New research at MGH reveals rarity of Red Sox’ LHP Eduardo Rodriguez’s COVID-19 complications

When Red Sox pitcher Eduardo Rodriguez was diagnosed with myocarditis as a result of his contracting COVID-19, there was a brief moment of fear among some in professional sports.

That the heart disease was becoming associated with the coronavirus was terrifying for a couple of reasons, mainly because these are otherwise young and healthy individuals and myocarditis requires a three-month period of complete rest, at minimum, before the athlete can try to exercise again.

But new research out of Massachusetts General Hospital and Emory University School of Medicine shows that myocarditis is much more rare than originally expected among athletes.

There were single-digit cases of myocarditis at MGH amongst thousands of athletes who tested positive for COVID-19, said Dr. Aaron Baggish, director of the cardiovascular performance program at MGH and author of the new findings.

“We’re seeing very little of it,” Baggish told the Herald. “Nobody is going to say it doesn’t exist, and nobody is going to say there won’t be rare isolated cases. But our recommendations really have to be catered to more of a public health approach.”

The purpose of the study was to alert doctors across the country that they can probably save resources on athletes who test positive for the coronavirus. Those with symptoms should be tested thoroughly, the study revealed.

But as long as they don’t have symptoms, they’re highly unlikely to develop any heart affects and hospitals should be saving resources for those who could be more likely to benefit.

“There are basically four principal tests we try to think about when we think of the evaluation of COVID heart injuries,” Baggish said. “It’s a standard ECG, which is not particularly costly. There’s a blood test for a heart protein called troponin, which is not particularly costly. Then there’s an echocardiogram which is an ultrasound test that does cost money and takes time and is hard to get en masse. And then of course there’s the MRI, which is most costly and is being used by a lot of places without a lot of data to support its use.

“But this is like every conversation about health care utilization. We don’t live in a world where health care resources are infinite. So we have to think about how to responsibly use what we have because every time we use something for one purpose, we take it away from another purpose.”

Rodriguez came down with the coronavirus just before the Red Sox were to begin their summer camp in July. An MRI revealed myocarditis, which requires three months of absolute rest to reduce inflammation in the heart.

But at the time, he was told only to rest for one week, a potentially dangerous instruction.

“The doctor told me just take a week, just rest, don’t get your heart rate up too much,” Rodriguez said on July 26. “Just rest for a week and we wait to see the next MRI what it says. If it goes out, if it goes away, just go back to work.”

Baggish warned that athletes who do end up with myocarditis need much more than a week of rest, which Rodriguez ultimately did receive. He missed the entire season and only started walking again in late September, two months after the diagnosis.

“The most important part of the treatment is to remove the athlete from exercise training and competition, because exercise can make the problem worse,” Baggish said. “We typically rest people for at least a three-month period of time, then we reassess them to make certain the injury is cleared. If it’s cleared and they’re back to looking healthy, we can resume sports again.

“What we really don’t know yet, because we just haven’t had enough time, is how much long-term or permanent damage will come along with this.”

That’s the question the Red Sox are still pondering. They think Rodriguez will be ready for spring training, but it’s uncertain.

“There’s no precedent for this,” chief baseball officer Chaim Bloom said recently. “It looks the way we kind of sketched it out that that is a reasonable expectation (to be ready in February), but we’re going to go through some things that is a bit unlike what we’ve gone through with any other player.”

Baggish said athletes returning from myocarditis need to be carefully monitored to make sure their heart is reacting normally.

“Another population we worry about are people who get COVID, resolve and when they start exercising again, they have symptoms,” he said. “Our recommendations, and the most important part for the readers, is that if you get back into exercising and you don’t feel good, you should talk to your doctor.

“There’s a chance (they develop myocarditis). Or there’s a chance they had it and didn’t feel it until they started exercising. The thing about exercising is it turns up the game on any sort of health problem. You can feel normal sitting at your computer doing 11 hours of Zoom every day, but if you get to the gym or show up at the ballpark and you start training, if there’s something wrong, that’s when you’re going to feel it.”

Still, the team of sports cardiologists are optimistic that the heart will rarely be affected in athletes who come down with COVID-19.

“We’re realizing the cardiac risk is generally a lot lower than what we worried about initially,” Baggish said. “But I still think the major driving concern around sports is the degree to which sports propagate the transmission of the disease. And so I think one of the important points we made in our recommendations is that people shouldn’t be cancelling or postponing sports because of heart concerns. We should be doing that if organizations, communities, teams, can’t effectively reduce the risk of transmission.

“You turn on the TV every morning and there’s a different athlete coming down with COVID. I don’t worry about those people getting sick with heart problems; I worry about those people and what they’re doing to their local community, how much they’re passing it along to their teammates, friends, families, other students in the university, that sort of thing.”

from Boston Herald https://ift.tt/3oKOBEK