On December 31, 2019 first case of an unexplained low respiratory infection detected in Wuhan (China) was reported to the WHO Country Office in China. The WHO Director Dr. Tedros Adhanom Ghebreyesus, announced that the disease caused by a new coronavirus (CoV), called "COVID-19", which is the acronym of "coronavirus disease 2019".

This new virus has rapidly spread around the world, with the number of infected pneumonia patients that far exceeded that of SARS (severe acute respiratory syndrome) in 2003. Unfortunately, the COVID-19 cases are continuing to climb. Until 20th October 2020, a total of over 40 million infected patients (including over 1.100.000 deaths) were reported by the World Health Organization. In addition to the challenge of the COVID-19 pandemic for the health care system the current situation revealed numerous effects on physical (in-)activity levels and thus on public health.

Physical inactivity is a modifiable risk factor for several chronic diseases (e.g. cardiovascular diseases, cancer, diabetes, neurodegenerative diseases) (12, 15). In contrast, physical activity and/or exercise is a low-cost intervention in primary and secondary prevention for numerous chronic diseases (17, 19, 22). Current research indicates strong evidence of physical activity effects on reduced rates of all-cause mortality, coronary heart disease, high blood pressure, cancer, diabetes, depression, stroke, and falling (15). Furthermore, strong evidence indicates increased cardiorespiratory and muscular fitness, improved bone health, improved cognition and healthier body mass and composition following physical activity.

Currently, a variety of recommendations exists to meet the minimum requirement for physical activity. The WHO has recommended a minimum of 150-min moderate-intensity or 75 min vigorous-intensity aerobic activity and strength training per week (10). Already before COVID-19 pandemics a global analysis reports a prevalence of insufficient physical activity of 27.5 % (11). The highest physical inactivity levels were in women in Latin America and the Caribbean (>40%) and high-income Western countries (>40%). Because of the high prevalence of global physical inactivity and its effect on major non-communicable diseases this presents a major public health problem.

Due to home-confinement and social isolation during the COVID-19 pandemic, reductions in Performing physical activities were apparently observed (2, 23). Preliminary results from a global questionnaire indicated that physical activity decreased by over 20% and daily sitting time increased by more than 28% during the COVID-19 pandemic (2, 3, 4). A cross-sectional online survey reported a physical activity level decrease of 26.5% in older community-dwellers in Japan (23). Additionally, Tison et al. reported a global decrease of daily steps (mean 27.3% within 30 days following pandemic declaration) with large regional differences (20). In recognition of the strong relationship between physical activity and public health, the WHO agreed to a 10% relative reduction in the prevalence of physical inactivity by 2025 as one of the nine global targets to improve prevention of non-communicable diseases (9). This target is in the context of the COVID-19 pandemic hardly reachable.

Due to the negative effects of the COVID-19 pandemic on physical activity levels interdisciplinary prevention approaches are urgently needed. Especially, an active lifestyle (including physical and social activity) is an important modifiable factor for maintaining health benefits across lifespan. In this context we recommend emphatic physical activity and social interactions (under consideration of current restrictions) to counteract negative effects of the COVID-19 pandemic. Furthermore, physical exercise exerts anti-inflammatory effects (8) and thus maybe potentials against viral diseases like COVID-19 (1, 5, 21).

In the absence of a specific investigation focused on the value of enhanced physical activity during quarantine and a difficult to predict further development of the COVID-19 pandemic physical activity and exercise recommendations need a revision. In particular home-based workouts (including endurance, resistance and balance exercises) and outdoor activities should be recommended (6, 7, 14, 16).

Future research is needed to investigate the impact of the COVID-19 pandemic on physical activity and health in detail. Particularly, the long-term consequences would be central for future research. It can be assumed that the negative consequences of the COVID-19 pandemic on physical inactivity would have elementary consequences for public health including increased risk for several chronic diseases (e.g. diabetes, coronary heart disease, depression, dementia (13, 18)).

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.

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.

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.

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.