Dr. Matthew Martinez studied so many images of a beating heart that he couldn’t count them. Maybe 500,000. Maybe 1 million. As a non-invasive cardiologist, his job is to constantly evaluate images of the heart.
He knows what a strong, healthy heart looks like. He knows what a poor, struggling heart looks like. And he knows what a heart looks like once COVID-19’s tentacles reach the human body’s most vital organ. “This virus,” he said, “seems to have an affinity for causing damage to the heart. »
In a small percentage of infected patients, COVID-19 leaves troubling scarring in the throbbing muscles of the chest, known as myocarditis. The virus directly invades the heart muscle, weakening and damaging its cells, through blood clots and inflammatory responses to the viral infection. Earlier in the pandemic, doctors only associated the disease with severe and, often, hospitalized COVID victims, usually patients who were elderly or had underlying health conditions.
Lately, doctors are identifying this disease in healthy young Americans, including athletes. “For the past one or two months, even asymptomatic young people have developed myocardial lesions,” explains Martinez.
Among all the obstacles hindering a 2020 college football season, there is one that has been largely overshadowed: buried under other larger obstacles, such as testing, travel, a bubble-free college campus, and quarantine requirements. This obstacle? The heart.
“That was the final straw,” says a team doctor at a major college football program. “The commissioners finally understand everything. The commissioners say: “Oh my God! And the doctors say, “Yeah…”
University and conference leaders are grappling with new information from the medical world about the aftereffects of the virus on its victims, exacerbating an already difficult conundrum: Take the risk and play a fall season, or sit back and watch an industry potentially collapse? Revelations from doctors like Martinez have deepened the debate.
In fact, the brewing heart issue is a topic of recent calls within the Power 5 conference medical task force, including commissioners and team doctors. Fear over myocarditis has reached the highest levels of the sport, with Big 12 Commissioner Bob Bowlsby and Big Ten Commissioner Kevin Warren both privately expressing serious concerns about the disease. A Power 5 team doctor who is familiar with the conference commissioners’ calls says heart disease is a main topic during the discussions. “We discuss it on every call,” says the doctor on condition of anonymity.
The question surfaced Saturday in what was, until now, college football’s biggest shutdown news: The Mid-American Conference became the first FBS league to cancel its fall season. The MAC Medical Advisory Committee unanimously advised conference leaders to suspend the season. And while the financial implications were also a factor (MAC schools, in a normal year, lose money on football), the long-term and somewhat unknown health impacts of COVID victims- 19 – including myocarditis – were a key point of discussion.
“That’s what people aren’t getting,” says a high-ranking MAC administrator familiar with the presidents’ call Saturday. “These are lung and heart problems.”
Doctors themselves are still learning more about a new virus and its impacts on the human body after recovery. Myocarditis is one of many sequelae, but for athletes, it’s the most serious, says Martinez, medical director of sports cardiology at Atlantic Health System in New Jersey. Martinez knows a thing or two about athletes’ hearts. He is a cardiologist for Major League Soccer, a cardiology consultant for the NBA and a member of the NFL medical committee.
He acknowledges that cases in athletes with COVID-related cardiac impacts are very low. Among professional, college and youth league athletes, he has seen only a dozen in the United States. However, there are probably many more. Some go unnoticed or have not been brought to its attention. Doctors aren’t sure how common this condition is. Some have publicly stated that recovered COVID-19 patients have shown up to 50% impact on their hearts, but with striking degrees of severity.
A recent German study published in July found heart inflammation in 60 out of 100 patients recovered from the virus. This number included asymptomatic or mildly symptomatic patients.
A university team doctor said Sports Illustrated Saturday that he is aware of about 10 COVID-related cardiac impacts across college football, with most or all of them coming from mildly symptomatic players. Although this number represents only a fraction of the total population, the potential consequences of heart damage are serious. Symptoms of myocarditis include chest pain, abnormal heart rhythm, shortness of breath, and in more severe cases, sudden death. Myocarditis already accounts for approximately 2-5% of all sudden death cases in American sports.
While many cases of COVID-related myocarditis in athletes remain private, some have become public. Left-handed pitcher Eduardo Rodriguez, projected as the Red Sox’s No. 1 pitcher this year, developed myocarditis after contracting COVID-19. He will miss the 2020 season. The mother of an Indiana offensive lineman suggested in a Facebook post earlier this week that her son could have heart complications as a result of the virus.
At least one college football player developed an enlarged heart after contracting COVID-19, a team coach told SI on condition of anonymity. The recovery time for such heart injuries is at least three months of inactivity, Martinez says.
Martinez says he’s heard from virtually every major college football conference this summer regarding the heart issue. Some of them are moving forward, he said, with a plan to “pivot” if things go wrong. “Others said, ‘I think we should stop,’” Martinez says. “The MAC did it today.”
His advice to conference officials was to make cardiac screenings mandatory for those who have contracted the virus. That’s why the conference’s most recent medical plans include cardiac screenings as part of the return-to-play protocol.
Martinez recommends three-tier screening for all COVID-19 positives to return to activity: an ECG, an echocardiogram, and a troponin blood test, which measures the level of heart-specific troponin in the blood to help detect heart damage. Each blood test and EKG can cost about $50, Martinez says. The most intrusive echocardiogram can cost up to $500 per test. “It can be done. We can play football,” he said, “but we have to use the resources.
The disparity in college athletics is great. In FBS alone, there is a significant monetary gap between Power 5 conference programs and Group of 5 teams. The gap widens from Group of 5 to FCS and from Division II to Division III. Few if any FCS, D2 and D3 programs are scheduled to play football this fall. Many of them do not have the funds to meet the NCAA’s requirements for in-season testing, quarantining and contact tracing.
Saturday was a dark day also for the first division of the NCAA. After the MAC canceled its season, the Big Ten suspended pre-season training. And on Friday, there was this from the NCAA’s chief medical expert, Brian Hainline: “It would take almost everything being perfectly aligned to continue moving forward.” »
Add another obstacle to the list: the heart.
