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COVID-19 and Safety in Sport

Following on from our blog “The return of professional sport – who is responsible for ensuring players’ safety?Emma Hall discusses how to ensure the safety of athletes as some sports resume and others are still resting because of the COVID-19 pandemic.

Footballer in empty stadium
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Emma Hall is a solicitor who specialises in product liability and medical device injury claims on behaf of injured clients. 
As we discussed in our previous blog, formal guidance has been put in place for the Premier League Clubs to adhere to, to ensure player safety and to prevent further transmission of the virus.
 
It was of concern that, at the time that the news was released by the Football Association, at least five Premier League players had already tested positive for the virus. By 3 June 2020, that figure had increased to nine.
 
However, whilst the return of Premier League action which resumed on 17th June 2020 was initially met with delight, especially from supporters, it would seem that the Football Association has already suffered a setback, with the news that Michael O’Neill, manager for Stoke City, has tested positive for COVID-19.
 
As such, a planned ‘friendly’ match which was due to take place on 9 June 2020 between Stoke City and Manchester United was called off at the last minute. It is interesting that, in the previous five rounds of testing, O’Neill tested negative for the virus.
 
In addition to this, on 3 June 2020 it was confirmed that a Tottenham Hotspur player tested positive for COVID-19. Spurs were due to play their first match again Manchester United on Friday 19 June 2020. The match is still expected to go ahead as planned, although this will presumably only be the case if no further players test positive.
 
When the FA confirmed that the Premier League would be resuming, many players, coaches and clubs alike raised concerns about this.
 
After all, the daily death rate for COVID-19 is still in the hundreds and the government is still concerned about the ‘R’ rate and the potential for a second peak.
 
However, it would appear that despite these concerns and the fact that more players have tested positive for the virus in the last 14 days, the FA is still confident that the guidelines it has in place offer enough safety and protection to players, referees, coaches and physios.
 
It remains to be seen whether all of the planned matches will go ahead, or whether we will see a rise in the number of players testing positive for the virus.
 
And what of those players and athletes (in all sports) who have tested positive for COVID-19 already?
 
Whilst it is expected that they will follow government guidelines and self-isolate for 14 days, what will then come of their professional career?
 
For those who are fortunate enough to experience mild symptoms or even no symptoms at all, they may be lucky enough to return to play without any resulting difficulties within a matter of weeks.
 
But those who suffer moderate or severe symptoms are unlikely to be as lucky. Indeed, it is well-known that the COVID-19 virus primarily affects the lower respiratory tract, with studies reporting that some patients who had recovered from the virus had lost up to 30 per cent of their previous lung function.
For a professional athlete, such a reduction would have a significant impact on their fitness, and it is unclear whether this would improve over time with careful treatment and a phased return to training.
 
For those who experience moderate to severe symptoms of the virus, there is a significant risk that they may never return to their previous levels of fitness and indeed, may never return to competitive sport again.
 
One of the lesser known injuries caused by a severe reaction to COVID-19 is cardiac injury, or damage to the heart.
 
Viral myocarditis (a known consequence of COVID-19) can cause sudden death in five per cent to 22 per cent of athletes under the age of 35.
 
Recent guidance therefore suggests that, even if an athlete tests positive but is asymptomatic, they should avoid doing any exercise for at least two weeks.
 
After this period of rest it is recommended that all patients undergo screening cardiology tests to ensure that they are fit to return to play.
 
Those who suffer moderate symptoms should wait until their symptoms have resolved and then wait at least two weeks before returning to play. If any athlete is unlucky enough to develop viral myocarditis as a result of suffering COVID-19, guidelines suggest that they may not return to training for at least three  to six months.
 
Any athlete who is out of regular training and play for a significant length of time has to consider the risks of returning to the sport full-time.
 
Even in cases where COVID-19 is not an issue, many athletes have been unable to properly train since COVID-19 social distancing measures were put in place by the government.
 
Whilst many players are likely to have maintained some level of fitness whilst in lockdown, they have not been able to engage in full training under the watchful eye of their coach and physio. 
 
Many competitive sporting events such as the Olympic Games and Invictus Games have been postponed until next year which will hopefully allow athletes sufficient time to recover to their previous levels of fitness, but the wider impact of this hiatus from training is still to be seen.
 
It seems clear therefore that the prospect of an athlete developing a severe injury due to lack of proper training is a very real and likely risk. 
 
Many such injuries can be dealt with simply by resting and attending regular physiotherapy, however some injuries, such as tendon tears, torn ACLs or even fractures, can render an athlete unable to train or engage in their sport at a competitive level for the foreseeable future. 
 
In the worst case, they may never be able to return to competing in their sport at a professional level, which would be unimaginable for many professional athletes who are at the top of their game. 
 
It seems clear therefore that not only do the Club / Team doctors have an important part to play in protecting their athletes from the transmission of COVID-19 and the long-lasting effects of the  virus, they also have a significant role to play in ensuring that the athletes have sufficient knowledge and support on injury-prevention and how to return to training competitive sport in a safe and protected manner.
 
We cannot and should not ignore the health, social and economic benefits that are associated with the return of professional sport.

However, the decision to resume competitive sports must be met with caution and appropriate measures must be put in place to protect the safety of athletes, not only from COVID-19 but from all other injuries which could cause significant impairment and damage to their health, life and livelihood.

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