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.