HARTFORD, Conn. — Research from a database of more than 3,000 NCAA athletes who have tested positive for COVID-19 is expected to be released in the next few months and will help sports medicine doctors and cardiologists establish guidelines for college athletes returning to play after contracting the coronavirus.
The data could help doctors better understand the prevalence of myocarditis, or inflammation of the heart, in athletes who have had COVID-19. Myocarditis, if undiagnosed, can cause sudden exercise-related death.
Dr. Rachel Lampert, professor of medicine at Yale School of Medicine and a cardiologist with Yale Medicine, is on the steering committee for the Outcomes Registry for Cardiac Conditions in Athletes (ORCCA), which was formed by sports medicine and cardiologists at Harvard and the University of Washington in conjunction with the American Medical Society for Sports Medicine and the American Heart Society. Over 60 colleges nationwide are participating in the study.
“Very soon we will have better data on what the prevalence really is and that data, in addition to giving us a number, will also be helpful in guiding what the workup should be,” Lampert said.
A few high-profile athletes have had medical issues upon returning to play after contracting COVID-19. Red Sox pitcher Eduardo Rodriguez was the most notable, diagnosed with myocarditis in late July and sidelined for the season. University of Florida basketball player Keyontae Johnson had COVID-19 several months prior to collapsing on the court during a game. The cause of his collapse has not been confirmed publicly by the school or his family, although the Gainesville Sun reported through an anonymous source that he was diagnosed with myocarditis.
Many questions remain. How many athletes will develop myocarditis or have the potential for developing heart issues? Does every athlete who has had COVID-19 need to be tested for myocarditis?
That’s what doctors are hoping to have a better handle on when the results of the study are released.
“We are really flying blind,” said Dr. Paul Thompson, the chief of cardiology emeritus at Hartford Hospital and a staff cardiologist at Mass. General who has researched cardiac complications in athletes for decades. “We’re flying blind because there are these cardiac enzymes changes that we don’t know what they mean. And we’re flying blind because we haven’t followed people long-term after this.
“After the 1918 flu epidemic, there was an increase in Parkinson’s Disease. There can be sequela [a condition which is the consequence of a previous disease] from these infections that we know nothing about. It’s important to put registries together and figure out what actually is happening to people.”
Dr. Antonio Fernandez, the medical director of the Cardiac Intensive Care Unit at Hartford Hospital, has screened college athletes from the University of Hartford, Trinity, Southern Connecticut, as well as high school athletes, who have recovered from COVID-19.
“We have seen one case that maybe was related, maybe wasn’t,” Fernandez said. “I haven’t seen a case of myocarditis.
“A couple high-profile athletes have had myocarditis and that makes it into the news but over millions of athletes in the United States, what’s the actual incidence of myocarditis in the whole athletic body?
“I think the important part of that registry is that we don’t really know what the mid- to long-term implications of COVID-19 on the heart are and what is the frequency of occurrence of myocarditis? It would be helpful to know what the number is.”
Fernandez said there have been studies published but the “numbers are sort of all over the place, even in the non-athlete population, you don’t know really what the precise number is.”
Thompson was one of the authors of the guidelines issued by the American College of Cardiology’s Sports and Exercise Leadership Council on return to sports, which recommends consideration of cardiac screening for athletes with moderate to severe symptoms. Those who are asymptomatic or have minimal symptoms — defined as less than four days of fever or other symptoms — most likely don’t need evaluation before returning to exercise unless there are symptoms such as chest pain or shortness of breath.
