The Beijing Olympics are in the rearview mirror, the Omicron wave in Canada is receding, but world-class athletes are still facing the fact that age and fitness doesn’t spare them from prolonged COVID symptoms that could be career ending.
Since Olympic athletes train in four-year cycles, the worry is not only about the severity of symptoms or how long symptoms last but also about exactly when they occur. Jordan Clarke, Rowing Canada’s lead physiologist, says that training in a four-year cycle is like rolling a snowball down a hill: “You want to pick up momentum; you want to get bigger and better … COVID would basically be stopping that snowball.”
The next Olympics, the Summer Games, are scheduled for Paris in 2024 but the Games are only the culmination of the quadrennial for top athletes. Many of them compete internationally between Olympics, and each sport has its own system for qualification. For example, in rowing, athletes have two opportunities to qualify for the Games – the World Championships and the Final Olympic Qualifying Regatta.
“If you got COVID … your chance at the Olympics probably would be over,” says American Olympic rower Kendall Chase.
One recent study of German and Italian soccer players detected subtle but long-lasting declines in function, including a six per cent drop in passing ability that did not fully recover for several months.
Canadian skeleton bobsled athlete Grace Dafoe, who did not qualify for Beijing, says her physical ability had declined when she returned to Olympic training six weeks after catching COVID: “That first block back was really hard.”
Olympic champion bobsledder Alex Kopacz, who won gold in 2018 and now coaches, says, “I think it took me a month to be able to walk further than 200 metres, just to the end of the street with my dog and back, without taking breaks.”
‘I tried going for a short little walk outside and barely made it half a block’
Chase had the same experience: “I tried going for a short little walk outside and barely made it half a block; I was exhausted. If this happened before the Games, I don’t know what would’ve happened.”
Common post-COVID symptoms include fatigue, shortness of breath and cough, says Jane McKay, medical lead of British Columbia’s Post-COVID-19 Interdisciplinary Clinical Care Network. And there is “no one single therapy proven in the literature.”
Because such symptoms can have many causes, “it takes a while to recognize (athletes) are in trouble,” says Jill Calder, a physical medicine and rehabilitation specialist.
Dafoe says she knew something was wrong last fall when her resting heart rate became abnormally high. Soon after, she began coughing and experienced loss of smell, altered taste, weight loss and feeling unwell. She was diagnosed with COVID, and her symptoms persisted for more than a month.
And athletes don’t just have to deal with physical symptoms. They often also contend with self-blame and other mental-health issues.
Dafoe says that post-COVID she had trouble teasing apart which training setbacks were coronavirus-related and which were not.
“I try to pick what’s me, what can I push through, and what can I blame myself for. I asked myself, ‘What standards can I hold myself to while realizing I was very sick?’… As athletes, we can be so hard on ourselves.”
This self-blame is no surprise to Calder, who says that athletes tend to recognize declines in their physical ability more than non-athletes: “They’re ‘type A’; they have high-performance expectations of themselves.”
The mental-health side of COVID is often not given enough weight when she hears stories about athletes who have become ill, Dafoe says. “It was actually quite traumatic,” she says of her own experience.
McKay says of her patients that “38 to 40 per cent have mental-health issues – anxiety, depression and PTSD,” sometimes combined with impaired ability to think. Calder recalls one of her patients, a teenage straight-A student and basketball player whose post-COVID syndrome unearthed an underlying anxiety disorder: “When I asked her how she felt, she said, ‘I feel really scared … I don’t know what’s wrong with me.’ ”
The question of when to return to training can be a tricky one. Dafoe was still plagued with a cough after six weeks and could resume training only when prescribed a puffer. “I really think the puffer … allowed me to get back to training, even though it was at a very low intensity,” she says.
‘If they do more than they can handle in a day, they have an episode of significant fatigue’
Calder says the pacing of intensity is important. To help post-COVID sufferers predict the amount of activity they can tolerate, Calder designed the Living In Your Energy Envelope Tool, a detailed symptom diary that helps people understand the relationship between their activities and their symptoms. It may also help them avoid post-exertional malaise (PEM), in which symptoms actually worsen 24 to 48 hours after undertaking too much activity too soon.
Activities that cause PEM can be surprisingly benign sounding.
“It can be just thinking, or something as simple as grocery shopping,” says McKay. “If they do more than they can handle in a day, they have an episode of significant fatigue and increased symptoms thereafter.”
When it comes to helping Olympic rowers return from COVID, Clarke says that “so much stuff comes out early now, without a ton of peer review . . . It’s hard to tell what’s really good evidence on this.”
A November multi-study analysis of long COVID in athletes found “limited research” upon which to make recommendations for return to training. In general, however, it recommends first screening for and treating specific organ damage or mental-health problems to focus treatment.
Experts recommend a multidisciplinary team, which, for an élite athlete, may include a physiotherapist, occupational therapist, dietitian, sports medicine physician and other specialists.
With all the uncertainty regarding treatment, Calder stresses that vaccinations provide protection from long COVID and those with boosters have fewer symptoms. A recent U.K. study of twice-vaccinated adults who then contracted COVID showed 41 per cent fewer symptoms 12 weeks later. A second French study, still in preprint in medical journal The Lancet, suggested similar results at 120 days.
Having seen many cases of long COVID in her career, Calder has this advice: “The best treatment for long COVID is to not get COVID in the first place.”