Young Athletes in the Light of New Threats
At the end of 2019 few expected a new coronavirus – SARS-CoV-2 – whose outbreak appeared in Wuhan, China, would significantly affect the world population. After the World Health Organisation (WHO) announced a pandemic in March 2020, there was concern about patients who suffer from chronic diseases, including those with respiratory symptoms. Due to the on-going phase of the pandemic at the time of writing, we are likely to see many new research developments. In this section, we discuss a few early results.
Presently there is no evidence that asthma in children is a risk factor for infection with coronavirus disease 2019 (COVID-19). However, symptoms of COVID-19 can mimic asthma exacerbation, including dry cough and shortness of breath. Fever, which commonly occurs in COVID-19, could be a differentiating factor from asthma exacerbation. Furthermore, epidemiologic information such as travel history and possible contact with infected persons should be considered. From the limited data from the United States, children with symptoms of asthma should continue therapy. This approach is supported by the statement of the Global Initiative for Asthma (GINA), the Centers for Disease Control and Prevention and the North American Consensus Guideline on Allergy Care. Additional recommendations include frequent handwashing, apply the principle of social distancing, and avoiding airborne allergens.
Special attention should be paid to athletes whose sports plans were cancelled or postponed by this pandemic, including those with EIB and asthma. There is currently no data available on prevalence, nature and behavior of COVID-19 in athletes.
Consequences of isolation favor increased sedentary behaviors, lack of communication among athletes and coaches, and an insufficient amount of exercise. Negative lifestyle changes can lead to inappropriate nutrition and an increase in body fat, which affects both physical and mental health. There is a global consensus that the beneficial effect of regular physical effort at moderate volume and intensity is associated with decreased risk of respiratory infections. A sedentary lifestyle poses a greater threat to athletes who depend on daily exercise. The restrictions put in place by governments to prevent spread of COVID-19, limit athletes’ ability to train. At the time of writing COVID-19 symptoms reported in pediatric patients are relatively mild with recovery lasting 5-7 days. Nevertheless, a prolonged rest period for such patients is recommended.
Jukic et al. offer strategies and solutions for athletes during the COVID-19 pandemic. Firstly, they recommend encouraging athletes to re-adapt their approach to isolation as an opportunity for “personal development.” Secondly, by using the proper technology, athletes should be supported and be in constant contact with experts, such as coaches, nutritionists, physicians and psychologists. Adequate equipment should be provided at the athletes’ living conditions, such as cardio equipment (e.g. treadmill, bicycle), resistance training equipment (e.g. dumbbells, elastic or medicine bands), and other techniques, which the athlete can use to support exercise (e.g. mats, foam rollers). Alternative sports skills training should be considered (e.g. kinesthetic ball training in small space). The physician’s role is to educate athletes about nutrition, supplementation, and hydration, and also to encourage “preventive behaviors” (e.g. washing hands, social distancing). Every athlete should use forms of self-assessment and establish daily monitoring by the use of modern technology28.
To summarize, athletes should comply with limitations and apply strategies that will allow them to maintain an appropriate level of physical exertion. Those, who have asthma symptoms should remain on their current medication and introduce detailed control over the treatment. More research will be required to help improve these guidelines in the coming months29,30.