The SARS-CoV-2 pandemic has changed life across the globe—and sports are no exception. For the foreseeable future, frequent policy changes and the threat of new variants will remain our new normal. We encourage all athletes to follow the latest public health recommendations, and to let their providers know if they have been exposed to the infection so they can be managed and cleared to return to sport. 

Cardiac

Mild illness is defined as cold symptoms, gastrointestinal symptoms, loss of taste and smell without fever, or cardiac symptoms (chest pain and shortness of breath). Athletes with mild illness are advised to refrain from exercising for 3 days from symptom onset. Symptom-free athletes who receive a positive test result should also abstain from exercise for 3 days. We recommend a medical evaluation before returning to sport. 

Moderate illness is defined as a fever for more than 2 days, chills, flu-like symptoms, chest pain, or shortness of breath. Athletes with moderate illness are advised to refrain from exercising for at least 5 days from symptom onset, and until all fever and cardiac symptoms have been resolved. We recommend a medical evaluation before returning to sport. Testing may include an ECG, echocardiogram, and a cardiac blood test.

Any athlete with a severe infection or requiring hospitalization must obtain clearance from their provider before resuming activity. If any athlete returning to activity develops chest pain, shortness of breath, palpitations, or unexplained exercise intolerance, they should stop all activity and consult their provider.

Neurologic

Although not much has been published on this matter, we are concerned that many of the prolonged COVID-19 symptoms are similar to those seen in post-concussive syndrome. For this reason, we are recommending a reevaluation from a concussion risk perspective for all the athletes who have had or currently have neurologic symptoms.