Perspective by Matey Juric, Roger S. Blumenthal, Martha Gulati
In the setting of the COVID-19 pandemic, undergraduates across the country and their families face many uncertainties about how this academic year will unfold. One of the major concerns about this year is the safety of college athletes and whether they
will be able to play this season.
The Pac-12 and Big Ten athletic conferences in August canceled their football seasons likely due to the fear of an increased risk of myocarditis (heart muscle inflammation) in people who have had COVID-19. Meanwhile, other conferences including the Big
12, Atlantic Coast Conference (ACC) and Southeastern Conference (SEC) decided to compete this year. The Big Ten eventually reversed its decision in mid-September and will kick off its first week of games Oct. 23.
News reports of athletes who had COVID-19 and heart issues have caused alarm in the athletic community. Brady Feeney, a freshman on Indiana University’s football team, experienced prolonged trouble breathing after testing positive for COVID-19.
[1] Stories like these clearly influenced university presidents and
chancellors when making their decisions.
While some medical professionals do not think it is prudent to return to play, others disagree. Jason Johnson, MD, at Le Bonheur Children’s hospital in Memphis
maintains that myocarditis is not the right reason for sports to be canceled. Johnson says any virus can cause myocarditis and although COVID-19 does appear to enter the cardiac muscle more easily than other viruses, the likelihood of serious complications
in athletes is small.
[2]
In addition, Michael Ackerman, MD, from the Mayo Clinic, says information about the prevalence of myocarditis in patients who tested
positive for the virus may be misleading.[3] He cites a Journal of the American Medical Association study, in which 100 individuals who were infected by
COVID-19 had also received cardiac MRIs. Out of those 100 people, 78 had abnormal findings in their MRI.[4]
While this study does seem to show that myocarditis is prevalent in COVID-19 patients, it has several limitations. All the participants were from Germany with an average age of 50 years old. Some also had pre-existing cardiovascular diseases. We
also have no baseline to compare these results to determine if this is a worrisome high number or not, as it is unknown how prevalent myocarditis is with other viruses. Additionally, these findings do not appear to apply to individuals infected with
COVID-19 who are asymptomatic. As a result, this information may not directly translate to college athletes in their early 20s.
When people get the influenza (flu) virus, no one typically gets a cardiac MRI after 10 to 14 days to see if there are any abnormal findings in the heart.[5] However, with the COVID-19 pandemic, these extra precautions including echocardiograms and occasionally an MRI are being taken. COVID-19 could cause an increased risk of myocarditis, but we cannot confidently
say as there is not enough data to support the claim.
For athletic conferences that have decided to have sports, various measures have been put in place. Big 12 athletes will get tested three times per week in high contact sports such as basketball and football. Players will need to get tested at least 72
hours before a game. This will mitigate the risk of transmission of the virus to athletes at other schools and their communities. Furthermore, if a player tests positive, they will receive an ECG, troponin blood test, echocardiogram, and a cardiac
MRI.
[6]
The decision whether to have a sports season is a tough one to make. New information about this novel virus appears each week. For now, there is not enough evidence to determine if the risk of myocarditis should preclude intercollegiate sports and vigorous
exercise.
In our view, the main issues that led many schools to cancel fall sports involve the need to improve rapid testing, mitigation efforts, and ways to lower the risk of developing COVID-19 infection in the first place.
Matey Juric is a premedical student at Drexel University. Roger S. Blumenthal, MD, FACC, is Director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Martha Gulati, MD, FACC, is the Editor-in-Chief of CardioSmart.