Article Text

Download PDFPDF

Infographic. COVID-19 RT-PCR testing for elite athletes
Free
  1. Alan Rankin1,2,
  2. Andrew Massey3,
  3. Éanna Cian Falvey4,5,
  4. Todd Ellenbecker6,
  5. Peter Harcourt7,
  6. Andrew Murray8,9,
  7. Denis Kinane10,
  8. Bert Niesters11,
  9. Nigel Jones12,
  10. Rhodri Martin13,14,
  11. Michael Roshon15,
  12. Michael Edmund David McLarnon16,
  13. James Calder17,
  14. Dionisio Izquierdo18,
  15. Babette M Pluim19,20,
  16. Niall Elliott21,
  17. Neil Heron22
  1. 1Sports Medicine, SportNI Sports Institute, Newtownabbey, UK
  2. 2Sports Medicine NI, Belfast, UK
  3. 3Medical and Anti-Doping Department, Federation Internationale de Football Association, Zurich, Zürich, Switzerland
  4. 4Sport Medicine Department, World Rugby, Dublin, Ireland
  5. 5Department of Medicine, University College Cork, Cork, Ireland
  6. 6ATP Medical Services, Ponte Vedra, Florida, USA
  7. 7Australian Football League, Docklands, Victoria, Australia
  8. 8St Andrew’s House Edinburgh, Scottish Government Sport and Physical Activity Policy Team, Edinburgh, Scotland, UK
  9. 9Sports Medicine, Scottish Institute of Sport, Stirling, UK
  10. 10Department of Immunology, University of Bern, Bern, Switzerland
  11. 11Microbiology, University of Groningen, Groningen, The Netherlands
  12. 12Medical Department, British Cycling, Manchester, UK
  13. 13Sports Medicine, Sport Wales, Cardiff, UK
  14. 14Cwm Taf Morgannwg University Health Board, Abercynon, Rhondda Cynon Taf, UK
  15. 15Medicine, USA Cycling, Colorado Springs, Colorado, USA
  16. 16School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
  17. 17Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, UK
  18. 18Public Health/SEM, Barts Health NHS Trust, London, UK
  19. 19Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  20. 20AMC/VUmc IOC Research Center of Excellence, Amsterdam Collaboration on Health & Safety in Sports (ACHSS), Amsterdam, The Netherlands
  21. 21Sports Medicine, Sport Scotland Institute of Sport, Stirling, UK
  22. 22Department of Family Practice, Queen's University Belfast, Belfast, UK
  1. Correspondence to Dr Neil Heron, Department of Family Practice, Queen's University Belfast, Belfast BT7 1NN, UK; neilheron{at}yahoo.co.uk

Statistics from Altmetric.com

This infographic outlines evidence-based recommendations on COVID-19 reverse transcriptase PCR (RT-PCR) testing in elite sport settings, aiming to protect personal and population health, and acknowledging resources and expertise that are often available in elite sport. Public health recommendations vary by country and region, and protocol decisions should be made in consultation with relevant public health authorities.

Form an expert group

An expert, multidisciplinary group with input from clinical virology, microbiology, public health, infectious diseases and sports medicine provides optimal implementation and interpretation of testing.

Prevention is best

Interventions to prevent COVID-19 transmission should be implemented consistently1 2 and should include

  • Effective hand hygiene.

  • Physical distancing: athletes should minimise discretionary social contacts and maintain a distance of at least one metre from others.

  • Wearing a mask at all times when around others, especially indoors.3

  • Prioritising outdoor over indoor activity where possible.

COVID-19 and RT-PCR testing

The current gold standard of testing is RT-PCR testing.4–6 The test is highly sensitive and specific to SARS-CoV-2 viral RNA in laboratory conditions.2 Test results should be interpreted on the basis of the pretest probability, previous test results and clinical history. Test sensitivity and specificity will rely on the (1) quality and location of swabbing; (2) testing equipment and reagents, and (3) laboratory expertise.

Close contacts7 to a positive-testing athlete should be isolated and proceed with daily monitoring for symptoms and temperature, and where available testing. If the contact is asymptomatic and COVID-19 RT-PCR tests are negative at 7 hours of follow-up, the close contact could be considered for a return to sport, depending on discussions with local public health authorities.

Testing and elite athlete gatherings

Prior to a gathering of elite athletes, for example, at a training camp or competition, all athletes should have regular symptom checks and should undergo RT-PCR or other screening for the virus. For the first gathering, testing 6 and 3 days prior to the event is recommended, as well as testing as close to the event as logistically possible, ideally within 48 hours of the meeting. Interval (eg, weekly) PCR testing for the duration of the gathering should be considered.

Managing a positive test

Positive tests should be managed according to national and local public health guidance, but elite sport can often provide additional medical and testing support. The positive case, as well as all close contacts, should be isolated as soon as possible, and contact tracing should be undertaken.

If an asymptomatic athlete tests positive in screening, they should be isolated but retested to ascertain whether the result represents a true or false positive. False positives are less likely when the prevalence of COVID-19 is high. In a symptomatic individual, a positive result is considered a true positive. Careful attention should be paid to the PCR cycle threshold (Ct) and the gene expression of the result, as this correlates strongly with cultivable virus.4 A test with a high Ct (>30, and especially >35) may not indicate current infectivity,4 5 although the viral load may rise in subsequent days.

Interpreting a negative test in an athlete

If an athlete has symptoms indicative of coronavirus (eg, loss of taste/smell, dry cough or fever) but test results are negative, repeat testing is recommended to exclude a false negative, especially if there is a high prevalence of COVID-19 activity. An alternative diagnosis with testing for other viral aetiologies should also be considered. Unusual test results should be discussed within the expert group.

Retesting Post-COVID infection

Viral RNA can persist in individuals beyond infectivity for several months.4–6 For this reason, repeat PCR screening in asymptomatic athletes is not routinely recommended for 90 days postinfection. Repeat testing can stratify whether viral load is decreasing and may inform decisions to isolate a patient beyond 10 days in some cases. In the event an athlete has been retested within 90 days, consider their Ct value. When Ct is >35 and the patient’s symptoms have resolved, infectivity is unlikely.6

Return to sport for a COVID-19 confirmed case

Following infection, there should be a graduated return to sport, guided by professional advice which may vary based on the severity of the illness, the demands of the sport and logistical factors.8–10 Additional cardiac testing should be considered based on the severity of illness.11

Acknowledgments

The authors cknowledge the support and guidance provided by the UK Home Institute of Sport Medical and support staff, particularly from the Sport Institute of Northern Ireland.

References

Footnotes

  • Twitter @andy_massey, @docandrewmurray, @mmclarnon98, @DrDionisioizq, @docpluim, @dundeesportsmed, @neilSportDoc

  • Collaborators Science and medical support staff at the UK Home Institutes of Sport and particularly at the Sport Institute of Northern Ireland.

  • Contributors The infographic idea was conceived by AR and NH and then developed by all authors; AR and NH produced the initial infographic, which was then revised by all authors; all authors approved the final version of the infographic.

  • 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 consent for publication Not required.

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

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.