The Premier League (EPL) is set to resume June 17th

by Darren

It is a welcome relief to fans, clubs, players and owners after 3 months of a lockdown. Resuming sports during a pandemic, even without fans, brings its own set of concerns.

The EPL has done a remarkable job with testing and have completed almost 6300 tests now through six rounds with only 13 positive cases. There were 0 positive cases in the latest round of testing that recently concluded. Its been more than a week now since contact training started so this is good news because a rise in positive cases could have led to another delay in resumption.

The challenges though remain and are very real. As someone who has been treating active cases and is now seeing patients who have recovered from COVID-19 I am only too aware how precarious the current balance is.

From a cardiovascular perspective, we have seen myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, and venous thromboembolic events among COVID-19 patients. While athletes generally do not have co-morbidities that increase the risk of cardiovascular events, there are not without risk. A 2018 study published in the New England Journal of Medicine looked at screening over 11,000 soccer players in the UK from 1996-2016. A cardiac screening program was implemented which consisted of a questionnaire, physical exam, electrocardiography (ECG), and echocardiography. During screening, 42 athletes (0.38%) were found to have cardiac disorders that are associated with sudden cardiac death and a further 225 athletes (2%) were identified that had congenital or valvular abnormalities. Specifically, as it related to COVID-19, my biggest concern is the development of myocarditis among athletes should they develop COVID-19.

Myocarditis is a condition where there is inflammation of the heart muscle. This is usually caused by a viral illness such as influenza, Coxsackie, Ebstein-Barr and Adenovirus, among others. These cases are often mild, but do lead do a period of convalescence, more so if arrhythmias result from the bout of myocarditis. Recently, the former Manchester United and current Ajax player, Daley Blind, was diagnosed with myocarditis unrelated to COVID-19. In his case, his physicians felt that the arrhythmia complications were serious enough to require the placement of a defibrillator in his chest.

Since the pandemic began, myocarditis has been frequently described in patients with COVID-19 and there have been several case reports published on myocarditis as the presenting feature in young patients. Here in the U.S., the NFL, NBA, indeed all professional sports leagues, have baseline cardiovascular and pulmonary baseline testing on their athletes. This includes baseline ECGs, echocardiogram, and cardiopulmonary exercise testing. I assume it is the same for the Premier League. This testing will help identify disease as a variation from the baseline. It becomes even more important as a tool for when it is safe for a player to return to training and matches AFTER contracting COVID-19.

For now, though I plan to enjoy the sense of normalcy watching live sports will bring again. There will be bumps in the road and I will share my thoughts and reflections along the way. Stay safe.

Sadi Raza

Sadi Raza, M.D., F.A.C.C, is a board-certified consultant cardiologist specializing in advanced cardiac imaging with a focus on prevention. A life-long Manchester United fan, he is the current director of echocardiography for one of the largest independent cardiology groups in the country and the immediate past-chair of the department of cardiovascular services. You can follow him on Twitter @SadiRazaMD.

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