As the summer comes to a close and the weather begins to cool off, our weekends usually are filled with trips to the stadium or the gymnasium. Fall sports in Montana are some of the most anticipated events of the year. However, due to the COVID-19 pandemic, there are risks that need to be considered. Specifically for our athletes, coaches, officials, family members, and spectators.
By now we all know that the more time spent in close proximity to a person infected with COVID-19 the more likely we are to become infected with the virus. We also know that we can reduce the risk of spreading the virus by practicing hand hygiene, wearing cloth face coverings, cleaning and disinfecting frequently touched equipment, and prioritizing physical distancing.
These recommendations need to be applied to our fields of play and arenas. Cloth face coverings should be worn by coaches, officials, spectators, and any volunteers. Those athletes who are not on the field of play should wear a cloth face covering and practice physical distancing.
There are perceptions in the public that young people and young athletes are likely to remain asymptomatic or only have very mild forms of the disease without significant consequences to getting the infection. As a result, sports are moving forward and preventative measures such as mask-wearing and social distancing on the fields are not commonly observed. However, in a study of Ohio State athletes, it was found that out of 26 athletes who had been diagnosed with COVID-19 and had at most mild symptoms, 15% had findings consistent with inflammation of the heart (myocarditis). Also within the study, a total of 31% had evidence of heart muscle injury (myocardial injury). Large case studies in the past have demonstrated an increased risk of heart muscles not working correctly (myocardial dysfunction) and even sudden death when these findings were present.
Recently the Montana Chapter of American Academy of Pediatrics published a letter emphasizing the unknown effects of COVID-19 on young athletes. Given these uncertainties, the following recommendations were created based on expert opinion from Montana pediatric cardiologists and national guidelines from the American Academy of Pediatrics and the American College of Cardiology.
- Athletes or participants who exhibit any signs or symptoms of COVID-19 should be held out of ALL practices, games, and events.
- They should seek the advice of their healthcare provider and/or public health for recommendations on testing, isolation, and return-to-play.
- Following Montana High School Association guidelines, all athletes with a positive test should have an evaluation by a licensed healthcare provider for new symptoms of dyspnea, chest pain, palpitations, or dizziness/syncope.
- National and local pediatric cardiologists also recommend the following:
- Asymptomatic: The athlete should not return to sports until 14 days after receiving their test results and after evaluation by a healthcare provider.
- Mild illness (no fever and symptoms lasting <3 days): The athlete should not return to sports until 14 days after their COVID-19 symptoms have resolved AND have a normal EKG before return.
- Moderate illness (prolonged fevers lasting >3 days, bed rest, but no hospitalization or abnormal cardiac testing): The athlete should not return to sports until 14 days after their COVID-19 symptoms have resolved AND a referral to a pediatric cardiologist for further evaluation should be done before return.
- Severe illness (hospitalization, abnormal cardiac testing, Multisystem Inflammatory Syndrome in Children (MIS-C)): The athlete should not return to sports until they have complete cardiac testing done and be cleared by a pediatric cardiologist. Some of these patients may require a 3-6 month restriction from sports due to concern for heart inflammation (myocarditis).
Like most things during the COVID-19 pandemic, these recommendations are likely to change as we learn more about its effects on athletes and children. I would ask local pediatric health experts and our athletes, families, coaches, and schools to work closely together so we may stay in lockstep as our collective understanding of the virus evolves.
Maintaining some sort of normalcy is important for our everyday lives, but we must be sure that we are taking actions that will keep our children and community safe from the COVID-19 virus.
Jennifer Davenport, MD
Chief Medical Officer, St. James Healthcare