The Parallel Evolution of COVID-19 and Sport

Over the past 2.5 years, the world of sports has been dominated by COVID-19. Many of the challenges faced in global communities were mirrored in sport. For example, on the same day that the World Health Organization declared a pandemic, the National Basketball Association season was dramatically suspended just minutes before the tipoff in Oklahoma City. This heralded a seemingly endless series of cancelations or postponements of normal life activities and sporting events. The severity and duration of what was to come remained unknown. Since then, science has advanced the understanding of the transmission and clinical manifestations of COVID-19, broadened prevention techniques, and rapidly developed effective vaccinations and treatments. The widespread availability of COVID-19 vaccines and testing have restored a sense of normalcy, allowing fans to return to stadiums, workers to offices, and students to schools. However, frequent headlines of athletes being disqualified after testing positive for COVID-19 serve as reminders of the ongoing threat of COVID-19—from which even multiple boosters cannot guarantee protection—and that the impact of COVID-19 may be seen for years to come. In this month’s issue of Sports Health, several articles explore provocative issues related to COVID-19. Bullock et al describe epidemiologic findings from a multistate study within 176 high schools focused on injuries in the prepandemic year versus the initial year of COVID-19. They found that the injury incidence ratio increased by 1.3 times between the prepandemic and pandemic years, with similar incidence ratios in men versus women. This harks back to 2011, when an increased number of Achilles tendon ruptures were reported in National Football League (NFL) players after the 4-month lockout. The recent NFL public injury reports and Major League Baseball transactions database revealed similar increases in the rate of injuries during the modified 2020 seasons. The results of Bullock et al show that this trend is not unique to professional athletes. While extended interruptions in training and competition will hopefully not be a regular occurrence, a more gradual return to sport should be considered by high school athletes, parents, and coaches. Asín-Izquierdo et al conducted a systematic review of the physiologic effects of face mask use during exercise a highly relevant and thought-provoking topic in the sports community. While athletes may experience dyspnea, discomfort, or increased exertional effort, this study did not show a difference in oxygen saturation, blood pressure, or the concentration of blood lactate in those who used masks while exercising. Results suggest that masking during sport can be done safely. When assessing the extent of the impact of COVID-19 on the body and, subsequently, athletic performance, imaging plays an essential role. Rashidi and Fritz provide a narrative review of the spectrum of sports imaging in COVID-19 infection, systemic effects on organs, vaccine effects, and complications that could affect athletic participation. Specifically, they examine changes that may occur in the cardiovascular, musculoskeletal, neurologic, and respiratory systems, to appropriately utilize imaging modalities to improve patient outcomes. Finally, our team describes potential paths forward with regards to athletic participation and the future of COVID-19. As our knowledge of COVID-19 evolves, so too have our protocols for sports safety. Cycle threshold values, which once may have been discussed only among those in laboratory medicine and virology, are now a topic of debate by sports pundits. Inherent to return-to-play decisions are the risks that are willing to be shared between key stakeholders, which include consideration of risks to both the physical and mental health of athletes. While COVID-19 may have widened the chasm between individuals or groups with different political agendas, it has served to foster more collaboration in the sports medicine community. An example includes the examination of cardiac outcomes for collegiate athletes with COVID-19. Further collaboration is needed to fully combat the COVID-19 pandemic, along with its impact on the community and the sporting world.