When the Pac-12 decided against playing college football this fall, the conference cited “evolving information regarding potential serious cardiac side effects” in athletes who tested positive for COVID-19 as one of its primary reasons for shutting it down.
But on the same day that the Pac-12 and Big Ten announced there would be no football in 2020 for their conference members, the Big 12 didn’t follow that path — and its commissioner, Bob Bowlsby, pointed to new heart-related testing measures that would be used before clearing infected athletes to return.
So how could there be such disparate views about playing or not playing when it comes to an athlete’s heart risks?
As some University of Kansas Health System specialists explained in a recent news conference, the issue comes down to a risk-benefit analysis for individuals rather than hardline recommendations.
“We don’t know what we don’t know,” KU Health System sports cardiologist Dr. Tim Beaver said of gauging how safe it is for an athlete who tested positive to return to high-intensity or high-impact competition. “I think it’s the million-dollar question.”
Within Beaver’s field of expertise, he said myocarditis — the inflammation of the heart muscle — in people who had the virus has become a polarizing topic. He said the majority of young and healthy athletes were going to be safe.
“The problem is with the propensity of this virus to affect the heart more and emerging data showing asymptomatic people having evidence of inflammation,” Beaver explained.
The major concern, he added, is the knowledge that there is an 8% baseline rate of sudden death with myocarditis. Beaver said that percentage could potentially be higher with an asymptomatic population, making it a greater risk.
The problem right now is doctors don’t know for certain what all the risks might be for COVID-19 patients who have recovered. Beaver said most of the published data available so far deals with an older age group.
A significant amount of patients recover from myocarditis, Beaver said. But if an athlete has inflammation or scarring in his heart while pushing adrenaline levels through high-intensity sports, that can lead to dangerous heart rhythms, making it a high-risk situation.
That’s why the Big 12 will require athletes who get the virus to have a cardiac MRI, EKG and other heart-related tests before they are cleared to return to practice or competition.
It might have been the advice of Dr. Michael Ackerman, genetic cardiologist at the Mayo Clinic, that helped convince the Big 12’s leadership to keep football going while two other Power Five conferences canceled fall competition. He spoke to Big 12 decision-makers before they finalized their plans. In an interview with The Athletic’s CJ Moore, Ackerman said he doesn’t think the risk of myocarditis alone is reason enough to cancel or postpone fall sports.
Ackerman said there isn’t a lot known yet about what happens to young, healthy people when COVID-19 does some damage to their hearts. He said it’s not a fair comparison to look at a study on infection and heart damage done mostly on patients who were older than 50 and in patients who are obese and say similar results will occur in college-age athletes.
Nevertheless, Ackerman stressed to The Athletic that he wasn’t intending to downplay the danger of myocarditis. He said it's a serious condition, and that’s why others in his field have advised to err on the side of caution.
Myocarditis doesn’t always go away in patients. Ackerman said the general rule for anyone who is diagnosed with the inflammation is that a third get better, a third potentially need medications and therapies for the remainder of their lives, and a third have “a very, very bad version of the myocarditis that damages the heart muscle so much that they might need machines or transplants to counter that.”
According to Ackerman, he’s neither for nor against college sports being played this fall. He told The Athletic his perspective on the possibility of myocarditis cases in athletes who get the virus comes from treating at-risk patients with genetic heart disease.
“I’ve chosen to endorse an approach where I’m doing everything I possibly can to help that individual live and thrive,” he said.
Reportedly, a different picture was painted for the Pac-12’s administrators. Per The Athletic’s Bruce Feldman, one doctor gave a Powerpoint presentation that included references to:
• heart issues for Red Sox pitcher Eduardo Rodriguez that will keep him from playing this season;
• Indiana freshman offensive lineman Brady Feeney’s issues with recovering from the virus;
• former Florida State basketball player Michael Ojo dying of a heart attack at the age of 27 earlier this month after recovering from the virus;
• and a 19-year-old former high school football player from Washington who died from COVID-19.
University of Kansas Health System experts also said during their news conference that about 20% of COVID patients end up with significant lung disease or inflammation or scarring in the lung.
Bruce Toby, KU Health System's chair of orthopedics and sports medicine, has doubts about letting athletes play after recovering from COVID-19. He said if one of his children had the virus, he would recommend they not play sports for an extended amount of time, such as sitting out the entire season.
It’s the unknown that worries Toby.
“Life is precious, and health is precious,” he said. “Life doesn’t end when you finish your high school career or your college career. It goes on.”