As I am writing this article the COVID-19 cases in Minnesota continue to rise at a rapid pace. It remains true that children who get COVID-19 typically have mild symptoms and recover quickly without problems. However, as we learn more about this virus we are learning more about it’s potential to cause serious problems such as heart inflammation, known as myocarditis.

This heart inflammation is of particular concern to our young athletes. The American Academy of Pediatrics and The Minnesota State High School League both have put out policies to guide return to play after COVID-19 infection in athletes. These recommendations include a rest period after COVID-19 infection along with a medical evaluation prior to returning to play. This evaluation includes a good heart exam and screening for cardiac symptoms and may include testing such as an EKG.

The recommendations for return to play vary based on how severe the symptoms of the COVID-19 infection were in an athlete. Athletes who have asymptomatic or mild symptoms with a COVID-19 infection may be ready to start a gradual return to play after a 14 day resting period. Children and teens with moderate COVID-19 symptoms, such as fever and/or symptoms lasting longer than 5 days, are currently recommended to rest for a minimum of 14 days prior to starting a gradual return to play. All of these athletes are recommended to see their doctor prior to returning to exercise for guidance.

An athlete who had severe disease requiring hospitalization or who was diagnosed with MIS-C may be out of play for 3-6 months to allow their heart to heal. MIS-C (multi-system inflammatory syndrome in children) is a rare, but serious condition that results in widespread inflammation in the body that can lead to blood clots, kidney problems and heart inflammation. We are still learning about MIS-C and it’s association with COVID-19 infections, so far it has been found to be treatable. Thankfully, MIS-C and serious COVID-19 infections in children resulting in hospitalization are very rare. To date there have been 31 cases of MIS-C in Minnesota and none have resulted in deaths.

Any athlete who has a history of COVID-19 infection should return to play gradually to monitor for heart symptoms. They would start with 2 days of light aerobic activity, followed by starting to do drills and then gradually increasing the intensity and duration back to full play. This gradual return is done over a period of 1-2 weeks. If an athlete has any cardiac symptoms such as: chest pain, chest tightness, fatigue, fainting or feeling lightheaded they should stop participation and see their doctor for further evaluation.

As with anything related to COVID-19 our information about this virus is rapidly changing as we learn more every day about the effects of this virus. The information in this article is up to date as of 11/13/20 but is likely to change as we gain more knowledge. The safest thing for you and your athlete to do before returning to play after any severity of COVID-19 infection is to see your pediatrician for guidance. We stay up to date on all of the latest guidelines so that we can work together to keep your athlete safe and active in the sports they love.