Guidelines for return to sport following COVID-19

As the percentage of the population affected by COVID-19 increases it becomes more important to understand some of the long term effects of this virus.  There is building evidence that the novel coronavirus can cause cardiovascular damage during the course of the infection.  Data is currently being collected about the prevalence of cardiac injury due to a bout with COVID-19.  In reports earlier this year from hospitalized patients, it has been shown to be greater than 20% demonstrating cardiac injury.  However there is much variety in symptoms and severity with COVID-19 and we are still learning much.  For athletes and the general public frequently engaged in fitness pursuits, cardiovascular damage can be a cause of sudden cardiac arrest.   Based on the ongoing uncertainty about the cardiovascular risk of returning to sport following a COVID-19 diagnosis there are some new recommendations being put forth for returning to sport activities.

• Positive COVID test but no symptoms:  Wait ten days of complete rest after the positive test before gradual return to exercise. 
• Positive COVID test with mild symptoms: Wait ten days of complete rest from the date of the positive test before gradual return to sport.  Must also have full resolution of symptoms before return to exercise or sport.  
• Moderate symptoms:  This includes people who were able to stay home, but longer duration and increased intensity of symptoms.  Wait until full symptom resolution and then wait ten more days of complete rest before returning to sport.  Very slow and gradual return is recommended.  
• Severe cases involving hospitalization:  If they had cardiovascular symptoms they likely had screening completed in the hospital during the course of their treatment.  Before return to sport it is advised to repeat cardiovascular screening and MD clearance is highly recommended before return to sport activities.  
• Age group differences:  
  1. Over age of 65, independent of symptom level, recommend an MD screening for cardiovascular risk before returning to exercise.  
  2. Children under 15: 14 days of rest following symptom resolution, if symptoms were mild or more refer to MD for further screening.

In general, listen to your body!   Take it slow, and if an athlete is reporting more fatigue than usual during their gradual return to sport, referral to MD for cardiovascular screening is recommended.

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Reference:  Jonathan H. Kim, MD, MSc; Benjamin D. Levine, MD; Dermot Phelan, MD, PhD; et al.  “Coronavirus Disease 2019 and the Athletic Heart Emerging Perspectives on Pathology, Risks, and Return to Play” JAMA Cardiol. Published online October 26, 2020. doi:10.1001/jamacardio.2020.5890.  Accessed November 23, 2020.

Research article link:  https://jamanetwork.com/journals/jamacardiology/fullarticle/2772399