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Is extensive cardiopulmonary screening useful in athletes with previous asymptomatic or mild SARS-CoV-2 infection?
  1. Salvatore Francesco Gervasi1,2,
  2. Luca Pengue1,
  3. Luca Damato2,
  4. Riccardo Monti2,
  5. Silvia Pradella3,
  6. Tommaso Pirronti4,
  7. Alessandro Bartoloni5,
  8. Francesco Epifani6,
  9. Alessio Saggese6,
  10. Francesco Cuccaro1,
  11. Massimiliano Bianco1,2,
  12. Paolo Zeppilli2,
  13. Vincenzo Palmieri1,2
  1. 1 Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  2. 2 Sports Medicine Unit, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma, Lazio, Italy
  3. 3 Department of Emergency Radiology, University Hospital Careggi, Firenze, Toscana, Italy
  4. 4 Diagnostic Imaging Area, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
  5. 5 Department of Experimental and Clinical Medicine, University Hospital Careggi, Firenze, Toscana, Italy
  6. 6 Synlab Med, Sesto Fiorentino, Florence, Italy
  1. Correspondence to Dr Salvatore Francesco Gervasi, Catholic University of the Sacred Heart Faculty of Medicine and Surgery, Roma 00166, Lazio, Italy;{at}


Objective During the COVID-19 pandemic, it is essential to understand if and how to screen SARS-CoV-2-positive athletes to safely resume training and competitions. The aim of this study is to understand which investigations are useful in a screening protocol aimed at protecting health but also avoiding inappropriate examinations.

Methods We conducted a cohort study of a professional soccer team that is based on an extensive screening protocol for resuming training during the COVID-19 pandemic. It included personal history, antigen swabs, blood tests, spirometry, resting/stress-test ECG with oxygen saturation monitoring, echocardiogram, Holter and chest CT. We also compared the findings with prior data from the same subjects before infection and with data from SARS-CoV-2-negative players.

Results None of the players had positive swab and/or anti-SARS-CoV-2 IgM class antibodies. Out of 30 players, 18 (60%) had IgG class antibodies. None had suffered severe SARS-CoV-2-related disease, 12 (66.7%) had complained of mild COVID-19-related symptoms and 6 (33.3%) were asymptomatic. None of the players we examined revealed significant cardiovascular abnormalities after clinical recovery. A mild reduction in spirometry parameters versus pre-COVID-19 values was observed in all athletes, but it was statistically significant (p<0.05) only in SARS-CoV-2-positive athletes. One SARS-CoV-2-positive player showed increased troponin I level, but extensive investigation did not show signs of myocardial damage.

Conclusion In this small cohort of athletes with previous asymptomatic/mild SARS-CoV-2 infection, a comprehensive screening protocol including blood tests, spirometry, resting ECG, stress-test ECG with oxygen saturation monitoring and echocardiogram did not identify relevant anomalies. While larger studies are needed, extensive cardiorespiratory and haematological screening in athletes with asymptomatic/mild SARS-CoV-2 infection appears unnecessary.

  • athlete
  • exercise testing
  • heart disease
  • prevention
  • soccer

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  • Contributors All authors gave substantial contribution to the conception or design of the work, or the acquisition, analysis or interpretation of data. All authors gave substantial contribution to drafting the work or revising it critically for important intellectual content. All authors approved the version published. All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The whole study was conducted according to the GCP and the Helsinki Declaration. The study design was approved by the Ethics Committee of the Policlinico Universitario 'A. Gemelli' Foundation of Rome (protocol ID 3246).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. Deidentified participant data are available in a database held by the Sports Medicine Unit of the University Hospital Policlinico A Gemelli. They are not available for reuse. Additional information can be requested by contacting the corresponding author (

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