IOC Medical COVID-19 Hub

This IOC Medical Covid-19 hub has been created to help support staff provide good medical care of Olympic athletes. Over a year ago, the IOC brought together an international group of experts in respiratory illnesses to develop a Consensus statement on Acute respiratory illness in athletes led by Martin Schwellnus from South Africa.

The consensus group was divided into six sub-groups to cover different aspects of acute respiratory illness. A seventh subgroup has now been established focusing on COVID-19 to help medical support teams cope with the demands of the new situation. The IOC has created a large team primarily from the IOC research centres and representatives from International Federations to work on COVID-19 Scientific Evidence for Athlete management.

The IOC realises the challenges of finding, studying, and acting on the flow of current information. This hub will help all those involved in athlete care to decide whether news is real or fake and whether supposed scientific break-throughs are based on real data or are hypothetical extrapolations.

The IOC Medical COVID-19 Hub content will be a combination of the following:

  1. A repository of scientific advice, communications, links and relevant information that is gathered and provided by our colleagues in IOC Research Centres, Academic Sport Medicine Institutions, NOCs, IFs, and general sports medicine
  2. Disseminating ongoing literature searches for relevant scientific papers to add to the existing repository
  3. Provide a platform for publishing international Case Series to study the recovery of athletes from COVID-19

Latest News

Weekly updates on all COVID-19 resources can be found in this section. 


Evidence-based Research

The COVID-19 subgroup of the IOC Consensus group on “Acute Respiratory Illness in Athletes” is currently working in the following main areas. Please click on the area to access to the latest evidence-based resources on COVID-19 in athletes. To find out how the reviews are done, please follow this link

The focus of this section is on the incidence/prevalence of COVID-19 in athletes and specific risk factors associated with COVID-19 in athletes.

24 June 2020 reviewed by Lars Engebretsen

The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

This paper presents basic early epidemiology of Covid-19. Be aware that this was written in February where the knowledge of consequences was still limited, but the paper represents the knowledge at that time.

Type of investigation: Review
Level of evidence: 3B
Practical guideline rating scale: B


18 June 2020 reviewed by Lars Engebretsen

Novel Coronavirus Infection (COVID-19) in Humans: A Scoping Review and Meta-Analysis. J Clin Med

A growing body of literature on the 2019 novel coronavirus (SARS-CoV-2) is becoming available, but a synthesis of available data has not been conducted. This study performed a scoping review of currently available clinical, epidemiological, laboratory, and chest imaging data related to the SARS-CoV-2 infection.

Qualitative synthesis and meta-analysis were conducted using the clinical and laboratory data, and random-effects models were applied to estimate pooled results. A total of 61 studies were included (59,254 patients). The most common disease-related symptoms were fever, cough, muscle aches and/or fatigue, dyspnoea, headache in 12%, sore throat in 10% and gastrointestinal symptoms in 9%. Laboratory findings were described in a lower number of patients and revealed lymphopenia and abnormal C-reactive protein. Radiological findings varied, but mostly described ground-glass opacities and consolidation. Data on treatment options were limited. All-cause mortality was 0.3%. Epidemiological studies showed that mortality was higher in males and elderly patients. The majority of reported clinical symptoms and laboratory findings related to SARS-CoV-2 infection are non-specific. Clinical suspicion, accompanied by a relevant epidemiological history, should be followed by early imaging and virological essay.

Type of investigation: Review
Level of evidence: 3B
Practical guideline rating scale: B


17 June 2020 reviewed by Alan McCall

Nowhere to hide: The significant impact of coronavirus disease 2019 (COVID-19) measures on elite and semi-elite South African athletes. Journal of Science & Medicine in Sport. 2020

This study surveyed 692 female & male elite and semi-elite athletes from both team and individual sports in South Africa. The response rate was 64% (602/1080 respondents). The survey aimed to collect perceptions and experiences on return to sport during the current COVID-19 pandemic and in particular relating to physical, nutritional and psychological perspectives. The most represented sports were soccer (26%), hockey (16%) and rugby (13%).

The survey revealed that the COVID-19 lockdown period may have resulted in adverse physical, nutritional and psychological consequences for athletes and these areas should be given particular focus by sports organisations and support teams working with athletes upon return to sport.

Despite some novel information in this study and common sense practical recommendations, some methodological concerns are present. We encourage the reader to interpret the results in this context. Firstly, the time from design to implementation of the survey is short and the rigour of survey development may have been affected. The methods are too short to allow critique. Additionally, the authors have adapted already validated questionnaires on ‘maintenance of activity, nutrition and mental state’. Adapting validated instruments can affect their validity.

Type of investigation: Other
Level of evidence: 5
Practical guideline rating scale: C

The focus of this section is on the pathology / pathophysiology of COVID-19 including possible involvement of organ systems other than the respiratory tract (e.g. what % cases have myo-pericarditis and other possible systemic organ involvement)

24 June 2020 reviewed by Lars Engebretsen

The Stanford Hall Consensus Statement for post-COVID-19 Rehabilitation

This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post-COVID-19 illness, for a target population of active individuals, including military personnel and athletes.

Type of investigation: Expert group consensus
Level of evidence: 3B
Practical guideline rating scale: C

The focus of this section is on the interaction between exercise, sport, training and risk of COVID-19.

The focus of this section is on special considerations in the clinical presentation and diagnosis in athletes with suspected COVID-19.

The focus of this section is on special considerations in the management (pharmacological and non-pharmacological) of COVID-19 in athletes.

The focus of this section is on a number of areas including the following (please click on the area of interest) (by clicking – redirect to another webpage dedicated to this section)

01 July 2020 reviewed by Lars Engebretsen

Possible indirect transmission of COVID-19 at a squash court, Slovenia, March 2020: case report. Cambridge University Press.

Since the beginning of the COVID-19 epidemic, there is an ongoing debate and research regarding the possible ways of virus transmission. An epidemiological investigation was conducted which revealed a cluster of five COVID-19 cases, linked to playing squash at a sports venue in Maribor, Slovenia. Acquired data raises possibility that the transmission occurred indirectly through contaminated objects in changing room or squash hall or via aerosolisation in a squash hall.

Type of investigation: Prevention
Level of evidence: 4
Practical guideline rating scale: Insufficient evidence to provide rating


01 July 2020 reviewed by Lars Engebretsen

Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1. NEJM

The results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, and they provide information for pandemic mitigation efforts.

In the athletic and sport setting, this has potential practical implications for risk mitigation strategies e.g. when using sports equipment made from different materials.

Type of investigation: Prevention
Level of evidence: 3B
Practical guideline rating scale: Insufficient evidence to provide rating


1 June 2020 reviewed by Alan McCall

Returning to Play after prolonged restrictions in professional collision sports. Keith A Stokes et al. Int J Sports Med.

This narrative review provides a general insight into three key areas: (i) The potential impact of a period of restricted training in athletes from a physiological and psychological perspective, (ii) Provides some general considerations for returning to training and competition focusing mainly on physical/physiological qualities, including training interventions, progressions, basic training principles, and nutritional aspects, and (iii) Outlines considerations for athletes returning to sport after suspected or confirmed COVID-19 infection. The information may help sports science & medicine practitioners to plan restricted training and return to sport programmes from an exercise and nutrition perspective. The section on returning to sport following suspected or confirmed COVID-19 infection may need to be interpreted with caution as the section is based on early reports and recommendations/considerations are not backed up with a relevant scientific base and information may have changed/be changing compared to when this paper was accepted on 14th May 2020.

Type of investigation: Review
Level of evidence: 5
Practical guideline rating scale: C

01 July 2020 reviewed by Lars Engebretsen

Aerosol and Surface Stability of SARS-CoV-2 as compared with SARS-CoV-1. NEJM

The results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, and they provide information for pandemic mitigation efforts.

In the athletic and sport setting, this has potential practical implications for risk mitigation strategies e.g. when using sports equipment made from different materials.

Type of investigation: Prevention
Level of evidence: 3B
Practical guideline rating scale: Insufficient evidence to provide rating


25 June 2020 reviewed by Lars Engebretsen

Safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 vectored COVID-19 vaccine: a dose-escalation, open-label, non-randomised, first-in-human trial. The Lancet

A vaccine to protect against COVID-19 is urgently needed. The aim of this study was to assess the safety, tolerability, and immunogenicity of a recombinant adenovirus type-5 (Ad5) vectored COVID-19 vaccine expressing the spike glycoprotein of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strain.
This is the first published article in a major journal on the vaccine research and shows that: The Ad5 vectored COVID-19 vaccine is tolerable and immunogenic at 28 days post-vaccination.

Humoral responses against SARS-CoV-2 peaked at day 28 post-vaccination in healthy adults, and rapid specific T-cell responses were noted from day 14 post-vaccination. Our findings suggest that the Ad5 vectored COVID-19 vaccine warrants further investigation. This is what you need to resume professional sports.

Type of investigation: Prevention
Level of evidence: 3B/4
Practical guideline rating scale: Insufficient evidence to provide rating


19 June 2020 reviewed by Tim Meyer

The resumption of sports competitions after COVID-19 lockdown: The case of the Spanish football league. Chaos, Solitons and Fractals 138 (2020)

The paper presents a modelling approach for disease transmission in a football league, in this case the Spanish one. Several assumptions (some of them questionable) are put into the model and parameters varied to demonstrate their effect on the outcome variable: number of infected players during the season. I am not the kind of expert to assess the modelling approach in detail. However, the more interesting part of this are the responses to varying parameters. The number of infections decreases when the time between matches is reduced (probably due to less chances of acquiring the infection in private life) and when the number of PCR tests is increased. The second result seems obvious, the first one a bit counterintuitive. The absolute numbers of infections are, of course, dependent on the assumptions about the likelihood of getting infected during training and match play. These estimations, however, seem very vague. Therefore, the prediction of the number of infections is probably a weaker aspect of the paper.

Type of investigation: Prevention
Level of evidence: N/A
Practical guideline rating scale: B


2 June 2020 reviewed by Paolo Emilio Adami

https://bjsm.bmj.com/content/early/2020/05/23/bjsports-2020-102539

The paper presents in detail the risk assessment tool developed by the World Health Organization (WHO) to evaluate stadium/venue-based sports mass gathering events. Through the practical examples of two football matches, it illustrates the potential different results that the tool could provide based on the mitigation actions the event organisers takes. Based on the sport’s characteristics and on mitigation actions taken, the risk of transmission can be significantly reduced, and the sport event staged. Close cooperation across sectors, in particular with public health authorities, is fundamental to coordinate actions and protect athletes and local communities.

Type of investigation: Other
Level of evidence: 5
Practical guideline rating scale: C

2 June 2020 reviewed by Paolo Emilio Adami

https://bjsm.bmj.com/content/early/2020/05/23/bjsports-2020-102539

The paper presents in detail the risk assessment tool developed by the World Health Organization (WHO) to evaluate stadium/venue-based sports mass gathering events. Through the practical examples of two football matches, it illustrates the potential different results that the tool could provide based on the mitigation actions the event organisers takes. Based on the sport’s characteristics and on mitigation actions taken, the risk of transmission can be significantly reduced, and the sport event staged. Close cooperation across sectors, in particular with public health authorities, is fundamental to coordinate actions and protect athletes and local communities.

Type of investigation: Other
Level of evidence: 5
Practical guideline rating scale: C


1 June 2020 reviewed by Alan McCall

Returning to Play after prolonged restrictions in professional collision sports. Keith A Stokes et al. Int J Sports Med.

This narrative review provides a general insight into three key areas: (i) The potential impact of a period of restricted training in athletes from a physiological and psychological perspective, (ii) Provides some general considerations for returning to training and competition focusing mainly on physical/physiological qualities, including training interventions, progressions, basic training principles, and nutritional aspects, and (iii) Outlines considerations for athletes returning to sport after suspected or confirmed COVID-19 infection. The information may help sports science & medicine practitioners to plan restricted training and return to sport programmes from an exercise and nutrition perspective. The section on returning to sport following suspected or confirmed COVID-19 infection may need to be interpreted with caution as the section is based on early reports and recommendations/considerations are not backed up with a relevant scientific base and information may have changed/be changing compared to when this paper was accepted on 14th May 2020.

Type of investigation: Review
Level of evidence: 5
Practical guideline rating scale: C

14 July 2020 reviewed by Martin Schwellnus

Persistent Symptoms in Patients After Acute COVID-19, 2020, JAMA

Information is lacking on symptoms that may persist after recovery from COVID-19. In this research letter, persistent symptoms following recovery from COVID-19 were assessed in 143 hospitalized patients that were discharged and followed up. The main findings are that a high proportion of individuals still reported fatigue, dyspnea, joint pain and chest pain at follow-up. Although this is a single-centre study, with a small number of older patients that were hospitalized (more severe illness), there is potential application of these results in athletes and active individuals that recover from COVID-19. In athletes with more severe COVID-19, medical staff need to be aware of persistent symptoms that may affect return to training.

In athletes with more severe COVID-19, symptoms such as fatigue, dyspnea, joint pain and chest pain may persist for weeks following recovery, highlighting the importance of continuous symptom monitoring following return to play.

Type of investigation: Prognosis
Level of evidence: 4
Practical guideline rating scale: C


24 June 2020 reviewed by Lars Engebretsen

The Stanford Hall Consensus Statement for post-COVID-19 Rehabilitation

This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post-COVID-19 illness, for a target population of active individuals, including military personnel and athletes.

Type of investigation: Expert group consensus
Level of evidence: 3B
Practical guideline rating scale: C


24 June 2020 reviewed by Lars Engebretsen

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

Return to high altitude training and monitoring. This paper should be important in the coming year.

Type of investigation: Review
Level of evidence: 3B
Practical guideline rating scale: C


18 June 2020 reviewed by Lars Engebretsen

Training Restrictions in Professional Collision Sports. Int J Sports Med

With a focus on rugby league and rugby union, the purpose of this review is to examine the available evidence related to the following: potential changes to physical qualities and function during the period of modified training, strategies to mitigate this decline in function, and the time taken to return players and teams to “game ready” status. It is anticipated that many of the principles outlined in this review will be applicable to a broader range of collision sports (e. g. American football, Australian football). The final section provides practical recommendations that focus on restarting these sports after an extended break from training.

Type of investigation: Review
Level of evidence: 4
Practical guideline rating scale: C


3 June 2020 reviewed by Maarit Valtonen

Exercise in the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) era: A Question and Answer session with the experts. Endorsed by the section of Sports Cardiology & Exercise of the European Association of Preventive Cardiology (EAPC). Sanjay Sharma et al.

The publication offers practical recommendations for exercise in athletes based on symptoms and COVID-19 (viral RNA) test result. The authors propose a cardiac evaluation protocol of elite athletes prior to return to training and competitions. As the gaps in the literature still exists, the recommendations are based on the current understanding on possible cardiac involvement as a complication of the infection and potential implications for athletes, who push their cardiovascular system to the limits. The publication promotes safe participation in exercise in the COVID-19 era and offers a framework of management for physicians caring for athletes.

Type of investigation: Expert Group Consensus
Level of evidence: 5
Practical guideline rating scale: C


2 June 2020 reviewed by Andy Massey

https://www.germanjournalsportsmedicine.com/archiv/archive-2020/issue-5/position-stand-return-to-sport-in-the-current-coronavirus-pandemic-sars-cov-2-covid-19/

A position stand from an expert group from the German Society for Sports Medicine and Prevention and the German Olympic Sports Confederation looking at the potential presentation of SARS-CoV2/COVID-19 in the sporting population. The authors propose a model of investigation (in the form of a decisional algorithm), dependent upon symptoms affecting the cardiovascular and respiratory systems, prior to reintegration in sport.

Type of investigation: Expert Group Consensus
Level of evidence: 5
Practical guideline rating scale: B


1 June 2020 reviewed by Alan McCall

Returning to Play after prolonged restrictions in professional collision sports. Keith A Stokes et al. Int J Sports Med.

This narrative review provides a general insight into three key areas: (i) The potential impact of a period of restricted training in athletes from a physiological and psychological perspective, (ii) Provides some general considerations for returning to training and competition focusing mainly on physical/physiological qualities, including training interventions, progressions, basic training principles, and nutritional aspects, and (iii) Outlines considerations for athletes returning to sport after suspected or confirmed COVID-19 infection. The information may help sports science & medicine practitioners to plan restricted training and return to sport programmes from an exercise and nutrition perspective. The section on returning to sport following suspected or confirmed COVID-19 infection may need to be interpreted with caution as the section is based on early reports and recommendations/considerations are not backed up with a relevant scientific base and information may have changed/be changing compared to when this paper was accepted on 14th May 2020.

Type of investigation: Review
Level of evidence: 5
Practical guideline rating scale: C

1 June 2020 reviewed by Alan McCall

Returning to Play after prolonged restrictions in professional collision sports. Keith A Stokes et al. Int J Sports Med.

This narrative review provides a general insight into three key areas: (i) The potential impact of a period of restricted training in athletes from a physiological and psychological perspective, (ii) Provides some general considerations for returning to training and competition focusing mainly on physical/physiological qualities, including training interventions, progressions, basic training principles, and nutritional aspects, and (iii) Outlines considerations for athletes returning to sport after suspected or confirmed COVID-19 infection. The information may help sports science & medicine practitioners to plan restricted training and return to sport programmes from an exercise and nutrition perspective. The section on returning to sport following suspected or confirmed COVID-19 infection may need to be interpreted with caution as the section is based on early reports and recommendations/considerations are not backed up with a relevant scientific base and information may have changed/be changing compared to when this paper was accepted on 14th May 2020.

Type of investigation: Review
Level of evidence: 5
Practical guideline rating scale: C

14 July 2020 reviewed by Martin Schwellnus

Persistent Symptoms in Patients After Acute COVID-19, 2020, JAMA

Information is lacking on symptoms that may persist after recovery from COVID-19. In this research letter, persistent symptoms following recovery from COVID-19 were assessed in 143 hospitalized patients that were discharged and followed up. The main findings are that a high proportion of individuals still reported fatigue, dyspnea, joint pain and chest pain at follow-up. Although this is a single-centre study, with a small number of older patients that were hospitalized (more severe illness), there is potential application of these results in athletes and active individuals that recover from COVID-19. In athletes with more severe COVID-19, medical staff need to be aware of persistent symptoms that may affect return to training.

In athletes with more severe COVID-19, symptoms such as fatigue, dyspnea, joint pain and chest pain may persist for weeks following recovery, highlighting the importance of continuous symptom monitoring following return to play.

Type of investigation: Prognosis
Level of evidence: 4
Practical guideline rating scale: C


24 June 2020 reviewed by Lars Engebretsen

The Stanford Hall Consensus Statement for post-COVID-19 Rehabilitation

This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post-COVID-19 illness, for a target population of active individuals, including military personnel and athletes.

Type of investigation: Expert group consensus
Level of evidence: 3B
Practical guideline rating scale: C


1 June 2020 reviewed by Alan McCall

Returning to Play after prolonged restrictions in professional collision sports. Keith A Stokes et al. Int J Sports Med.

This narrative review provides a general insight into three key areas: (i) The potential impact of a period of restricted training in athletes from a physiological and psychological perspective, (ii) Provides some general considerations for returning to training and competition focusing mainly on physical/physiological qualities, including training interventions, progressions, basic training principles, and nutritional aspects, and (iii) Outlines considerations for athletes returning to sport after suspected or confirmed COVID-19 infection. The information may help sports science & medicine practitioners to plan restricted training and return to sport programmes from an exercise and nutrition perspective. The section on returning to sport following suspected or confirmed COVID-19 infection may need to be interpreted with caution as the section is based on early reports and recommendations/considerations are not backed up with a relevant scientific base and information may have changed/be changing compared to when this paper was accepted on 14th May 2020.

Type of investigation: Review
Level of evidence: 5
Practical guideline rating scale: C

 

The focus of this section is on the mental health issues that athletes may face during the COVID-19 pandemic.

27 July 2020 reviewed by Lars Engebretsen

Hosting the Olympics in Times of a Pandemic: Historical Insights from Antwerp 1920, Bram Constandt & Annick Willem

Postponing the Tokyo 2020 Olympics due to the global outbreak of COVID-19 marks a unique moment in the history of the Olympic Movement. For the first time since the cancellation of the Olympic Games during both World Wars, the Olympics will not take place as scheduled. This unprecedented postponement strongly impacts the Olympic Movement. Although only the future can tell exactly, the Antwerp 1920 Olympics can offer certain historical insights. Exactly 100 years ago, the Antwerp Olympic Games were the first Olympics organized after World War I and the Spanish flu pandemic. Their value in terms of rising the Olympic Movement from its ashes is vital.

Type of investigation: Prevention
Level of evidence: 5
Practical guideline rating scale: C

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