The COVID-19 pandemic set the whole world in front of a relatively new situation. Knowledge of the new infection, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2), was sparse and people in every industry started to rethink their habits and guidelines. Acute respiratory illnesses and infections are a major burden to competitive athletes and some guide lines considering avoiding infections and return to sport already exist. However, proper scien tific based guidelines were and are still missing, especially considering return to sport. The purpose of this thesis was to enhance the understanding of respiratory viral infections in athletes and to describe the nature COVID-19 in a cohort of Finnish cross-country skiers. 15 cross-country skiers who had been infected with SARS-CoV-2 in spring 2020, were inter viewed two months and 13 months after symptoms onset. Symptoms, training status and sub jective evaluation of performance were asked in the interviews. Blood samples were collected three months and 14.5 months after symptoms onset. Samples were analysed for antibodies against SARS-CoV-2 nucleoprotein (N) and spike glycoproteins RBD (spike receptor-binding domain) and SFL (full-length spike protein) IgG concentration, and neutralizing antibody titres against the wildtype virus. All athletes had mild symptoms and none of the athletes required hospital care. The most com mon symptoms were alterations in sense of taste and/or sense of smell, abnormal fatigue, mus cle soreness, runny nose or nasal congestion, fever and headache. Mean symptom duration was 10 days, symptom severity on scale one to three was 1.6, number of symptoms 5 and mean days to return to training happened 9 days from the symptom`s onset. All athletes developed meas urable positive antibody responses. In serum samples collected three months after the infection, all athletes had values over the line of positivity in IgG anti-N, IgG anti-RBD and IgG anti SFL. At the same time 13 out of 15 athletes microneutralization test (MNT) titre was positive. Finding in this thesis supports the previous knowledge that athletes experience mostly mild COVID-19 and can successfully return to training and competitions. Athletes develop measur able antibody response and vaccination seems to strengthen the response after natural COVID 19 infection. The cohort of this thesis was small, including only one sport discipline and inter pretation of these results should be made with caution. Guidelines to return to training still varies after a few years of the COVID-19 pandemic and thus, more information and updated guidelines are required to ensure athletes safe return to play regarding not only COVID-19 infection but also of other viral respiratory infections.
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