Review Implications of the COVID-19 pandemic on athletes, sports events, and mass gathering events: Review and recommendations Jehad Feras AlSamhori a , Mohammad Ali Alshrouf b, * , Abdel Rahman Feras AlSamhori a , Fatimah Maytham Alshadeedi a , Anas Salahaldeen Madi a , Osama Alzoubi c a School of Medicine, The University of Jordan, Amman, 11942, Jordan b Medical Internship, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan c Shmaisani Hospital, Amman, 11195, Jordan ARTICLE INFO Kew words: COVID-19 Cardiorespiratory Athletes Sport Mass gathering events Recommendations ABSTRACT Since the coronavirus disease 19 (COVID-19), which caused several respiratory diseases, was formally declared a global pandemic by the World Health Organization (WHO) on March 11, 2020, it affected the lifestyle and health of athletes, both directly through cardiorespiratory and other health related effects, and indirectly as the pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world. In this review, we explore the journey of athletes throughout the pandemic and during their return to their competitive routine. We also highlight potential pitfalls during the process and summarize the recom- mendations for the optimal return to sport participation. We further discuss the impact of the pandemic on the psychology of athletes, the variance between the team and individual athletes, and their ability to cope with the changes. Moreover, we specifically reviewed the pandemic impact on younger professional athletes in terms of mental and fitness health. Finally, we shaded light on the various impacts of mass gathering events and recom- mendations for managing upcoming events. Introduction Coronaviruses (CoVs) are a group of highly diverse, enveloped, positive-sense, and single-stranded RNA viruses that can cause several diseases involving respiratory, gastrointestinal, and nervous systems with varying severity among humans and animals. 1 Although most human coronavirus infections are mild, the last 20 years have seen two betacoronavirus epidemics, one involving the severe acute respiratory syndrome coronavirus (SARS-CoV) 2–4 and the other involving the Middle East respiratory syndrome coronavirus (MERS-CoV) 5,6 with fatality rates of 10% for SARS-CoV and 37% for MERS-CoV, which have generated more than 10 000 cumulative cases during the previous 20 years. 7,8 The coronavirus disease 19 (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus, which led to several respiratory ailments. 9 On March 11, 2020, the World Health Organization (WHO) formally proclaimed COVID-19 a global pandemic with extremely high risk. 10 The highly con- tagious character of the virus is primarily related to the ease with which it may spread from person to person, both via respiratory droplets and direct contact from surfaces to mucosal membranes. 11 Most symptoms of SARS-CoV-2 infection, such as fever, cough, sore throat, fatigue, and the sequelae of pneumonia and acute respiratory distress syndrome (ARDS), are related to the respiratory tract. 9 The COVID-19 pandemic has forced the suspension, postponement, or cancellation of most professional sporting events around the world in order to reduce the risk of viral propagation, with the question now being raised of how athletes can safely return to traditional competitive sports, taking into consideration the world's evolving knowledge of the virus and the shifting of governmental and public health recommendations. 12 The virus caused social restrictions that led to the cancellation of sporting events in Brazil in March 2020, followed by outlawed sports training. 13 In addition, on March 30, 2020, the International Olympic Committee (IOC) and the Japanese government announced that the 2020 Tokyo Olympics had been moved to July 20, 21 14 This social isolation increased the likelihood that athletes would experience addictions, anxiety, sadness, and other mental health issues, 15 and it also caused changes in eating practices during the pandemic. 16 Moreover, numerous behavioral changes, including social withdrawal, staying in, avoiding crowds, and avoiding familiar exercise locales like gyms and health clubs, have been brought on by the COVID-19 pandemic. 17 Teams like volleyball, football, field hockey, and cheer/dance groups had a higher incidence risk of infection among young athletes and students than those involved in * Corresponding author. The School of Medicine, The University of Jordan, Amman, 11942, Jordan. E-mail address: M.Alshrouf@outlook.com (M.A. Alshrouf). Contents lists available at ScienceDirect Sports Medicine and Health Science journal homepage: www.keaipublishing.com/smhs https://doi.org/10.1016/j.smhs.2023.07.006 Received 8 January 2023; Received in revised form 2 July 2023; Accepted 24 July 2023 Available online 25 July 2023 2666-3376/© 2023 Chengdu Sport University. Publishing services by Elsevier B.V. on behalf of KeAi Communications Co. Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Sports Medicine and Health Science 5 (2023) 165–173