INTRODUCTION: The COVID-19 pandemic is posing profound challenges to the athletic community. While there are numerous studies investigating the SARS-CoV-2 infection and its consequences in the general population, there is a lack of data concerning elite athletes. The objective of this study was to evaluate the epidemiological data to identify contact mechanisms of SARS-CoV-2 and the prevalence of persisting symptoms with a focus on sport-restricting complaints 16 weeks after COVID-19 infection in elite athletes. METHODS: 65 German Olympic Sports Confederation athletes (43 men, 22 women; age 23 ± 4.6), including 16 Olympic athletes, from various sports with laboratory-confirmed COVID-19 (via reverse transcription-polymerase chain reaction (PCR) or serum immune globulin G antibody against SARS-CoV-2) were included. Data were collected longitudinally between June 2020 and October 2021. Standardized questionnaires were used to collect data about contact mechanisms, number, type and duration of symptoms, severity of the disease, training suspension and the current perceived physical performance ability. SARS-CoV-2 antibody status was determined at the Institute of Cardiology and Sports medicine of the German Sports University Cologne. RESULTS: 39 athletes (60%) were infected in Germany, whereas 22 (33.8%) were infected abroad. In 4 (6.2%) athletes the location of infection could not be determined. 48.8% of the infections occurred in the athletic context, with most (40.6%) being infected during a competition abroad. Combat sport athletes were most frequently affected (53.8%). 96.8% of the athletes experienced a symptomatic course. 93.8% had at least one Covid-specific symptom (e.g. cough), while 71.2% reported of other symptoms, that are not officially declared as COVID-specific. In 44.1 % of the symptomatic cases, symptoms lasted > 4 weeks, while 28.8 % and 20.3 % experienced symptoms lasting longer than 8 and 16 weeks, respectively. After 16 weeks, the majority of athletes (63.8%) reported not being symptom-free during physical exercise. Most frequently a reduction in physical performance ability (19%), fatigue and shortness of breath during physical exertion (15.5% respectively) and musculoskeletal complaints (6.9%) were notified. 78.1% of the athletes reported reduced performance ability at baseline. Of these, 42.2% indicated their performance to be reduced by 30% or more. 16 weeks after baseline, 42.6% had not regained their former performance level, but only 3.8% reported a reduction by 30% or more. In 80% of the cases, a training suspension of at least 4 weeks was recorded. None of the SARS-CoV-2 positive athletes required hospitalization. CONCLUSION: The main cause of SARS-CoV-2 transmission in elite sports was competitions abroad. Although no hospitalization was required, a broad spectrum of clinical symptoms was evident in the studied cohort 16 weeks after confirmed infection, especially sport restricting complaints and performance limitations.
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