Young Ju, Ph.D.

We are finally getting out of the pandemic phase of COVID-19.  Over 147 million Americans (~25% of the total population) have been infected with COVID-19 since 2020 (CDC Data Tracker, CDC).  According to estimates by the Center for Disease Control and Prevention, about 13.3% of people who contracted COVID-19 will experience symptoms for at least a month, and 2.5% will experience symptoms for longer than three months.  A substantial number of people who contracted COVID-19 subsequently experience lasting symptoms including fatigue, shortness of breath, and neurological complaints that may last from weeks to years.  This condition is referred to by various terms including post-COVID-19 conditions, long COVID-19, post-COVID-19 syndrome, or persistent COVID-19 symptoms, etc.  As a competitive tennis player, you may be interested in the latest updated information on post-COVID-19 conditions which could affect you or become a significant health burden.

Speculated Causes

Although the exact causes of post-COVID-19 conditions are not known yet, several researchers have proposed three leading theories (Couzin-Frankel, 2022).

Initial COVID-19 infection may:

(1)   impair blood circulation.

(2)   leave lingering coronavirus in the body.

(3)   alter the immune system.

Currently, researchers know very little about these mechanisms.  More studies are definitely required to understand what causes post-COVID-19 conditions.

Symptoms

People may have a wide range of symptoms that could seem similar to other health problems, including respiratory, cardiological, neurological, and digestive symptoms.  It appears that the timing of symptom onset varies from one patient to another.  Common reported symptoms to include dyspnea (respiratory difficulty), myalgia, cough, headache, joint or muscle pain, chest pain, change in smell or taste, diarrhea, fever, difficulty breathing or shortness of breath, heart palpitations, brain fog, depression or anxiety, stomach pain, swollen extremity, and changes in menstrual cycles, etc.  

Although there is no estimated prevalence of COVID-19 and post-COVID-19 conditions among athletes, some studies reported that most infections are asymptomatic or a mild form of the disease (Gualano et al., 2021; Raipal et al., 2021). One researcher characterized COVID-19 and post-COVID-19 conditions in athletes for the first time including 43 studies with 11.518 athletes (Lemes et al., 2022). This study showed that 25.5% of participating athletes had asymptomatic COVID-19 and 1.3% of them had severe COVID-19. Approximately 8.3% of participants experienced post-COVID-19 conditions. The most common post-COVID-19 symptoms reported were smell/taste disorder, cough, fatigue, chest pain, and headaches. 

There is no specific study on tennis players, but tennis players may be especially concerned with other reported symptoms such as fatigue, a lack of endurance, and post-exertional malaise when symptoms worsen following minor physical or mental exertion. To avoid these symptoms, you can spread out your play or training by resting between activities.

Currently, it is unknown whether post-COVID-19 symptoms leave permanent dysfunction or whether the symptoms will be resolved.  There is as yet no test to diagnose post-COVID-19 conditions.  Doctors must make diagnoses based on patients’ health history and current health conditions.

Susceptible Population

Some groups of people may have higher chances of developing post-COVID-19 conditions:

• People who experienced more severe COVID-19 illness, especially those who were hospitalized or admitted to intensive care.

• People who had existing health conditions (including hypertension and chronic lung conditions) prior to COVID-19 infection.

• People who did not get a COVID-19 vaccine.

• People who had multisystem inflammatory syndrome (a condition where different systems become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, or gastrointestinal organs) during or after COVID-19 illness.

• Older people may have higher chances.

• Women may have higher chances compared to men.

Prevention

The best way to prevent post-COVID-19 conditions is not to be infected.  Vaccination against COVID-19 can help prevent COVID-19 infection and protect against post-COVID-19 conditions. Vaccination is also recommended for patients who have had COVID-19 infection.  The timing of boosters for patients already infected has not yet been determined, but the current recommendation is to wait 3 months after infection.  If you are not sure about your eligibility or timing for a COVID-19 booster, ask a doctor.

Care and Management

Although there is no cure for post-COVID-19 conditions right now, many symptoms can be managed by primary health care providers and by rehabilitation approaches.  If you were infected with COVID-19 and are experiencing post-COVID-19-like symptoms, you may need to see a healthcare professional and establish symptom management approaches.

People with post-COVID-19 conditions should continue to follow COVID-19 prevention measures including wearing a mask, maintaining social distance, avoiding crowds and poorly ventilated indoor spaces, washing hands, etc.

For some people, surviving COVID-19 was just the beginning of long-term health problems. A better and deeper understanding of post-COVID-19 conditions is needed.  It is likely that guidance for healthcare professionals and patients will change over time as more evidence builds up.  You can refer to the live links below to stay up to date on current research.  

REFERENCES

COVID Data Tracker https://covid.cdc.gov/covid-data-tracker/#datatracker-home

Estimated COVID-19 Burden https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/burden.html

Post-COVID Conditions: Overview for Healthcare Providers https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-care/post-covid-conditions.html

Couzin-Frankel 2022 Clues to Long Covid. Scientists strive to unravel what is driving disabling symptoms. Science 2022, 376(6599):1261-1265.

Gualano et al. High SARS-CoV-2 infection rate after resuming professional football in Sao Paulo, Brazil. Br J Sports Med 2021, 104431

Lemes et al. Acute and post-acute COVID-19 presentations in athletes: a systematic review and meta-analysis. Br J Sports Med 2022, 105583

Raipal et al. Cardiovascular magnetic resonance findings in competitive athletes recovering from covid-19 infection. JAMA Cardiol 2021, 6:116.

As always this information is provided for your reference and you use at your own risk; you should rely on your medical professional for medical advice.