Lancaster Physician Spring 2021 - 7

SPRING 2021

M

ost student athletes who test positive for COVID-19 are eager to
get back in the game as quickly
as possible.

However, the possibility of long-term
complications after a COVID-19 infection
has local medical professionals and school
administrators urging caution when it comes
to clearing young athletes to return to the field,
court or pool.
Patrick J. Moreno, MD, of Penn Medicine
Lancaster General Health Physicians Sports
Medicine, said recent research suggests that
about 20 percent of patients hospitalized with
moderate or severe COVID-19  have  some
evidence of cardiac damage. 
" We are still learning about the short- and
long-term complications of COVID-19 in
the pediatric population, " he shared. " Because
there is so much that we still don't know, we
recommend a cautious approach to children
and teens returning to competitive sports after
testing positive. "
LG Health follows recommendations developed by cardiology experts from Children's
Hospital of Philadelphia (CHOP). In general,
any child who tests positive should wait at least
14 days after their COVID-19 symptoms
resolve before returning to competitive sports.
Cardiac testing may be recommended for
some children, depending on their age and
severity of illness.
HERE ARE THE SPECIFIC GUIDELINES
FOR EACH SITUATION:
* Children who did not have symptoms
may return to competitive sports 14 days
after testing positive for COVID-19.

IN GENERAL, THERE IS LESS
CONCERN ABOUT CHILDREN
UNDER AGE 12 AND
SPECIFICALLY UNDER AGE 7
These guidelines are similar to recommendations for adults, who should wait 10 to
14 days before returning to high-intensity
exercise, Moreno said. However, LG Health
recommends some form of cardiac testing for
all adults who have recovered from COVID19, regardless of activity level.
Following the CHOP guidelines has
become the standard protocol at Lancaster
County high schools, he explained. More
than 100 local student athletes have gone
through this protocol so far. Some have
shown signs of myocarditis-or inflammation of the heart muscle-other cardiac
irregularities or lung damage.
LG Health has strengthened existing partnerships with local public and private schools
during the pandemic, providing guidance in
many areas related to COVID-19, he said.
School administrators, athletic directors,
team physicians and athletic trainers are
involved in implementing the post-COVID
return-to-sports protocol.
" One concern that was coming up frequently was when it was safe for students to
return to sports after testing positive, " he said.
" Schools have a lot of responsibility but not
necessarily the expertise or resources to deal
with all facets of this public health crisis. "

* Children who had a mild or moderate
illness should wait at least 14 days after
their symptoms resolve. Children 12 or
older should have cardiac testing before
returning to sports. 

In general, there is less concern about children under age 12 and specifically under age
7, Moreno shared. Younger children generally
will self-regulate their physical activity, so
they do not reach the same intensity level
as older competitive athletes.

* Children who were hospitalized should
be evaluated by cardiology 14 days
after discharge.

In addition to waiting 14 days to return
to sports, children ages 12 and over with
moderate illness should see their primary-care

LANCASTER

7

PHYSICIAN

provider for a physical exam and symptom
screening, he said. An EKG (electrocardiogram), a simple test that measures electrical
activity in the heart, also is recommended.
LG Health works closely with CHOP
cardiologists, who see local patients at the
CHOP Specialty Center at the LG Health
Suburban Pavilion. Though it is rare, children who had more severe illness requiring
hospitalization should follow up with a
cardiologist. They may have to sit out from
competition for three to six months.
In addition, children who have any kind
of existing cardiac abnormality or show
cause for concern based on the initial exam,
screening questions, or EKG should follow
up with a cardiologist before returning to
sports, Moreno said. Insurance typically covers the costs of these assessments and testing.
Because every child and situation are
unique, parents should discuss with their
child's primary-care provider any individual
concerns, including what follow-up testing
or other steps may be recommended before
returning to sports.
" Overall there is no reason to panic, "
Moreno offered. " Long-term complications
of COVID-19 do not appear to be common
in children and teens, but we still need to
be vigilant. "
Lancaster Physician Spring 2021

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