Return to play after Covid-19

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Let’s be clear. It’s not the flu. SARS-CoV-2 is a coronavirus. And as I explained to one of my rancher patients last week, comparing a coronavirus to an influenza virus is like comparing a cow to a horse. They are different animals, so to speak. The transmission rate is greater, the case fatality rate is higher, and the clinical manifestations are more varied.

It was announced earlier this month that Eduardo Rodriguez, a pitcher for the Red Sox who had recently contracted Covid-19, will miss the rest of the season due to myocarditis, an inflammatory condition that impairs heart function and can lead to congestive heart failure, abnormal heart rhythms, and even death. He had returned to the team but complained of shortness of breath after throwing only twenty pitches.

A recent German study using cardiac MRI found that a surprisingly high percentage of patients who had recovered from Covid-19 infections had evidence of myocarditis. These results have not yet been replicated, but the findings are concerning.

Recognizing that myocarditis is an important cause of sudden cardiac arrest in athletes, the American College of Cardiology’s Sports and Exercise Cardiology Council has recommended that athletes who have recovered from Covid-19 infections be screened with a high sensitivity troponin, an ECG, and an echocardiogram. If there is evidence of myocarditis, they should suspend all training and competition for three to six months and undergo reevaluation before returning to play.

Photo by Timothy Eberly on Unsplash

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