Returning to play after having COVID-19

Sports have looked quite different during the COVID‑19 pandemic. As the virus continues to spread, one question might be unclear if an athlete receives a COVID‑19 diagnosis: When can they return to play safely?

The answer to that question may depend on the individual athlete, says Troy Smurawa, M.D., Director of Pediatric Sports Medicine at Children's Health℠ Andrews Institute for Orthopaedics & Sports Medicine.

"We want to make sure we look at three key areas when deciding whether an athlete can return to play: Have they minimized risk of spreading the infection? Can they return to play without exacerbating symptoms? And are there concerns for long-term complications?" he says.

Learn more about how to stay safe and healthy when returning to play after a COVID‑19 diagnosis.

When can an athlete return to play after COVID‑19?

The timeline for returning to sports after having COVID‑19 depends on symptoms and overall health. Guidelines for returning to sports after COVID‑19 may differ from guidelines for returning to school. This means that just because a student athlete can go back to school does not mean they are ready to resume sports.

In general, all athletes should follow guidelines for COVID-19 isolation from the Centers for Disease Control and Prevention (CDC). This includes isolating for at least 5 days and wearing a mask around others for 10 days. Some athletes may need extra recovery time before resuming physical activity.

• Asymptomatic athletes (athletes with no symptoms but tested or presumed positive) and athletes with mild symptoms should isolate for 5 days from the infection date and mask for a full 10-day period. All children and adolescents who test positive for COVID-19 should inform their pediatrician. An assessment by a primary care physician is recommended for appropriate guidance. Typically, the athlete can return to physical activity after their 5-day isolation ends as long as they have been fever-free for 24 hours without the use of fever-reducing medication.
• Athletes with moderate symptoms (four or more days of fever, muscle or body aches, chills or lethargy) and any non-ICU hospital admission with no evidence of MIS-C, should be evaluated by their primary care physician before returning to physical activity. A gradual return to physical activity may be granted after 10 days have passed from the date of the positive test result and after 24 hours symptom-free without the use of fever-reducing medication.
• Athletes with severe symptoms (symptoms that require hospitalization with intensive care, intubation or show evidence of MIS-C) should be restricted for a period of at least 3-6 months. A cardiac evaluation is required as well as a cardiology clearance before returning to any activity and should be arranged prior to hospital discharge.

All athletes should consult their primary care provider before returning to play, even if they were asymptomatic. Their doctor can screen for any signs of long-term complications and answer any questions you might have about safely returning to play.

Are there any long-term side effects of COVID‑19 for athletes?

Doctors are still learning about the long-term side effects of COVID-19. Based on early studies and existing research on viral infections, the American College of Cardiology warns that COVID‑19 could increase the risk of inflammation of the heart, also called myocarditis. While the incidence of myocarditis has decreased since the earlier days of the pandemic, it has been tied to sudden cardiac arrest in athletes of all ages.

"Myocarditis is something you can acquire from any type of virus, which means athletes could have a healthy heart and then get an infection that leads to myocarditis," says Clarisa Ysela Garcia, M.D., Pediatric Cardiologist at Children's Health and Pediatric Cardiology Associates of Houston. "As a parent, you have to pay attention to the signs and symptoms and be cautious before putting your children back out there after they've had a viral illness like COVID‑19."

If your child has been diagnosed with COVID‑19, it's important to keep an eye out for signs of myocarditis, even if they didn't show symptoms of the virus. Symptoms of myocarditis include:

• Chest pain
• Easily fatigued
• Fainting
• Feeling tired all day
• Racing heartbeat (palpitations)
• Shortness of breath

Parents should also be on the lookout for any other unusual symptoms, even if it is a couple of months after the child had COVID‑19. This is especially important if your child has an underlying medical condition like diabetes or asthma.

"If you notice your child has any new symptoms, make sure you see your doctor or pediatrician," Dr. Smurawa says. "We don't know the long-term effects of this virus yet and it's best to be cautious and see a doctor if anything new comes up."

What can athletes do while they're quarantined?

Any athlete with COVID‑19 symptoms should rest during quarantine. "The important thing is to make sure they're recovering and can go back to playing their sport without the risk of complications and without risk of infecting teammates," says Dr. Smurawa.

Dr. Smurawa recommends parents loosen up any social media restrictions to allow more virtual socialization while their athlete is in quarantine. He also suggests finding projects their child can work on at home, which can help keep their minds off the game they may be missing.

What should athletes do if they experience COVID‑19 symptoms?

Any young athlete who has COVID‑19 symptoms – including cough, fever, shortness of breath or headaches – should immediately tell their parent or coach. While these symptoms may not always point to COVID‑19 infection, Dr. Smurawa says it's important to play it safe to avoid spreading the virus to other teammates.

If a coach notices an athlete with symptoms, Dr. Smurawa recommends removing the athlete from play and notifying parents as soon as possible that there may have been COVID‑19 exposure.

"In these situations, coaches and parents need to be more aware of any questionable symptoms and err on the side of caution," he adds.

Learn more

Children's Health is committed to remaining a trusted source of health information and care for you and your family during this time. See more resources to keep your family healthy at the Children's Health COVID‑19 hub.