For sports fans across the country, the resumption of the regular sports calendar has signaled another step toward post-pandemic normality. But for the athletes participating in professional, collegiate, high school or even recreational sports, significant unanswered questions remain about the aftereffects of a covid infection.
Chief among those is whether the coronavirus can damage their hearts, putting them at risk for lifelong complications and death. Preliminary data from early in the pandemic suggested that as many as 1 in 5 people with covid-19 could end up with heart inflammation, known as myocarditis, which has been linked to abnormal heart rhythms and sudden cardiac death.
Screening studies conducted by college athletic programs over the past year have generally found lower numbers. But these studies have been too small to provide an accurate measure of how likely athletes are to develop heart problems after covid, and how serious those heart issues may be.
Without definitive data, concerns arose that returning to play too soon could expose thousands of athletes to serious cardiac complications. On the other hand, if concerns proved overblown, the testing protocols could unfairly keep athletes out of competition and subject them to needless testing and treatment.
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“The last thing we want is to miss people that we potentially could have detected, and have that result in bad outcomes — in particular, the sudden death of a young athlete,” said Dr. Matthew Martinez, director of sports cardiology at Atlantic Health’s Morristown Medical Center in New Jersey and an adviser to several professional sports leagues. “But we also need to look at the flip side and the potential negatives of overtesting.”
With millions of Americans playing high school, college, professional or master’s level sports, even a low rate of complications could result in significant numbers of affected athletes. And that could prompt a thorny discussion of how to balance the risk of a small percentage of players who could be in danger against the continuation of sports competition as we know it.
Limited Impact on Pro Sports
Data released from professional sports leagues in early March provided at least some reassurance that the problem may not be as great as initially feared. Pro athletes playing football, men’s and women’s basketball, baseball, soccer and hockey were screened for heart problems before returning from covid infections. The players underwent an electrical test of their heart rhythms, a blood test that checks for heart damage and an ultrasound exam of their hearts. Out of 789 athletes screened, 30 showed some cardiac abnormality in those initial tests and were referred for a cardiac MRI to provide a better picture of their heart. Five of those, less than 1% of athletes screened, showed inflammation of the heart that sidelined them for the remainder of their seasons.
The researchers compiling the data did not name the players, although some have disclosed their own diagnoses. Boston Red Sox pitcher Eduardo Rodríguez returned to the mound this spring after missing the 2020 season following his covid and myocarditis diagnoses. Similarly, Buffalo Bills tight end Tommy Sweeney was close to returning from a foot injury when he was diagnosed with myocarditis in November.
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In the college ranks, many assumed Keyontae Johnson — a 21-year-old forward on the University of Florida men’s basketball team who collapsed on the court in December, months after contracting covid — might have developed myocarditis. The Gainesville Sun reported that month he had been diagnosed with myocarditis, but his family issued a statement in February saying the incident was not covid-related and declined to release additional details.
Consequences Still Unclear
Doctors still don’t know how significant those MRI findings of myocarditis may be for athletes. Tests looking for rare medical events often generate more false positives than true positives. And without comparing the results with those of athletes who didn’t have covid, it is hard to determine what changes to attribute to the virus — or what may just be an effect of athletic training or other causes.
