OPINION
COVID-19:
Considerations for the disabled athlete
COVID-19: Considerações
para o atleta com deficiência
Matheus Jancy Bezerra Dantas1, Thaísa
Lucas Filgueira Souza Dantas1,2, José da Penha Dantas Júnior3,
Leônidas de Oliveira Neto3, José Irineu Gorla1
1Campinas State
University – UNICAMP, Brazil.
2Edmond and Lily Safra International Neuroscience Institute – ISD, Brazil
3Federal University of Rio Grande do Norte
– UFRN, Brazil
Received
2020, april 14th; accepted 2020.april 26th
Corresponding author: Matheus Jancy Bezerra Dantas, Av. Antonio
Basílio, 4315 Morro Branco 59054-380 Natal RN
Matheus Jancy Bezerra Dantas: matheusjancy@gmail.com
Thaísa Lucas Filgueira Souza
Dantas: thaisasdantas@gmail.com
José da Penha Dantas
Júnior: josedantasjr@icloud.com
Leônidas de Oliveira Neto:
leonidasoliveiraneto@gmail.com
José Irineu Gorla: gorla@unicamp.br
COVID-19 is a new disease caused by a new coronavirus (SARS-CoV-2) with
a fast spreading around the world that culmination with the state of Pandemic
decreed on March 11, 2020 by the World Health Organization [1]. Studies have
shown that a large portion of the population is asymptomatic for this disease,
as well as having a low mortality rate. In those who are symptomatic, the main
symptoms include the presence of fever and cough that can progress to acute
respiratory distress, pneumonia and death [2,3].
Although typical athletes have fewer comorbidities compared to the
general population and, therefore, are less at risk of developing serious
problems or death when infected with COVID-19 [4].the same cannot be said of
athletes with disabilities who have, to a large extent, a health condition that
can increase the risk of serious problems or death when infected.
There is currently no data on how COVID-19 affects athletes with
disabilities. However, because there is no vaccine and no proven therapies for
the treatment of the disease [2] there is a plausible concern that athletes
with disabilities may be at greater risk of contracting the infection or have
severe manifestations of COVID-19.
This concern is based on the presence of comorbidities such as
hypertension, diabetes and cardiovascular disease, associated with a worse
prognosis and mortality for COVID-19 [5]. In practical terms, a study by Guo et
al. [6] reported an almost two-fold increase in mortality in patients with
cardiovascular disease.
Thus, based on these recent findings, the scientific community [5,7,8]
has proposed that the course of treatment and the prognosis of COVID-19 must be
stratified according to the presence or absence of comorbidities before
SARS-COV-2 infection. Thus, those patients who have acute respiratory failure
syndrome (SIRA), a characteristic symptom of COVID-19, but do not have any comorbidities,
are stratified in TYPE A patients. Those who, in addition to SIRA also have
some comorbidities are classified as TYPE B. Finally, those classified as TYPE
C are those that additionally have multiple organ dysfunction. Thus, the higher
the classification, the worse the prognosis for the disease [8].
Thus, considering the profile of the pathologies of athletes with
disabilities [9], the increased relative risk for this population is evident,
if they are affected by SARS-COV-2.
Sports authorities from clubs and associations, the medical department
of the National Paralympic Committees and the International Paralympic
Committee must be involved in the care of their athletes and must be aware of
the COVID-19 prevention strategies, common symptoms for possible treatment
options, including risk stratification for each of them, until it can be
discussed when this group can be safe to train and participate in sporting
events after the reduction of the worldwide epidemiological curve of this infection.
The
impact of COVID-19 on paralympic sports
Since the beginning of March 2020, sporting competitions for people with
disabilities have gradually been suspended or canceled [10] worldwide. However,
in late March, the International Olympic Committee and the International
Paralympic Committee announced that the Tokyo 2020 Games would also be
postponed and would now take place in 2021 [10].
During the history of the Olympic Games, only three editions were not
held and all for reasons of political divergence that ended in Guerra, Berlin
1916, Tokyo 1940 and London 1944. Only this time there is no political
divergence, but a war against COVID-19.
Unprecedented in sports history, COVID-19 paralyzed training, national
and international competitions. It also suspended or canceled the sporting
activities of some international federations for the year 2020, such as that of
the Boccia International Sports Federation - BISFed.
Prevention
of COVID-19 in disabled athletes
Preservation objective and isolating strategies are relevant aspects for
these athletes during this pandemic.
Preservation
objective
While the typical athlete may experience only mild symptoms as a result
of COVID-19 [4], prevention strategies are necessary for athletes with
disabilities who have impaired immune function as a result of disease
conditions or medications such as the use of steroid tablets or chemotherapy,
with renal or hepatic dysfunction [11,12], cardiovascular diseases [8], lung
conditions such as asthma, emphysema or bronchitis [11], cancer [13] and mainly
with neurological damage [11] because there is no scientific clarity on the
complications arising from the infection.
However, some neurological conditions are associated with weakness in
the swallowing mechanism (bulbar weakness), weakness of the respiratory muscles
or cardiac function, motor neuron disease and some myopathies [11]. These
factors increase the risk of more serious infection.
Thus, it is necessary to reduce the risk of serious infection or death
for groups at higher risk [4,12,13] informing about infection prevention as
well as maintaining care during the pandemic.
Strategies
for isolating athletes with disabilities
Social isolation has been applied to all people [14,15]. However, for
athletes with disabilities with impaired immune function, with kidney or liver
dysfunction, cardiovascular disease, cancer or neurological injury, we suggest
strengthening home isolation as much as possible. Creating a support network
with family, friends and technical committee for all activities that require
leaving home.
Family members should leave as little as possible [11,16], even to carry
out activities such as going to the supermarket or bakery. Thus, shopping for a
longer period minimizes the risk of infection.
Hygiene care must be redoubled and reinforced, including the use of masks,
use of gel alcohol, hand washing with soap and water and everything that will
be used, from food to items for personal use.
When the athlete needs a caregiver, it is necessary to avoid excessive
rotation of these people. Caregivers must also be a sanitary barrier and for
this reason they must make use of Personal Protective Equipment (PPE), such as
masks and gloves.
The athlete's place of stay during social isolation must always be clean
and disinfected. Just like all people who share daily space with the athlete,
they must be attentive to all the care mentioned above. We recommend priority
attention in social distance for all people with any neurological condition,
their caregivers and family members. It is necessary that athletes have constant
contact with their doctor, whether private, with their sports team or
federation, and that they combine the best way for their family members or
friends to get their medical prescriptions.
Athletes with Multiple Sclerosis or other disabilities who use
immunosuppressive drugs may be at greater risk of serious illness due to
COVID-19 [11]. The additional risk of these treatments is not known, but it
must be emphasized that the risk of discontinuing therapy for some patients is
high and the consequences can be devastating [11]. Thus, the athlete must be in
constant contact with his doctors to deal with the interruption of the use or
replacement of immunosuppressants [11,16,17].
Athletes with neuromuscular diseases are a group of individuals in constant
need of medical assistance. Thus, they must have extra attention and much more
rigorous care with social distance measures, especially when they already use
non-invasive ventilatory support equipment.
In periods of disasters and emergency public health, innovations have
been implemented, such as telemedicine, which can be used during the COVID-19
pandemic [18], guiding the athletes' visit to the emergency service or not, or
in monitoring the evolution of your underlying disease.
Return
to training
We suggest that the training conducted during social isolation and the
return to training in sports facilities should be decided with the technical
and medical team, considering the pathologies and morbidities present in each
individual.
Whenever possible to carry out training at home during social isolation,
the orientation and monitoring of the training must be carried out by a trained
professional and the information can be provided remotely [4]. Recently
published [19] a pre-participation screening the practice of telepresential exercise in face of the pandemic by COVID-19
(sars-cov2), where the following questions are encouraged “Do you feel a sore
throat?”, “Do you feel cough and sputum production?”, “Do you feel fatigued?“,
“Do you feel short of breath or difficulty breathing?”, “Do you feel fever
>37,8ºC?”, “Have you had fever for more than three days >37,8ºC?”, “Have
you had any contact with anyone who has been diagnosed or suspected of the
COVID-19?”. A positive answer to the last two questions may indicate the need
for a medical consultation before performing the exercises.
Certainly, modalities with pathological profiles that have people with
disabilities with less risk of complications from COVID-19 should return to
training much faster than modalities that have athletes with pathologies with
higher risks.
The athlete's day-to-day is training and his life is intrinsically
linked to sports equipment, such as fields, tracks, courts and swimming pools.
In March 2020, everyone was invited to a big competition against COVID-19 and
the final prize is life. The training was replaced by the focus on preventing
viral spread with social distance and other common hygiene measures that are
the strategies used to win this competition.
Understanding the need for greater attention for athletes with
disabilities with pathological profiles that increase the risk of complications
in the COVID-19 infection is a need for family members, friends and
institutions that work with this audience.
The best advice for everyone is to reduce or avoid the risk of getting
the virus.
We will meet in Tokyo 2021.