When commentators discuss the “heart” of a player, they aren’t usually talking about the athlete’s literal, beating organ – at least not until recently.
There is a newfound focus on athletes’ actual hearts with sports’ starting back up as the COVID-19 pandemic continues.
Despite being known primarily as a respiratory disease, COVID-19 can cause cardiac-related health problems that are dangerous for those infected and may linger longer than the virus itself. One such cardiac-related issue is myocarditis, a medical condition that has been the talking point of the collegiate sports world the past couple of weeks.
Many collegiate conferences decided to alter their fall sport plans – including the Pac-12, which canceled all athletic competitions until 2021 – because of COVID-19, and it was reported that a fear of myocarditis was a major factor in the decisions.
Myocarditis is an inflammation of cardiac muscle that can reduce the heart’s ability to pump blood and cause abnormal heart rhythms, which in rare cases can ultimately lead to death, according to the Mayo Clinic.
So when leagues, teams and individual athletes began to ponder if and when they should resume play, the athlete’s hearts were at the forefront of the discussion.
“This virus has no real limit as to what it can do,” said Srikanth Krishnan, a cardiology fellow at Ronald Reagan UCLA Medical Center. “What we’re seeing in children to what we’re seeing in hospitalized patients and in elite athletes is that there is evidence of heart muscle damage.”
The heart problems are just one of many potential issues regarding the virus outside of the respiratory threat it poses.
Once it passes the respiratory system, the virus can travel anywhere in the body, Krishnan said, and cause harm throughout. So far, basic data – albeit a limited sample – have shown increased rates of strokes, blood clots and damage to organs away from the heart and lungs.
But perhaps the most dangerous part of the virus, according to Krishnan, is the fact that so little is known about it. All of the potential risks of the virus are unknown, and it is also uncertain the severity and length of these effects.
“Our understanding (is) that it’s not limited to the respiratory system – it is not limited to anywhere,” Krishnan said. “The damage it can do is not known. This is a virus that is brand new, we don’t completely understand it and we don’t know the long-term effects of it.”
While little is known about the specific side effects of COVID-19, one thing is certain – there is a substantial risk, especially for athletes.
An Ohio State study found that nearly 15% of COVID-19-positive student-athletes had myocarditis, despite most of the sample’s showing of little to no COVID-19 symptoms.
Boston Red Sox pitcher Eduardo Rodriguez is out for the entire 2020 MLB season with myocarditis after testing positive for COVID-19 in July. Rodriguez said his experience with the disease left him feeling “100 years old” despite being in his late 20s.
Former Florida State men’s basketball player Michael Ojo died of suspected heart complications at age 27 following a bout with COVID-19 while playing professional basketball overseas.
Krishnan said it is worrisome to see these cases occurring in young athletes in great physical shape.
“These are young, physically fit, at-the-peak-of their-fitness people who get mild symptoms of (COVID-19) and then end up having potentially lifelong damage to their heart,” Krishnan said. “This virus causing these kinds of effects is extremely alarming.”
With all this known by key decision-makers, one specific question was asked across the nation: Is it worth it for athletes to play with a potentially heightened risk of devastating health issues?
The Pac-12 answered that question with a resounding “no” when it shut down all competitive sports until the new year, citing the uncertainty surrounding the short- and long-term health risks of COVID-19, which was a decision that was later reversed.
“We are concerned about health outcomes related to the virus,” the Pac-12 stated in its Health and Well Being Considerations for Pac-12 Institutions. “Among these, there is new and evolving information regarding potential serious cardiac side effects in elite athletes. We do not have enough information to understand the short and long-term outcomes regarding these health issues.”
Kimberly Harmon, the section head of sports medicine for the University of Washington, has been working with the Pac-12 and said the Pac-12 is boosting its test capacity, and it’s a game changer.
“With this new development, being able to test frequently, we can potentially keep anybody infected out of practice (and) hopefully keep the virus from spreading within the sports activities,” Harmon said. “Our athletes will be no more at risk than our students on campus.”
According to the conference, players will be tested daily, and those who test positive will follow isolation protocols until it is safe for them to return to action.
This, however, doesn’t necessarily dictate a return to a typical sports environment.
The testing framework needed to have a safe return to sports would rival the entire public health infrastructures of most cities, according to Krishnan, and the cost alone for something like this would price out many.
This means it’ll be hard for smaller leagues – such as smaller collegiate conferences or high school athletics – to return to competition safely until a vaccine is available and widespread.
Krishnan said how well the infection is controlled in the surrounding areas will be an important factor when restarting competitive sports.
“The safety of returning to sports and the safety of returning to schools depends on the control of the community they are taking place in – it’s just basically a reflection on how well the infection is controlled,” Krishnan said.
Although the college setting may pose a risk, the Pac-12 has made it clear that it will do its due diligence to make sure sports happen with the athletes’ health as its first priority.
“We have been reassured by what we’ve seen at this point, but I think the bottom line is that not enough information is known so we need to get back more information,” Harmon said. “We need to remain vigilant.”