COVID-19 implications for Athletes

Should Athletes get the COVID-19 vaccine?

Yes (for the most part, but please discuss with your medical provider).

Here’s why. 

From a practical standpoint, controlling the pandemic can help avoid further cancellation of sporting events and vaccines can help prevent transmission to teammates, opponents, support staff, and spectators. 

Though limited, there have been several studies that have shown that exercise can actually help boost the immune response to the influenza vaccine and at the very least exercise does not negatively impact vaccine efficacy. 

What about side effects?

Current research shows only 1 to 3% of individuals will have severe side effects. Though limited, data on athletes reveal muscle aches reported in 21% after 1st dose and 37% after the second. Unfortunately, there is no additional information on the duration and extent of the side effect to determine if it impacted sports performance. 

Some experts suggest reducing the training load for 2 to 3 days post-vaccine. A shared decision model with the athlete, coaching staff, and medical providers is a practical approach to take when considering COVID-19 vaccination.

What is the Impact of COVID-19 on athletic performance? 

Return to play/training after covid is an important topic to explore. The British Journal of Medicine suggests a graduated 7-day return. Using the “neck rule”, athletes with symptoms above the neck such as the sore throat or runny nose can return to play (with limitations) sooner. Those with respiratory symptoms should take time off until recovery.

The Cleveland Clinic also recommends a gradual return to play through a 7 stage process shown below. 

The limited data thus far on the athletic population suggest mild symptoms for a short duration. For example, this study out of the UK found 147 elite athletes diagnosed with COIVd-19. The majority of these athletes had no prior medical conditions and exhibited mild symptoms with resolution averaging 10 days for males and 12 days for females. They did, however, find that 21% of athletes had symptoms more than 28 days and  3% of those athletes had symptoms lasting greater than 90 days. These athletes were not able to return to full participation within those timeframes.

So which athletes are more likely to exhibit prolonged symptoms and a long time away from training? The researchers found that those presenting chest pain or shortness of breath were more likely to have prolonged symptoms. Other studies showed that those presenting with fatigue are 70% more likely to have a prolonged (40 days or more) return to full participation. 

Organizations have provided recommendations –

1. JAMA Network
2. Australian Institute of Sport
3. Respiratory health athletes Lancet

Athletes at ABT

We’ve tested several athletes with ongoing COVID-19 symptoms. Some call it “Long-Haulers”. The mainstream media has run several stories on this topic including, HBO’s Real Sports and the NY Times article. The few athletes we’ve seen had mostly normal blood results and have displayed a wide range of complaints. We encourage those athletes to work with their medical team.

Nutritional Considerations for athletes

Despite what you may read on the internet, there is no food or supplement that can “boost” your immune system above 100% capacity. BUT, that doesn’t mean there isn’t anything you can do to make sure your immune system is in tip-top shape. 

Mega-dosing isn’t going to make your immune system stronger, but if you are low in some nutrients, getting those levels up can help strengthen your immune system.

Supplements for COVID-19

Supplements such as echinacea, vitamin E, and zinc have some clinical data but can also have potential long-term safety issues. My recommendation is to focus on foods rich in these nutrients and if you do choose to take a supplement (full disclosure, I take 50 mg zinc for a few days if I get sick) make sure it’s short term (no more than a few days) and not a ridiculously high dose, you can really throw off your biochemistry and other nutrient levels with improper supplementation.

Vitamins C and D have the largest benefit-to-risk ratio. This doesn’t mean they’re the most effective, but they do offer the most benefit for the least risk based on a recent meta-analysis (a study that looks at all the studies done on a specific topic and summarizes them).

A teaspoon or two of honey has antimicrobial activity and may suppress your cough if you do get sick.

Your white blood cells need carbohydrates to function, so having some easy-to-digest carbs, such as a banana, can be helpful. 

Here are some nutrients that are important for immune function. A friendly reminder that blind supplementation can be dangerous and it is best to get nutrients from food unless advised via a blood test or medical doctor. 

• vitamin E: nuts, seeds, avocados, spinach, Swiss chard, butternut squash
• zinc: beef, pork, lamb, oysters, crab, lobster, nuts, seeds, beans, lentils, eggs, dairy, whole grains
• vitamin C: kiwi, oranges, grapefruit, strawberries, tomatoes, peppers, broccoli, Brussels sprouts

vitamin D: cold-water fish such as salmon, herring, sardines, tuna, egg yolks, meat, dairy, mushrooms, fortified foods. Read our vitamin D article here.

References

1. Hull JH, Schwellnus MP, Pyne DB, Shah A. COVID-19 vaccination in athletes: ready, set, go…. Lancet Respir Med. 2021;9(5):455-456. doi:10.1016/S2213-2600(21)00082-5
2. Wilson MG, Hull JH, Rogers J, et alCardiorespiratory considerations for return-to-play in elite athletes after COVID-19 infection: a practical guide for sport and exercise medicine physiciansBritish Journal of Sports Medicine 2020;54:1157-1161.
3. Elliott N, Martin R, Heron N, et alInfographic. Graduated return to play guidance following COVID-19 infectionBritish Journal of Sports Medicine 2020;54:1174-1175.
4. Hull JH, Wootten M,Moghal M, et al.Br J Sports Med Epub aheadof print: [please include DayMonth Year]. doi:10.1136/bjsports-2021-104392
5. https://health.clevelandclinic.org/returning-to-sports-or-exercise-after-recovering-from-covid-19/