SAJSM 595 (COMMENTARTY).indd

POSITION STATEMENT

1 SAJSM VOL. 32 NO. 1 2020

Creative Commons Attribution 4.0 (CC BY 4.0) International License

Implications of COVID-19 for resumption of sport in South
Africa: A South African Sports Medicine Association (SASMA)
position statement – Part 1

DA Ramagole,1 MBChB, MSc; DC Janse van Rensburg,1,2 MMed, MD; L Pillay,1 MBChB, MSc; P Viviers,3,4,5

MBChB, MMedSc; P Zondi,6,7 MBChB, MSc, J Patricios,8 MBBCh, MMedSci

1 Section Sports Medicine & Sport, Exercise Medicine and Lifestyle Institute (SEMLI), Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
2 Medical Board Member, International Netball Federation, Manchester, UK
3 Campus Health Service, Stellenbosch University, South Africa
4 Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences,

Stellenbosch University, South Africa
5 FIFA Medical Centre of Excellence, South Africa
6 Sports Science Institute of South Africa, Newlands, South Africa
7 South African Sports Confederation and Olympic Committee, Medical Advisory Committee
8 Wits Institute for Sport and Health (WISH), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Corresponding author: DA Ramagole (maki.ramagole@up.ac.za)

South Africa, like many other countries, is

grappling with the various implications of the

coronavirus disease 2019 (COVID-19) pandemic.

The pandemic has had a significant effect on

individuals, businesses, and society at large. Sport

was not spared from the impact with the cessation of all

professional and non-professional sport. All recreational parks

and fitness centres were closed. South Africans participating in

many codes of amateur and elite sport had scheduled events

cancelled or postponed and their ability to train was limited.

Government imposed a lockdown period to control and slow

down the spread of infection, strongly advocating for

preventative measures, including physical distancing and hand

sanitising, emphasising that no specific treatment or vaccine is

available. The initial ‘hard’ level 5 lockdown was supposed to be

for three weeks, but was subsequently increased by two more

weeks to further contain the spread of the virus and to give the

relevant authorities time to coordinate a national and subnational

response. A risk-adjusted approach was thereafter adopted,

implementing various levels of societal reintegration to

progressively return the country to normality while trying to

mitigate the spread of disease.

Carmody et al., describe similar periods of lockdown and what

these measures aim to achieve when facing a novel pathogen and

pandemic for which most were unprepared.[1] The South African

Sports Medicine Association (SASMA) has written a position

statement on guidelines for the safe return to sports for athletes,

based on literature from experts in various fields. This is intended

as a guide, and should be used in conjunction with medical

practitioners’ clinical evaluation of athletes and local government

guidelines.

Reducing transmission

Globally, governments have restricted activities to minimise

human-to-human transmission of the virus. This activity

restriction is aimed at buying time and allowing for

international collaboration between governments and local

authorities while strategising to allocate medical resources to

counter the pandemic. In this period three pillars of the strategy

have been identified, namely.[1]

1. Testing: Suspected cases should be tested where possible,

but this has to be done where it is clinically appropriate

and preventative strategies should be in place. [1]

2. Contact tracing: Measures should be in place to follow-up

on all confirmed cases of COVID-19 and all contacts traced

to identify and stop transmission. [1]

3. Treatment: All cases should be managed effectively, and

governments should be equipped to provide adequate

numbers of hospital beds, intensive care unit (ICU)

capacity, ventilators and healthcare professionals. [1]

Organised events

Five key questions address risk factors when allowing

organised events. These are highlighted by the World Health

Organisation (WHO) and have been incorporated into a risk

assessment tool developed to guide event organisers in

mitigating the spread of COVID-19.[2] The questions are as

The significant impact of the coronavirus disease 2019 (COVID-

19) pandemic has extended to sport with the cessation of nearly

all professional and non-professional events globally.

Recreational parks and fitness centres have also closed. A

challenge remains to get athletes back to participation in the

safest way, balancing the protection of their health while

curbing the societal transmission of the virus.

With this Position Statement, the South African Sports

Medicine Association (SASMA) aims to guide return-to-sport as

safely as possible, in an evidence-based manner, given that

COVID-19 is a new illness and new information from experts in

various fields continues to emerge. Clinical considerations are

briefly described, focusing on a return-to-sport strategy,

including education, preparation of the environment, risk

stratification of sports and participants, and the practical

implementation of these guidelines. The management of the

potentially exposed or infected athlete is further highlighted.

It is important that persons charged with managing athletes’

return-to-sport in any environment must be up-to-date with

local and international trends, transmission rates, regulations

and sport-specific rule changes that might develop as sport

resumes. Additionally, such information should be applied in a

sports-specific manner, considering individual athlete’s and

team needs and be consistent with national legislation.

Keywords: return to play, coronavirus, pandemic

S Afr J Sports Med 2020; 32:1-6. DOI: 10.17159/2078-516X/2020/v32i1a8454

http://dx.doi.org/10.17159/2078-516X/2020/v32i1a8454
https://orcid.org/0000-0001-6682-3438
https://orcid.org/0000-0002-5341-6080
https://orcid.org/0000-0002-8353-3376
https://orcid.org/0000-0003-1058-6992
https://orcid.org/0000-0002-6829-4098
https://orcid.org/0000-0001-6001-5966

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SAJSM VOL. 32 NO. 1 2020 2

follows:

 Is there documented active local transmission of COVID-

19 (community spread) in the country that will be hosting

the events?

 Are there multiple venues, cities or countries hosting the

event, or is it held in a single venue?

 Are the participants and spectators also from other

international destinations? Do those countries have

documented local transmission of COVID-19 which is still

active i.e. documented community spread?

 Are most of the participants or spectators expected to be

high-risk for becoming infected and developing severe

COVID-19 disease? This category includes people over 65

years of age or people with underlying chronic medical

conditions.

 Does the event involve contact or non-contact sports

(where contact sports are considered a higher risk for

transmission of COVID-19)?

One method of mass gathering risk stratification is colour

coding, as proposed by Carmody et al[1] (Table1).

Clinical considerations

The clinical presentation of severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) differs in individuals, ranging

from mild to severe.[3]

Cardiorespiratory complications

Respiratory system illnesses are a major characteristic of the

disease and in athletes it may result in a significant loss of

training time, so requires special mention. [4] There is also an

increased risk of cardiac complications in patients with a

history of viral infection.[5] Persons with influenza infections

have a higher incidence of cardiovascular complications, like

myocarditis, heart failure and acute myocardial infarction, in

comparison to non-infected individuals.[6] Athletes who have

had a febrile viral infection, including SARS-CoV-2, are at risk

of developing cardiovascular complications, as shown by

elevated troponin levels in affected individuals. [7] Athletes

should avoid competitive sports for three to six months if they

sustain a myocarditis,[4] and a risk stratified return-to-sport

paradigm should be implemented.[6] Guidance on return to

sport for these athletes should include a cardiology review

supported by an ECG, echocardiogram, and a slow gradual

retraining and return to sports programme.[7] This gradual

retraining and loading is also necessary for the prevention of

injuries and acute illnesses, and to maintain the psychological

wellbeing of athletes.[8]

Mental health

This “cool off” period will negatively affect the recreational and

professional athlete’s level of conditioning and ability to

qualify and compete. Forced training restriction is also

associated with alterations in mood and feelings of depression

in athletes, and has been described in approximately 50% of

athletes during South Africa’s lockdown. [9] Mental fatigue due

to the lockdown will thus need to be addressed to help them

deal with this pandemic and the consequences of training

restrictions.[10]

Exercise and immune function

It has been widely publicised that exercise helps to improve the

immune system and that during lockdown exercise should be

continued as advised by the WHO, but the greatest

responsibility is to limit the exposure to and spread of COVID -

19.[11] It is recognised that moderate levels of activity are

required to assist in improving immunity, and that people who

are physically active are likely to have a less severe form of

illness and may recover earlier than those who are less active. [11]

Athletes should be cautioned to avoid marked changes in load

Table 1. Risk stratification guide

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3 SAJSM VOL. 32 NO. 1 2020

and high-intensity bouts of exercise as this may reduce

immunity. These high-intensity activities are described as

‘activities performed by highly athletic individuals’. [11] In

addition, with the approaching winter in South Africa, it is

advisable to have a flu vaccine. This does not protect against

COVID-19 but may reduce the burden of illness during the

vulnerable winter months.[12]

Body composition and diet

Although many athletes may continue to exercise under

lockdown (64%),[9] a change in training habits and reduction in

training load may have resulted in changes in body

composition. There is a concern that athletes will have

deconditioned and may succumb to injuries should they return

to full activity prematurely or in an uncontrolled manner.

Dietary habits and nutrition may also be impacted negatively.[9]

The importance of balanced nutrition, good hydration,

adequate Vitamin D and continuing to exercise under

lockdown has been emphasised.[10]

Considering all of the aforementioned factors, a return -to-

sports strategy has to be structured safely and plans should

include a staged increase in exercise levels.

Return-to-sport

Several international and South African associations have

presented plans on restarting competitive sport post-

lockdown. These include specific clinical work-ups for the

participating athletes.[7,13] Both the athletes and administrators

need to be aware of how to return to sport as safely as possible.

The WHO has published a guideline ‘Mass gathering

mitigation checklist for COVID-19: addendum for sporting

events’ with a checklist of measures that have been

implemented to reduce the risk of transmission. [2] Based on the

scoring system of 0 to 6, where 0 is a negligible risk, and 6 is a

very high risk, event organisers can then classify the risk level,

formulate a risk-appropriate return-to-play strategy, and

gauge their preparedness. This complete risk evaluation can be

found in the separate supplementary document.

The Australian Institute of Sports released a detailed white

paper on exercise loading after reduced exercise which can be

used as a guide to protect against injuries. This paper

recommends that the length of reduced exercise and the

percentage of exercise reduction should be used to determine

the period it will need to return to the previous level of

conditioning.[14]

The South African Sports Confederation and Olympic

Committee (SASCOC) released a media statement wherein

they stated that they cannot dictate to federations how to phase

in their return-to-sport strategies. Instead, they advised that

each federation’s medical team, in conjunction with other

medical authorities, should make use of all available

knowledge and resources to formulate a sport-specific plan on

how to safely resume sporting activities.[15]

In compliance with the government’s risk-adjusted strategy

to reduce coronavirus transmission risk and address the need

for a phased return-to-sport, a stepwise return to normality has

been recommended.[1] These levels of alert have also been

adopted by the Wits Institute of Sport (WISH) on risk

assessment and return-to-sport[16] (Table 2).

As the risk-adjusted levels become more lenient, the ideal is

to achieve a return-to-sport participation whilst protecting

athletes and others from infection. It is important to note that

all guidelines should be in tandem with government protocols

presented by the National Institute of Communicable Diseases

Table 2. Alert levels on risk assessment and return-to-sport

Alert level Environment Modifications Examples

5 Exercise in home

environment only

No use of public gyms

Exercise alone

Exercise with asymptomatic family members only

Stretch and strengthen routines

· Yoga, Pilates

· Home-based online classes

· Home treadmill, stationary cycle and rower

4 Exercise in suburbs,

open spaces and

nearby sports fields

No group exercising

· Increase social distancing to at least six metres

· Strict hygiene practices (nose-blowing, coughing, spitting)

· Exercise alongside each other or staggered instead of behind each

other

Jogging, cycling, multiple sprints

· Individual sports-specific skills training

· Single tennis games

3 Exercise at training

grounds

Avoid public transport to and from training and wear a cloth mask

when travelling

· No team travel

· Coaching and support staff to wear cloth masks

· Disinfecting equipment before and after use

· No on-site team or group meetings

· Maintain social distancing at six metres minimum for all exercises

· Exercise alongside or staggered to each other instead of behind

each other

· No sharing of water bottles

· Shower at home

· No spectators at training

Sport-specific fitness

· Sports-specific skills training with limited

equipment e.g. soccer and hockey drills,

netball/basketball skills, cricket batting and

bowling

2 Exercise at training

grounds with full

equipment

Train in small groups (maximum five at a time maintaining two

metres social distancing during sessions)

· No team meetings

· Shower at home

· No spectators

Non-contact soccer and rugby drills

· Hockey, netball and basketball team drills

· Squash games

1 Full training and

competition

Limit team meetings

· No spectators

Matches and games

· No spectators

Adapted from and copyright granted by BJSM and Carmody et al.[1]

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(NICD) and the Department of Health (DOH).

SASMA guidelines

The South African Sports Medicine Association (SASMA)

recommends that, as a minimum, the following be incorporated

into any post-COVID-19 return-to-sport strategy:

1. Education

2. Preparing the environment

3. Risk stratifying the sport

4. Risk stratifying the participants

5. Practical implementation of mitigating measures of

different sports

1. Education

 Ensuring that there is continuous education of athletes and

staff regarding physical distancing, hand hygiene,

respiratory etiquette and mask-wearing.

 Displaying posters around training areas and change

rooms reminding everyone about the aforementioned

issues.

 Forbidding team handshakes or contact celebrations.

 Appointing a health officer to ensure compliance with all

these aspects.

 Educating athletes regarding temporary rule changes that

may be adopted by sporting bodies, both local and

international (e.g. no spitting on fields or not using saliva

to shine cricket balls).

2. Preparing the environment

 Ensuring that there is sufficient access to “non-touch” soap

dispensing and running water as a minimum.

Alternatively, 70% alcohol-based sanitiser must be

provided.

 Cleaning thoroughly and regularly with appropriate

products of all contact surfaces (0.5% sodium hypochlorite)

before and after sports participation.

 Ensuring closed areas are ventilated, physical distancing (at

least two meters) of an athlete not participating is enforced

and face masks are worn (e.g. change rooms during half-

time).

 Washing of kit by the player themselves as per guidelines

(in water of at least 60 degrees Celsius where possible).

 Allocating a dedicated room in case temporary isolation is

required.

3. Risk stratifying the sport

 Stratifying individual sports with no physical contact as

low risk (e.g. singles tennis and golf) while classifying

contact and collision sports (team or individual, such as

football and rugby) as high risk.

 Considering the number of essential persons required at

the event, as well as spectators, media and non-essential

staff in the risk strategy.

 Accounting for the ventilation of the playing area where

unventilated areas will be considered as higher risk while

those held outdoors will be considered as lower risk.

4. Risk stratifying the participants

 Daily screening, aligned to the recommendations of the

DOH, using an App or paper-based questions to identify

symptomatic individuals prior to arriving at training

sessions.

 The taking of temperatures daily when entering the

sporting environment.[2]

 Identifying and preventing the attendance and

participation of higher-risk participants (those older than

60 years and those with comorbid diseases).

5. Practical implementation of guidelines

 Initially forbidding the gathering of any groups during

events (no parents etc., only officials and competing

individuals).

 In lockdown level 3, Minister Nkosazana Dlamini Zuma

indicated that more time will be allowed for exercise as

long as it is well organised with the observation of social

distancing and healthy practices. Non-contact sports may

resume without spectators.[17]

 Recommending outlines on when not to come to training

and what the reporting lines are e.g. coach, manager, and

health authorities.

 Avoiding public transport to get to training/matches.

 Detailing and availing an action plan in the case of a

suspicious case (including targeted tracing) – this may need

medical guidance (even remotely).

 Considering the higher risk of injury in the return-to-sport

strategy.[18,19]

SASMA acknowledges that several federations in South Africa

have drafted sports-specific guidelines for the potentially

exposed and the infected athlete. Based on international

guidelines, SASMA recommends the following approach:

1. All athletes:

 Ensuring physical, psychological and competitive equity to

athletes to allow them time to return to their previous level

of fitness before major events are rescheduled.[20]

 Upholding the principles of social distancing and hand

hygiene.[7]

2. Athletes that were exposed to individuals who were affected

by COVID-19:

 Those at high risk (were closer than one metre to the

infected person or in contact for more than 15 min), and

medium risk (>one metre or less than 15 min contact),[21]

need to follow the guidelines for self-quarantine, namely 14

days whilst monitoring for symptoms of COVID-19.

 Alerting their medical provider if they have symptoms in

order to undergo further investigations, including a

polymerase chain reaction (PCR) test.[22]

 If testing is positive, following the “infected person

protocol” as dictated by the DOH and NICD.[23]

 If they display no symptoms during these 14 days, they

may follow a guided return to sport, ensuring load is

started at low intensity and progressed.

3. Athletes who were infected and tested positive:

 These athletes need to avoid exercise for the recommended

seven to ten days after cessation of symptoms

(approximately 21 days from onset of symptoms).[9]

 They must follow DOH/NICD isolation protocols.[23]

 They should be monitored daily if they are self-isolating.

Any worsening of symptoms should be reported to the

dedicated health officer.

 There is no disease-specific treatment to be prescribed for

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5 SAJSM VOL. 32 NO. 1 2020

COVID-19; symptomatic treatment is advised.

4. Following 14 days of isolation or recovering from the disease:

 It is recommended that these athletes have 2 COVID-19

tests at least 48 hours apart that are negative.

 In any event, clinical monitoring, inflammatory markers

and cardiovascular monitoring should be implemented.[24]

 Ensure cardiac screening, which should include a resting

and effort ECG, and cardiac echo.[25] The stress ECG must

only be done ≥ seven days after the mandatory 14 days

isolation and at least seven to ten days after symptom

resolution.

 A cardiologist should clear the athlete before commencing

exercise due to the possibility of developing a viral

myocarditis.

5. Positive tests after the mandatory isolation period:

 The above protocol implies a mandatory 21 day period of

stand down before an athlete can resume training after a

positive test. This can last up to three months or however

long it takes until symptoms resolve and the clearance

protocol is complete.

 It is recommended that in these cases[26], the same protocol

must be followed as in point 4.

 The return-to-sport approach must be more cautious in

these cases.[7,27]

 These athletes, upon return to training, must be screened

daily as per usual.

 Any recurrence of symptoms must be addressed

accordingly and urgently.

6. Other medical conditions:

 Because COVID-19 has poorer outcomes in cases with

comorbidities, such as diabetes mellitus, cardiac disease,

hypertension and cancer[27,28], any such existing conditions

must be appropriately treated.

Conclusion

In conclusion, it is important that persons charged with

managing athletes’ return-to-sport in any environment must be

up-to-date with local and international trends, transmission

rates, regulations and sport-specific rule changes that might

develop as sport resumes. Additionally, such information

should be applied in a sports-specific manner, considering

individual athlete’s and team needs and be consistent with

national legislation.

Disclaimers:

This document has been compiled as a guide for safe retur n to

sports, and should be used as such. It is still the responsibility

of organisers to ensure that facilities for training are compliant

with directives by WHO, NICD and DOH, and updates should

be adhered to.

Please use the information for its intended use, i.e. as a guide

to assist in sport resumption. This document is not a tool to

return to sport prematurely, but should be used aligned with

the statutory guidelines (which may change constantly and

differ from area to area).

Conflicts of interest and source of funding: The authors

declare that they have no conflict of interest and no source of

funding.

Approved by: South African Sports Medicine Association

(SASMA) Executive Committee

Author contributions:

Drafting the paper: DA Ramagole, DC Janse van Rensburg, L

Pillay. Content review: P Viviers, P Zondi, J Patricios.

References

1. Carmody S, Murray A, Borodina M, et al. When can professional

sport recommence safely during the COVID-19 pandemic? Risk

assessment and factors to consider. Br J Sports Med. Published

online ahead of print: 07 May 2020. [doi.: 10.1136/bjsports-2020-

102539] [PMID: 32381501]

2. World Health Organization. Guidance for the use of the WHO

Mass Gatherings Sports: addendum risk assessment tools in the

context of COVID-19. WHO Global; 30 Apr 2020. Available from:

https://www.who.int/publications/m/item/guidance-for-the-use-

of-the-who-mass-gatherings-sports-addendum-risk-assessment-

tools-in-the-context-of-covid-19

3. Filatov A, Sharma P, Hindi F, et al. Neurological complications of

coronavirus disease (COVID-19): encephalopathy. Cureus

2020;12(3):e7352. [doi:10.7759/cureus.7352] [PMID: 32328364]

4. Hull JH, Loosemore M, Schwellnus M. Respiratory health in

athletes: facing the COVID-19 challenge. Lancet Respir Med 2020;

8(6): 557-558. [doi: 10.1016/S2213-2600(20)30175-2] [PMID:

32277869]

5. Xiong TY, Redwood S, Prendergast B, et al. Coronaviruses and the

cardiovascular system: acute and long-term implications. Eur

Heart J 2020;41(19):1798-1800. [doi: 10.1093/eurheartj/ehaa231]

[PMID: 32186331]

6. Eichhorn C, Bière L, Schnell F, et al. Myocarditis in athletes is a

challenge: Diagnosis, risk stratification, and uncertainties. JACC

Cardiovasc Imaging. 2020;13(2 Pt 1):494-507. [doi:

10.1016/j.jcmg.2019.01.039] [PMID: 31202742]

7. Bhatia RT, Marwaha S, Malhotra A, et al. Exercise in the severe

acute respiratory syndrome coronavirus-2 (SARS-CoV-2) era: a

question and answer session with the experts. Endorsed by the

section of Sports Cardiology & Exercise of the European

Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol

2020; 2047487320930596. [doi: 10.1177/2047487320930596] [PMID:

32475157]

8. Soligard T, Schwellnus M, Alonso JM, et al. How much is too

much? (Part 1) International Olympic Committee consensus

statement on load in sport and risk of injury. Br J Sports Med

2016;50(17):1030-1041. [doi:10.1136/bjsports-2016-096581] [PMID:

27535989]

9. Schwellnus M, Soligard T, Alonso JM, et al. How much is too

much? (Part 2) International Olympic Committee consensus

statement on load in sport and risk of illness. Br J Sports Med

2016;50(17):1043-1052. [doi: 10.1136/bjsports-2016-096572] [PMID:

27535991]

10. Pillay L, Janse van Rensburg DC, Jansen van Rensburg A, et al.

Nowhere to hide: the significant impact of coronavirus disease

2019 (COVID-19) measures on elite and semi-elite South African

athletes. J Sci Med Sport 2020;S1440-2440(20)30602-2.

[doi:10.1016/j.jsams.2020.05.016] [PMID: 32448749]

11. Jukic I, Calleja-González J, Cos F, et al. Strategies and solutions for

team sports athletes in isolation due to COVID-19. Sports (Basel)

2020;8(4):56. [doi: 10.3390/sports8040056] [PMID: 32344657]

12. Simpson RJ, Katsanis E. The immunological case for staying active

during the COVID-19 pandemic. Brain Behav Immun 2020:S0889-

1591(20)30573-30580. [doi: 10.1016/j.bbi.2020.04.041] [PMID:

32311497]

13. Tisa V, Barberis I, Faccio V, et al. Quadrivalent influenza vaccine:

a new opportunity to reduce the influenza burden. J Prev Med Hyg

2016;57(1):E28-33. [PMID: 27346937]

14. Phelan D, Kim JH, Chung EH. A game plan for the resumption of

POSITION STATEMENT

SAJSM VOL. 32 NO. 1 2020 6

sport and exercise after coronavirus disease 2019 (COVID-19)

infection. JAMA Cardiol. Published online ahead of print: 13 May

2020. [doi:10.1001/jamacardio.2020.2136] [PMID: 32402054]

15. AIS. Prescription of training load in relation to loading and

unloading phases of training. 2015. Australian Institute of Sport.

Available from: https://rowingaustralia.com.au/wp-

content/uploads/2015/02/AIS-whitepaper-on-load.pdf.

16. SASCOC cannot prescribe to Federations when to resume sporting

activities. Media release, 2020. Available from:

https://www.sascoc.co.za/2020/05/17/sascoc-cannot-prescribe-to-

federations-when-to-resume-sporting-activities/

17. Wits Institute for Sport and Health (WISH). WISH Covid-19 and

Sport Guidelines - Risk Reduction and Stratification for Sports and

Exercise 2020. Wits University. 2020. Available from:

https://www.wits.ac.za/media/wits-university/students/wits-

sport/documents/WISH%20Covid-

19%20and%20Sport%20Guidelines.pdf.

18. Summary of level 3 lockdown regulations. Media release, 2020.

Available from: https://sacoronavirus.co.za/2020/05/28/summary-

of-level-3-regulations/

19. Myer GD, Faigenbaum AD, Cherny CE, et al. Did the NFL lockout

expose the Achilles heel of competitive sports? J Orthop Sports

Phys Ther 2011;41(10):702‐705. [doi:10.2519/jospt.2011.0107]

[PMID: 21941038]

20. Mason J. The Bundesliga Blueprint: early lessons from the return

of German football, May 2020. Available from:

https://www.trackademicblog.com/blog/bundesligablueprint

21. Mann RH, Clift BC, Boykoff J, et al. Athletes as community;

athletes in community: COVID-19, sporting mega-events and

athlete health protection. Br J Sports Med 2020;bjsports-2020-

102433. Published online ahead of print. [doi: 10.1136/bjsports-

2020-102433] [PMID: 32303522]

22. World Health Organisation (WHO). Rational use of personal

protective equipment for coronavirus disease (COVID-19): interim

guidance. Published online, 27 Feb 2020. Available from:

https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-

2019-nCov-IPCPPE_use-2020.1-eng.pdf

23. The National Institute for Communicable Diseases (NICD).

COVID-19 Advice for the public, 2020. Available from:

https://www.nicd.ac.za/diseases-a-z-index/covid-19/advice-for-

the-public/

24. The National Institute for Communicable Diseases (NICD).

COVID-19 guidelines, 2020. Available from:

https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-

guidelines/

25. Toresdahl BG, Asif IM. Coronavirus disease 2019 (COVID-19):

considerations for the competitive athlete. Sports Health

2020;12(3):221-224. [doi:10.1177/1941738120918876] [PMID:

32250193]

26. Nieß A, Bloch W, Friedmann-Bette B, et al. Recommendations for

exercise testing in sports medicine during the current pandemic

situation (SARS-CoV-2/COVID-19). German Journal of Sports

Medicine 2020; 71(5): E1-E2 [doi.org/10.5960/dzsm.2020.438]

27. Kang Y-J. South Korea’s COVID-19 infection status: from the

perspective of re-positive after viral clearance by negative testing.

Disaster med public health prep, 2020.1-3. Published online ahead

of print. [doi:10.1017/dmp.2020.168] [PMID: 32438941]

28. Jordan RE, Adab P, Cheng KK. Covid-19: risk factors for severe

disease and death. BMJ 2020;368:m1198. [doi:10.1136/bmj.m1198]

[PMID: 32217618]

29. Gémes K, Talbäck M, Modig K, et al. Burden and prevalence of

prognostic factors for severe COVID-19 disease in Sweden. Eur J

Epidemiol 2020;35(5):401–409. [doi: 10.1007/s10654-020-00646-z]

[PMID: 32424571]

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