American Medical Society for Sports Medicine
For Immediate Release Jul 09, 2020

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

LEAWOOD, Kan. — An expert medical task force appointed by the American Medical Society for Sports Medicine (AMSSM) and National Federation of State High School Associations (NFHS) 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 online in Sports Health, a multi-disciplinary journal of the American Orthopaedic Society for Sports Medicine (AOSSM). 

The complete guidance statement can be accessed on Sports Health’s website.

“COVID-19 has raised many concerns regarding the health and safety of athletes,” said AMSSM Past President Jonathan Drezner, MD, FAMSSM, the director of the University of Washington Medicine Center for Sports Cardiology 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, MD, 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 even 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.”

About the AMSSM: AMSSM is a multi-disciplinary organization of more than 4,200 sports medicine physicians dedicated to education, research, advocacy and the care of athletes of all ages. The majority of AMSSM members are primary care physicians with fellowship training and added qualification in sports medicine who then combine their practice of sports medicine with their primary specialty. AMSSM includes members who specialize solely in non-surgical sports medicine and serve as team physicians at the youth level, high school, NCAA, NFL, MLB, NBA, WNBA, MLS and NHL, as well as with Olympic and Paralympic teams. By nature of their training and experience, sports medicine physicians are ideally suited to provide comprehensive medical care for athletes, sports teams or active individuals who are simply looking to maintain a healthy lifestyle. www.amssm.org

About the NFHS: The NFHS, based in Indianapolis, Indiana, is the national leadership organization for high school sports and performing arts activities. Since 1920, the NFHS has led the development of education-based interscholastic sports and performing arts activities that help students succeed in their lives. The NFHS sets direction for the future by building awareness and support, improving the participation experience, establishing consistent standards and rules for competition, and helping those who oversee high school sports and activities. The NFHS writes playing rules for 17 sports for boys and girls at the high school level. Through its 50 member state associations and the District of Columbia, the NFHS reaches more than 19,500 high schools and 12 million participants in high school activity programs, including more than 7.9 million in high school sports. As the recognized national authority on interscholastic activity programs, the NFHS conducts national meetings; sanctions interstate events; offers online publications and services for high school coaches and officials; sponsors professional organizations for high school coaches, officials, speech and debate coaches, and music adjudicators; serves as the national source for interscholastic coach training; and serves as a national information resource of interscholastic athletics and activities. For more information, visit the NFHS website at www.nfhs.org.