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The important mental, physical, social and fiscal role of organised, professional sport in our lives as athletes, athlete support personnel, consumers and various stakeholders was highlighted by the gaping hole its absence left after global COVID-19 lockdowns and restrictions brought professional sporting activities to a standstill. However, as seen in various industry sectors, clinical, and social settings, the burdens of the COVID-19 pandemic were borne unequally. While the clinical effects of the virus were similar worldwide, their implications were superseded by the different socioeconomic contexts in which they occurred. This editorial highlights how COVID-19 exacerbated global inequities in professional athletes’ physical, mental and fiscal health outcomes and how those in low and middle-income countries (LMICs) were left further behind.
COVID-19’s impact on training and the physical health of marginalised athletes
At the onset of the pandemic, as many were forced to stay from their workplaces, athletes were encouraged to train from home. Communication with coaches, trainers and healthcare providers was remote and required online programmes, home equipment and telehealth resources. In South Africa, like other industries,1 those professional athletes who earned high incomes before the pandemic managed better than their lower earning peers. Home training adaptations require space, equipment, access to internet connectivity and other technologies, which meant training had to stop completely for those who lacked these resources, while it could continue for their higher income counterparts.2 This cool-off period during lockdown compromised all aspects of effective training and periodisation, and lower ranked or marginalised athletes with less resources were further disadvantaged.2 Less than 40% of athletes could fully perform their training programmes,2 3 and coaches, even in high-income countries (HIC), had difficulties engaging athletes in online training because of lack of access and ability to use relevant technologies.4 The reduced training load imposed on these athletes may have long-term impacts on injury risk, performance, rankings and remuneration in years to come.
COVID-19’s impact on the mental health of marginalised athletes
The lack of training and competition also led to poor mental health outcomes in athletes struggling with the loss of structure, self-identity and financial stability.5 For some athletes, these negative mental health effects were mitigated by home training programmes. However, those in LMICs like South Africa, whose income was precarious to begin with (eg, those with informal jobs, day labourers, migrant or undocumented workers, semiprofessional and amateur athletes), lost their livelihoods at much higher rates than their high-income counterparts, with the associated mental health effects.1 Forced training restrictions and modifications were associated with alterations in mood and feelings of depression in over 50% of South African athletes,6 and the prolonged uncertainty over the resumption of organised sports led to mental fatigue and reduced motivation to train. This effect was more pronounced in women athletes in general,3 with even further impact in African women athletes.6
COVID-19’s impact on the fiscal gap
In some professional team sports associations, to support the sustainability of sport during lockdowns, virtual competitions were arranged, with winners encouraged to donate prize money to the lower ranked players, who suffered the most from the lockdown.7 8 In some countries, governments injected funds into the sporting movement, with the most affected, such as community and youth sports, given greater priority.7 In LMICs, however, at the best of times sports budgets are perpetually stretched and other more urgent issues such as conflict resolution, hunger and poverty eradication, and provision of sanitation receive priority. Generally, a pandemic which shuts down the global economy can push sport further down the funding priority list. When professional sport returned to our screens, this threw a lifeline for those who derive revenue from broadcast rights, helping to mitigate the loss of income for their athletes.8 For those dependent on labour and matchday attendance to drive revenue, a return to sport without spectators did not bring much financial respite.
Eventually, as lockdowns eased, live professional (mostly men’s) sport gradually returned, but under strict COVID-19 guidelines. These included maintaining social distancing, social bubbles, proper self-isolation when symptomatic, frequent handwashing, disinfecting facilities, wearing personal protective equipment, rapid deployment of test-and-trace protocols, symptom screening and monitoring, medical screening of athletes following infection and, later, vaccination.9 As most of these were developed by sports and exercise medicine and public health specialists from HICs,9 they were impractical in some LMICs. In addition to conducive sociocultural environments, compliance with these guidelines required financial, infrastructural, sociopolitical and human resources that most LMIC sporting federations could ill afford. Ubiquitous lack of access to general pandemic resources, running water for regular handwashing, testing (which was a prerequisite to entry in sporting venues) and vaccines when they first became available were additional hardships encountered by most LMICs. Hence, when the time came to return to sport with restrictions, the public health mandate to preserve lives superseded the socioeconomic need to preserve sport. Consequently, where professional sport in HICs could resume early in the pandemic, even without spectators, and allow athletes to earn a living, in LMICs, live training and competition were delayed or restricted, as were their associated physical, mental and financial benefits.
In conclusion, while the COVID-19 pandemic was undeniably challenging for all athletes at various levels globally, with even high-profile athletes suffering pay cuts, women, those with disabilities and/or those from LMICs bore an even larger physical, mental and financial burden. Acknowledging that the consequences of COVID-19 in athletes were exacerbated by various socioeconomic, cultural and geographical circumstances should be part of a greater commitment to a postpandemic retrospection by stakeholders to help confront persistent inequity in sport to better support marginalised athletes and avert further disparities. We are all in the same storm, but not in the same boat.10
Patient consent for publication
This article is part of a series commissioned by BJSM for the World Innovation Summit for Health (WISH) 2022. BJSM peer reviewed, edited and made the decision to publish. The lead author(s) received a small honorarium for this work. The series, including open access fees and honorarium, is funded by WISH, which is an initiative of the Qatar Foundation.
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Correction notice This article has been corrected since it published Online First. The author details have been updated.
Contributors NSM drafted the initial version of the manuscript and critical review was provided by all authors. All authors read and approved the final version 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 NSM, JST, JK and JD are editors of the British Journal of Sports Medicine. PCZ and OBAO are deputy editors of the British Journal of Sports Medicine.
Provenance and peer review Not commissioned; externally peer reviewed.