COVID-19: the Risk to Athletes

Abstract

Purpose of review: The COVID-19 pandemic has had a profound impact on athletics, and the question of safely resuming competitive sports at all levels has been a source of significant debate. Concerns regarding myocarditis and the risk of arrhythmias and sudden death in athletes have prompted heightened attention to the role of cardiovascular screening. In this review, we aim to comprehensively outline the cardiovascular manifestations associated with COVID-19 infection, to discuss screening, diagnosis, and treatment strategies, and to evaluate the current literature on the risk to athletes and recommendations regarding return-to-play.

Recent findings: COVID-19 is known to cause myocarditis, with presentations ranging from subclinical current or prior infection detected on cardiac MRI imaging, to fulminant heart failure and shock. While initial data early in the pandemic suggested that the risk of myocarditis could be significant even in patients with nonsevere COVID-19 infection, recent studies suggest a very low prevalence of clinically significant disease in young athletes.

Summary: While COVID-19 can have significant cardiovascular manifestations, recent data demonstrate that a screening approach guided by severity of COVID-19 infection and cardiovascular symptoms allows the majority of athletes to safely return to play in a timely manner. We must continue to tailor our approach to screening athletes as knowledge grows, and further research on the longitudinal cardiovascular effects of COVID-19 is needed.

Keywords: Athlete’s heart; COVID-19; Myocarditis; Sports cardiology.

Fig. 1.

COVID-19 return-to-play algorithm for adult athletes in competitive sports. Originally published in JAMA Cardiology by Kim et al. [•]. CV = cardiovascular, hs-cTn = high-sensitivity troponin-I, RTP = return to play. Mild symptoms = anosmia, ageusia, headache, mild fatigue, mild upper respiratory tract illness, and mild gastrointestinal illness. Moderate symptoms = persistent fever, chills, myalgias, lethargy, dyspnea, and chest tightness. CV symptoms = dyspnea, exercise intolerance, chest tightness, dizziness, syncope, and palpitations.