How Young Athletes Can Safely Return to Sports After COVID-19

Updated: Sep 15, 2021

Most student athletes who are diagnosed with COVID-19 can’t wait to feel better and get back in the game.

However, the possibility of long-term complications after a COVID-19 infection has medical professionals and school administrators urging caution when it comes to clearing young athletes to return to the field, court, or pool. In addition to the usual activities that go along with a return to sports, such as annual physicals or buying new gear, student athletes who had COVID-19 require special attention.

Patrick J. Moreno, MD, a Sports Medicine physician at Penn Medicine Lancaster General Health (LG Health), said the primary concern for competitive athletes after COVID-19 is potential heart damage. In an effort to safeguard local student athletes, the Sports Medicine team worked with colleagues in Cardiology, Family Medicine, and other specialties, as well as local school districts, to develop a protocol for student athletes to safely return to competitive sports, and the strenuous exercise levels associated with those activities.

“We are still learning about the short- and long-term complications of COVID-19 in the pediatric population,” Moreno said. “As there is so much that we still don’t know, we recommend taking a cautious approach to children and teens resuming competitive sports practices or games after testing positive.”

LG Health’s protocol is based on recommendations developed by cardiology experts from Children’s Hospital of Philadelphia. 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 (especially those 12 or older), depending on their age and severity of illness. However, it’s important to note that all children who had severe illness resulting in hospitalization — not just competitive athletes — should be evaluated by a cardiologist 14 days after discharge.

The guidelines are similar to those for adults, who should wait 10 to 14 days before resuming high-intensity exercise. However, Penn Medicine recommends some form of cardiac testing for all adults who have recovered from COVID-19, regardless of activity level or severity of illness.

Identifying young athletes at risk

Matthew D. Elias, MD, a CHOP cardiologist and assistant professor of Pediatrics at the Perelman School of Medicine who sees patients at LG Health’s Suburban Pavilion in Lancaster, said it’s relatively common for adults to develop cardiac issues with COVID-19 — even those who had only minor or moderate illness. However, medical professionals are still learning about the long-term effects of COVID-19 on children and teens.

“Our biggest concern as cardiologists is the possibility of developing myocarditis, or inflammation of the heart,” he said. “Myocarditis is one of the primary causes of sudden cardiac arrest in competitive athletes.”