Return to Play for Athletes After Coronavirus Disease 2019 Infection—Making High-Stakes Recommendations as Data Evolve

As the coronavirus disease 2019 (COVID-19) pandemic began to evolve, case reports suggested that a clinical syndrome consistent with inflammatory myocarditis could occur as the underlying mechanism for the oft-seen elevations in biomarkers of myocardial injury and stress.¹ However, as data have progressed, a picture has emerged from autopsy studies of myocardial involvement with viral infection and a cytokine response, but less often inflammatory cell infiltrate consistent with myocarditis.² In July, a high-profile report³ emerged from Germany showing that more than 2 months after COVID-19 diagnosis, in a group of patients who had clinically recovered after a broad spectrum of disease severity (ranging from asymptomatic to severe illness with intubation), cardiac magnetic resonance (CMR) imaging and biomarker findings in the recovery phase were consistent with active ongoing myocardial involvement and inflammation in 60% of patients.