Is cardiac injury to athletes from the coronavirus a reason to postpone sports? Researchers say no

Posted at 11:22 PM, Oct 27, 2020

While public health experts have acknowledged the risk for healthy athletes when becoming infected with the coronavirus has been rather low, lingering questions have remained on if the virus causes long-term cardiac damage.

Doctors from the Sports and Exercise Cardiology Section of the American College of Cardiology released some of their preliminary findings on the effect the coronavirus has on athletes’ hearts.

With college football fully resuming this week with the return of the Pac-12, and college basketball slated to get underway next month, sports are beginning to return to normal amid the pandemic. While some athletes are being frequently tested for the virus, testing alone has not stopped team-wide outbreaks from occurring.

Despite there being some limited evidence that the virus causes cardiac injury to athletes, researchers wrote in JAMA that heart damage alone should not be the primary reason to postpone athletic competitions amid the pandemic.

“While concerns about the implications of cardiac injury attributable to COVID-19 infection deserve further study, they should not constitute a primary justification for the cancellation or postponement of sports,” the researchers wrote.

“Rather than canceling sports because of unsubstantiated concerns about cardiac safety based on limited data of unestablished clinical relevance, this decision should be driven by the need to limit viral spread,” researchers added. “With uncontrolled community transmission, we share concerns with public health officials about risks of increased disease transmission attributable to the resumption of organized sports. Accordingly, the decision to proceed with or delay organized sports should be based on community disease prevalence, coupled with the availability of resources that can be responsibly allocated to identify and prevent new infections among athletes.”

The researchers said that initial findings have produced only a handful of cases of cardiac injury, but stressed that more research is needed.

“Reports of presumptive myocarditis among several athletes with high profiles have magnified concerns about COVID-19 CV sequelae in athletes,” the researchers wrote. “Our combined experience suggests that most athletes with COVID-19 are asymptomatic to mildly ill, and to date, (return to play) risk stratification has yielded few cases of relevant cardiac pathology. However, we underscore that these observations may not reflect the true prevalence and attendant prognosis of COVID-19 CV involvement in athletes.”

As far as what players should do following their 10-day isolation period, assuming they minimal coronavirus symptoms?

“We do not advocate for (cardiovascular) risk stratification among athletes who remain completely asymptomatic with prior COVID-19 infection, following completion of US Centers for Disease Control and Prevention (CDC) guided self-isolation,” the researchers wrote. “Given the current lack of published data, consideration of comprehensive screening for this population could be reasonable if it is based on research and data collection.”

The Big Ten, which was among several leagues that held out on playing at the start of the football season, requires athletes to undergo cardiovascular screening following a positive coronavirus test. Part of what concerned the Big Ten initially was reports that a number of its athletes who tested positive for the virus had shown myocarditis symptoms.

According to the National Institutes of Health, myocarditis is an acute injury that “leads to myocyte damage, which in turn activates the innate and humeral immune system, leading to severe inflammation.”

“All COVID-19 positive student-athletes will have to undergo comprehensive cardiac testing to include labs and biomarkers, ECG, Echocardiogram and a Cardiac MRI,” the Big Ten said in a statement. “Following cardiac evaluation, student-athletes must receive clearance from a cardiologist designated by the university for the primary purpose of cardiac clearance for COVID-19 positive student-athletes. The earliest a student-athlete can return to game competition is 21 days following a COVID-19 positive diagnosis.

“In addition to the medical protocols approved, the 14 Big Ten institutions will establish a cardiac registry in an effort to examine the effects on COVID-19 positive student-athletes. The registry and associated data will attempt to answer many of the unknowns regarding the cardiac manifestations in COVID-19 positive elite athletes.”

To read an abstract of the research, click here.