What should you do if you contract coronavirus? We ask the experts for the latest advice on returning to training

Since the Covid-19 pandemic began in the early part of 2020, many people have now caught the virus. Some have had it recently after being vaccinated too. But how do you deal with this if you are trying to train for athletics?

How long are you likely to have the symptoms?

Every athlete has different experiences but, for a study in the British Journal of Sports Medicine this year, Dr Craig Ranson, director of athlete health at the English Institute of Sport, and Dr James Hull, a sports pulmonologist at Royal Brompton Hospital in London, looked at symptom duration and time loss in a cohort of UK elite athletes, many of whom were in training for the Tokyo Olympics at the time.

Surveying a total of 147 athletes between February 24, 2020 and January 18, 2021, all of whom had been diagnosed with Covid-19 or had symptoms, they found that fatigue was the most prevalent symptom (57 per cent), followed by dry cough (50 per cent) and headache (46 per cent).

Most athletes reported symptoms persisting for 6-17 days, although for around 14 per cent symptoms lasted 28 days and a further 27 per cent were not able to return to full training a month or longer after the initial date of infection.

Encouragingly, for most athletes it is “a mild, self-limiting illness” although for some it can be a “prolonged recovery period”.

How quickly can you get back to training?

There is no one size fits all rule. Some athletes recover quickly despite experiencing severe symptoms, while others describe struggling to re-establish their training routines, with muscle weakness and breathing difficulties lingering.

In their guidance for performance athletes and coaches, the English Institute of Sport says a “graduated” return to play (GRTP), or training and competition, is critical.

“In the case of Covid-19 it appears that a process that is too fast or too intense may significantly slow recovery,” reads the guidance developed by leading sports doctors in the UK.

In practice, even athletes with mild symptoms should take their time getting back into training and should wait at least 10 days since symptoms first appeared and be symptom-free for seven days before resuming any type of exercise. Or, as the EIS puts it, “the earliest training could resume is 17 days after the initial onset of symptoms”.

“Data published tends to suggest that, after the early onset of symptoms, there’s an improvement and then a further deterioration after days seven to 10 so it is important not to return too rapidly,” says Hull.

As loss of taste or smell may persist well beyond 10 days in some cases, but these symptoms are considered less important when making decisions around returning to training.

What should you look out for when you do start training again?

Along with the general population, recovering athletes are susceptible to a number of Covid-19-related complications, including cognitive dysfunction and coagulopathy (deep vein thrombosis, pulmonary embolism).

Be aware that breathlessness and fatigue can remain for several weeks and should be closely monitored. If any symptoms get worse, the advice is to stop training immediately and consult a medical professional.

How soon can you resume strength and conditioning?

Guidelines published by the US National Strength and Conditioning Association and the Collegiate Strength and Conditioning Coaches Association (CSCCa) of the United States suggest the 50/30/20/10 per cent training adjustment – using totals performed prior to Covid-19 illness as a baseline.

You adjust the total workload of sets, repetitions and weights by at least 50 per cent during the first week back, by 30 per cent during the second week and so on. A lower percentage of the one rep maximum is also recommended initially and the percentage increased gradually over subsequent weeks.

How can coaches monitor a safe return?

The period of inactivity before an athlete can begin training again will cause a degree of detraining and increases the risk for potential injury, particularly if the athlete bounces back too quickly. Keeping tabs on rate of perceived effort, heart rate, tiredness and breathing issues is critical during their return.

If an athlete is struggling with any of these, reduce the training load until it eases. Also, remain mindful of their mental health – there will inevitably be unsettling bouts of anxiety about whether athletes are able to match their pre-virus physical peaks.

A study on the impact of coronavirus disease on elite and semi-elite South African athletes reported that 79 per cent had disturbed sleep and 52 per cent reported feeling depressed during and after the symptoms.

Are there long-term risks for the heart?

There are concerns about the after-effects of Covid-19 on the heart, although the long-term consequences for anyone – athletes included – are not yet fully understood. In one small but concerning study of US collegiate athletes who had recovered from Covid-19, researchers reported in JAMA Cardiology it was found that 15 per cent had signs of heart inflammation.

For the trial, cardiologists at Ohio State University conducted scans on the hearts of 26 male and female athletes who had tested positive for Covid-19 but who had been mostly asymptomatic.

Scans revealed that, even after several weeks of isolation, four male athletes displayed signs of myocarditis, inflammation of the heart muscle which can be triggered by viral infections.

A further eight athletes showed signs of some scarring or other abnormalities to their heart. Given that myocarditis is a leading cause of sudden cardiac death among athletes, the authors suggested that cardiac MRI could offer a useful tool post infection to identify high-risk athletes from those safe to resume training and competition.

However, other researchers have cautioned that this was a small study and that it did not prove the virus results in heart damage. They also point out that the hearts of competitive athletes will look and function differently from a regular person, so the irregularities might not have been associated directly with the virus.

Results of a larger subsequent study published more recently (January 2021) involved 145 competitive athletes, all of whom who had tested positive for Covid-19. Using cardiac MRI, EEG and serum markers of cardiac pathology 15 days after their positive test result, these researchers found that only two athletes had MRI results consistent with myocarditis, which suggested an association with Covid-19 that was much less prevalent than previously thought.

“The good news from our studies is that myocarditis may not be as prevalent as thought and that the small area of scarring observed may be from athletic remodelling, not the virus,” said Daniel Clark, clinical instructor of cardiovascular medicine at Vanderbilt University and lead author on the studies.

“The concerning news is that some athletes who develop Covid-19-induced myocarditis appear to have sequelae of arrhythmias (uneven heartbeat) and systolic dysfunction.”

A statement by the American College of Sports Medicine suggests that if you notice any symptoms of heart involvement, including chest pain or shortness of breath, before or after testing positive you should consult a doctor.

How does it affect the lungs?

In Ranson and Hull’s research, lower respiratory problems including dyspnoea (shortness of breath), chest pain and a cough were found to be present in 18 per cent of the athletes and those athletes had a longer delay before returning to sport. For some the persistent and residual symptoms, particularly a cough and breathing difficulties, can continue for weeks to months after virus infection, so it is important to monitor them carefully.

“Coaches and athletes should also ensure existing respiratory issues, such as asthma, are well managed throughout, and any worsening breathlessness should be addressed immediately,” says Hull.

What about Long Covid?

Even with the most cautious return to training and competition, not everyone has an easy post-Covid ride and athletes are certainly not immune from lingering symptoms and the enduring fatigue of “Long Covid”.

Tom Bosworth, the multiple world race walk record-holder who was 25th in the Tokyo Olympics 20km walk, told AW how he got the virus in March 2020 just weeks after setting 5000m and 10,000m British records but, having resumed light training in May of that year, he reportedly found the virus had a “weird effect” on his body and says he did not feel “back to normal” until early August.

“We lost all of June,” he said. “I didn’t do any training in June and then just some light training in July, easing my way back. At this point mentally I was exhausted – from being ill, then getting back to training, going off again and then back into training. Racing seemed like a long, long way away.

“You have your symptoms, which is quite a short stage, then you’ve got a period of time where your body is recovering and that’s the key bit. I didn’t leave it long enough. When you feel okay, you’ve got to leave it another two weeks. Allow your body to get used to feeling okay again.”

Former women’s 5000m world record-holder Zola Budd Pieterse, now 54, has also shared her experiences of the virus on social media.

“It has been four weeks now since our positive test and three weeks since I experienced any symptoms,” Budd wrote. “I decided to start training again and am experiencing the following symptoms: elevated heart rate. My heart rate, even doing easy runs of not more than 30 minutes is about 20 beats per minute faster than normal.”

In other words, all athletes should listen to their bodies, be extra cautious and take more time than they think the need to come back. It will pay off in the long run.