Feb 2, 2021, 9:52:36 AM CST Jul 16, 2021, 7:33:31 PM CDT

Returning to play after having COVID-19

What athletes should know about returning to sports safely after a COVID-19 diagnosis

Girl holding basketball Girl holding basketball

Sports have looked quite different during the COVID‑19 pandemic – with seasons cut short, games canceled and safety measures implemented to keep athletes safe. 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 wait a minimum of 10 days from infection date before returning to play. Some athletes may need extra recovery time before heading back out on the field:

  • Asymptomatic athletes (athletes with no symptoms but tested or presumed positive) and athletes with mild symptoms or symptoms that last less than four days, should quarantine for 10 days from the infection date. After 10 days, they should see their primary care physician to review a sports pre-participation questionnaire, focusing on cardiac symptoms, and to repeat a sports physical. The athlete can return to play 10 days after the first positive test result and after 24 hours symptom-free 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 quarantine and rest during that time. Athletes should be symptom free for a minimum of 10 days without the use of fever-reducing medication before returning to play. This means if symptoms resolve on day 8 of infection, they should wait 10 more days before returning to play. An ECG and cardiology referral are recommended after symptoms resolve.
  • 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 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?

COVID‑19 hasn't been around long enough for doctors to know the long-term side effects of the virus. But 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. Myocarditis 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 of 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.

Sign up for Performance Playbook

Receive the latest advice from our orthopedic and sports performance specialists – right in your inbox. Sign up for Performance Playbook, the monthly newsletter from Children's Health Andrews Institute.

athlete, cardiology, coronavirus, infectious diseases, sports, virus

Childrens Health