DOVER — Relatively speaking, the coronavirus pandemic hasn’t been around very long.

And so the long- and short-term issues that come from having contracted COVID-19 are still being discovered.

One thing that health professionals are keeping a close eye on — including as it pertains to young athletes — is the potential damage the virus might do to the heart. The virus brings with it the increased chance of myocarditis (heart muscle inflammation).

While any virus can cause the condition, COVID-19 is believed to enter the heart muscle more easily.

To be clear, the threat of heart issues in teenagers seems to be very small.

Damage to the heart is much more of a concern in people who are sick enough to be hospitalized due to COVID-19.

Still, it seems to be enough of an issue that experts suggest it’s something that parents should at least discuss with a doctor before a student-athlete is cleared to resume participation following a positive test for COVID-19.

According to the local organization Heart in the Game, one in seven athletes who “contract COVID-19 have myocarditis.”

Cardiac testing was part of the protocol for some college athletes during the fall. The ACC, for instance, mandated a cardiac evaluation for any athlete who tested positive for the virus.

The National Federation of High School Associations put together a task force to look into the subject.

Among other things, the group said that a student-athlete who has tested positive should pay attention to “the presence of chest pain or shortness of breath with exertion, palpitations (heart racing), excessive fatigue, or decreased exercise tolerance.”

Dr. Bradley Bley, a member of the Delaware Interscholastic Association board of directors, said there’s a recommended five-day schedule for student-athletes gradually returning to competition from a positive virus test. It’s similar to if they were returning from a concussion.

“If you’re asymptomatic, they still need to do a gradual resumption of exercise activity,” said Dr. Bley. “If you’re symptomatic, it really depends. The various organizations break it down into mild, moderate, severe.

“The NFHSA recommends that a full cardiac workup is not needed unless there’s a severe, hospitalized situation for the virus. But the American Academy of Pediatrics recommends that it may be needed for people even with moderate symptoms.

“There’s still a lot of information and research that we need,” he added. “At this point everything is based off of expert opinion and trying to take a cautious but reasonable approach.”

Dr. Bley said one of the biggest issues in the state with athletes returning to play is that they can’t always get into see their doctor to be cleared right away.

“Not only do they have to be wait to be cleared by the Division of Public Health from an infection standpoint,” he said, “but then they have to get in to see their primary-care doctor for evaluation — listen to the heart and lungs — and determine if there’s any residual symptoms.”

It’s worth noting that sudden cardiac arrest is an issue with young athletes even when a COVID-19 diagnosis isn’t involved.

Heart in the Game’s website states that Sudden Cardiac Arrest is the leading cause of death in sports and on school campuses with 7,000-10,000 students dying every year.

That’s why Heart in the Game was created in the first place. The group offers regular screenings to try to diagnosis issues in young people before there’s a problem.

Statistics kept by the organization show that two youths per 300 tested in Delaware have some heart abnormality.

Heart in the Game also trains people in CPR/AED and has tried to make more defibrillators available in the state.

Dr. Bley said there are some countries that take the issue of Sudden Cardiac Arrest in young athletes very seriously. In Italy, he said, all high school students are required to have an EKG before they can play sports.

That’s in part because there’s a genetic predisposition to a specific heart issue in that country. It’s easily detectable by EKG.
“The biggest thing we worry about for all our athletes is that risk of sudden cardiac death,” said Dr. Bley. “That’s one of the things we really don’t want to happen in our state.

“On the national level, even before COVID-19, there was a big debate about what athletes should get screened with an EKG or echo-cardiogram. … I’m sure that’s an ongoing discussion that’s going to continue for a few more years here.”

As far as the pandemic is concerned, Dr. Bley said he doesn’t know of any student-athletes in the state who have needed to be hospitalized because of the virus.

The pandemic and understanding of the virus will continue to evolve, of course. In the meantime, Dr. Bley said it never hurts to be thorough if a student-athlete tests positive.

“You err on the side of caution, you make sure that they get evaluated from a cardiac perspective,” said Dr. Bley. “At least a physician listens to their heart and asks them questions. You do a gradual return to play progression just to be on the cautious side,”