COVID-19 is the name of the disease that is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This is a new virus recently identified in Wuhan, China. Currently there are seven types of Coronavirus that are known to infect humans, four of those commonly circulate in the community and generally result in minor illness such as the common cold. The remaining two are associated with significant illness being Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) and Severe Acute Respiratory Virus (SARS).

COVID-19 results in a spectrum of illness ranging from possible asymptomatic carriage, common cold to severe cases requiring hospital admission. In a small minority of cases, COVID-19 can be fatal.

The early epidemiological characteristics published should be interpreted with caution. Patients with milder disease would be less likely to seek medical attention and therefore may not be included in the statistics.

Epidemiological reports from patients who received medical attention in China suggest the following breakdown of COVID-19 cases:

• 1% have no symptoms
• 81% have mild symptoms like the common cold
• 14% have severe symptoms that cause them to miss work and/or attend hospital
• 5% have severe symptoms, often requiring ICU admission (including a fatality rate of about 2.3%)

(Wu & McGoogan, 2020).

There were no reports of deaths in people aged nine years or younger and of the 1716 health care workers diagnosed who may be presumed to be younger with less co-morbidities there were five deaths reported giving a fatality rate 0.003%, which may be more representative to athletes and coaches (Wu & McGoogan, 2020).

The most common symptoms are fever, cough and shortness of breath. Atypical symptoms include loss of taste and smell, conjunctivitis and gastrointestinal upset. It is not possible to tell the difference between COVID-19 and other common respiratory illness particularly in the early stages of illness. Individuals should consult with their doctor by calling ahead. The doctor can take a thorough history, including travel history, perform a physical exam and make a recommendation regarding testing for COVID-19.

The estimated incubation period is between 1-14 days but is about five days on average. The incubation period is the time from when exposure to the virus occurs until symptoms start. Symptoms can persist for longer than three weeks, although the duration of illness will be highly variable.

The literature has demonstrated older, immune compromised and persons with cardiovascular disease are more likely to have worse outcomes from the virus, compared to fit young healthy people. However, it has been observed that even mild cases that can be managed as an outpatient have resulted in viral pneumonia observed on lung imaging, myocarditis, post viral arthritis, post viral fatigue and other non-respiratory complications. What this means for athletes is that for those athletes who contract the virus the risk of becoming critically unwell is low, however even the course of a mild infection is likely have a significant impact on your ability to train for weeks to months, re-enforcing the need to be diligent with infection prevention measures.

Analysis of the number of cases from the Diamond Princess suggests that COVID-19 is more contagious than seasonal influenza.

This can change based on the circumstances the outbreak is occurring in and it is expected this will be refined over time as more is known.

It has been established that individuals are contagious prior to the onset of symptoms, on average this is expected to be approximately 48 hours.

In the absence of dedicated control measures, it is expected that every case of diagnosed COVID-19 will generate a further 2 to 3 cases.

The virus is primarily transmitted primarily through respiratory droplets. There is mounting evidence demonstrating the relevance of aerosol spread and ongoing research to determine if there are other possible modes of transmission such as faecal.

Hand hygiene remains the single best action individuals can take to reduce their risk of acquiring any respiratory or gastrointestinal tract infection. Annual influenza vaccination remains an important infection prevention measure.

You should be vigilant with frequent hand washing using soap and water or an alcohol-based hand rub. Make sure you adhere to 'illness etiquette'. If you are coughing and sneezing, do so away from people into a tissue, your elbow or hands. If you cough or sneeze into your hands, make sure you wash your hands afterwards. Do not attend training if you are feeling unwell and seek medical review early if you have mild symptoms.

Research in respiratory infections in travelling sporting teams suggests that the most likely pattern of spread occurs from within a team, rather than from external sources. When an unwell team member joins the team, due to the regular close physical contact between team members the infections can spread readily within a team (Valtonen et al., 2019).

Unwell members of the team should not be permitted to attend training or attend work.

Social distancing is an effective measure that can contribute to the reduction of transmission of COVID-19 in the community. The current federal government provides detailed recommendations for social distancing on their web site.

Currently there is no specific treatment for COVID-19 in patients who are well enough to be managed outside of the hospital. The aims of outpatient medical management are to provide supportive care by identify other treatable causes of illness (such as influenza), manage any complications from COVID-19 and provide advice on how to limit the transmission from known cases.

Exercise and maintaining your level of fitness remains an important part of physical and mental health for everyone.

For those who are well, they should continue to train, within the current restrictions on public gatherings.

Athletes should discuss with their national sporting organisations and coaching staff methods for continuing to exercise and maintain their fitness through this period.

Currently there is not enough available information to provide strong, specific advice regarding any additional risks posed by COVID-19 in pregnancy. The decision for women who are pregnant or are planning to become pregnant to travel with teams to areas that have a higher risk profile is best made on an individual basis after a discussion with a medical practitioner.

NSO and coaching staff should support any decision a woman makes regarding their decision to travel or attend work in these circumstances. NSOs should offer measures to allow women to continue to contribute remotely should this be practical.

The CDC provides a summary of what is currently known regarding additional risks in pregnancy.

In planning for the post COVID-19 pandemic period, sports will need to have built in infection control measures to their daily approach. It is strongly advised the sport seek medical input when performing a risk assessment and designing infection control procedures. Teams travelling or living together represent a risk similar to that described for boarding schools and community sport. Each sport should “consider the risks versus the benefits” of staying in a team training environment, and consider the resources available to follow social isolation procedures while in that environment. For example;

Does each individual have their own bedroom?

Does each individual have their own bathroom?

Is there capacity to for individuals to prepare and consume meals away from a dining hall?

What will the team do in the event of the first and subsequently identified cases of COVID-19?

• In a team environment there will be increased proximity and duration of physical contact that can facilitate transmission of respiratory and gastrointestinal pathogens. Research in respiratory infections in travelling sporting teams suggests that the most likely pattern of spread occurs from within a team, rather than from external sources. When an unwell team member joins the team, due to the regular close physical contact between team members the infections can spread readily within a team (Valtonen et al., 2019).
• Larger group size when travelling to areas of elevated risk may increase the potential exposure to the group as a whole.