Need for rest & advanced cardiac imaging in Covid-19 recovered sportspersons
(This blog is the summary of the discussion I had with my good friend Dr Arun Nayak, a well-known orthodontist, athlete and a mountaineer. I thought whatever I told him over the phone should reach maximum people)
We keep hearing about many unfortunate incidents involving previously healthy young athletes who died post-Covid recovery after they resumed their daily sports routines.
That’s why many collegiate athletic conferences, professional sports leagues, and high school teams are debating what to do. A few have decided to err on the side of caution.
This is what I understand from various pieces of evidence and would like to recommend.
Just like Chikungunya, even Covid-19 has long term effects. The only difference is that in Chikungunya, we quickly come to know the joint symptoms during our daily activities. These symptoms automatically keep us away from doing intense activities for a few months. But, in Covid-19, the worst long term effects, which pertain to the heart, may or may not be visible until they manifest during intense physical activities.
So far, Covid-19 imaging has mainly been lung-centric. 50% asymptomatics show the same lung CT features as symptomatic patients do. We need similar cardiac imaging studies in asymptomatic Covid-19 cases. The way we take HR-CT in the beginning, we may have to use advanced cardiac imaging tools too, which holds good esp for athletes. We need to assess their cardiac damage and recommend them rest (not to exert) for the next 3- 6 months based on the extent and severity of the damage.
Chikungunya automatically restricts your activity for 3 to 6 months. In Covid-19, we may have to give clear cut post-recovery instructions deliberately. The instructions to rest for a few months post-recovery would be more critical for the athletes and sports persons, who will be in a hurry to bounce back to their daily sports routine.
Doing advanced cardiac imaging in every infected person may seem impractical. Still, even if we do it in symptomatic athletes at the time of their discharge, and give clear cut advice, it can save lives. A few months ago, the norm was to do RT PCR before discharge from the hospital. Now we should do advanced cardiac imaging at the time of discharge, esp. for symptomatic, hospitalized athletes.
Infected athletes and sportspersons who remained asymptomatic should also undergo advanced cardiac imaging and receive advice based on the extent and severity of heart damage.
Even if sportspersons don’t undergo advanced cardiac tests or imaging, they should rest, exercise caution and delay returning to their sports routine. Please understand that we are still learning about this phenomenon. We have a long way to go.
Want to read more? Covid-19 can affect the heart:
#SARSCoV2 has marked tropism for the heart and can lead to myocarditis (inflammation of the heart), necrosis of its cells, mimicking of a heart attack, arrhythmias, and acute or protracted heart failure (muscle dysfunction).
Cardiac complications, which at times are the only features of #COVID19 clinical presentation, have occurred even in mild cases and asymptomatic individuals.
Link: Science Mag, 23 Sept 2020. Click here to read
