Cardiac injury and sustained cardiovascular abnormalities in long-COVID syndrome, i.e. post-acute sequelae of coronavirus disease 2019 (COVID-19) have emerged as a debilitating health burden that has posed challenges for management of pre-existing cardiovascular conditions and other associated chronic comorbidities in the most vulnerable group of patients recovered from acute COVID-19. A clear and evidence-based guideline for treating cardiac issues of long-COVID syndrome is still lacking. In this review, we have summarized the common cardiac symptoms reported in the months after acute COVID-19 illness and further evaluated the possible pathogenic factors underlying the pathophysiology process of long-COVID. The mechanistic understanding of how Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) damages the heart and vasculatures is critical in developing targeted therapy and preventive measures for limiting the viral attacks. Despite the currently available therapeutic interventions, a considerable portion of patients recovered from severe COVID-19 have reported a reduced functional reserve due to deconditioning. Therefore, a rigorous and comprehensive cardiac rehabilitation program with individualized exercise protocols would be instrumental for the patients with long-COVID to regain the physical fitness levels comparable to their pre-illness baseline.
The incidence of acute respiratory infections (ARinf), including SARS-CoV-2, in unvaccinated student rugby players during phases from complete lockdown during the COVID-19 pandemic to returning to competition is unknown. The aim of the study was to determine the incidence of ARinf (including SARS-CoV-2) during non-contact and contact phases during the COVID-19 pandemic to evaluate risk mitigation strategies. In this retrospective cohort study, 319 top tier rugby players from 17 universities completed an online questionnaire. ARinf was reported during 4 phases over 14 months (April 2020–May 2021): phase 1 (individual training), phase 2 (non-contact team training), phase 3 (contact team training) and phase 4 (competition). Incidence (per 1 000 player days) and Incidence Ratio (IR) for ‘All ARinf’, and subgroups (SARS-CoV-2; ‘Other ARinf’) are reported. Selected factors associated with ARinf were also explored. The incidence of ‘All ARinf’ (0.31) was significantly higher for SARS-CoV-2 (0.23) vs. ‘Other ARinf’ (0.08) (p < 0.01). The incidence of ‘All ARinf’ (IR = 3.6; p < 0.01) and SARS-CoV-2 (IR = 4.2; p < 0.01) infection was significantly higher during contact (phases 3 + 4) compared with non-contact (phases 1 + 2). Demographics, level of sport, co-morbidities, allergies, influenza vaccination, injuries and lifestyle habits were not associated with ARinf incidence. In student rugby, contact phases are associated with a 3–4 times higher incidence of ARinf/SARS-CoV-2 compared to non-contact phases. Infection risk mitigation strategies in the contact sport setting are important. Data from this study serve as a platform to which future research on incidence of ARinf in athletes within contact team sports, can be compared.
The purpose of this research was to use a historical method and core principles from scientific philosophy to explain why mistakes were made in the development of the lactic acidosis construct. On a broader scope, this research explains what science is, why some scientists despite good intention, often get it wrong, and why it takes so long (decades) to correct these errors. Science is a human behaviour that consists of the identification of a problem based on the correct application of prior knowledge, the development of a method to best resolve or test the problem, completion of these methods to acquire results, and then a correct interpretation of the results. If these steps are done correctly there is an increased probability (no guarantee) that the outcome is likely to be correct. Thomas Kuhn proposed that you can understand what science is from how it has been performed, and from his essays he revealed a very dysfunctional form of science that he called ‘normal’ (due the preponderance of its presence) science. Conversely, Karl Popper was adamant that the practice of ‘normal’ science revealed numerous flaws that deviate from fundamental principles that makes science, science. Collectively, the evidence reveals that within the sports medicine and health sciences, as with all disciplines, errors in science are more frequent than you might expect. There is an urgent need to improve how we educate and train scientists to prevent the pursuit of ‘normal’ science and the harm it imparts on humanity.
Myocarditis is a rare cardiomyocyte inflammatory process, typically caused by viruses, with potentially devastating cardiac sequalae in both competitive athletes and in the general population. Investigation into myocarditis prevalence in the Coronavirus disease 2019 (COVID-19) era suggests that infection with Severe acute respiratory syndrome coronavirus (SARS-CoV-2) is an independent risk factor for myocarditis, which is confirmed mainly through cardiovascular magnetic resonance imaging. Recent studies indicated that athletes have a decreased risk of myocarditis after recent COVID-19 infection compared to the general population. However, given the unique nature of competitive athletics with their frequent participation in high-intensity exercise, athletes possess distinct factors of susceptibility for the development of myocarditis and its subsequent severe cardiac complications (e.g., sudden cardiac death, fulminant heart failure, etc.). Under this context, this review focuses on comparing myocarditis in athletes versus non-athletes, owing special attention to the distinct clinical presentations and outcomes of myocarditis caused by different viral pathogens such as cytomegalovirus, Epstein-Barr virus, human herpesvirus-6, human immunodeficiency virus, and Parvovirus B19, both before and after the COVID-19 pandemic, as compared with SARS-CoV-2. By illustrating distinct clinical presentations and outcomes of myocarditis in athletes versus non-athletes, we also highlight the critical importance of early detection, vigilant monitoring, and effective management of viral and non-viral myocarditis in athletes and the necessity for further optimization of the return-to-play guidelines for athletes in the COVID-19 era, in order to minimize the risks for the rare but devastating cardiac fatality.