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On Football

The effects of myocarditis, a possible complication of COVID-19, on athletes has experts concerned

Dr. Allen Sills is the NFL's chief medical officer.
Dr. Allen Sills is the NFL's chief medical officer.Wilfredo Lee/Associated Press

There are many horror stories about people dealing with COVID-19. The symptoms can include fever, night sweats, loss l of taste and smell, and most notably, shortness of breath.

But many experts are becoming concerned that COVID-19 is also having a significant effect on the heart. Viral infections can lead to an inflammation of the heart known as myocarditis, which can result in rapid or abnormal heart rhythm, blood clots, or even cardiac arrest. Simple acts of exercise can trigger a heart attack and sudden death for those who don’t know they have myocarditis.

“All of us in medicine have known for a long time that you could have cardiac complications from viral illnesses,” said Dr. Allen Sills, the NFL’s chief medical officer. “We’ve certainly been aware of the potential for cardiac complications ever since we began putting the protocols together.”

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Research on the link between COVID-19 and myocarditis is in its infancy. But the anecdotal evidence is starting to alarm some experts, especially when it comes to sports due to restart in the fall.

Per ESPN, the potential for myocarditis was a major reason why the Big Ten and Pac-12 recently canceled their fall sports seasons, including football. At least five Big Ten athletes were found to have myocarditis after testing positive for COVID. The mother of Indiana offensive lineman Brady Feeney said her son has been dealing with significant heart issues.

Red Sox pitcher Eduardo Rodriguez was shut down for the season when he was diagnosed with myocarditis following his COVID infection. Former Florida State basketball player Michael Ojo recently died of a heart attack at 27 after dealing with COVID, though it is unclear whether he had myocarditis.

Dr. Jonathan Drezner has been following the anecdotal evidence closely, and was one of the medical experts who recommended to the Pac-12 that it shut down. He is the director of the University of Washington Medicine Center for Sports Cardiology and a team doctor for the Seattle Seahawks and Washington Huskies.

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“Myocarditis is not why we are recommending to postpone [college] sports,” he said. “We’re recommending to postpone sports because the pandemic is out of control.”

But Drezner said team physicians at schools across the country have been sharing their experiences with myocarditis as college football players returned to campuses this summer, and that the stories “raise a lot of concern.”

“I cannot remember a time where I’ve heard about this many new cases of a potential problem that might place an athlete at an elevated risk of sudden cardiac arrest,” Drezner said. ”It’s not like this is hundreds you’re hearing about, but it’s more in a two- to three-week period of time that we’ve really heard about a lot of cases, and we just don’t know a lot about it yet.”

Most worrisome is the emerging evidence suggesting that myocarditis can develop even if a person doesn’t show COVID symptoms. In a recent study out of Germany, people with mild COVID symptoms developed myocarditis as frequently as those who were hospitalized. Drezner said that many college team physicians are sharing similar stories.

“Amongst those communications are people reporting cases of myocarditis in college athletes who had mild symptoms or even no symptoms,” Drezner said. “We don’t know how frequently [myocarditis] shows up. We don’t know how best to find it. And we don’t have the clinical outcomes yet, either. There’s a whole lot we don’t understand.”

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The NFL has been aware of the potential for heart complications since the pandemic began in March. The NFL also has far more resources than college football teams, with daily COVID testing and mandatory heart testing.

As part of the league’s protocols, any player who tests positive for COVID-19 or shows certain symptoms has to undergo three heart tests before returning to the field: high-sensitivity troponin testing, a standard 12-lead electrocardiogram, and a two-dimensional resting echocardiogram. If the tests discover anything abnormal, the player is given a cardiac MRI.

And when a player is cleared to return, he can’t just jump right back into the huddle. He has to undergo a three- or seven-day ramp-up period of activity, depending on the severity of his symptoms. Team doctors will monitor a player to ensure he is not showing any issues with his heart or lungs as he returns to exercise. A diagnosis of myocarditis could end a player’s season.

“Most guidelines suggest 3-6 months of rest from exercise before a return to sports,” Drezner said. “And most of the time they do well and they return and it’s considered a short-term condition.”

The NFL has not yet stated whether anyone in the league has developed myocarditis. However, the additional heart screening did help Minnesota linebacker Cameron Smith discover last week that he had a congenital heart condition. Smith will undergo open-heart surgery and will miss the 2020 season.

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“It is really a blessing that we found this as my heart is severely enlarged and wouldn’t have lasted much longer,” he said on Instagram.

No one knows yet whether myocarditis in COVID-19 patients is rare or common, or if certain types of people are more at risk of developing it.

But the anecdotal evidence is alarming, and exemplifies how there are many side effects to COVID-19 that need to be considered.

“I think if you remove the myocarditis issue completely, I still don’t think we were quite prepared to move towards fall sports [in college], because the pandemic is out of control in many places and we don’t have the testing infrastructure to protect our athletes,” Drezner said.

“What the myocarditis did is it shined a light on why this is so important, and why protecting the athlete from getting new infections within the sports setting is so critical.”


Ben Volin can be reached at ben.volin@globe.com. Follow him on Twitter @BenVolin