While most children and teens with COVID-19 recover completely, sometimes the virus can have lasting effects. One of these effects can be damage to the heart muscle – and if the damaged heart is stressed by exercise, it can lead to an irregular heartbeat, heart failure, or even sudden death.
This appears to be rare. But given that we’re literally learning on the go when it comes to COVID-19, it’s hard for us to know just how rare – and how dangerous it is to exercise after testing positive for COVID-19. To help doctors, coaches, gym teachers, parents, and caregivers make safe decisions, the American Academy of Pediatrics has published some of the following: Tips for returning to sports and physical activity After infection with COVID-19.
This is the “interim directive” – our best guess right now of what to do, based on what we know so far. Unfortunately, there is a lot we don’t know and cannot know until we have more time to study the virus and monitor what happens to patients as they recover over weeks, months and years.
What is important to know about returning to sport and physical activity?
Teens and teens who engage in competitive sports are more likely to have a heart problem. This is because younger children seem to be less affected by COVID-19, and because older teens and young adults have harder exercises that are more likely to stress the heart muscle. Of course, no one can say for sure that running around an elementary school playground is completely risk-free for a child with COVID-19.
Guidelines for returning to physical activity depend on whether the COVID-19 case is considered mild (including without symptoms), moderate or severe.
- Mild: less than four days of fever over 100.4, and less than a week of muscle pain, chills, or fatigue (this includes those with conditions without symptoms)
- Moderate: four or more days of fever of more than 100.4; A week or so of muscle aches, chills, or fatigue. Or a hospital stay (not in the ICU) without evidence of this MIS-C. (MIS-C is the multisystem inflammatory syndrome that occasionally occurs with COVID-19.)
- Severe: Any stay in the ICU and / or intubation, or evidence of MIS-C. During intubation, a tube is placed through the mouth into the airway and connected to a machine to help the child breathe.
What screening can be done after a child has recovered from a mild to mild case of COVID-19?
It is even more difficult to provide guidance to young people who have experienced mild or asymptomatic cases, because we already have limited data on this group when it comes to the health of their hearts.
For these children, experts recommend that parents see their child’s primary care provider. Wait for the child to recover from their illness (or at least 10 days after a positive test if the child is asymptomatic). They should be checked for any symptoms of heart problems, with the most worrisome cause
- More shortness of breath than you would expect after a cold
- Palpitations they didn’t have before
- Dizziness or fainting.
A simple phone call to the doctor’s office may suffice after very mild or asymptomatic cases in serious non-athletic children.
A personal exam is a good idea for those whose conditions are more severe, if there are any concerns at all, or if the child is a serious athlete.
If there are any concerns based on the questions’ answers or a physical examination, an EKG and a referral to a cardiologist makes sense.
If there are no concerns, children can return to recreational physical activity when they feel up to it. Return to competitive sports should take place gradually, with symptoms monitored along the way. See the AAP instructions linked above for suggestions on how to do this.
What screening can be done after a child has recovered from a moderate or severe case of COVID-19?
Any child with moderate disease should see their primary care provider to be checked for symptoms and screening. Schedule a visit at least 10 days after your child has tested for the virus, and has not developed symptoms for at least 24 hours without taking any acetaminophen or ibuprofen.
If there are any questions or concerns at all about your symptoms or the result of the physical examination, a referral to a cardiologist for clearance and guidance about returning to physical activity is a good idea.
Children who have become severely ill need to see a cardiologist, and they should be prevented from exercising for at least three to six months, and only return when the cardiologist says it is okay.
Again, these are interim guidelines that will evolve as we learn more about COVID-19 and its effects in the short and long term. If you have questions, talk to your doctor.
Follow me on Twitter Embed a Tweet