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When Keyontae Johnson collapsed on the basketball court on Saturday, college sports temporarily stood as still as his teammates. He was rushed to the hospital where he is currently in stable but critical condition. There are many possible causes for Johnson’s condition, but in the midst of the Covid-19 pandemic, the fact that the 21-year-old and many of his team tested positive for the virus over the summer didn’t go unnoticed. While it may well turn out that Johnson’s collapse this weekend had nothing to do with Covid-19, there is growing evidence the virus can have serious effects on athletes, even when it appears they have made a full recovery.
The Covid-19 pandemic has shown how a society’s desire to return to “normal” can clash with science. Earlier this year, US college sports’ governing body, the NCAA, initially cancelled all winter and spring men’s and women’s championships, including the March Madness basketball tournaments, due to coronavirus concerns. Most other leagues in North America soon followed suit. Since then, some sports have returned, with the NBA managing to successfully navigate a bubble to complete its season. The NFL, however, has been less successful with games postponed or cancelled with increasing frequency as Covid-19 surges across the US. Now, the spotlight is back on NCAA basketball.
When it comes to getting athletes back to sports, team doctors must navigate a world where the parents, players, fans, and institutions want to see sports played while also trying to mitigate the spread of Covid-19 and protect athletes from potential short and long-term side-effects of the virus. The biggest concern regarding athletes’ health in relation to Covid has been a condition in which the heart becomes inflamed, known as myocarditis. Studies have shown that patients with Covid-19 can develop myocarditis, and the condition has been implicated in the sudden cardiac death (SCD) of athletes even without coronavirus. Several years ago, myocarditis was found to be the third-most common cause of SCD in young people behind coronary artery abnormalities and hypertrophic cardiomyopathy (also referred to as an “enlarged heart” or HCM). Meanwhile, US military data suggests that myocarditis is the leading killer of recruits in basic training. Additionally, there is also a thought that exercise in individuals with myocarditis may result in accelerated replication of the coronavirus virus within the body.
In a particularly concerning study, 26 athletes from Ohio State University with confirmed Covid-19 underwent heart testing. Of those tested, 46% were mildly symptomatic for Covid-19 and the other 54% were asymptomatic. All of their labs and electrocardiograms were normal. Yet, using a much more expensive test known as a Cardiac MRI (CMR), 46% showed heart abnormalities, and 15% met the criteria for myocarditis.
In a recent paper, the Canadian Cardiovascular Society/Canadian Heart Rhythm Society recommended that athletes who test positive or have had suspected cases of Covid-19 can return to sports gradually after seven days without symptoms of the virus. Their statement emphasized that they did not recommend routine labs, electrocardiograms, or CMR before returning to sports if the athlete had no symptoms. They pointed out that abnormalities on CMR often resolve within a few months. Their statement tried to strike a balance between safeguarding athletes while not alarming them unnecessarily – after all, many people have heart abnormalities but never go on to suffer serious cardiac events. The Canadians cardiologists’ advice was similar to recommendations by their European and American counterparts, suggesting cardiac testing is unnecessary if athletes display no symptoms following a Covid-19 infection.
However, within the same issue of a recent edition of the British Journal of Sports Medicine, one US paper suggested considering an ECG for Covid-19 infected athletes while another paper from a UK group maintained no cardiac workup was needed in asymptomatic individuals.
Today, as Keyontae Johnson lies in hospital, we still don’t know if his condition is related to Covid-19. Fortunately for many, vaccines are beginning to roll out across several countries. Yet, millions of people have been infected with Covid-19, and many were asymptomatic. There is a temptation to watch young men and women in peak physical shape performing amazing feats of athleticism and assume Covid-19 is not a threat to them; that it is a virus that only preys on the old and infirm. Indeed, when we see athletes test positive and return to the field of play a few weeks later, it is easy to believe Covid-19 is merely an inconvenience to sports stars. But complications from the virus in the young, fit athlete are real. Just as pertinently, the controversy as to who to test and whose life may be saved by testing is unclear.
Source: The Guardian
Keyword: Think Covid-19 can’t harm healthy, young athletes? Think again | Sport