Athletes who test positive for the coronavirus – even if they’re asymptomatic – can show inflammation of heart muscles with unclear long-term effects. But a debate has raged this week on the specific levels of this inflammation, called myocarditis, and what it means for college athletics.
How Often Myocarditis Accompanies COVID-19
This week, a Penn State University doctor made headlines by referencing an older study on myocarditis. Speaking to the State College Area Board of School Directors, Penn State director of athletic medicine Dr. Wayne Sebastianelli said that among COVID-positive athletes, 30 to 35 percent showed inflammation of the heart muscles.
The school clarified his comments yesterday, saying Sebastianelli inadvertently referenced preliminary numbers that had been shared by a colleague. Unbeknownst to Sebastianelli, the rates were actually lower when the study was officially published. A New York Times story in August referenced a study from an Ohio State doctor with myocarditis rates in close to 15% of athletes who had the coronavirus. Almost all of the athletes with myocarditis had mild or no coronavirus symptoms.
Potential Effects To Athletes & Sports Seasons
As schools and sporting organizations grapple with major coronavirus decisions, one key argument has been that young and healthy individuals are at a lower risk of death from COVID-19. But the mystery of myocarditis throws some uncertainty on that idea.
“We really just don’t know what to do with it right now,” Sebastianelli told the Board. “It’s still very early in the infection.”
Sebastianelli said there’s no clear answer on how myocarditis could affect athletes long-term, or whether the cardiac inflammation could cause an athlete to drop from elite to just average, even if they have a mild or asymptomatic bout with the coronavirus.
“What we have seen is when people have been studied with cardiac MRI scans — symptomatic and asymptomatic COVID infections — is a level of inflammation in cardiac muscle that just is alarming,” Sebastianelli said.
That’s set off a debate between experts on how school sport decision-makers should proceed.
Mayo clinic genetic cardiologist Michael Ackerman has been a very public voice on the side of proceeding with sports. AL.com called him the doctor who ‘saved the college football season.’ After the Big Ten and Pac-12 had postponed fall sports, Ackerman advised the Big 12, easing concerns about myocarditis. The Big 12 ultimately ended up moving forward with its fall sports, leaving three of the Power-5 conferences still playing this fall.
Ackerman was quick to dispute the 30-35% numbers referenced by Sebastianelli this week, before the Penn State clarification. He tweeted yesterday highlighting the uncertainty over what we know about myocarditis:
I look forward to seeing the peer-reviewed publication. Equating a cardiac MRI finding, which is at best a Finding of Uncertain Significance (F.U.S.), to #Myocarditis in this setting is a FOUL (again). Making a ton of FUSS out of a F.U.S! Time to pick up the penalty flag.
— Michael J. Ackerman MD,PhD (@MJAckermanMDPhD) September 3, 2020
Meanwhile, MedPageToday’s Dr. Anthony Pearson wrote yesterday that the concerns about myocarditis are still valid. Pearson didn’t take a firm stance on whether college football should or shouldn’t happen, but said that “we need more data and more studies to know how important these early findings really are.”
Pearson also took aim squarely at Ackerman, arguing that decisions on sports should be made based on data, not on financial bases:
“Ideally, they should not be made on the basis of political or monetary calculations,” Pearson wrote. “Nor should one genetic cardiologist who happens to tweet what athletic directors want to hear (no matter his expertise with culinary and sports analogies) have an out-sized influence.”
(Ironically enough, Pearson identifies himself as a huge fan of Oklahoma Sooners football, while Ackerman says he’s not a football fan.)
Pac-12’s Listed Concerns
Myocarditis is important to the discussion because falls squarely under one of three main concerns the Pac-12 cited when it postponed all sports until January of 2021.
When the Pac-12 canceled its fall seasons, it published three major medical issues supporting that decision:
- Community prevalence: travel between campuses and on commercial aircraft is a major risk for teams and campuses
- Health outcomes related to COVID: the unknown health issues related to the coronavirus, including myocarditis. The Pac-12 said it didn’t have enough information to fully understand these short- and long-term outcomes.
- Testing capacity: the ability to test athletes more and receive results quicker is needed to prevent the spread of the virus.
The third point is already being somewhat addressed, as the Pac-12 came to an agreement with a testing manufacturer for rapid-result tests on all Pac-12 campuses.