How Athletes Can Return to Practice After COVID-19 Infection: New Guidelines

Throughout the epidemic, several professional and collegiate sports leagues have canceled major events and seasons, partly to slow the spread of COVID-19, but also because of alarming reports of athletes developing a syndrome called myocarditis – inflammation of the heart muscle – following a COV. Infection.

After two years of research, the American College of Cardiology released guidelines on Tuesday that say the incidence of heartburn among athletes after COVID-19 is lower than previously thought, but they still suggest a step-by-step plan to help competing athletes and weekend fighters alike. Will help them safely return to their activities.

“For athletes recovering from COVID-19 with ongoing cardiopulmonary symptoms … further evaluation should be done before resuming exercise,” said ACC expert Consensus Decision Pathway, published in the Journal of the American College of Cardiology. “For all others who are asymptomatic or with less indicative symptoms of cardiopulmonary etiology … Additional cardiac examination is not recommended.”

Developed science

Doctors were conducting “extremely rigorous tests to detect myocarditis” at the start of the epidemic, Dr Tamanna Singh, co-director of the Cleveland Clinic Sports Cardiology Center, who was not involved in the new guidelines, told ABC News. It’s going to be much more than that. “

In September 2020, while much was still unknown about COVID-19, researchers at Ohio State University tested 26 athletes after a mild COVID-19 infection that did not require hospitalization. Myocarditis has been found in 15% of athletes, while 30% has created a scar in their heart, which has created a sense of uncertainty surrounding the safety of athletes returning to the sport after an infection.

“Although the data on cardiomyopathy are preliminary and incomplete, the uncertain risks at this time were unacceptable,” Big Ten Commissioner Kevin Warren wrote in an August 2020 open letter about the college conference’s decision to cancel the 2020-2021 fall sports season.

But over time, that is likely to change.

“Many conferences, including the Big Ten, were doing cardiac MRI on every athlete recovered from Covid, and what they saw was that the incidence of severe MRI abnormalities was very low, in the order of 1 to 2%,” said Dr. Nicole Vave, a cardiologist and echocardiographer at the University of Michigan, and vice chair of the committee that published the new guidelines.

The general rate for myocarditis involvement in athletes is “very low, the rate is usually around 0.6 to 0.7%,” Singh said.

Although experts’ understanding of COVID-19 has developed, it is clear that the symptoms, obvious or subtle, persist even after infection in many patients. And although not every athlete with COVID-19 will experience myocarditis, it is dangerous enough to be noticed by doctors.

“Myocarditis is a very rare but serious complication of covid,” Vave said. “Patients with covid myocarditis should be directed to a really high-level center. [with the proper equipment]Because these patients can go south quickly. “

Guidelines for Athletes

The ACC’s new guidelines suggest that it is safe for athletes who have no symptoms of Covid-19 to return to practice after three days of self-isolation. For mild symptoms that do not involve the heart or lungs, it is safe to return to exercise once the symptoms have resolved.

Athletes who are constantly suffering from chest pain, palpitations or pass out need more cardiac tests. If the results are related to myocarditis, the ACC recommends abstaining from exercise for three to six months.

“We don’t think everyone who has covid needs a routine MRI before they can start exercising again,” says Vave.

If an athlete has endless symptoms, Vave says, “One of the recommendations we’re making in the document is that people try to do something where they’re actually sitting, instead of trying to walk. So orthostatic intolerance. [the inability to tolerate quick movements] It’s not a big deal. “

For athletes who experience long-term COVID-19 symptoms, the recovery process can be frustrating.

“You’re basically seeing someone with a decade and a half, even two decades, of unlimited sports participation and unlimited exercise ability who now has serious limitations,” Singh said. “They are not only losing their physical connection to themselves, but also their social connection to their community, which can be really devastating emotionally.”

Both Singh and Vave said that the resumption of exercise after infection should be gradual, starting small and increasing the frequency, duration and intensity as tolerable.

“It’s important to say, as a doctor, ‘Hey, I’m here with you, and I know you haven’t returned to where you were. “We still have a lot to learn, and I think that’s a message that is very helpful for depressed patients.”

Nicholas P. Condoleezza, MD, is an internal medicine resident at the Cleveland Clinic and a contributor to the ABC News Medical Unit.

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