despite this, the results of this study provide an early understanding of the effects of acute and post-acute COVID-19 symptoms experienced by athletes and could impact return-to-play decisions and timing.
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