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Clinical patterns, recovery time and prolonged impact of COVID-19 illness in international athletes: the UK experience
  1. James H Hull1,2,3,
  2. Moses Wootten4,
  3. Moiz Moghal2,
  4. Neil Heron5,
  5. Rhodri Martin6,
  6. Emil S Walsted7,
  7. Anita Biswas8,
  8. Mike Loosemore2,
  9. Niall Elliott9,
  10. Craig Ranson2
  1. 1 Department of Respiratory Medicine, Royal Brompton and Harefield NHS Foundation Trust, London, UK
  2. 2 English Institute of Sport, Manchester, UK
  3. 3 Sports Respiratory Service, Institute of Sport, Exercise and Health (ISEH), UCL, London, UK
  4. 4 UK Sport, London, UK
  5. 5 Sport Institute Northern Ireland, Belfast, UK
  6. 6 Sports Medicine, Sport Wales, Cardiff, UK
  7. 7 Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
  8. 8 Sports Medicine, English Institute of Sport, Manchester, UK
  9. 9 Sports Medicine, Sport Scotland Institute of Sport, Stirling, UK
  1. Correspondence to Dr Craig Ranson, English Institute of Sport, 299 Alan Turing Way, Manchester, M11 3BS, UK; craig.ranson{at}


Objectives To report COVID-19 illness pattern, symptom duration and time loss in UK elite athletes.

Methods Observational, clinical and database review of athletes with symptomatic COVID-19 illness managed within the UK Sports Institutes. Athletes were classified as confirmed (positive SARS-CoV-2 PCR or antibody tests) or probable (consistent clinical features) COVID-19. Clinical presentation was characterised by the predominant symptom focus (eg, upper or lower respiratory illness). Time loss was defined as days unavailable for full sport participation and comparison was made with a 2016–2019 respiratory illness dataset from the same surveillance system.

Results Between 24 February 2020 and 18 January 2021, 147 athletes (25 Paralympic (17%)) with mean (SD) age 24.7 (5.2) years, 37% female, were diagnosed with COVID-19 (76 probable, 71 confirmed). Fatigue was the most prevalent symptom (57%), followed by dry cough (50%) and headache (46%). The median (IQR) symptom duration was 10 (6–17) days but 14% reported symptoms >28 days. Median time loss was 18 (12–30) days, with 27% not fully available >28 days from initial date of infection. This was greater than our historical non-COVID respiratory illness comparator; 6 days, 0–7 days (p<0.001) and 4% unavailable at 28 days. A lower respiratory phenotype (ie, including dyspnoea±chest pain±cough±fever) was present in 18% and associated with a higher relative risk of prolonged symptoms risk ratio 3.0 (95% CI: 1.4 to 6.5) and time loss 2.1 (95% CI: 1.2 to 3.5).

Conclusions In this cohort, COVID-19 largely resulted in a mild, self-limiting illness. The presence of lower respiratory tract features was associated with prolonged illness and a delayed return to sport.

  • athletes
  • COVID-19
  • infection
  • sport
  • illness

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No data are available. No additional data are available.

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Data availability statement

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  • Contributors JHH and CR designed and developed the protocol, assisted with data analysis, and drafted, edited and approved the manuscript. MW performed all data analyses and acts as the guarantor for data. ESW provided statistical analysis and review of the manuscript. MM, NH, RM, AB, ML and NE contributed to the methods and data collection, and assisted production of the manuscript.

  • 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.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.