Myocarditis in general has a wide spectrum of presentation. In the developed countries and in younger patients, it is most often due to a virus, though a lot of the pathogenesis is still not fully known.
Background rates in normal years is roughly 5-10 per 100,000 patients (though this varies based on age and gender). The CDC data shows that for ALL patients, the risk of myocarditis in any patient infected with COVID is about 15-20x higher rates than would be expected. This data is somewhat messy for pediatrics/young adults, but for those of us in pediatric cardiology, we often cite that it is about a 10x higher risk than normal....which is still quite low and unlikely. This number takes into account some other cardiac manifestations we have seen (namely an entity called MIS-C), that can be more severe.
The best data, though, comes from the Big Ten study (https://jamanetwork.com/journals/jamacardiology/fullarticle/2780548). This study found that of nearly 1600 Big Ten athletes across all institutions, the overall rate of myocarditis was 2.3% for those who had COVID. However, when we dig into the data, it is important to note that only 9 athletes (0.5%) had clinical signs of myocarditis and the other group had cardiac MRI findings that may support a diagnosis of myocarditis IN THE CORRECT CLINICAL SETTING (my emphasis). These sub-clinical detections were clustered to some universities instead of others and some of the abnormal findings can also sometimes be more prevalent incidental findings in athletes. Which led a lot of us to question if the true rate is really 2-3% (still seems high to us) and more likely 0.5%.
Long story short, without clinical findings suggestive of myocarditis, it is quite unlikely to have significant myocarditis simply after a mild, self-limited case of COVID. Further, return to play testing for patients with just mild is not driven by any evidence or data. Some pediatricians have been doing ECG testing, but this is a test with poor specificity and negative predictive value.
Seems like something that a simple waiver could take care of if the school is that concerned.
1. The studies for this were done, and risk of adverse cardiac events only occurred in kids with severe disease with primary infection. The AAP recommends a pediatrician see an infected kid after recovery for an additional sports physical.
2. Kids with risks for mortality are held out of sports. A parent can't sign a waver saying they're cool if their kid with Hypertrophic Cardiomyopathy drops dead at a game. The school retains some liability, parents don't get to risk their kids lives, and they don't get to scar the rest of the team/spectators for life.
And is diagnosed with asthma (don't know if that plays a part at all). Her pediatrician ordered an EKG before she returned to high school swimming. This was Jan 2020. Doctor said it was abundance of caution. It was definitely not required by our school system.
examined if he has significant symptoms for more than a couple days but if not once he is clear to go back to school he can play.
Sports medicine sometimes has a few extra hoops to jump through for return to play as opposed to a return to activities of daily living. For example, return to the classroom from a broken ankle will be much sooner than playing a full basketball game.
The pediatrician can clear a kid to resume activities, but it is ultimately up to the school and sports medicine team there to determine cleared to practice and compete.
Just curious.
put out guidance that kids participating in high risk sports should sit out 10 days even though the quarantine requirement has been lowered. Perhaps it is not related to the Myocarditis but to the perceived risk of infection to others playing compared to being in class.
Of course none of these kids are gathering together outside of school without masks. I am really tired of this. Kids are vaccinated and boosted. IF they get they get it but to preemptively test them is a bridge too far.
I have no clue what the original post is about. But man, this idea that health policy should just come down to a permission slip is messed up. I had to get a physical to play high school sports. Surely a permission slip waiver instead would have been easier.
decision of what I think the school should do. Part of the problem is they sent an email about the rule without stating why the changes were being made. Has become more of an issue as they are now requiring testing of all players regardless of vaccination status and unrelated to any known exposure.
After the year and a half these kids have endured including having a classmate commit suicide last week it seems to me the school has reached a new level of stupidity in terms managing the risks. I asked not to be able to say ND nation told me it is right but to be able to present stats to the school.
for changing the rule.
High school sports, like college and pros, should have a return-to-play policy for athletes returning from COVID, similar to how there are return-to-play policies for athletes returning from any injury. Such procedures might vary depending on whether the absence was due to close contact quarantine or positive isolation, severity of illness, duration of symptoms, etc. It might also vary on a sport-by-sport basis. The idea being to ease back into full-time play after a layoff.
That doesn't really help you here, especially without the reasoning behind the change, but I wouldn't assume one reason or another for a change in policy. Could be that the school wasn't following the state or local policy and just noticed, could be a change from above them, could be any number of reasons.