key: cord-0832412-74r1pb3o
authors: Maolin, You; Heng, Liu; Zijing, Wu
title: The Spread of COVID-19 in Athletes
date: 2021-08-25
journal: Sci Sports
DOI: 10.1016/j.scispo.2021.03.012
sha: 6ee4fde3b219b0039df5d4c9e23c294f3e155810
doc_id: 832412
cord_uid: 74r1pb3o

Background/ Objectives: According to the reported cases, more than 100 athletes were infected with severe acute respiratory syndrome coronavirus 2 in March 2020 alone, and this has created an increased interest in the effect of coronavirus disease (COVID-19) on athletes. This promoted us to study the spread of COVID-19 in athletes and formulate prevention strategies. Methodology: We collected and analyzed the demographic information, such as nationality, sex, age, name, sport played, sport level, source and cause of infection, date of symptoms onset or confirmation of positive status, date of recovery, location of infection contraction, symptoms, and the people infected by the contracted athletes, of 521 infected athletes worldwide, as of the end of July, 2020. Results: The cohort comprised 95.49% male athletes; 57.2% were aged 19–35 years, with the average age 23 years. Most of these cases emerged in March 2020 (27.3%) and June 2020 (30.1%), 90.8% of cases were active athletes and 74.2% were professional players, 45.2% of infected athletes exhibited mild symptoms and 30.6% of them were asymptomatic; however, 23.1% of the cases died, including cases aged less than 40 years. Most infected athletes represented soccer (46.6%), football (15.9%), and basketball (10.9%). Most of the infected athletes were from the United States, Western Europe, and Eastern Asia. The athletes primarily contracted the infection in the United States, Western Europe, and Japan. The spread of COVID-19 in these athletes primarily occurred during training- and game-related activities. More than 60% of the infected athletes were unaware of their source of infection. Conclusion: It found that the halting of training and matches, isolation of athletes at home, and timely testing can effectively control the spread of COVID-19 among athletes, and it is recommended that athletes discontinue international travel, especially to countries with a high epidemic risk.

Many people expect athletes to be strong and healthy enough to fend off being infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1] .

Unfortunately, more than a hundred athletes were found to be infected with this virus in March 2020 (N=140, 87.77% were men and 12.23% were women; they were from 30 countries, most of them were American(21), Italian(11), Chinese(11), Germen(8), British(7); they were infected in 24 countries, most of them infected in America(29), Spain(20), Italy(20), Britain(19),German(9); they aged from 14 to 95, 46.43% of them aged from 19 to 35; 57 cases reported their symptoms, 44 of them were milt and 3 were dead) and this has created an increased interest in the effect of J o u r n a l P r e -p r o o f coronavirus disease (COVID-19) on athletes.

Some studies have explained the effects of this virus in athletes, [ 2] proposed suggestions for the prevention of COVID-19 in athletes, [3] and further suggested that athletes should participate in low-to-moderate-altitude (2000-2500 m) training camps to preserve their health after the COVID-19 pandemic [4] . While there have been many discussions with respect to the effect of COVID-19 on athletes, [5] we still do not understand how this virus is spreading in this group of individuals.

In the light of the spread of COVID-19 among athletes, it is important to develop strategies to protect the health of both athletes and the public and propose guidelines for professional sport leagues as they restart their games and for national sport teams as they commence preparation for Tokyo Olympic Games.

521 COVID-19-positive athletes were identified as of July 2020. These cases do not represent all of the infected athletes, but athletes are the public persons, most of the infected athletes would be officially or individually reported. With the main search engines Baidu, Google, and Bing, it can be ensured that we collected most of the infected athletes worldwide before August 2020, and this study can generate valuable findings. The search terms used were "运动员," "球员," "athlete," "player," and "COVID-19." The collected information regarding nationality, sex, age, name, sport played, sport level, the source and cause of infection, date of symptoms onset or confirmation of positive status, location of infection contraction, symptoms, and J o u r n a l P r e -p r o o f people infected by infected athletes.

A distribution map of the infected athletes and the locations where they contracted the virus was generated using ArcGIS 10.2 (Esri, Redlands, CA, USA).

Descriptive statistics such as frequency and percentages were determined to assess the demographics of the infected athletes using SPSS 19.0 (IBM Corp., Armonk, NY, USA). The graphs were drawn to visualize the statistical figures using Excel 2003 (Microsoft, Redmond, WA, USA).

The study sample comprised 95.53% men; the ages ranged from 14 to 99 years, the average age was 23 years, and 57.2% of the population was aged 19-35 years. In total, 90.8% of the sample comprised active athletes and 74.2% of them were professional players, followed by college athletes (17.4%), and national athletes (7.8%). There were few youth athletes (0.4%) and amateur athletes (0.2%).

Furthermore, 45.2% of the infected athletes exhibited mild symptoms (the typical symptoms include fever, dry cough and shortness of breath) and 30.6% were asymptomatic; however, 23.1% of the infected athletes died. These athletes represented 31 different sports, with the three most common sports being soccer (46.6%), football (15.9%), and basketball (10.9%).

Page 7 of 19 J o u r n a l P r e -p r o o f It found that most of the infected athletes were from the regions with more serious epidemic (Figure 1) , and contracted in theses regions ( Figure 2) . First, the earliest reported case was a Chinese on January 26, 2020, then China was the epidemic center. Second, 79.95% of the infected athletes reported were from the USA (37.02%), Brazil (7.46%), Japan (6.43%), France (5.4%), England (4.88%), Italia (4.63%), Russia (3.08%), Spain (3.08%), China (3.08%), Serbia (2.83%) and

German (2.06%). Third, 81.15% of them contracted the disease in the USA (39.73%), Spain (7.68%), Italia (7.1%), England (6.91%), Brazil (6.72%), France (5.18%), Japan (4.99%), and Russia (4.22%). The findings indicate that the distribution of infected athletes with respect to the different countries and regions was consistent with the spread of the disease locally. 

A major cause of the spread of the virus in athletes can be the hosting of sports events (e.g., the NBA and Olympic-qualifying events), which created favorable conditions for the infection. For example, when an infected South Korean fencer participated in an Olympic-qualifying fencing event held in Hungary in May 2020, 

Are athletes more resistant to COVID-19? Chinadaily

What athletes need to know about COVID-19

Coronavirus disease 2019 (COVID-19): Considerations for the competitive athlete. Sports Health-A Multidisciplinary Approach

Recommendations for altitude training programming to preserve athletes' health after COVID-19 pandemic