Dr. Matthew Martinez studied so many images of a beating heart that he couldn’t possibly count them. Maybe 500,000. Maybe a million. As a non-invasive cardiologist, his work revolves around the constant evaluation of images of the heart.
He knows what a strong, healthy heart looks like. He knows what a poor, struggling heart looks like. And he knows what a heart looks like after the tentacles of COVID-19 reach the most important organ in the human body. “This virus,” he says, “appears to have an affinity to damage the heart.”
In a small percentage of infected patients, COVID-19 leaves annoying scars on the throbbing muscle in the chest known as myocarditis. The virus penetrates directly into the heart muscle and weakens and damages its cells by causing blood clots and inflammatory responses to viral infections. At the beginning of the pandemic, doctors only linked the condition to severe and frequently hospitalized COVID victims, usually elderly patients or those with underlying health problems.
Recently, doctors are identifying the condition in young, healthy Americans – including athletes. “In the past month or two, even asymptomatic young people will develop myocardial injury,” Martinez says.
Of all the hurdles hindering a 2020 college football season, there is one roadblock that has been largely overshadowed and buried under the other prominent obstacles such as testing, travel, a bubble-free college campus, and quarantine requirements. This hurdle? The heart.
“That was the last straw,” says a team doctor on a prominent college football program. “The commissioners are finally finding out everything. The commissioners say: “Oh my god!” And the doctors say: “Yes …”
College directors and conference leaders grapple with new information from the medical world about the aftermath of the virus on its victims, compounding an already difficult puzzle: are you risking it and playing a fall season or are you watching an industry potentially collapse? Revelations from doctors like Martinez have deepened the debate.
In fact, the brewing heart issue was a topic that was recently raised among the Power 5 conference commissioners. The fear of myocarditis has reached the highest level in sport. Big 12 Commissioner Bob Bowlsby and Big Ten Commissioner Kevin Warren have both raised serious concerns about the disease in private. A Power 5 team doctor familiar with conference calls says heart disease is a major topic of discussion. “We discuss it every time we call,” says the doctor on condition of anonymity.
The topic culminated on Saturday in the most important college football news of the closure to date: the Mid-American Conference was the first FBS league to cancel its fall season. The MAC Medical Advisory Board unanimously advised conference leaders to suspend the season. While financial implications were a factor (MAC schools lose money to football in a normal year), the long-term and somewhat unknown health effects of COVID-19 victims – including myocarditis – were a major topic of discussion.
“People don’t get that,” says a senior MAC administrator who knows about the presidents’ call on Saturday. “It’s lung and heart problems.”
Doctors themselves are still learning about a novel virus and its effects on the human body after recovery. Myocarditis is one of many aftereffects, but it’s the most serious for athletes, says Martinez, the medical director of sports cardiology for the Atlantic Health System in New Jersey. Martinez knows a thing or two about the hearts of athletes. He is the league cardiologist for Major League Soccer, the cardiac-specific advisor to the NBA, and the NFL medical committee.
He admits that cases in athletes with COVID-related heartbeats are very low. He has seen no more than a dozen of professional, college, and youth league athletes in the United States. There is probably a lot more to it, however. Some remain undetected or have not been brought to his attention. Doctors aren’t entirely sure how common the condition is. Some have publicly stated that recovered COVID-19 patients had an impact of up to 50% on their heart, but with striking degrees of severity.
A German study recently published in July found heart inflammation in 60 out of 100 recovered virus patients. This number included patients who were asymptomatic or mildly symptomatic.
A college team doctor said Sports illustrated As of Saturday, he was aware of about 10 COVID-related cardiac effects in all college football, many or all of mildly symptomatic players. While the number makes up a fraction of the total population, the potential consequences of a heart injury are grave. Myocarditis symptoms include chest pain, abnormal heartbeat, shortness of breath and, in the worst case, sudden death. Myocarditis already accounts for around 2-5% of all sudden deaths in American sports.
While many cases of COVID-related myocarditis in athletes remain private, some have occurred publicly. Left-handed Eduardo Rodriguez, predicted to be the No. 1 Red Sox pitcher this year, developed myocarditis after contracting COVID-19. He will miss the 2020 season. The mother of an offensive lineman from Indiana suggested in a Facebook post earlier this week that her son could 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 heart damage is at least three months with no activity, says Martinez.
Martinez says he has heard of virtually every major college football conference this summer on the heart problem. Some of them are progressing, he says, with a plan to “turn around” if something goes wrong. “Others said, ‘I think we should stop,” says Martinez. “The MAC did that today.”
His advice to conference officials was to make cardiac exams mandatory for those infected with the virus. For this reason, recent medical plans for conferences include cardiac exams as part of the return-to-play protocol.
Martinez recommends three-step screening for all COVID-19 positives to become active again: an EKG, an echocardiogram, and a troponin blood test, which measures cardiac-specific troponin levels in the blood to detect heart injuries. Each blood test and EKG can cost about $ 50, Martinez says. The more intrusive echocardiogram can be up to $ 500 per test. “It can be done. You can play football, “he says,” but resources have to be used. “
The differences in college athletics are huge. In FBS alone, there is a large financial gap between the Power 5 conference programs and the group of 5 teams. The gap between the Group of 5 and the FCS and between Division II and Division III is widening. Few FCS, D2, and D3 programs are expected to play football this fall. Many of them do not have the resources to meet NCAA requirements for testing, quarantine, and in-season contact tracing.
Saturday was also a bleak day for the top NCAA league. After the MAC canceled its season, the Big Ten paused their pre-season training. And on Friday, there was the following from NCAA’s Senior Medical Expert Brian Hainline: “Almost everything would have to be perfectly coordinated to move forward.”
Add another obstacle to the list: the heart.
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