When Cody Garbrandt pulled out of UFC 255, his bicep tear was the big story until he later revealed that he also tested positive for COVID-19. Unlike other fighters who had to pull out due to testing positive only to return soon after, Garbrandt spoke candidly about suffering from blood clots, pneumonia, and ‘brain fog’ (a common symptom associated with the body’s reaction to being in an intensive care unit).
For doctors, none of this is unexpected. Ten percent of COVID-19 patients will have lasting symptoms, and blood clots are something doctors expect to see in those with more severe infections. But with so much focus on deaths and cases — including some Veep-level confusion from high ranking officials over the most basic concepts — this has left a lot less discussion toward the cases themselves, which is ultimately where we’ll learn the most.
We know that COVID-19 is caused by the SARS-CoV-2 virus, which then triggers a respiratory tract infection. However, one of the more frightening revelations is that COVID-19 may not just be a respiratory disease but a vascular one as well. Current research suggests that SARS-CoV-2 may infect heart tissue, similar to how myocarditis — an infection of the heart muscle caused by viruses, bacteria, and other toxic substances — occurs.
Early data from China revealed that 40 percent of the deaths occurring as a result of COVID-19 featured cardiac injury. In the US, preliminary reports show seven-to-seventeen percent of patients being hospitalized for the virus, also experienced heart injuries. This connection between COVID-19 and heart infections was the crux of the Big Ten debate over whether it was safe for college athletes to resume play when a Penn State doctor found that early studies showed COVID-positive college athletes and a correlation with inflamed heart muscles (it’s worth noting that no athletes actually tested positive for myocarditis, however). If COVID-19 is potentially responsible for the new wave of heart disease, as some suggest, why should athletes of all people be worried?
Because athletes already have strange hearts, literally. Scientists got a head start on understanding what makes an athlete’s heart different from a regular one a long time ago when they decided to look at the hearts of cross country skiers in parts of the world that needed skiing for warfare. As we now know, athlete’s heart syndrome is a fairly common condition among professional athletes. Unlike Hypertrophic Cardiomyopathy, which is the leading cause of sudden death in professional athletes, athlete’s heart is nothing to worry about. It’s just an abnormality. However, the end result of so much cardiac use is an enlarged heart. For athletes, the question is whether or not COVID-19 can provoke more strain, creating a greater cardiac load?
We don’t know, but data’s out there thanks to the continued push to let the show go on. An MRI study on the hearts of twenty-six COVID-positive athletes found evidence of heart inflammation in four who either had mild symptoms, or none at all. In a German study of 100 people recovering from Covid-19, eighty percent showed evidence of abnormalities roughly two months after receiving their diagnosis, and sixty percent showed signs of myocarditis.
These lingering affects are precisely why doctors recommend pulling athletes from playing for at least three to six months if they get myocarditis. “Sometimes a bad virus creates an airway disease similar to an asthma,” Panagis Galiatsatos, a pulmonary physician and assistant professor at Johns Hopkins, told The New York Times. “They can ravage the lungs, where the lungs were rebuilt, but not well, and patients are stuck with an asthmalike reactive airway disease situation.”
This rest window is based on what preliminary research indicates when it comes to physical exertion following the infection. For people who caught mild symptoms disease, little more than a week is the suggested amount of rest. However, that comes with a major asterisk. According to The Lancet, “a key concern in athletic individuals surrounds the timing or ability to return to full physical exertion (a return to play strategy), following an infection. Many young individuals with COVID-19 infection appear to develop relatively mild disease and recover almost completely over 5–7 days. However, an apparent heightened risk of further deterioration has been suggested to occur between days 7 and 9, with individuals developing more fulminant lower respiratory tract manifestations and thus requiring more intense medical care.”
Of course, all of these studies are preliminary. In that way, I find it similar to the CTE discussion, where the veracity of the links to other problems might seem and be tenuous, but that doesn’t mean our efforts to understand them should be tenuous too. Especially in a culture that questions the coronavirus itself, which MMA happily takes its cues from.
The scary thing about myocarditis and myocarditis-like problems for athletes is that, like the coronavirus, people who have it may not show any symptoms at all. Even the symptoms that exist, such as fatigue, shortness of breath, or chest pain could easily be attributed to a ‘hard day’s work’ in the gym. Time isn’t healing all wounds. Instead it’s allowing us to find new ones.