Although most children and adolescents with COVID-19 can fully recover, sometimes the virus can have a lasting effect. One of these effects may be damage to the heart muscle-if exercise damages the heart, it may cause arrhythmia, heart failure or even sudden death.
This seems to be rare. However, given that we are actually learning when we are learning about COVID-19, it is difficult for us to know how rare it is and how high the risk may be after testing positive for COVID-19.To help doctors, coaches, physical education teachers, parents, and caregivers make safe decisions, the American Academy of Pediatrics has issued some Guide to resuming exercise and physical exercise After getting COVID-19.
This is “temporary guidance”, that is, based on what we know so far, our current best guess as to what to do. Unfortunately, there is a lot we don’t know, and they don’t know until we have more time to study the virus and observe what happens when patients recover in weeks, months, and years.
What is the important information for returning to sports and physical exercise?
Teenagers and young people who participate in competitive sports have the highest risk of heart disease. This is not only because younger children seem to be less affected by COVID-19, but also because older teenagers and young people are more difficult to exercise and are more likely to put stress on the heart muscles. Of course, no one can say with certainty that for children with COVID-19, running on the elementary school playground is completely risk-free.
Guidance for resuming physical activity depends on whether the COVID-19 case is considered mild (including asymptomatic), moderate or severe.
- Mild: less than 100.4 for four days with fever less than 10 days, and less than a week of muscle soreness, chills or fatigue (this includes asymptomatic cases)
- Moderate: Fever greater than 100.4 for four days or more; muscle soreness, chills or fatigue for a week or more; or hospitalization without evidence (not in ICU) MIS. (MIS-C is a multi-system inflammatory syndrome that sometimes occurs with COVID-19.)
- Severe: Evidence of any ICU stay and/or intubation, or MIS-C. During the intubation process, a tube is inserted into the airway through the mouth and connected to the machine to help the child breathe.
What screenings can be performed after children recover from asymptomatic to mild COVID-19?
It is the most difficult to provide guidance to young people with mild or asymptomatic cases, because we do lack data on this population when it comes to their heart health.
For these children, experts recommend that parents contact the child’s primary care provider. Wait until the child recovers from the illness (or if the child has no symptoms, at least 10 days after the positive test).They should be screened for symptoms of heart disease, the most worrying thing is
- Chest pain
- Shortness of breath after a severe cold exceeds your expectations
- They never had a heart pit
- Dizziness or fainting.
For children who are not serious athletes, if they have mild or asymptomatic conditions, just calling the doctor’s office is enough.
For those who are more marginal, or have no worries at all, or the child is a serious athlete, it is a good idea to check in person.
If you have any concerns about the answer to the question or the physical examination, you can use an EKG and refer to a cardiologist.
If there is no worry, then children can resume recreational physical exercises according to their abilities. Return to competitive sports should be carried out gradually, and pay attention to symptoms throughout the process. For suggestions on how to do this, see the AAP guide linked above.
What screenings may be performed after children recover from moderate or severe cases of COVID-19?
Any child with a moderate illness should visit a primary care provider to screen for symptoms and be tested. Arrange visits for at least 10 days after the child has tested positive for the virus and have no symptoms for at least 24 hours without taking any acetaminophen or ibuprofen.
If you have any questions or concerns about symptoms or physical examination, it is a good idea to refer to a cardiologist to clear and guide you to resume physical activity.
Children with serious illnesses absolutely need to see a cardiologist, and should be restricted from activities for at least three to six months, and only come back if the cardiologist says it can.
Again, this is a temporary guide, which will continue to evolve as we learn more about COVID-19 and its short- and long-term effects. If in doubt, consult your doctor.
Follow me on twitter @drClaire