key: cord-0853971-shu15nvf authors: Rankin, Alan; Massey, Andrew; Falvey, Éanna Cian; Ellenbecker, Todd; Harcourt, Peter; Murray, Andrew; Kinane, Denis; Niesters, Bert; Jones, Nigel; Martin, Rhodri; Roshon, Michael; McLarnon, Michael Edmund David; Calder, James; Izquierdo, Dionisio; Pluim, Babette M; Elliott, Niall; Heron, Neil title: Infographic. COVID-19 RT-PCR testing for elite athletes date: 2021-01-17 journal: Br J Sports Med DOI: 10.1136/bjsports-2020-103751 sha: 896f1a2a195c874c8eabbada05c462be2dbe6cd1 doc_id: 853971 cord_uid: shu15nvf nan Interventions to prevent COVID-19 transmission should be implemented consistently 1 2 and should include ► Effective hand hygiene. ► Physical distancing: athletes should minimise discretionary social contacts and maintain a distance of at least one metre from others. ► Wearing a mask at all times when around others, especially indoors. 3 ► Prioritising outdoor over indoor activity where possible. The current gold standard of testing is RT-PCR testing. [4] [5] [6] The test is highly sensitive and specific to SARS-CoV-2 viral RNA in laboratory conditions. 2 Test results should be interpreted on the basis of the pretest probability, previous test results and clinical history. Test sensitivity and specificity will rely on the (1) quality and location of swabbing; (2) testing equipment and reagents, and (3) laboratory expertise. Close contacts 7 to a positive-testing athlete should be isolated and proceed with daily monitoring for symptoms and temperature, and where available testing. If the contact is asymptomatic Infographic and COVID-19 RT-PCR tests are negative at 7 hours of follow-up, the close contact could be considered for a return to sport, depending on discussions with local public health authorities. Prior to a gathering of elite athletes, for example, at a training camp or competition, all athletes should have regular symptom checks and should undergo RT-PCR or other screening for the virus. For the first gathering, testing 6 and 3 days prior to the event is recommended, as well as testing as close to the event as logistically possible, ideally within 48 hours of the meeting. Interval (eg, weekly) PCR testing for the duration of the gathering should be considered. Positive tests should be managed according to national and local public health guidance, but elite sport can often provide additional medical and testing support. The positive case, as well as all close contacts, should be isolated as soon as possible, and contact tracing should be undertaken. If an asymptomatic athlete tests positive in screening, they should be isolated but retested to ascertain whether the result represents a true or false positive. False positives are less likely when the prevalence of COVID-19 is high. In a symptomatic individual, a positive result is considered a true positive. Careful attention should be paid to the PCR cycle threshold (Ct) and the gene expression of the result, as this correlates strongly with cultivable virus. 4 A test with a high Ct (>30, and especially >35) may not indicate current infectivity, 4 5 although the viral load may rise in subsequent days. If an athlete has symptoms indicative of coronavirus (eg, loss of taste/smell, dry cough or fever) but test results are negative, repeat testing is recommended to exclude a false negative, especially if there is a high prevalence of COVID-19 activity. An alternative diagnosis with testing for other viral aetiologies should also be considered. Unusual test results should be discussed within the expert group. Viral RNA can persist in individuals beyond infectivity for several months. [4] [5] [6] For this reason, repeat PCR screening in asymptomatic athletes is not routinely recommended for 90 days postinfection. Repeat testing can stratify whether viral load is decreasing and may inform decisions to isolate a patient beyond 10 days in some cases. In the event an athlete has been retested within 90 days, consider their Ct value. When Ct is >35 and the patient's symptoms have resolved, infectivity is unlikely. 6 Following infection, there should be a graduated return to sport, guided by professional advice which may vary based on the severity of the illness, the demands of the sport and logistical factors. [8] [9] [10] Additional cardiac testing should be considered based on the severity of illness. Coronavirus disease 2019 (COVID-19): considerations for the competitive athlete Interpreting a covid-19 test result To mask or not to mask: modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic Duration of infectiousness and correlation with RT-PCR cycle threshold values in cases of COVID-19 Interpretation of PCR results and infectivity Predicting infectious severe acute respiratory syndrome coronavirus 2 from diagnostic samples Guidance for contacts of people with confirmed coronavirus (COVID-19) infection who do not live with the person Infographic. graduated return to play guidance following COVID-19 infection When can professional sport recommence safely during the COVID-19 pandemic? risk assessment and factors to consider Recommendations for return to sport during the SARS-CoV-2 pandemic Resurgence of sport in the wake of COVID-19: cardiac considerations in competitive athletes revised by all authors; all authors approved the final version of the infographic. The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.Competing interests None declared. Provenance and peer review Not commissioned; externally peer reviewed.This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.