Clinical patterns, recovery time, and prolonged impact of COVID-19 illness in international athletes: the UK experience

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 (e.g., 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 (i.e., including dyspnoea +/- chest pain +/- cough +/- fever) was present in 18% and associated with a higher relative risk of prolonged symptoms RR 3.0 (95%CI: 1.4-6.5) and time-loss 2.1 (95%CI: 1.2-3.5). 
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.