Cases like Washington’s raise questions about how aggressively to screen. Her condition was found only because Vanderbilt took a much more conservative approach than that recommended by current guidelines: It screened all athletes with cardiac MRIs after they had covid, regardless of the severity of their symptoms or their initial cardiac tests.
Of the 59 athletes screened post-covid, the university found two with signs of myocarditis. That’s just over 3%.
“Is the current rate of myocarditis that we’re seeing high enough to warrant ongoing cardiovascular screening?” asked Dr. Daniel Clark, a Vanderbilt sports cardiologist and lead author of an analysis of the school’s screening efforts. “Five percent is too much to ignore, in my opinion, but what is our societal threshold for not screening highly competitive athletes for myocarditis?”
Even though myocarditis is rare, studies have found that noncovid-related myocarditis causes up to 9% of sudden cardiac deaths among athletes, said Dr. Jonathan Drezner, director of the University of Washington Medicine Center for Sports Cardiology, who advises the NCAA on cardiac issues. Thus covid adds a new risk. The NCAA alone reports more than 480,000 athletes. To provide a sense of scale: If all of them got covid and even 1% were at risk of heart problems, that’s 4,800 athletes.
Waiting for More Data
Doctors are now waiting for the release of data pooled from thousands of college athletes screened after having covid last year. The American Heart Association and the American Medical Society for Sports Medicine have created a national registry to track covid cases and heart disease in NCAA athletes, with more than 3,000 athletes enrolled, while the Big Ten conference is running its own registry.
That registry data may eventually help parse who is most at risk for heart complications, target who needs to be screened and improve the reliability of the tests. Doctors may discover that some symptoms are better indicators of risk than others. And down the road, genetic testing or other types of tests could identify who is most vulnerable.
But will smaller schools have the resources and know-how to screen all their athletes?
“How about all the junior colleges, all the Division III programs, the Division II programs?” Martinez said. “A lot of them are saying, ‘Look, forget it. If we have do all this extra testing, we can’t do it.’”
He said the new pro sports data should reassure those colleges and even high schools, because the vast majority of young, healthy athletes who contract covid generally have mild or asymptomatic infections, and won’t need further testing.
The same guidelines apply to recreational athletes. Those with mild or asymptomatic covid can slowly resume exercising once their symptoms resolve without much concern. Those with moderate or severe cases should talk to their doctors before returning to sports.
Concerns for Small Schools
Large, wealthy universities like Vanderbilt have cutting-edge medical facilities with the resources and expertise to properly interpret cardiac MRIs. Smaller schools could struggle to get their athletes screened.
“There’s only a small number of centers around the country that have the true expertise to be able to effectively do cardiac MRIs on athletes,” said Dr. Dermot Phelan, a sports cardiologist with Atrium Health in Charlotte, North Carolina. “And the reality is that those systems are already stretched trying to deal with normal clinical data. If we were to add a huge population of athletes on top of that, I think we would stretch the medical system significantly.”
Some schools with limited resources for testing could decide to bench athletes recovering from moderate or severe covid rather than risk a devastating event. Others could allow athletes to resume playing once they’ve recovered, and then monitor them for signs of cardiac complications. Many NCAA schools added automated external defibrillators after Gathers’ death in case an athlete collapses during a game or practice.