PURPOSE: The aim of the study was to identify factors associated with prolonged time to return to full performance (RTFP) in athletes with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
METHODS: Prospective cohort study with cross sectional analysis. A total of 84 athletes with confirmed SARS-CoV-2 infection assessed at a coronavirus disease 2019 recovery clinic gave a history of age, sex, type/level of sport, co-morbidities, pre-infection training hours, and 26 acute SARS-CoV-2 symptoms from 3 categories ("nose and throat", "chest and neck", and "whole body"/systemic). Data on days to RTFP were obtained by structured interviews. Factors associated with RTFP were demographics, sport participation, history of co-morbidities, pre-infection training history, and acute symptoms (type, number). Outcomes were: (a) days to RTFP (median, interquartile range (IQR)) in asymptomatic (n���=���7) and symptomatic athletes (n���=���77), and (b) hazard ratios (HRs; 95% confidence interval) for symptomatic athletes with vs. without a factor (univariate, multiple models). HR < 1 was predictive of higher percentage chance of prolonged RTFP. Significance was p < 0.05.
RESULTS: Days to RTFP were 30 days (IQR: 23-40) for asymptomatic and 64 days (IQR: 42-91) for symptomatic participants (p > 0.05). Factors associated with prolonged RTFP (univariate models) were: females (HR���=���0.57; p���=���0.014), endurance athletes (HR���=���0.41; p < 0.0001), co-morbidity number (HR���=���0.75; p���=���0.001), and respiratory disease history (HR���=���0.54; p���=���0.026). In symptomatic athletes, prolonged RTFP (multiple models) was significantly associated with increased "chest and neck" (HR���=���0.85; p���=���0.017) and "nose and throat" (HR���=���0.84; p���=���0.013) symptoms, but the association was more profound between prolonged RFTP and increased total number of "all symptoms" (HR���=���0.91; p���=���0.001) and "whole body"/systemic (HR���=���0.82; p���=���0.007) symptoms.
CONCLUSION: A larger number of total symptoms and specifically "whole body"/systemic symptoms during the acute phase of SARS-CoV-2 infection in athletes is associated with prolonged RTFP.
