Journal AMA Largely No Longer Recommends Cardiac Testing for Covid(+) Athletes
Ross Dellenger reporting on new JAMA Cardiology study which outlines cardiovascular monitoring guidelines for adult athletes with positive covid test.
Top line takeaways:
- NO CV testing for asymptomatic Covid (+) patients recommended
- Limited testing for mildly symptomatic athletes with protracted length of illness
- Incidence of CV abnormality is <1% in Covid (+) mildly symptomatic athletes
- Important to remember that mild and transient myocarditis is not uncommon with a variety of respiratory viruses
The nine-page report, heralded by physicians across the country, indicates that doctors are finding so few heart abnormalities in COVID-positive athletes that they are no longer recommending any cardiac screenings for those who experienced mild symptoms or no symptoms.
...
“The article is trying to restore some semblance of order to the universe with a rationale approach,” says Michael Ackerman, a genetic cardiologist at the Mayo Clinic in Minnesota who briefed both the Big 12 and Conference USA in August regarding the myocarditis scare that swept across college sports.
https://twitter.com/RossDellenger/status/1321564452999831553
https://images.saymedia-content.com/.image/cs_srgb/MTc2NDI1MTI4ODc0MjIyNzY1/hsc200003_annotatedproof.pdf
Implications for B1G policy and Wisconsin game
October 28th, 2020 at 9:14 PM ^
So is this a good thing or a bad thing?
October 28th, 2020 at 9:16 PM ^
It’s a good thing. BIG should change their rule to only 14 day quarantine. Last 7 days are now useless...
October 28th, 2020 at 9:25 PM ^
Okay. I'm not that smart so I needed someone to tell me about it.
October 28th, 2020 at 9:34 PM ^
It is a good thing but the B1G really shouldn't change their rule because the last 7 days are also about an athlete, that isn't allowed to practice for two weeks, getting themselves back into game shape before taking the field again.
October 29th, 2020 at 2:18 AM ^
Eh, two weeks off does not require an acclimatization period. I guess if you did nothing for two weeks it would be a problem, but mild symptoms or asymptotic cases can do things to stay in shape. A full week is overkill.
October 29th, 2020 at 8:12 AM ^
You'd be amazed how much of a step an athlete can lose after only two weeks of inactivity. Especially when the competition has no such lag in training/competing.
October 29th, 2020 at 9:42 AM ^
I think it'd be up to a coach to determine if a player has lost a step and his backup would be a better option. Also, I'd trust the coaching staff to determine that conditioning suffered from a 2-week layoff and a player needs to come out for a rest. There's no need to dictate this at a corporate level.
October 28th, 2020 at 9:18 PM ^
Depends on your point of view!
October 28th, 2020 at 10:18 PM ^
Once you start the process it seems very problematic if you amend the rules and that favors one or more teams that couldn't stay healthy when other teams are able to avoid infection or paid a higher price previously.
October 28th, 2020 at 10:19 PM ^
True, but the season only started 12 days ago, so they could amend the back end of the silly 21 day period
October 28th, 2020 at 10:18 PM ^
Once you start the process it seems very problematic if you amend the rules and that favors one or more teams that couldn't stay healthy when other teams are able to avoid infection or paid a higher price previously.
October 28th, 2020 at 11:46 PM ^
Given how much worse the Covid situation is in Wisconsin than in other Big Ten states, I’m not sure that it is entirely correct to just assume Wisconsin was particularly careless. In terms of cases per million: Wisconsin has 726. Second is Nebraska at 420. Illinois, Iowa and Indiana round out the top five at 375, 374 and 337. Wisconsin also has the worst test positivity at 28% and increasing. Iowa follows at 26.4% and increasing and Nebraska is 3rd at 21.8% and increasing. Wisconsin is only 6th in increase in cases in the last 14 days at 42% (but obviously are starting from a way higher baseline than anyone else). Michigan is first at 75%. Illinois is second at 64% and Ohio. Pennsylvania and Indiana round out the top 5 at 56%,,45% and 44% respectively.
Given the trends in other big ten states, I think it is realistic to expect other schools will also face covid challenges before the season ends.
Numbers from Covid Exit Strategy
October 28th, 2020 at 11:12 PM ^
I think one can objectively say that a low likelihood of something serious like this is a good thing, regardless of school, sport, or political affiliation.
October 28th, 2020 at 9:18 PM ^
So lets "follow the science" shall we, give Wisconsin a 'L' for choosing not to play Nebraska!
October 28th, 2020 at 9:26 PM ^
From the article:
1) As recently as September, cardiologists were mostly recommending full-scale heart screenings in the absence of workable data—what some might call an appropriate, cautious approach to a novel virus’s impacts on such a significant organ.
2) Sports cardiologists contacted this week described Monday’s article as excellent and sound, but cautioned that data is still incomplete. A full study is expected later this fall when more numbers are crunched.
Nothing has changed - still don't have enough data. You're either cautious or you're not and it is easy to see what side all the names in that article come down on.
October 28th, 2020 at 9:30 PM ^
I thought I saw the exact opposite over the weekend in a Twitter trending topic.... Doctors pushing for more Cardiac testing of athletes than most are currently doing. It was twitter but I noted it because -without digging into it much -- it appeared to make the B1G look good for taking the extra precautions. This was prior to the Mertz news
Given the changing goalposts in this pandemic, the risk-aversion of B1G presidents, and the fact that all the B1G programs agreed to the protocol -- I doubt they will change things mid-season.
My 2 cents
October 28th, 2020 at 10:43 PM ^
Yeah its not likely to change any time soon or at all until there is 100 percent certainty either way.
On a slightly unrelated note, and I know this is probably going to get me negged, I think anyone who tests positive should have the option to come back around 10 to 14 days if they so desire. These young men are capable of making their own decisions and should be more in control of their own bodies. Present them with the facts of the situation (after they are negative) and let them make a choice to come back at 10 to 14 days. Anyone who decides to stay away should not be looked down upon and anyone who comes back early should not be celebrated like a hero. It's just making a logical choice based on what they know about their own body and how they feel. Simple as that.
October 29th, 2020 at 1:55 AM ^
"These young men are capable of making their own decisions and should be more in control of their own bodies."
I can see it already. "Bros vs. B1G Ten"
October 29th, 2020 at 8:46 AM ^
I don't understand what you're saying here... Do you mean to imply that a player - once testing negative - should be allowed to get back into practice early (at 10 days, vice 14)? If he tests negative (by whatever protocol the B1G has in place for negativity), then I agree - he should be brought back. If you're saying that any number of days is enough, negative test or not, and if players can suck it up, I think you're dead wrong.
The last 7 days are optional for conditioning, per B1G directives. So if a player tests negative when the initial 14 days are up, a coach can plop him directly into a game. This will happen at some point - most probably with Graham Mertz, if the timing works out.
October 28th, 2020 at 9:31 PM ^
The BIG could easily alter protocols based on this peer reviewed study published in a highly regarded medical journal. In fact, it would be the correct choice if they want to retain the integrity of their initial decision to rely on solid data to inform their decisions.
October 29th, 2020 at 12:45 AM ^
Except it isn't a study as it has no data.
October 29th, 2020 at 1:08 AM ^
Fair point. It was a report, not a study. I stand by my statement though, regardless of publication classification!
October 29th, 2020 at 6:44 AM ^
Except that the paper recommends both a ten day period of no activity after a positive test even if asymptomatic then a slow and carefully monitored resumption of activity. While it doesn’t go into detail about what this means, it is hard to imagine 4 days allowing for a “slow and careful resumption of activity”. Maintaining their integrity would involve using a study that determines what such a resumption of activity looks like. Or, maybe, since it is doubtful that one exists, doing one to determine how much time is appropriate.
October 28th, 2020 at 9:43 PM ^
This is a paper for peer review and not a study and looking through the paper it is more like a summary of different observations than an actual study with data on the CMR imaging of young athletes that were covid19 positive. How many athletes have actually had imaging? I don't see any real data that this was based on and read the conflict of interest section.
October 28th, 2020 at 9:50 PM ^
Covid good news buzz kill guy alert! We must not have good news on Covid.
October 28th, 2020 at 9:53 PM ^
So, looking through the paper, first of all it doesn't look like a clinical study, and it does not make terribly bold statements. The authors clearly state that they're waiting on critical data, and that these are observations based on barely-relevant data from adults.
The biggest statement that they make is something along the lines of, "fear of myocarditis should not be the primary justification to cancelling a season."
Does this mean the B1G should adjust the COVID protocols? That would be a stretch at this point.
October 28th, 2020 at 10:02 PM ^
Okay mods. Do your job.
October 28th, 2020 at 10:12 PM ^
Key point is that at this point in time, not enough data to justify changing Big10 policy to let UW QB (Mertz?) play against Mich. (But M should, assuming mild symptoms, be fine in the long run, thank goodness.)
October 28th, 2020 at 10:19 PM ^
...you're an idiot. Take a seat.
October 28th, 2020 at 10:21 PM ^
"Journal AMA" doesn't "recommend" anything. It publishes papers that pass peer review. Some of those papers will support one conclusion. Others will support others. Treating any one study as definitive proof of something, when the data is still very limited and experts continue to disagree, betrays a total misunderstanding of scientific research.
October 28th, 2020 at 10:32 PM ^
Very smart.
October 29th, 2020 at 5:03 AM ^
Confirmed US coronavirus deaths now roughly equal the immediate death toll of the atomic bombs the US dropped on Japan.
The CDC calculates excess deaths since the arrival of the pandemic at more than 1000 9/11s.
Go ahead and tell me about how there's no evidence for caution again, oh great person expressing stupid opinions on the internet.
October 31st, 2020 at 10:30 PM ^
New dumb things in every post!
October 28th, 2020 at 10:24 PM ^
Good info for the ever changing COVID environment this season
October 28th, 2020 at 11:02 PM ^
Wisconsin grads running JAMA?
October 28th, 2020 at 11:18 PM ^
I think this is good news, and if some sort of actual data and numbers come out in the coming weeks then that could spur a change in B1G’s protocol.
I work as a cardiology PA at a relatively large hospital and have personally seen zero Covid related myocarditis cases that I’ve had to care for. And I haven’t heard of any in our practice. Although, very few tests such as echocardiograms and cMRI’s have been conducted on the Covid patients we have been consulted on because they are in isolation. Also to be considered is the fact that the vast majority of patients I’m speaking of aren’t undergoing the type of physical exertion these athletes are.
October 28th, 2020 at 11:38 PM ^
Yes, I agree with post-Mortem exams seeing relatively few cases of frank myocarditis, although certainly things consistent with stress cardiomyopathy, in situ thrombosis etc.
In any case, 14 day quarantine after positive test makes a lot of sense, plus some days of reacclimation (whether it needs to be 7 days is just a judgement call).
I think the 14 day quarantine is esp needed because that is more like the average person doing a 10-12 day quarantine after a positive test, since most of us aren’t being serially testing, so some football players are prob Getting caught very early in their disease course.
October 29th, 2020 at 12:43 AM ^
Of course, which are of even more concern. It’s a great point because myocarditis has been pushed so hard as the fear, that other complications are overlooked. Still, in young relatively healthy/active adults I believe those cases to be a low percentage (unsure if there are actual statistics, just my best guess from what I have encountered).
I think 14 days is sufficient if the data supports.
October 28th, 2020 at 11:30 PM ^
How out of Touch is this?
”...some semblance of order to the universe with a rationale approach,”
October 28th, 2020 at 11:31 PM ^
I always thought this was the case that the one study the B1G used to suspend the season was very suspect and overdone. Players would have about the same risk for myocarditis if they had caught one of the flu strains or a cold that turns into a more intense respiratory infection. Oh well, we don't have any wiggle room to make up games, so I expect most B1G team will miss 2 or 3 games this shortened season.
October 29th, 2020 at 12:09 AM ^
You suspected correctly
October 29th, 2020 at 12:31 AM ^
The article says “we believe it is reasonable to reduce complete exercise abstinence in cases of asymptomatic covid-19 infection to 10 days from the date of positive test result. Following this restriction, a slow and carefully monitored resumption of activity, ideally under the direction of a certified athletic trainer, is appropriate.” It later repeats that “Among all athletes with Covid-19 regardless of symptom severity, a gradual escalating approach to training is recommended”. Going from 10 days of no training to playing a division 1 football game 4 days later doesn’t sound much like a gradually escalating approach to training,
It also points out that ‘there is a shared focus in the sports medicine and cardiology communities to define the prevalence of clinically significant cardiac injury in athletes infected with covid-19 and define the efficacy of current consensus based cv-stratification practices. Prospective acquisition of comprehensive large scale registry data at the college and professional levels coupled with surveillance for adverse clinical outcomes will be required to address these areas of uncertainty.”
An organization like the big ten that prides itself on both athletics and research and that can afford to do more comprehensive testing, being somewhat cautious while also developing significant data to help address important uncertainties for literally millions of high school and college athletes doesn’t seem like a bad thing.