Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): a cross-sectional study—AWARE study I

Background There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP). Objective To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI. Design Cross-sectional descriptive study. Setting Online survey. Participants Athletes with confirmed/suspected COVID-19 (ARI COV ) (n=45) and athletes with other ARI (ARI OTH ) (n=39). Methods Participants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: ‘nose and throat ’, ‘chest and neck ’ and ‘whole body ’. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARI COV versus ARI OTH subgroups. Results The symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was ‘excessive fatigue ’ (75%; p<0.0001), ‘ chills ’ (65%; p=0.004), ‘ fever ’ (64%; p=0.004), ‘ headache ’ (56%; p=0.006), ‘altered/loss sense of smell ’ (51%; p=0.009), ‘ Chest pain/pressure ’ (48%; p=0.033), ‘ difficulty in breathing ’ (48%; p=0.022) and ‘ loss of appetite ’ (47%; p=0.022). ‘ Excessive fatigue ’ remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARI OTH , the ARI COV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043). Conclusion Symptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).