2022年7月更新
保持健康的最佳方法是保持健康。这意味着在可能的情况下减轻风险。COVID-19（Omicron-Next或BA-Next）的当前主要谱系是有史以来最可传播的病原体。曾经。似乎每次在任何时间内都会有大量人类（没有口罩）的大量聚会，都会有大量的共同传播，许多人都会被感染。
不过，实际上，一切都开放了，我们出去了，竞争，旅行和冒险。因此，我们看到许多运动员在第二轮，第三或第四轮旅行和生病。这些共同感染和重新感染使我们许多人惊讶地吸引了我们许多人。如果发生这种情况，我们作为运动员和教练的管理方式将在接下来的几天，几周或几个月内决定健康和表现，从而使我们可以安全地重返运动。
The primary concern for athletes contracting COVID appears not to be the usual list of symptoms (fever, cough, fatigue, trouble breathing, etc.) but something far more sinister, myocarditis. This inflammation of the heart tissue can send the electrical system that makes your heart work efficiently awry and cause arrhythmias which could be life-threatening. Or “worse,” they could cause damage that results in one being permanently disabled.
这就是导致职业体育联盟为运动员煽动分层保护的动机。这些在这项运动巅峰的高价值资产使娱乐产品成为可能。他们也是与家人的人类，所以就是这样。
Professional Leagues and Athletes Leading the Way
通过科学，技术和倾斜的一些壮举，许多体育联赛能够在2020年之前取得成功，并利用他们的经济福祉使运动员重新发挥作用。NBA的年收入为90亿美元，是第一个证明Covid可以用“泡沫”来驯服的。它起作用了，更重要的是，它使其他人有信心自己尝试。
2020年环法自行车赛(TdF)是第一次ince the Spanish Flu that a Grand Tour had been attempted during a public health emergency. Many people doubted the ability of the organizing entity, ASO, to execute a “race bubble” effectively, but they had more than $217 million in reasons to make it successful. As I write this, the 2022 TdF has begun, and the complete lack of rider safety concerning COVID is disappointing.
UCI列出了反兴奋剂控制的主要原因是“保护运动员”，但同时曝光并迫使运动员与传染性和多系统疾病竞争。已知这种疾病会出现诸如心肌炎之类的症状，并且在主动患有这种疾病的同时，世界一流的竞争效果尚不清楚。但是，ASO再次有数亿个理由来确保演出继续进行。
一些适合文学展示如何NFLleveraged its $15.26 billion annual revenue to pull off a complete competitive season with only a few interruptions. The thoroughness of the protocols is mind-boggling. In 2020 between Aug. 9 and Nov. 21 (15 weeks), the 11,400 players and staff were administered 623,000 tests, with most being tested six days per week. That’s basically a nose swab with your daily morning coffee.
If someone were to test positive, the NFL would do extensive contact tracing, quarantining (in fancy hotels) and more testing. These protocols saved the NFL season and demonstrated that producing a sporting season with minimal disruptions is possible. This also served as a model that NCAA basketball was able to leverage to give us March Madness in 2021.
When the pandemic began, seemingly decades ago, I provided concise and effective guidance for a coach as they指导运动员重返训练following infection with COVID. However, treatment and outcomes are of utmost importance when determining best practices.
Those same professional sporting leagues mentioned above executed an effective return to play/training (RTP) model that included an advanced and extensive cardiac testing protocol. This extensive testing and retesting goal was simple: detect and assess inflammatory heart disease in professional athletes with prior COVID infection and use the established guidelines to safely guide the athletes to return to play.
The outcomes of the RTP protocols were exceptional. Athletes were still infected with COVID, and 1-3% of the athletes developed myocarditis. The outcomes were far from catastrophic other than extended rest. To date, no adverse cardiac events have occurred. Not a single one.
But what is this extensive testing and screening protocol, and how available is it to anyone not active in a professional sports league? Tests include IgG, PCR, Troponin, Electrocardiogram (ECG), Echocardiogram (Echo), Cardiac MRI and Stress Echo.
If you’ve ever had a reason to be involved with any cardiac care, you know that these tests are expensive, time-intensive and not scalable for the general sporting population. In short, this level of care is only possible for these sports leagues because they spend immense resources on the health of their most valuable asset to ensure that those assets stay valuable.
职业体育联赛的总和有数十亿美元的资源可供使用，大量的团队卫生专业人员以及高级医疗服务。我们其余的人生活在一个现实中，等待扫描需要几天，结果需要数周，而医院同时又有整体和空虚。我们应该竭尽所能避免共同事件和任何潜在的心脏事件。
The good news is that while COVID has evolved and the Omicron-Next lineage outcompetes Omicron-Previous, our existingmodels for safe RTPhaven’t changed much other than to reinforce what we knew before.
什么教练不应该做
Throughout the entire COVID process, a coach should not attempt to insert themselves into the diagnosis process. Furthermore, they should not take it upon themselves to know the clinical presentation or pathophysiology of myocarditis. They should understand cardiovascular signs and symptoms of myocarditis or other cardiac conditions and how they show up in exercise data andperceived exertion. In short, the coach should know when the athlete should cease exercise and be referred to a physician for testing and diagnosis.
Guiding the Comeback from COVID
I like the idea of action flow charts in this particular instance. As a coach guiding the athlete, the best thing you can do is keep the athlete informed of the process and what to expect. The RTP process takes weeks or months, not days. The best way to safely RTP is to take the time to follow the protocol.
首先确定该疾病的严重程度，您可以用这张桌子做。
COVID-19疾病严重性用于RTP筛查
| Illness severity | 定义和常见的临床发现 |
| Asymptomatic | Positive COVID-19 test with no symptoms |
| 次要的 | 低血压，咳嗽，仅轻度疲劳，URI症状（例如，鼻塞，喉咙痛），可能是其他症状（例如，恶心，呕吐，腹泻，腹泻，厌食，Ageusia） |
| 缓和 | Persistent fever (38°C [100.4°F] or higher), persistent fatigue (at least 7 days duration), pneumonia (CXR <50% lung parenchyma involvement), chest pain not associated with cough, activity-limiting dyspnea, orthopnea, edema, palpitations, syncope |
| Severe | Dyspnea, hypoxia (SpO2<94％的房间空气），需要补充氧气，CXR浸润，涉及> 50％的肺实质，需要住院治疗 |
| Critical | 呼吸衰竭（即机械通气，ECLS），休克，多器官功能障碍 |
“Moderate illness” indicates a different action compared to lesser disease states, and more severe than moderate places the athlete in the hospital.
Next, we move on to some共同治疗方案如以下流程图所示。作为教练，我们只需要关注正确的分支机构即可。但是，向左看，注意它的广泛程度和所涉及的时间。很多。
Finally, the bottom right box points toan individualized RTP planwhich we can find on the Faculty for Sport and Medicine UK website.
As a coach, you’ll spend most of your time guiding the athlete through the RTP space. There are other protocols, too, and this should be an individualized RTP action plan. One size does not fit all.
Finally, as a coach, it’s essential to support the athlete mentally during this process. Our athletes are accustomed to moving and working and resting. They will struggle to rationalize protocols, especially when they don’t feel “bad.” Keep them aware of why they are resting and remind them that it will end and they will be crushing it soon enough.
Thanks for reading.
参考
Daniels CJ，Rajpal S，Greenshields JT等。近期SARS-COV-2感染的竞争运动员中临床和亚临床心肌炎的患病率：十大Covid-19心脏注册中心的结果。贾马心脏。2021; 6（9）：1078–1087。doi：10.1001/jamacardio.2021.2065
Udelson JE, Rowin EJ, Maron BJ. Return to Play for Athletes After COVID-19 Infection: The Fog Begins to Clear. JAMA Cardiol. 2021;6(9):997–999. doi:10.1001/jamacardio.2021.2079
Kim JH, Levine BD, Phelan D, et al. Coronavirus Disease 2019 and the Athletic Heart: Emerging Perspectives on Pathology, Risks, and Return to Play. JAMA Cardiol. 2021;6(2):219–227. doi:10.1001/jamacardio.2020.5890
Martinez MW，Tucker AM，Bloom OJ等。患有系统性回到运动心脏筛查的先前COVID-19感染的职业运动员中炎症性心脏病的患病率。贾马心脏。2021; 6（7）：745–752。doi：10.1001/jamacardio.2021.0565
Mack CD, Wasserman EB, Perrine CG, et al. Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, Aug. 9–Nov. 21, 2020. MMWR Morb Mortal Wkly Rep 2021;70:130–135.
Klawitter, Paul M.D., Ph.D.*; Cowen, Leslie ATC, MS†; Carhart, Robert M.D.‡ Low Risk of Cardiac Complications in Collegiate Athletes After Asymptomatic or Mild COVID-19 Infection, Clinical Journal of Sports Medicine: July 2022 – Volume 32 – Issue 4 – p 382-386 doi: 10.1097/JSM.0000000000001043
Risch M, Grossmann K, Aeschbacher S on behalf of the COVID-19 remote early detection (COVID-RED) consortium, et al
调查使用传感器手镯在与COVID-19相关的生理参数变化的预症状检测：前瞻性队列研究的临时分析（COVI-GAPP）（COVI-GAPP）
BMJ开放2022;12:e058274。doi: 10.1136 / bmjopen - 2021-058274
Moulson N, Gustus SK, Scirica C, et al
诊断评估和心肺运动测试结果在Covid-19之后具有持续症状的年轻运动员
British Journal of Sports Medicine Published Online First: May 18 2022,. doi: 10.1136/bjsports-2021-105157
Rosie K. Lindsay, Jason J. Wilson, Mike Trott, et al. (2021) What are the recommendations for returning athletes who have experienced long-term COVID-19 symptoms?, Annals of Medicine, 53:1, 1935-1944, DOI: 10.1080/07853890.2021.1992496
