Dr. Matthew Martinez has studied so many images of a beating heart that he could not count them. Maybe 500,000. Maybe 1 million. As a non-invasive cardiologist, his job revolves around the constant evaluation of photos of the heart.
He knows what a strong, healthy heart looks like. He knows what a poor, wrestling heart looks like. And he knows what a heart looks like after tentacles of COVID-19 reached the most vital organ in the human body. “This virus,” he says, “seems to have an affinity for damage to the heart.”
In a small percentage of infected patients, COVID-19 leaves restless scars in the throbbing muscle inside their chest, known as myocarditis. The virus directly enters the heart muscle, weakens and damages its cells, through blood clots and inflammatory responses to viral infection. Earlier in the pandemic, physicians only associated the condition with severe and, perhaps, COVID hospitals, mostly older patients than those with underlying health problems.
Recently, doctors have been identifying the condition in young, healthy Americans – including athletes. “Over the last month or two, even asymptomatic young people have been developing myocardial injury,” Martinez says.
Of all the obstacles that hamper a 2020 college football season, there is one roadblock that has been most overturned, buried among the other more prominent obstacles, such as testing, travel, a bubble-free college campus, and quarantine requirements. That obstacle? The heart.
“That’s what’s been the last straw,” said a team doctor at a leading college football program. “It simply came to our notice then. The commissioners go, ‘Oh my gosh!’ And the doctors are like, ‘Yes …’ “
University leaders and conference readers are struggling with new information from the medical world about the virus’ effects on its victims, exacerbating an already difficult conundrum: risk it and play an autumn season, or sit out and watch a sector potentially crumble? Revelations from doctors like Martinez have deepened the debate.
Indeed, the issue of breaking hearts was a topic on a recent call among Power 5 conference commissioners. Fear of myocarditis has reached the top level of the sport, with Big 12 commissioner Bob Bowlsby and Big Ten commissioner Kevin Warren both privately concerned about the condition. One doctor 5-team doctor, who is envious of conference commissioner talks, says heart condition is a primary topic during talks. “We discuss it on every call,” the doctor says on condition of anonymity.
The issue hit his head Saturday in what was, to this point, the most important college football news of the shutdown: The Mid-American Conference became the first FBS league to cancel its fall season. The MAC Medical Advisory Board unanimously advised conference leaders to stop the season. And although financial implications were also a factor (MAC schools, in a normal year, losing money on football), the long-term and somewhat unknown health effects of COVID-19 victims – including myocarditis – were a major point of discussion.
“That’s what people do not get,” said a high-ranking MAC administrator with knowledge of the presidents’ call Saturday. “It’s lung quality, heart problems.”
Doctors themselves are still learning about a new virus and its consequences after recovery on the human body. Myocarditis is one of many side effects, but for athletes it is the most serious, says Martinez, the medical director of sports cardiology at Atlantic Health System in New Jersey. Martinez knows a thing or two about athletes’ hearts. He is the league cardiologist for Major League Soccer, is the cardiac-specific consultant for the NBA and for the NFL Medical Committee.
He acknowledges that cases in athletes with COVID-related heart disease are very small. Among professional, athletic colleges and youth competitions, he has seen no more than a dozen in the US. However, there are probably many more. Some are undetected or have not been brought to his attention. Doctors are not exactly sure how common the condition is. Some have publicly said that recovered COVID-19 patients have as much as a 50% impact on their heart, but with striking degrees of severity.
A recent German study released in July public heart attack in 60 out of 100 recovered virus patients. That number included patients who were asymptomatic as well as mildly symptomatic.
A doctor team from the college told Sports Illustrated on Saturday that he is aware of about 10 COVID-related heart attacks in entire college football, many if all of mildly symptomatic players. While the number is a fraction of the total population, the possible consequences of heartbeat are severe. Symptoms of myocarditis include chest pain, abnormal heartbeat, shortness of breath and, in the most serious case, sudden death. Already, myocarditis represents roughly 2-5% of all sudden deaths in American sports.
While many cases of COVID-related myocarditis in athletes remain private, some have occurred in public. Left-handed pitcher Eduardo Rodriguez, projected as the Red Sox No. 1 pitcher, 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 may have heart complications as a result of the virus.
At least one college football player has developed an enlarged heart after contracting COVID-19, a team coach told SI on condition of anonymity. The recovery time for such heartbeat is a minimum of three months of no activity, Martinez says.
Martinez says he has heard of the heart problem this summer from almost every major football conference for colleges. Some of them are pushing ahead, he says, with a plan to “turn around” when things go wrong. “Others have said, ‘I think we need to stop,'” Martinez says. “The MAC did that today.”
His advice to conference officials has been to make heart protection compulsory for those who have contracted the virus. That’s why the conference’s recent medical plans include embracing hearts under the return-to-play protocol.
Martinez recommends a three-level 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 with it detection of heart defects. Each blood test and ECG can cost about $ 50, Martinez says. The more intrusive echocardiogram can run as high as $ 500 per test. ‘It can be done. You can play football, “he says,” but resources must be used. “
The inequality in athletics of colleges is great. In FBS alone, there is a large monetary gap between the Power 5 conference programs and the Group of 5 teams. The gap grows wider from Group 5 to FCS and from Division II to Division III. Bad as some FCS, D2 and D3 programs are expected to play this fall. Many of them do not have the funding to meet NCAA requirements for seasonal testing, quarantine and contact tracking.
Saturday was also a naked day for the top division in the NCAA. After the MAC canceled its season, the Big Ten stopped its practice for press breaks. And on Friday, Brian Hainline, the NCAA’s chief medical officer, said: “Almost everything would have to be perfectly tuned in order to move forward.”
Add another obstacle to the list: the heart.
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