If You Work With Elite Athletes, Covid-19 Mitigation Should Be a Top Priority
Elite athletes nearly always have short careers in their respective sports. There is a limited window for them to capitalize on their talents. Maintaining peak physical condition is the key to extending their high-performing and high-earning years. Health is the top priority — without it, everything else falls by the wayside.
In the early years of the Covid-19 Pandemic, major sporting events were canceled to protect athletes and fans. In unprecedented moves, the 2020 Wimbledon tournament was canceled, the Summer Olympic Games were pushed back a year from 2020 to 2021 and held without live spectators, and the 2020 NBA season was played inside a biosecure bubble. These mitigations were designed to prevent the transmission of SARS-Cov-2 (the virus that causes the disease Covid-19).
With the pandemic, a harsh reality crashed into the aura of invincibility many young athletes carry. They are supreme physical specimens and often have access to the best medical care. Even so, SARS-Cov-2 infections have derailed or even ended promising athletic careers. This article can’t go into all the potential deleterious effects Covid-19 can have on athletes, but here are some key factors to consider:
Cardiovascular Disease and Stroke
As early as 2020, it became clear that patients with Covid-19 had an increased risk of cardiovascular disease, including heart attacks, arrhythmia, and heart failure. Infection with SARS-Cov-2 may lead to myocarditis (inflammation of the myocardium, the middle and thickest layer of the walls of the heart), even in cases where Covid-19 symptoms were mild. The vascular system (veins and arteries) also becomes inflamed by infection with SARS-Cov-2. This, combined with the excessive blood coagulation seen with Covid-19, makes it more likely for blood clots to form and cause a stroke.
Vigorous exercise is strictly contraindicated for myocarditis, so, while an athlete has this condition, they must extensively limit or even completely stop their workout routine. Recent studies show that elite athletes can fully recover from Covid-19-induced myocarditis and return to training and competing. However, reservoirs of SARS-Cov-2 may linger in heart and vascular tissue, and the consequences for cardiovascular health years down the line are unknown.
Muscle Impairment
SARS-Cov-2 infection may lead to musculoskeletal deterioration diseases, a serious concern for elite athletes. People infected with Covid-19 are at a high risk of developing sarcopenia (loss of muscle and strength, usually associated with aging) and cachexia (a complex metabolic syndrome that results in loss of muscle mass). These conditions inhibit athletes’ ability to gain and maintain muscle mass. It may become impossible for some athletes to complete the strength training required for them to achieve high performance and prevent injury. Muscle pain is also common with SARS-Cov-2 infection as well as other musculoskeletal conditions ranging from skeletal muscle atrophy to Guillain-Barré Syndrome (a rare autoimmune condition that affects nerves and causes tingling and numbness).
Brain Damage
Covid-19 damages the brain and can lead to serious cognitive impairment and mental health issues. A common complaint of people suffering from Covid-19 is “brain fog” — an inability to concentrate that sometimes leaves them unable to complete simple tasks. This is caused, in part, by inflammation of the brain and blood vessels.
Covid-19 has been associated with increased risk of cognitive impairment, including accelerating the progress of dementia. These serious neurological issues may have significant effects on elite athletes who, depending on their sport, may be called on to make quick decisions in fast-paced settings that can be dangerous. There is highly specialized knowledge at work in making these quick decisions. The ability to think clearly is vitally important in these circumstances.
Increased Concussion Risk
The potential of long-term cognitive impairment from Covid-19 is greater in sports that have a high risk of concussions from blows to the head (e.g., boxing, mixed martial arts, tackle football). A study of high school athletes found that they had higher rates of concussion following Covid-19.
Covid-19 results in ongoing brain injury that may not be picked up by routine tests. As a result, it is important that concussion protocols in sports evolve to include tests for more blood markers of brain injury. A history of traumatic brain injury also makes it more likely that someone will have worse Long Covid symptoms.
Career-derailing/ending Long Covid
As early as 2020, some patients with Covid-19 were identified as “long-haulers.” They had lingering symptoms including brain fog, heart palpitations, high levels of fatigue, and, most important for elite athletes, extreme intolerance to exercise. These symptoms were sometimes debilitating, and previously healthy and active people became bedbound. These long-haul symptoms are often called Long Covid.
Long Covid is of particular concern for elite athletes because exercise worsens the condition and prolongs it. This isn’t something you can “push past” by outworking everyone else. You have to rest completely for several months and restart training very slowly. Exertion will keep you sick. This state of being is contrary to every instinct an elite athlete has, and it will take a lot of support and guidance to help them make the right decisions as they recover.
Compromised Immune System
Covid-19 damages the immune system. When we contract certain illnesses, our immune systems work hard to clear the infections. Afterwards, some components of the immune system are replenished. Others are not. We cannot fight off unlimited infections. The SARS-Cov-2 virus is highly transmissible, and we do not develop strong immunity to it. The vaccines cannot prevent transmission of the virus and do not provide complete immunity. It is possible to be infected with SARS-Cov-2 multiple times in relatively quick succession, even if you’re vaccinated. Each time you’re infected, you deplete your immune system.
More importantly, Covid-19 causes dysfunction of the immune system. In 2020, this was one of the more troubling discoveries about the disease. Covid-19 causes the overproduction of compounds that cause inflammation and exhausts vitally important components of the immune system. The immune system attacks the body, and its ability to fight off pathogens is compromised. This means people who have had Covid-19 are more likely to get sick and have more trouble clearing infections. The damage to the immune system is cumulative. Each SARS-Cov-2 infection makes a bad outcome more likely.
Frequent illness interrupts training and competition and may deny an elite athlete important opportunities to perform at their best. More importantly, a compromised immune system may eventually completely destroy a person’s health.
Loss of Insurability
It may be tempting to dismiss some of the concerns raised here and rely on the robust health of a young athlete to fight off Covid-19. However, actuaries have described the trends they are seeing as one-in-200-year events in the insurance industry. Insuring an elite athlete is a complex process that will continue to be impacted by their exposure to the SARS-Cov-2 virus and the effects of Covid-19. If the costs of insuring an elite athlete become too high, it may price them out of their market. In addition, the ravages of Covid-19 may make it impossible for an athlete to pass a physical. Some may become uninsurable.
The SARS-Cov-2 virus forms reservoirs in all the organ systems of the body, including the placenta of pregnant women. This indicates that there may be as yet unknown health issues that may emerge years down the line, if the virus is reactivated. For example, the varicella zoster virus, which causes chicken pox, may reactivate to cause shingles decades after the initial bout of the disease. In addition, follow-up studies of patients from the SARS pandemic of 2002–2004 showed that many did not recover from their post-infection health issues and were permanently disabled.
The Covid-19 Pandemic has been a mass disabling event, and the risk of becoming disabled increases with each infection. According to the World Health Organization, one in every ten SARS-Cov-2 infections will result in a condition that requires longer-term care. These aren’t great odds when it’s possible to contract the virus multiple times a year. The best way to avoid a bad outcome with Covid-19 is to avoid becoming infected.
There are currently no pharmaceuticals that prevent transmission of the virus. SARS-Cov-2 may evade the immunity provided by the vaccines, but it cannot get around the laws of physics. Well-fitted, high filtration masks are an important first line of defense. Air filtration in shared spaces can also nearly eliminate the virus from the air. This is only the beginning, though. The most important tool in the kit is cooperation.
Everyone encircling an elite athlete must be on the same page about preventing the spread of Covid-19. That requires planning, communication, and commitment. Protecting an athlete long-term may also require preventing them from training and competing so they have the best chance to recover fully from Covid-19. This can be a fraught situation in highly competitive environments where someone younger and talented is always breathing down your neck. However, rest (sometimes for months at a time) is vitally important for recovery.
This is part of a series on Covid-19 and industry that spun off from my upcoming new collection of essays with the working title Welcome to the Zombie Apocalypse: Notes on Collapse from the Covid-19 Pandemic.
