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JOHN DOHERTY: COVID-19 study results positive thanks to negative tests
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SPORTS MEDICINE

JOHN DOHERTY: COVID-19 study results positive thanks to negative tests

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Amid the COVID-19-related college conference chaos of the last week, the news from the sports world’s next level up has been somewhat better.

A study published earlier this month in JAMA Cardiology Inflammatory Heart Disease in Professional Athletes With Prior COVID-19 and Return-to-Play Cardiac Screening looked at the prevalence of post-COVID-19 inflammatory heart disease among the athletes of the six professional leagues in North America between May and October of last year.

A year ago at this time, sports at all levels were shutting down. As months passed and professional teams faced bankruptcy, the pressure to resume playing increased. Meanwhile, research on the hearts of middle-aged victims was disturbing, with well over 50% in some studies experiencing some form of damage. Worse, a study published in September — also in JAMA Cardiology Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection — found that, among 26 Ohio State athletes diagnosed with COVID-19, 15% had cardiac inflammation and another 30% had scarring or swelling that may or may not have been tied to the infection. Additionally, concern was heightened when Red Sox pitcher Eduardo Rodriguez had his season ended by myocarditis.

Consequently, the American College of Cardiology and other medical governing bodies issued recommendations for extensive cardiac testing for any infected athlete prior to returning to play. Three procedures were strongly suggested: lab testing for troponin levels in the blood – which are indicative of heart damage, an EKG and an echocardiogram. Any athlete with an abnormal result from any of those three would require further testing including a stress test and/or a cardiac MRI.

In all, the study reported on 789 players gathered from the NFL, Major League Soccer, MLB, NHL, NFL, NBA, and WNBA, who had been diagnosed with COVID-19, 460 of whom had been symptomatic. Of those, only 30 registered an abnormal result in one or more of the three preliminary tests. However, only 5 of those 30 ended up being diagnosed with myocarditis or pericarditis and held out of playing, a rate of 0.6%.

While that news was encouraging, even more so was the fact that none of the five were among the 329 who had been asymptomatic or minimally symptomatic. Better yet, none of the 784 who returned to play experienced any heart-related issues thereafter.

“This study, like so much else we do, would not have been possible without the skilled, attentive care of club medical and athletic training staffs,” said Allen Sills, the NFL’s chief medical officer, in an email.

His comments were well-timed, considering March is National Athletic Training Month.

“Athletes with mild cases of COVID-19 did not experience the heart abnormalities that many in the medical community feared would be an impact of this virus,” Sills said. “This study illustrated a robust, year-long collaborative effort among professional sports leagues. Since the onset of the pandemic, we have worked more closely together than ever to share lessons learned to ensure the best possible care for players. Collectively, we are committed to paying it forward by sharing our own takeaways with our counterparts in other sports — as well as society at large.”

Dr. Sean Swearingen, a cardiologist with Community Care Network in Munster, was certainly appreciative of the study and encouraged by the results. He has been working with athletes at Purdue Northwest who have been diagnosed with COVID-19. “I’ve been using the American College of Cardiology guidelines for all collegiate athletes,” he said.

Updated guidelines are not as stringent as they were five months ago, when Clemson quarterback Trevor Lawrence was held out of the Notre Dame regular-season game while awaiting cardiac testing, even though he had been minimally symptomatic.

“I think the response the ACC had, with limited data from the Ohio State study, was appropriate,” Swearingen said. “Was it overkill? We took appropriate precautions based on the information we had at the time. No morbidity occurred because of the steps we took.”

Thanks to ongoing findings at the professional and collegiate level, the ACC is now recommending testing of those with only moderate symptoms or worse. “The findings from this study support updated expert consensus ACC recommendations, which do not advocate for cardiovascular risk stratification in athletes who were asymptomatic or athletes with mild COVID-19 viral illness who remain asymptomatic after completion of appropriate self-isolation,” the study’s authors concluded.

Nonetheless, according to Swearingen, victims with mild symptoms or better should not throw caution to the wind. “It is still a big deal in my mind to aggressively monitor symptoms during a gradual return to play,” he said. “I understand that in collegiate football a lot of money is involved. But among (victims of) sudden cardiac death over age 35, a majority have some symptoms prior. With younger patients, that is not always the case.”

However, Swearingen believes that vigilant coaches and athletic trainers could still reduce by half the already small number of athletes who might suffer SCD as a result of COVID-19. In those two weeks after a player is released to play, then, the athlete must be quizzed about possible heart-related symptoms such as dizziness, chest pain, palpitations, and unusual shortness of breath every day. If any one of those symptoms appear, then further medical evaluation is warranted.

John Doherty is a licensed physical therapist and athletic trainer. This column reflects solely his opinion. Reach him at jdoherty@comhs.org. Follow him on Twitter @JDohertyATC

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