13 May 2020
Alexander Fedorov: “One of the dangers of coronavirus is the loss of lung tissue”
Young athletes with a robust immune system, in case of picking up the new coronavirus infection, may not even show any symptoms. But in order to recuperate and restore full lung function after the illness, they may need comprehensive rehabilitation under the supervision of specialists.
Scientists and doctors in the midst of the coronavirus pandemic are now only studying the effect of the coronavirus on the human body. However, it is now obvious that the consequences of this disease can be quite serious. Even for young people and professional athletes who are accustomed to extreme physical exertion.
We discussed the novel coronavirus with an expert from the Center for Sports Medicine of the FMBA of Russia Alexander Fedorov, Doctor of sports medicine at the medical support department of the national teams of Russia and competitions.
— Coronavirus belongs to the family of RNA viruses. At present, four coronaviruses are known to circulate — HCoV-229E, -OC43, -NL63 and -HKU1. They are present year-round in acute respiratory viral infections, and, as a rule, cause damage to the upper respiratory tract ranging from mild to moderate severity, — said Fedorov. — The new SARS-CoV-2 that we are currently dealing with is supposedly a recombinant virus between the bat coronavirus and another unknown coronavirus. The genetic sequence of the novel coronavirus is 79% similar to SARS-CoV, which caused the outbreak of SARS in November 2003 and was generally more aggressive in terms of mortality rates than the current one.
The transmission of infection occurs predominantly by airborne droplets, that is, by coughing, sneezing and interacting in close proximity (less than 2 meters). Transmission is also common during handshakes and other forms of direct contact with an infected person, as well as through food products, surfaces and objects contaminated by the virus.
The key feature of this virus is the fulminant development of bilateral pneumonia, and in 3-4% of all pneumonia patients, it is accompanied by the development of acute respiratory distress syndrome (ARDS).
The virus attacks alveolar cells (II type) of the lungs causing the development of pneumonia in the form of alveolitis. However, there have been cases when the virus behaves unpredictably and insidiously, affecting the nervous system, the cardiovascular system and the kidneys. The mechanism of the immune system when fighting the coronavirus infection today requires further in-depth study.
I should note that quite often young people who do not have any chronic illnesses and lead an active lifestyle are hospitalized in the medical institutions of the FMBA of Russia. Moreover, they have the image CT2 (from 25% to 50% of lung tissue damage) and CT3 (from 50 to 75% of lung tissue damage).
I want to draw attention to a paradoxical fact. Young healthy athletes, with a robust immune system, in case of picking up the new coronavirus infection, may not even understand and feel that they are ill. And therein lies the trap. One athlete in his prime
complained to me that he became tired too quickly when working out. Subsequently, computed tomography showed that his lungs were affected by 60%. If an elderly person were in this situation, he would immediately feel the strain – it would be difficult even to walk. And so the athlete did not notice anything but increased fatigue, although his lungs stopped working by 60%.
Usually, the immune system works well against other microorganisms and viruses, and pneumonia develops in rare cases; however, the coronavirus quickly attacks the alveoli, where an inflammatory reaction develops. And if we look at the computed tomography of the patient at an early stage of the disease, we will see clusters of bright areas with the “opaque glass” effect, and after some time these areas sprout with connective tissue, compaction increases, and we can already observe changes in the form of fibrosis.
An analysis of world scientific research showed that high-intensity loads directly affect an athlete’s immune system and reduce the body’s resistance to bacterial and viral infections. This is especially true for high dynamic sports such as badminton, walking, running (marathon), squash, orienteering, tennis, basketball, biathlon, ice hockey, soccer, lacrosse, cross-country skiing, middle and long distance running, figure skating, swimming, handball, boxing, skiing, water polo, cycling, decathlon, rowing, speed skating, triathlon and so on.
For example, the risk of a respiratory tract infection in marathon runners doubles compared to athletes with moderate physical activity. Therefore, a decrease in the intensity of exorbitant loads increases the reactivity of the immune system to coronavirus infection and reduces the likelihood of infection.
To understand the causes that affect the human immune system during physical exertion, it is necessary to follow the physiological and biochemical processes that occur in the muscles during work. However, there is research showing that moderate physical activity — walking, light running, training in a gym no higher than the aerobic threshold, stimulates the differentiation of T-helpers, which provide the first line of defense against viral infections compared with people with complete physical inactivity.
As for the consequences of coronavirus, it is important to understand that we are now in the midst of an epidemiological situation, and the scientific data on the consequences for the human body are incomplete, so we have to observe scientific publications as well as people who have been ill.
One of the consequences that is already clear today is the loss of functioning lung tissue in people who have had a severe form of the illness. In world medicine, and at our Center for Sports Medicine of the FMBA, there is experience in treating athletes who have caught ordinary community-acquired viral pneumonia, that is why the principles of rehabilitation will be similar. Physiotherapy exercises are used to train the respiratory muscles, ventilation of distant segments of the lungs is increased, and drainage of the bronchial tree is augmented, performed under control of respiratory volume indicators.
The lungs contain “sleeping alveoli”, which can be involved in the regeneration and restoration of the normal function of external respiration. At the same time, it is impossible
to restore the alveoli lost in the lungs. But you can increase the functionality of neighboring ones, and maximize the use of “sleeping alveoli”.
There are sports where pneumonia is quite common. For example, swimming. We have observations when athletes who have had pneumonia successfully recover, perform at a high level and achieve great results. But it is also important to remember that pneumonia caused by the novel coronavirus is different from the usual one and has its own specifics.
Therefore, we will track each athlete and work with him individually. Everyone will need to undergo an examination so that we can assess the situation, analyze the medical history, determine the level of lung damage and how much lung tissue was lost, measure the respiratory volume and saturation during physical exertion (oxygen level in the blood), and decide on a further set of measures. Of course, the younger the athlete, the better his regeneration process will be and the faster he will recuperate.
In conclusion, I would like to say that the Center of Sports Medicine of the FMBA is ready to work with all athletes by carefully analyzing all clinical cases and, if necessary, organize consultations from leading pulmonologist experts and, together with sports medicine doctors, develop recuperation and rehabilitation treatment programmes on an individual basis. Doctors at the Center of Sports Medicine of the FMBA have experience working with the most difficult cases. For example, our doctor for sports medicine in football, Mikhail Butovsky, was able to provide treatment for an athlete with tuberculosis, and as of today the athlete competes quite well