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How Young Athletes Can Safely Return to Sports After COVID-19

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Most student athletes who are diagnosed with COVID-19 can’t wait to feel better and get back in the game.

However, the possibility of long-term complications after a COVID-19 infection has medical professionals and school administrators urging caution when it comes to clearing young athletes to return to the field, court, or pool. In addition to the usual activities that go along with a return to sports, such as annual physicals or buying new gear, student athletes who had COVID-19 require special attention.

Patrick J. Moreno, MD, a Sports Medicine physician at Penn Medicine Lancaster General Health (LG Health), said the primary concern for competitive athletes after COVID-19 is potential heart damage. In an effort to safeguard local student athletes, the Sports Medicine team worked with colleagues in Cardiology, Family Medicine, and other specialties, as well as local school districts, to develop a protocol for student athletes to safely return to competitive sports, and the strenuous exercise levels associated with those activities.

“We are still learning about the short- and long-term complications of COVID-19 in the pediatric population,” Moreno said. “As there is so much that we still don’t know, we recommend taking a cautious approach to children and teens resuming competitive sports practices or games after testing positive.”

LG Health’s protocol is based on recommendations developed by cardiology experts from Children’s Hospital of Philadelphia. In general, any child who tests positive should wait at least 14 days after their COVID-19 symptoms resolve before returning to competitive sports. Cardiac testing may be recommended for some children (especially those 12 or older), depending on their age and severity of illness. However, it’s important to note that all children who had severe illness resulting in hospitalization — not just competitive athletes — should be evaluated by a cardiologist 14 days after discharge.

The guidelines are similar to those for adults, who should wait 10 to 14 days before resuming high-intensity exercise. However, Penn Medicine recommends some form of cardiac testing for all adults who have recovered from COVID-19, regardless of activity level or severity of illness.

Identifying young athletes at risk

Matthew D. Elias, MD, a CHOP cardiologist and assistant professor of Pediatrics at the Perelman School of Medicine who sees patients at LG Health’s Suburban Pavilion in Lancaster, said it’s relatively common for adults to develop cardiac issues with COVID-19 — even those who had only minor or moderate illness. However, medical professionals are still learning about the long-term effects of COVID-19 on children and teens.

“Our biggest concern as cardiologists is the possibility of developing myocarditis, or inflammation of the heart,” he said. “Myocarditis is one of the primary causes of sudden cardiac arrest in competitive athletes.”

Though it’s believed to be rare, the return-to-sports guidelines aim to identify those cases where a young athlete’s heart is affected by COVID-19, Elias said. However, he noted, these guidelines are subject to change, based on the latest medical literature and local experience.

In general, cardiologists are most concerned about children ages 12 and up, he said. That’s when competitive sports typically become more strenuous, with coaches and teammates pushing athletes beyond their normal limits. Younger children, on the other hand, generally will self-regulate their physical activity, so they do not reach the same level of intensity.

Specifically, an EKG (electrocardiogram), a simple test that measures electrical activity in the heart, is recommended for student athletes ages 12 and older who have had mild or moderate COVID-19 symptoms. If the EKG results are normal, the athlete can return to sports. If the results are abnormal, a cardiologist will work with the athlete to deliver the care they need for clearance.

Once a student-athlete is cleared, Elias recommends a gradual return to sports. If the athlete experiences symptoms with exercise, such as chest pain, unusual shortness of breath, fainting, or dizziness that is not related to dehydration, they should stop exercising right away and seek medical attention.

“It’s not a good idea to just jump right back into high-intensity exercise after sitting out for a while,” he said. “We tell them to take it slowly and listen to their bodies.”

Teaming up with local school districts

LG Health has strengthened existing partnerships with local public and private schools during the pandemic, providing guidance in many areas related to COVID-19. School administrators, athletic directors, team physicians, and athletic trainers are all involved in implementing the post-COVID return-to-sports protocol.

“One frequent concern was related to timing. Most wanted to know when it was safe for students to return to sports after testing positive,” Moreno said. “Schools have a lot of responsibility but not necessarily the expertise or resources to deal with all facets of this public health crisis.”

LG Health clinicians serve as team physicians and athletic trainers for many local school districts, including Octorara Area School District in Chester County.

Octorara athletic director Angela Gaido said students and their parents are often disappointed at having to sit out after testing positive for COVID-19, especially if the athlete experienced only minor or no symptoms. Compounding that frustration, many young athletes have only recently returned to competition after widespread cancelled practices and shortened sports seasons earlier in the pandemic.

The LG Health medical team has been invaluable in educating and guiding families through the return-to-sports protocol, Gaido said. Student-athletes and their parents appreciate having clear, consistent guidelines from medical experts to help them get back in the game.

So far all Octorara students who have followed the protocol have successfully returned to playing sports. It helps that everyone — student athletes, their parents, medical professionals and school administrators — is working as one team.

“We all have the same goal,” she said. “We just want to keep our student athletes healthy and safe.”  

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