Sports Orthopedics
Editorial

Corona Vaccinations: Why Athletes and Young People Are Important!

Impfen gegen Corona: Weshalb Sportler und junge Menschen wichtig sind!

The SARS-CoV-2/Covid-19 Pandemic is a challenge for society, the population, doctors and of course sports.

We see that the disease has a severe course in many people but heals without consequences. We also see, however, that the elderly have a higher mortality risk. Of course, we as fellow human beings are concerned when these people become ill, suffer serious damage or even die. So nobody wants old-age homes to be dangerous places.

But younger people can also suffer devastating effects from COVID-19.  In 5-10% of those infected, we observe a multisystem illness for a shorter or extended time with loss of performance, fatigue, myocarditis, pulmonary disease, neurological symptoms – and we don’t yet know whether or when these will heal completely.

Side Effects of Physical Distancing?

Essential survival factors in the pandemic include physical activity as well as psychological and social well-being. On the other hand, social interactions comprise physical contact and closeness, which makes the spread of disease possible. The principles of “physical distancing” (the WHO now uses this term, since social contacts are important) that is, wearing a mask and disinfecting hands, when strictly adhered to, make a considerable contribution to reducing the infection rate. But they have side effects.

When we speak of the lockdown, social chances, educational chances and sports activities are considerably limited, thus limiting the chances for the future of young people (2).

When adolescents from socially-deprived groups riot or grossly violate rules and regulations, it is intolerable, but perhaps it is also a symptom that, from their point of view, their future is unimportant to our society? It is much easier for the upper middleclass (to which we and our politicians belong) to bring their children through the lockdown in their one-family homes with garden, than in the tenements of the social hotspots. We must remember that about 50% of the children in elementary schools belong to socially-deprived groups and require assistance (4).

These few factors alone show that there are various aspects which must be weighted in political decision. But does this really work? Or does the irrationality sometimes seen in the debates show that this is only sometimes the case? But those making the decisions rely on the expertise of virologists and even an Ethics Committee, don´t they? That can’t be wrong, can it?

Political theory shows (see (3)) that the definitions of good or bad – beneficial or harmful  - must be discussed and negotiated in a democracy. Thereby, the interests of all stakeholders (another odd term) must be taken into account, or tension will result.

Sports and Vaccination

The discussion about sports and vaccination is a ruthless demonstration of this. The avoidance of deaths in old-age homes takes priority. For this reason, the Ethics Committee has recommended that vaccination of only the elderly takes precedence, then their nurses (but not the cleaning crew?) and emergency doctors, but not personal physicians, not teachers and definitely not athletes.

The justified criterion is the reduction in the number of deaths. But there are additional means which have only been hesitantly applied. Regular testing in old-age homes has been and still is being hindered in many cases, Ministries and funders were against the idea for a long time. Even help from the Army in following up positive cases was sometimes rejected – is ideology more important? The staff and materials in most Health Offices have also still not been improved.

We can conclude that data protection apparently has a much higher priority, and the masks demanded by experts last March in this journal have only been hesitantly accepted. The lockdown is then the logical consequence – certainly necessary, but to such an extent with lost schooling and a ban on team sports it is definitely coupled with emotional and physical damage. This affects our youth, but everyone else as well!

In the usual public moral debate, professional and current Olympic sports are viewed with distain and even amateur sport is expected take a backseat. The athletes are only out to satisfy their egos, while others fight for their lives. How one-sided an argument can be! It is easy for former Olympic winners (5), editors or politicians to dispense with the Olympic Games. It doesn’t affect their chances in life and someone who has won Olympic medals or has attained a secure position in life often finds it easy to dispense with anyone else’s chances.

The Potential of Sports and the Olympics for our Society

Young people have a potential which they need chance to develop and which should last for a lifetime. For young athletes, the way is long to develop their own motoric, social and psychological capabilities, to practice their sport and even engage in high-performance sport. Competitions are an important motivation, interrupting training means a greater risk of later injuries, loss of performance capacity and demotivation. Correspondingly, emotional disorders, especially in well-being and quality of life, occur during the pandemic (1).

The Olympic Games are a very high goal for young people. Sports, sports medicine and the International Olympic Committee bear a great responsibility to organize safe Olympic Games, because these give young athletes the possibility of gaining unique experience.

Sports has shown that hygiene concepts (6) can effective prevent the transmission of SARS-CoV-2 viruses. This was demonstrated for example at the European Rowing Championships in Duisburg, Belgrade (Serbia) and Posznan (Poland) in 2020, with more than 3,000 participants. It is similar for other types of sports which do not involve increased risk of infection in the pandemic.

If we first vaccinate the weakest and most vulnerable in the risk group, it is appropriate. If, due to (justified) concern because of the deaths, we deny others the moral right to a chance in life simply because they have the slightest risk of dying and we make things easy for ourselves, this is unfair and ignores the dilemmas we face in the pandemic.

Athletes thus have a right to engage in their chosen sport. As vaccination advances and there is more vaccine available, we have to take about promptly vaccinating young athletes without envy and because of the risks. Their chances in life are worth it. As a society, we cannot afford to ignore in public discourse the justified concerns of young people. One-sided prioritizations divide society rather than bringing cohesion.

References

  1. Ammar A, Mueller P, Trabelsi K, Chtourou H, Boukhris O, Masmoudi L, Bouaziz B, et al; on behalf of the ECLB-COVID19 Consortium. Psychological consequences of COVID-19 home confinement: The ECLB-COVID19 multicenter study. PLoS One. 2020; 15: e0240204.
    doi:10.1371/journal.pone.0240204
  2. Bloch W, Halle M, Steinacker JM. Sport in Zeiten von Corona. Dtsch Z Sportmed. 2020; 71: 83-84.
  3. Howlett M, Rames M, Perl A (eds.). Studying Public Policy. Policy Cycles & Policy Subsystems. Third edition. Oxford University Press: Oxford 2009.
  4. Kobel S, Lämmle C, Wartha O, Kesztyüs D, Wirt T, Steinacker JM. Effects of a Randomised Controlled School-Based Health Promotion Intervention on Obesity Related Behavioural Outcomes of Children with Migration Background. J Immigr Minor Health. 2017; 19: 254-262.
    doi:10.1007/s10903-016-0460-9
  5. Sir Matthew Pinsent. https://twitter.com/matthewcpinsent/status/1348568766628696064 [10th February 2021].
    https://twitter.com/matthewcpinsent/status/1348570256625827841
  6. Steinacker JM, Bloch W, Halle M, Mayer F, Meyer T, Hirschmüller A, Röcker K, Nieß A, Scharhag J, Reinsberger C , Scherr J, Niebauer J, Wolfarth B und Sports Medicine Commission der FISA. Merkblatt: Gesundheitssituation für Sportler durch die aktuelle Coronavirus-Pandemie (SARS-CoV-2 / COVID-19). Dtsch Z Sportmed. 2020; 71: 85-86.
    doi:10.5960/dzsm.2020.431
Prof. Dr. med. Dr. h.c. Jürgen M. SteinackerUniversity Hospital UlmDivision of Sports and Rehabilitation MedicineLeimgrubenweg 14, 89075 Ulm, Germanyjuergen.steinacker@uniklinik-ulm.de

The Potential of Sports and the Olympics for our Society

Young people have a potential which they need chance to develop and which should last for a lifetime. For young athletes, the way is long to develop their own motoric, social and psychological capabilities, to practice their sport and even engage in high-performance sport. Competitions are an important motivation, interrupting training means a greater risk of later injuries, loss of performance capacity and demotivation.  Correspondingly, emotional disorders, especially in well-being and quality of life, occur during the pandemic (1).

The Olympic Games are a very high goal for young people. Sports, sports medicine and the International Olympic Committee bear a great responsibility to organize safe Olympic Games, because these give young athletes the possibility of gaining unique experience.

Sports has shown that hygiene concepts (6) can effective prevent the transmission of SARS-CoV-2 viruses. This was demonstrated for example at the European Rowing Championships in Duisburg, Belgrade (Serbia) and Posznan (Poland) in 2020, with more than 3,000 participants. It is similar for other types of sports which do not involve increased risk of infection in the pandemic.

If we first vaccinate the weakest and most vulnerable in the risk group, it is appropriate. If, due to (justified) concern because of the deaths, we deny others the moral right to a chance in life simply because they have the slightest risk of dying and we make things easy for ourselves, this is unfair and ignores the dilemmas we face in the pandemic.

Athletes thus have a right to engage in their chosen sport. As vaccination advances and there is more vaccine available, we have to take about promptly vaccinating young athletes without envy and because of the risks Their chances in life are worth it. As a society, we cannot afford to ignore in public discourse the justified concerns of young people. One-sided prioritizations divide society rather than bringing cohesion.

Sports and Vaccination

The discussion about sports and vaccination is a ruthless demonstration of this. The avoidance of deaths in old-age homes takes priority. For this reason, the Ethics Committee has recommended that vaccination of only the elderly takes precedence, then their nurses (but not the cleaning crew?) and emergency doctors, but not personal physicians, not teachers and definitely not athletes.

The justified criterion is the reduction in the number of deaths. But there are additional means which have only been hesitantly applied. Regular testing in old-age homes has been and still is being hindered in many cases, Ministries and funders were against the idea for a long time. Even help from the Army in following up positive cases was sometimes rejected – is ideology more important? The staff and materials in most Health Offices have also still not been improved.

We can conclude that data protection apparently has a much higher priority, and the masks demanded by experts last March in this journal have only been hesitantly accepted. The lockdown is then the logical consequence – certainly necessary, but to such an extent with lost schooling and a ban on team sports it is definitely coupled with emotional and physical damage. This affects our youth, but everyone else as well!

In the usual public moral debate, professional and current Olympic sports are viewed with distain and even amateur sport is expected take a backseat. The athletes are only out to satisfy their egos, while others fight for their lives. How one-sided an argument can be! It is easy for former Olympic winners (5), editors or politicians to dispense with the Olympic Games. It doesn’t affect their chances in life and someone who has won Olympic medals or has attained a secure position in life often finds it easy to dispense with anyone else’s chances.

Side Effects of Physical Distancing?

Essential survival factors in the pandemic include physical activity as well as psychological and social well-being. On the other hand, social interactions comprise physical contact and closeness, which makes the spread of disease possible. The principles of “physical distancing” (the WHO now uses this term, since social contacts are important) that is, wearing a mask and disinfecting hands, when strictly adhered to, make a considerable contribution to reducing the infection rate. But they have side effects.

When we speak of the lockdown, social chances, educational chances and sports activities are considerably limited, thus limiting the chances for the future of young people (2).

When adolescents from socially-deprived groups riot or grossly violate rules and regulations, it is intolerable, but perhaps it is also a symptom that, from their point of view, their future is unimportant to our society? It is much easier for the upper middleclass (to which we and our politicians belong) to bring their children through the lockdown in their one-family homes with garden, than in the tenements of the social hotspots. We must remember that about 50% of the children in elementary schools belong to socially-deprived groups and require assistance (4).

These few factors alone show that there are various aspects which must be weighted in political decision. But does this really work? Or does the irrationality sometimes seen in the debates show that this is only sometimes the case? But those making the decisions rely on the expertise of virologists and even an Ethics Committee, don´t they? That can’t be wrong, can it?

Political theory  shows (see (3)) that the definitions of good or bad – beneficial or harmful  - must be discussed and negotiated in a democracy. Thereby, the interests of all stakeholders (another odd term) must be taken into account, or tension will result.

Das Potenzial des Sports und der Olympiade für unsere Gesellschaft

Junge Menschen haben ein Potenzial, für das sie Entwicklungschancen brauchen und die für ein ganzes Leben reichen sollen. Für junge Sportler ist es ein langer Weg, um die eigenen motorischen, sozialen und psychologischen Fähigkeiten aufzubauen, um ihren Sport durchzuführen und sogar Leistungssport zu treiben. Wettkämpfe sind dabei ein wichtiger Motivationsgrund, die Unterbrechung des Trainings bedeutet ein großes Risiko für spätere Verletzungen, Leistungsverlust und Demotivation. In der Pandemie kommt es entsprechend zu psychischen Störungen, insbesondere bei Befinden und Lebensqualität (1).

Die Olympiade ist eines der ganz großen Ziele von jungen Menschen. Der Sport, die Sportmedizin und das Internationale Olympische Komitee haben die große Verpflichtung, sichere Olympische Spiele zu veranstalten, weil diese den jungen Athleten die Möglichkeit geben, einmalige Erfahrungen zu sammeln.

Der Sport hat durch seine Hygienekonzepte (6) gezeigt, dass die Übertragung von SARS-CoV-2-Viren wirksam verhindert werden kann. Dies konnten wir beispielsweise bei den Ruder-Europameisterschaften in Duisburg, Belgrad (Serbien) und Posznan (Polen) im Jahr 2020 mit über 3.000 Teilnehmern zeigen. Ähnliches gilt für viele andere Sportarten, die kein Risiko für die Pandemie darstellen.

Wenn wir zuerst die schwächsten und verletzlichsten in den Risikogruppe impfen, ist das richtig. Wenn wir aus (berechtigter) Betroffenheit über Todesfälle anderen das moralische Recht auf Lebenschancen absprechen, nur, weil sie das geringste Mortalitätsrisiko haben und wir uns es einfach machen, dann handeln wir unfair und ignorieren die Dilemmata, vor die uns die Pandemie stellt.

Sportler haben deshalb Anspruch darauf, ihren selbstbestimmten Sport zu treiben. Wenn die Impfung fortschreitet und mehr Impfstoff verfügbar ist, müssen wir darüber sprechen, junge Sportler ohne Neid und wegen der Risiken auch rechtzeitig zu impfen. Ihre Lebenschancen verdienen es. Wir können es uns als Gesellschaft nicht leisten, die berechtigten Anliegen der jungen Leute im öffentlichen Diskurs zu ignorieren. Einseitige Priorisierungen spalten die Gesellschaft und führen sie nicht zusammen.

Sport und Impfen

Die Diskussion um den Sport und das Impfen zeigt dies schonungslos. Priorität habe das Vermeiden von Todesfällen in Altersheimen. Deshalb hat der Ethikrat empfohlen, in Priorität nur ältere Menschen zu impfen, dazu noch die Pfleger (nicht aber die Reinigungskräfte?) und die Notärzte, nicht aber die Hausärzte, nicht aber die Lehrer und schon gar nicht die Sportler.

Das berechtigte Kriterium ist die Verringerung der Todeszahlen. Es gibt dazu aber auch weitere Mittel, die wurden bisher nur sehr zögerlich eingesetzt. Das regelmäßige Testen in Altenheimen wurde und wird mannigfach eher verhindert, Ministerien und Träger waren lange dagegen. Selbst die Hilfe der Bundeswehr bei der Nachverfolgung positiver Fälle wurde teilweise abgelehnt – ist Weltanschauung wichtiger? Auch sind die meisten Gesundheitsämter immer noch nicht personell und materiell verbessert ausgestattet worden.

Wir können feststellen, dass der Datenschutz offenkundig eine weit höhere Priorität hat, und Masken, die Experten in dieser Zeitschrift schon letzten März gefordert haben, wurden sehr zögerlich angenommen. Der Lockdown ist dann die logische Konsequenz – sicher notwendig, aber in seiner Ausprägung mit Unterrichtsausfall und Verbot des Vereinssports sehr wohl mit psychischen und physischen Schäden verbunden. Das schädigt unsere Jugend, aber auch alle anderen!

In der üblichen öffentlichen Moraldebatte wird auf Profi- und derzeitigen olympischen Sport herabgeschaut und auch der Amateursport soll sich ganz hinten anstellen. Diese würden ja nur ihre Egoismen befriedigen, während es um das Überleben
von anderen geht. Welch Einseitigkeit der Argumente! Es ist sehr einfach für ehemalige Olympiasieger (5), für Redakteure oder Politiker, auf die Olympiade zu verzichten.
Die eigenen Lebenschancen betrifft es ja nicht und wer Olympiamedaillen errungen oder eine gesicherte Position im Leben erreicht hat, dem fällt es oft leicht, auf die Chancen anderer zu verzichten.

Nebenwirkungen von Physical Distancing?

Essentielle Überlebensfaktoren in der Pandemie sind aber auch körperliche Aktivität und geistiges und soziales Wohlbefinden. Dem steht gegenüber, dass soziale Interaktionen auch körperlichen Kontakt und Nähe beinhalten, was die Ausbreitung des Virus ermöglicht. Die Grundsätze des „Physical Distancing" (die WHO verwendet jetzt diesen Begriff, da soziale Kontakte wichtig sind), Maske tragen und Hände desinfizieren, können konsequent angewendet, erheblich dazu beitragen, die Ansteckungsrate zu verringern. Sie haben aber Nebenwirkungen.

Wenn wir über Lockdown sprechen, dann sind soziale Chancen, Bildungschancen und Sportausübung und damit auch Zukunftschancen für die Jugend erheblich betroffen (2).

Wenn Jugendliche aus sozial benachteiligten Gruppen randalieren oder die Regeln grob missachten, ist das zwar nicht tolerierbar, aber vielleicht ein Symptom, dass aus deren Sicht deren Zukunft für unsere Gesellschaft nicht zähle? Es ist viel einfacher für den gehobenen Mittelstand (und aus dem stammen wir und unsere Politiker) im Einfamilienhaus mit Garten die Kinder durch den Lockdown zu bringen, als in den Wohnsilos der sozialen Brennpunkte. Wir dürfen nicht vergessen, dass etwa 50% der Kinder in den Grundschulen aus sozial benachteiligten Gruppen kommen und Förderung bedürfen (4).

Schon diese wenigen Fakten zeigen, dass es verschiedene Aspekte gibt, deren Gewichtung politisch entschieden werden muss. Aber funktioniert dies wirklich? Oder zeigt die teilweise Irrationalität in der Debatte, dass es nur zum Teil der Fall ist? Dabei verlassen sich die Entscheider doch auf die Expertise von Virologen und sogar eines Ethikrates? Das kann doch nicht falsch sein?

Die politische Theorie zeigt (siehe dazu (3)), dass in einer Demokratie die Definitionen von gut oder böse – nützlich oder schädlich – diskutiert und ausgehandelt werden müssen. Dabei sind die Interessen aller Stakeholder (auch so ein ungewohnter Begriff) zu berücksichtigen, ansonsten kommt es zu Spannungen.

Die SARS-CoV-2/ Covid-19-Pandemie stellt Gesellschaft, Bevölkerung, Ärzte und natürlich auch den Sport vor größte Herausforderungen.

Wir sehen, dass bei vielen Personen die Erkrankung zwar heftig verläuft, aber folgenlos abheilt. Wir sehen aber auch, dass ältere Menschen einem höheren Mortalitätsrisiko ausgesetzt sind. Natürlich sind wir als Mitmenschen betroffen, wenn diese Menschen erkranken, schwer geschädigt werden oder sogar versterben. Insofern haben wir alle kein Interesse daran, dass die Altenheime gefährliche Orte sind.

Aber auch bei Jüngeren kann sich COVID-19 verheerend auswirken. Wir finden bei 5-10% der Erkrankten zeitweise oder länger eine Multisystemerkrankung mit Leistungsverlust, Müdigkeit, Myokarditis, Lungenerkrankung, neurologischen Symptomen – und wir wissen noch nicht, ob und wann diese ausheilen.