SPORTS MEDICINE
At this time, we are nearly 7 months into the COVID-19 pandemic and we are all tired with the ideas of social distancing, mask wearing, and changes to youth sports participation. However, as we move into fall and transition back into [some] fall sports, it is important for us to remain vigilant so that we may continue to move forwards. I am a sports medicine physician, but I am also a mother. I want nothing more than to see my children and young patients get back to the activities they love, but we must continue to prioritize athlete safety.
Most of us are familiar with the recommended guidelines for participation in sport. The CDC guidelines include the following:
- Stay home if you are sick or not feeling well.
- Use your own equipment when possible (e.g. field hockey stick, ball, protective equipment).
- Maintain social distancing (6 feet) during sports practices and on the sidelines during contests.
- Wear a mask, if possible.
- Wash your hands before and after sport.
- Keep your mouth guard in for the duration of sport. If you must remove it, wash your hands each and every time.
- Tell a coach, athletic trainer, or staff member if you are not feeling well.
Sport specific guidelines have been further defined by the Rhode Island Interscholastic League and may be found here.
What happens, though, if a student is exposed to COVID-19, tests positive for COVID-19, or develops illness from COVID-19?
COVID-19 is a systemic disease affecting multiple organ systems, including the heart and lungs. In some instances, an inflammation of the heart muscle called myocarditis may put an athlete at risk for severe complications, and even death, following a viral illness like COVID-19. An international panel of experts has put forth recommendations for safe return to sport. These recommendations were recently published in the British Journal of Sports Medicine. These recommendations are based on a comprehensive clinical evaluation (including examination of the heart and lungs) and have been designed for six different groups according to the level of exposure to and illness from COVID-19. It is important to note that these groups are applicable to both recreational and professional athletes.
Group 1. No symptoms, no evidence of COVID-19 (i.e. negative test result).
If close contact or exposure, may need to quarantine/self-isolate. Medical evaluation not necessary.
Group 2. No symptoms, positive COVID-19 test result.
Medical evaluation is mandatory with electrocardiogram (ECG) to screen for heart abnormalities (such as myocarditis). Quarantine/self-isolation is mandatory.
Group 3. Mild symptoms, positive COVID-19 test, treated at home as outpatient.
Medical evaluation is mandatory with electrocardiogram (ECG) to screen for heart abnormalities (such as myocarditis). Consider blood tests for cardiac enzymes, cardiac stress test, and/or echocardiogram. Quarantine/self-isolation is mandatory.
Group 4. Moderate symptoms, positive COVID-19 test, treated inpatient without need for intensive care (ICU).
Medical evaluation is mandatory with electrocardiogram (ECG) to screen for heart abnormalities (such as myocarditis), and Chest X-Ray and spirometry blood gas analysis to evaluate lung function. Consider blood tests for cardiac enzymes, cardiac stress test, and/or echocardiogram. Quarantine/self-isolation is mandatory.
Group 5. Severe symptoms, positive COVID-19 test, requiring inpatient treatment in intensive care unit (ICU) WITHOUT need for mechanical ventilation.
Medical evaluation is mandatory with electrocardiogram (ECG), blood tests for cardiac enzymes, and cardiac stress test to screen for heart abnormalities (such as myocarditis). Chest X-Ray and spirometry blood gas analysis are mandatory to evaluate lung function. Consider echocardiogram and/or cardiac MRI. Quarantine/self-isolation is mandatory.
Group 6. Severe symptoms, positive COVID-19 test, requiring inpatient treatment in intensive care unit (ICU) WITH need for mechanical ventilation.
Medical evaluation is mandatory with electrocardiogram (ECG), blood tests for cardiac enzymes, and cardiac stress test to screen for heart abnormalities (such as myocarditis). Chest X-Ray and spirometry blood gas analysis are mandatory to evaluate lung function. Consider echocardiogram and/or cardiac MRI. Quarantine/self-isolation is mandatory.
The need for specific tests and the resumption of sports and physical activity following COVID-19 should be determined on a case-by-case basis by the evaluating physician. The big take-away here is that EVERY ATHLETE, no matter how minor the illness, needs to be evaluated following a positive COVID-19 test.
Remember, we as a medical community are doing our best to ensure our athletes are safe.
For more information regarding sports participation and COVID-19, please visit the CDC.
