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NFHS-AMSSM Guidance for Assessing Cardiac Issues in High School Student-Athletes with COVID-19 Infection

By NFHS on July 09, 2020 nfhs news Print

An expert medical task force appointed by the National Federation of State High School Associations (NFHS) and the American Medical Society for Sports Medicine (AMSSM) has issued guidance for assessing potential cardiac issues in high school student-athletes with COVID-19 infection.

The guidance is included in the “Cardiopulmonary Considerations for High School Student-Athletes During the COVID-19 Pandemic: NFHS-AMSSM Guidance Statement”published in Sports Health (https://journals.sagepub.com/doi/full/10.1177/1941738120941490), an online journal of the American Orthopaedic Society for Sports Medicine (AOSSM). 

“COVID-19 has raised many concerns regarding the health and safety of athletes,” said Jonathan Drezner, M.D., director of the University of Washington Medicine Center for Sports Cardiology, past president of the AMSSM and co-chair of the NFHS-AMSSM task force. “The risk of heart and lung involvement is likely related to the severity of the illness. This guidance statement addresses important cardiac considerations and the suggested evaluation of high school student-athletes with past or new COVID-19.” 

Before returning to sports participation this fall, the NFHS-AMSSM Guidance Statement suggests that student-athletes complete a COVID-19 questionnaire. Any positive response should trigger an evaluation by a medical provider.

In the cases of student-athletes who have had a previous COVID-19 related illness, the task force suggests the following: 

  • Student-athletes with a prior confirmed COVID-19 diagnosis should undergo an evaluation by their medical provider. Written medical clearance is recommended prior to participation. 
  • Student-athletes who had mild COVID-19 symptoms that were managed at home should be seen by their medical provider for any persisting symptoms. An electrocardiogram (ECG) may be considered prior to sports participation.
  • Student-athletes who were hospitalized with severe illness from COVID-19 have a higher risk for heart or lung complications. A comprehensive cardiac evaluation is recommended in consultation with a cardiology specialist.
  • Student-athletes with ongoing symptoms from diagnosed COVID-19 illness require a comprehensive evaluation to exclude heart and lung disorders that carry a risk of arrhythmia, respiratory compromise, sudden cardiac arrest (SCA) or sudden death. These individuals should not return to sports until medically cleared by a physician.
  • In addition, student-athletes should be evaluated by their medical provider if they have had close contact with family members with confirmed COVID-19 cases, if they have underlying medical conditions that place them at a higher risk of COVID-19 or if they had previous symptoms suggestive of COVID-19.   

“This document is the result of an outstanding collaborative effort between the NFHS and the AMSSM, with the goal of helping to safely return student-athletes affected by COVID-19 to sports activities,” said Bill Heinz, M.D., former chair of the NFHS Sports Medicine Advisory Committee and co-chair of the NFHS-AMSSM task force. “With so much unknown about the illness and its long-term effects, we called on nationally and internationally known experts to help develop guidelines for safe return to play that can be used by athletic administrators, coaches, team physicians and athletic trainers.”

Regarding new COVID-19 infections, the task force suggests that schools develop a daily tracking tool to ensure that student-athletes are self-monitoring and have not developed COVID-19 symptoms. 

In addition, student-athletes should not attend school, practices or competitions if they feel ill and referred to their medical provider if they have any COVID-19 symptoms. Any athletes who test positive with or without symptoms should be isolated per public health guidelines. No exercise is recommended for at least 14 days from diagnosis and seven days after symptoms are resolved.

Finally, the NFHS-AMSSM task force stated that “every school should have a well-rehearsed emergency action plan (EAP) for every sport, at every venue, to facilitate a coordinated and efficient response to SCA.”