BATON ROUGE — Just after the Big Ten to his north and the Pac-12 to his west – both fellow Power Five conferences – canceled football season last Tuesday because of the COVID-19 pandemic, Southeastern Conference commissioner Greg Sankey wondered out loud why.
The Mid-American and Mountain West, which are not Power Five but are of the upper division Football Bowl Subdivision, had previously canceled their football seasons. Most of the second-tier Football Championship Subdivision conferences have also canceled all or most of their seasons.
And NCAA president Mark Emmert then announced the cancellation of all fall sports championships, which does not include the College Football Playoff or the championship games of the FBS conferences still planning to play.
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The SEC, the Atlantic Coast Conference and the Big 12 of the Power Five continue to prepare to play football this fall as of Sunday.
"I look forward to learning more about the factors that led the Big Ten and Pac-12 leadership to take these actions," said Sankey, whose league will televise an announcement of a full season of game dates at 6 p.m. Monday on the SEC Network.
Heart complications enter the equation
The conference cancellation decisions were made because of the short- and long-term impact of COVID-19 on the heart, relatively new knowledge, said Dr. Mitchell Elkind, the president of the American Heart Association, in an exclusive interview Friday with the USA TODAY Network.
"Where it really has not been recognized until really just the last two or three weeks is this concern that even people who have mild cases of COVID-19 can have lingering cardiac manifestations, even though they may be subtle," said Elkind, a neurologist at New York-Presbyterian/Columbia University Irving Medical Center.
"So, that's what has gotten people concerned," he said. "Even people who recover from the virus may still have some evidence of heart damage."
For this reason, Elkind says that playing football this fall would be risky.
"The concern about the heart trouble is that people may look OK and be up and walking about and so forth and feel fine and be able to do some light exercise," he said. "But in the midst of the most intensive activity (like football), that could potentially trigger some kind of dangerous cardiac arrhythmia (too fast or too slow heartbeat) or other problems."
Asked about these "other problems," Elkind said: "Heart attack or heart failure. So, we'd be taking some risks."
Elkind said the various conferences' decisions not to play football this fall were not surprising.
"As an American citizen, it is tough to see," he said. "But as a physician and someone who is a stroke specialist – we see people having strokes as a consequence of this illness. Knowing that and knowing how evenly spread the virus is around the world (more than 21.5 million cases according to the Coronavirus Resource Center of the John Hopkins University of Medicine) and how it can cause some people to become so sick, I wasn't surprised."
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Even without fans in a college or NFL stadium during a game, there are still 200 people or more on the field – with dozens from the visiting team entering from another area.
"Plus the support staff and so forth? Those are going to be dangerous situations," Elkind said. "It's similar to the situation with opening up schools to some extent. I think that's going to turn out to be a lot harder to do than people would like it to be."
Even the young and healthy are at risk
There are already striking examples of what COVID-19 can do to seemingly healthy, young athletes.
• Former Florida State basketball player Michael Ojo, a professional in the Serbian League in Europe, tested positive for COVID-19 in July. He collapsed and died on Aug. 7 during a training session in Belgrade, Serbia. He was 27.
• Indiana freshman offensive lineman Brady Feeney of St. Louis tested positive for COVID-19 in July.
"After 14 days of hell battling the horrible virus, his school did additional testing on all those that were positive," his mother, Deborah Rucker, wrote in a Facebook post on Aug. 2.
"My son even received extra tests because he was one of the worst cases," she continued. "Now we are dealing with possible heart issues! He is still experiencing additional symptoms and his blood work is indicating additional problems."
• Boston Red Sox pitcher Eduardo Rodriguez, 27, of Valencia, Carabobo, in Venezuela tested positive for COVID-19 on July 7. He was later diagnosed with myocarditis, which is an inflammation of the heart caused by viral infection that in the worst cases can cause abnormal heart beat and heart failure. On Aug. 1, the Red Sox said Rodriguez would no longer pitch this season so he could recover.
At least 10 Big Ten football players were reportedly diagnosed with myocarditis at the time of the Big Ten's decision to not play fall football.
"Myocarditis is an inflammation of the heart," Elkind said. "All sorts of viruses can trigger myocarditis. The body's immune reaction against the virus can sometimes damage the heart in the process. That's why perfectly young, healthy people sometimes end up needing heart transplants because they get a viral myocarditis, and they go into heart failure."
There are approximately 1.5 million cases of myocarditis worldwide per year, according to the National Center for Biotechnology Information, which says the frequency of the condition is difficult to count and is likely under-diagnosed.
"It is rare, but even young, healthy people can develop these really bad complications," Elkind said. "There are more than 20 million people in the world right now who have been exposed to COVID-19. The vast majority of them are not having myocarditis, but because COVID-19 is so prevalent, and there are so many people with it, even that small percentage of people who can get myocarditis is going to add up in absolute terms. And that's going to include some athletes as well."
Myocarditis has played a role in nine percent of sudden cardiac arrest deaths among athletes under 35, according to studies.
LSU baseball coach Paul Mainieri has reacted to the recent news of COVID-19's potential impact on the heart.
"We're going to go to an extreme in monitoring heartbeats while they're actively on the field," he said Friday on a Zoom teleconference.
Six LSU baseball players had positive COVID-19 tests while at home.
"Most of them were either asymptomatic or had very light symptoms," Mainieri said. "But it's not still anything that we're taking lightly."
Even mild cases can be dangerous
What is increasingly frightening about COVID-19 is how stealthy it can be.
"People who barely knew they had it, or who had kind of a mild flu-like illness – low fever, cough, fatigue, generalized weakness – and got over it and went back to their lives are experiencing heart damage if you look for it," Elkind said.
Elkind cited a test in July at University Hospital in Frankfurt, Germany, in which 100 people who had COVID-19 infections were studied. The studies "revealed cardiac involvement in 78 patients and ongoing myocardial (heart tissue) inflammation in 60 patients, independent of preexisting conditions."
The conclusion stated, "These findings indicate the need for ongoing investigation of the long-term cardiovascular consequences of COVID-19."
Will testing be enough?
Vigilant, almost constant testing is what the remaining college conferences and the NFL hope is the answer.
"We're trying to stop it before there's a positive player in the building," said Saints coach Sean Payton, whose team begins contact practices on Monday. "We're relying more on what's taking place outside the building prior to coming here. We're testing daily."
Because Payton, who had COVID-19 in March, also said, "COVID and tackle football don't really mix."
COVID-19 tests, no matter how often, may not be a strong enough strategy, however.
"Even with aggressive testing, tests are not perfect," Elkind said. "Some people are going to slip through. So, there is always going to be that risk that somebody's going to have the virus despite a negative test. Or that they've been infected, recovered, and have some evidence of that heart trouble that wasn't recognized."
The unknown aspect of COVID-19 – short and long term – also weighed heavily in the conferences' decisions to cancel.
"That's exactly it," Elkind said. "Look, the whole thing is only six or seven months old. And we're learning more and more about it. And we're finding that there are people who have longer-term symptoms, or even seem to recover, and then get sick again later. And it's all those unknowns that have people scratching their heads."
That includes the most expert of medical professionals.
"I'd say we're learning something new about this virus every week," Elkind said. "It's amazing. And as a neurologist, I'm worried about what the long-term neurological consequences may be."
So is the Indiana offensive lineman's mother.
"Bottom line, even if your son’s schools do everything right to protect them," Deborah Rucker posted on Facebook. "They CAN’T PROTECT THEM!!"
Still more to learn about COVID-19
"Will there be cognitive effects or damage to the nerves and so forth? Given how much is unknown and what we've seen so far, I think we have to be really cautious," Elkind said. "It has economic implications. It has implications for sports. But I would be cautious about it."
OPINION: Sobering medical forecast for fall football amid COVID-19
Dr. Carlos del Rio, a dean at Emory University's School of Medicine and co-director of the Emory Center for AIDS research, was more blunt on a webinar Thursday put on by the Infectious Diseases Society of America as he ridiculed those still clinging to fall football.
"We have a serious problem," he said. "I feel like the Titanic. We have hit the iceberg, and we're trying to make decisions about what time should we have the band play."
More and more are taking COVID-19 seriously now as it continues to spread than in the early months, though.
"I know there are people who thought it was nothing, got it, definitely were sick, and found religion after that," Elkind said. "Unfortunately, it's a hard way to get religion."
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