As Justin Fields, the star quarterback at Ohio State, was gathering more than 300,000 electronic signatures to beseech Big Ten university presidents to reverse their decision to postpone football this fall, he was applauded by his coach, Ryan Day, who in turn was being hailed by his athletic director, Gene Smith.
Nobody, though, was cheering on Dr. Curt Daniels.
Daniels, the director of sports cardiology at Ohio State, had also been busy, working to publish a three-month study whose preliminary findings were presented to Pac-12 and Big Ten leaders before they shut down football earlier this month. Daniels said that cardiac M.R.I.s, an expensive and sparingly used tool, revealed an alarmingly high rate of myocarditis — heart inflammation that can lead to cardiac arrest with exertion — among college athletes who had recovered from the coronavirus.
The survey found myocarditis in close to 15 percent of athletes who had the virus, almost all of whom experienced mild or no symptoms, Daniels added, perhaps shedding more light on the uncertainties about the short- and long-term effects the virus may have on athletes.
But as Daniels’s survey awaits the rigors of peer review, it has received scant attention, in part because Ohio State has refused to make public any testing data about its athletes — who make up the bulk of the study — other than to announce last month that it had shut down workouts because of positive virus tests. Thus, Daniels said he could not disclose any more information about the data, including the number of athletes tested and those found with myocarditis, until it is published. (The school has said it is following privacy laws, but those prohibit only the disclosure of personally identifiable information.)
What is taking place at Ohio State — mixed messages, competing agendas and a lack of transparency — is playing out on a broader scale across the country as college football’s powerhouse conferences decide whether to go forth with a fall season, with a shutdown risking billions in television and ticket revenue. Those who have pushed toward playing have done so with little or no public health justification, and despite widespread pronouncements earlier this year that if students could not sit in classrooms, they could not play sports.
Last week, North Carolina, North Carolina State and Notre Dame, which will play in the Atlantic Coast Conference this season, backed off in-person instruction because of virus outbreaks, but encouraged their football teams to stay on campus. While some players in the Southeastern Conference used social media to criticize students for not wearing masks in classrooms, bars or fraternity houses, its schools were busy announcing plans to have upward of 25,000 fans at games — even at Alabama, where a vice president told students Friday the university was on a pace to run out of isolation beds by the end of the month. And a cardiologist at the Mayo Clinic who advised the Big 12 and Conference U.S.A. to soldier on with football said in a podcast that any conference that did not play because of myocarditis concerns was relying on “wimpy, wobbly, weak” evidence.
Nowhere, though, has there been more conflict than in the Big Ten, where it took Commissioner Kevin Warren eight days — and the prospect of angry parents demonstrating outside the conference’s offices — to issue a letter that summarized the medical criteria upon which the presidents based their decision not to play.
Warren has also had to beat back complaints from his own member universities.
Four of them expressed displeasure with the postponement, none as forcefully as Nebraska, which issued a statement not just from its football coach, Scott Frost, and its athletic director, Bill Moos, but also from its chancellor, Ronnie Green, and university system president, Ted Carter. They said they would continue to consult the medical experts who assured them athletes were safest on campuses.
As for the team of medical experts the Big Ten leaned on for its decision? It is led by Dr. Chris Kratochvil, an infectious disease expert at … Nebraska.
Meanwhile, Bob Bowlsby, the Big 12 commissioner, said he did not feel compelled to release the medical underpinnings for his conference’s decision to continue playing, even though new infection rates remained high in the counties of half its universities. “Well, if we got to the point where we were going to not play it probably requires more of an explanation,” he told reporters on a conference call. “The decision to continue to move forward and stay the course, I think, is a different one.”
Standing out as an exception to the obfuscation has been the Pac-12, whose medical advisory committee of two dozen team doctors, infectious disease specialists, cardiologists and public health experts detailed in a 12-page document why it was not safe to play contact sports until at least next year. It said that infection rates in the conference footprint remained high, there were too many uncertainties about myocarditis and other effects of the virus, and testing had been inadequate. The document also laid out metrics to measure when sports could return.
The Pac-12 document was the latest iteration of a text that has been amended over the course of several months based on federal health directives, N.C.A.A. recommendations, community infection rates and other information. Gregory Stewart, the team doctor at Tulane, said that all conferences have put together similar documents and their medical advisory groups share them with one another. Anytime there are new directives from the Centers for Disease Control and Prevention or the N.C.A.A., which has its own medical advisory group, or new approaches by other conferences, “we compare it to ours and make sure we’re good,” said Stewart, who leads the American Athletic Conference medical advisory group.
Still, few have been shared publicly, especially with any detail.
The A.C.C. published a seven-page report on July 29 focusing on protocols for playing, but there is no mention of virus side effects, and only one sentence — lifted from the N.C.A.A. guidelines — on local infection rates. It suggests that games could be canceled if campus or community transmission rates were considered “unsafe” by local public health officials, but the conference is still planning to play despite campus shutdowns at three of its schools.
Dr. Cameron Wolfe, an infectious disease specialist at Duke and chair of the A.C.C. medical advisory group, declined an interview request through a school spokeswoman.
The Coronavirus Outbreak
Sports and the Virus
Updated Aug. 21, 2020
Here’s what’s happening as the world of sports slowly comes back to life:
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- The Western & Southern Open tennis tournament — long held near Cincinnati — has been moved to Queens this year, making for an unusual doubleheader with the United States Open.
- The Mets had two games postponed after a player and a staff member tested positive for coronavirus.
- While live sports are back, spectators are not in most cases. Readers comment on what they were missing as fans in the stands.
The SEC announced Friday — one day after a Georgia State freshman quarterback, Mikele Colasurdo, announced he would miss the season because of a coronavirus-related heart problem — that specific cardiac screening tests would be required for infected athletes, though it did not include a cardiac M.R.I. It also said it would require additional testing closer to games.
Dr. John Swartzberg, an infectious disease and vaccinology professor emeritus at the University of California, Berkeley, who advised the Pac-12, has watched these worlds of medicine and college sports collide, with public health rationale being cloaked as carefully as a coach might conceal which quarterback had won a starter’s role. He was asked if in the current environment — where masks have become a political statement — presidents and the medical teams advising them were seeing what their constituents want them to see in the data.
“It’s seductive to go down that road, it clearly is,” said Swartzberg, who observed that in such a polarized society, of which sports has increasingly become a microcosm, it would be easy to draw that conclusion — even if he would not. “I want to make it clear: There’s no way I’d criticize a professor trained like I am who comes to a different conclusion,” Swartzberg added. “But we all bring our own biases to our conclusions.”
He laughed.
“I’m trying to be as generous as possible,” Swartzberg said.
He sees echoes of what has played out on a bigger stage, the dance that the White House pandemic adviser Dr. Anthony S. Fauci performs around President Trump’s desire to hear suggestions that benefit him politically. “It’s impossible not to. That’s the way our thinking has been guided over the last four years,” Swartzberg said. “It’s not possible to separate culture from sports.”
That schism may help explain why Dr. Michael Ackerman, a cardiovascular genomics research professor at the Mayo Clinic, ended up on a Zoom call earlier this month with Big 12 presidents, athletic directors and their medical advisory group, and then a day later on a similar call for Conference U.S.A.
Ackerman believes myocarditis is being portrayed as “the boogeyman,” and he has criticized experts giving weight to a German study that showed that 60 of 100 patients who had recovered from the coronavirus had signs of myocarditis, saying the patients were middle-aged and not in the peak physical condition of college athletes. He also decried Colleen Kraft, an infectious disease doctor at Emory University who is an adviser to the N.C.A.A., characterizing her as an alarmist for saying that disregarding concerns about myocarditis was “playing with fire.”
“Is this a blaze that’s out of control that’s wreaking havoc, or a campfire roasting marshmallows?” Ackerman said in an interview.
Ackerman’s position is outside the mainstream of the dozens of doctors who are advising university presidents and the N.C.A.A. on their decision. “I’m used to swimming upstream,” he said.
But Ackerman wedged his way into the discussion via Twitter, posting that shutting down college sports based on data about myocarditis would be “NONSENSE!” He said that, two days later, he received an email from a Big 12 athletic director, whose name he could not recall, who asked “would you be interested in expounding on your 250-character tweet” during that night’s meeting of Big 12 university presidents.
When asked by The New York Times if he could check his email for the athletic director’s name, Ackerman later replied that it was instead a Big 12 official. Asked for the name of the official, Ackerman said on Friday that the invitation had come through his secretary and that she was not working that day.
Bob Burda, a Big 12 spokesman, said he did not know who connected with Ackerman.
The University of Arizona’s president, Robert C. Robbins, a cardiac surgeon, shrugged off Ackerman’s characterization of the evidence as “wimpy, wobbly, weak,” saying it was best to err on the side of caution. He said it would be wise to monitor how professional sports leagues are screening their players for virus-related heart problems, and see where more data leads. “Maybe it will turn out that Dr. Ackerman is right, that this is something that will turn out to not be a big problem,” he said.
Myocarditis in the aftermath of viral infections is not a new phenomenon. So as doctors began to understand how the virus works, it was not a surprise for them to see it attack the lungs and the heart, which if inflamed becomes vulnerable to potentially fatal arrhythmias during vigorous exercise.
The prescription is straightforward: Rest for at least three months until further tests have indicated the inflammation has dissipated.
Most of this year’s early research, though, involved older patients, some of whom may have had compromised immune systems, leaving doubt as to whether the coronavirus attacks the heart any more virulently than other viruses do. There was scant evidence on how it might have affected young elite athletes who did not already have health problems.
Then, by early August, shortly after the German study was published, examples began to surface of otherwise healthy athletes showing signs of myocarditis after they recovered from Covid-19. Boston Red Sox pitcher Eduardo Rodriguez was sidelined for the season. The Indiana freshman lineman Brady Feeney’s doctor was concerned about Feeney’s heart after a difficult bout with the virus. A 27-year-old former Florida State basketball player, Michael Ojo, who had recovered from the virus, died of an apparent heart attack at a practice in Serbia.
“That was probably the tipping point in us saying we’re not ready to move forward,” Dr. Jonathan Drezner, a cardiologist at the University of Washington who advised the Pac-12, said of myocarditis uncertainty. “But it wasn’t the primary reason.”
Watching from afar has been Daniels, the Ohio State cardiologist.
The primary tests for myocarditis are an echocardiogram (an ultrasound), an electrocardiogram (which records the heart’s electric signals) and a blood test that measures a protein that is excreted when the heart muscle is damaged. But Daniels said a cardiac M.R.I., which he called the gold standard of testing for myocarditis, might reveal the condition when the other tests do not, though there are occasional false positives.
“It’s as close as we can get to a heart biopsy without doing one,” he said.
In May, as plans were being made to bring athletes back to prepare for their seasons, Daniels began working with the Ohio State team doctor James Borchers, who was coordinating the school’s protocols for sports. They concluded that cardiac M.R.I.s would provide the most salient data.
“Everybody is saying now that maybe we should do cardiac M.R.I.s,” Daniels said. “We’ve got three months of data.”
Just what that data says remains largely hidden. Daniels said he is prohibited by the school from revealing how many athletes who had the virus have been tested, how many attend Ohio State, what sport they play, the severity of the myocarditis symptoms, what parts of the heart it attacks, or most other questions about the data. He said only that 13 to 15 percent have shown symptoms of myocarditis, which he revealed only because Gov. Mike DeWine had coaxed it out of him during a news conference.
Soon, though, the peer review will be complete, which could clear the way for the study to be published, as soon as this week, Daniels said. That could open the door to more studies, larger data sets and better science about the risks that schools are asking unpaid athletes to assume — at least for those who are interested in hearing it.
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