School district changes policy for student athletes recovering from COVID-19

Last month Florida Gators star forward Keyontae Johnson collapsed during a game, falling face first onto the hardwood floor. He was whisked away to a local hospital and put into a medically induced coma. Johnson has since recovered enough to travel with the team in a coaching capacity, but it’s unclear whether he will play again this season.

Although the full medical picture is still not public, Johnson reportedly suffered from heart inflammation that is a common long-term after-effect of COVID-19—which Johnson had last year. That’s why the episode sent shockwaves through the sports world and caused many to ask: Is a “recovered” student athlete actually recovered?

As of today, Alachua County Public Schools (ACPS) has decided the answer is no.

“Beginning with cases reported Monday, which is the first day of the second semester, we will require student athletes to get clearance from a health care provider before returning to play after a positive COVID test, just as we do for concussions and other injuries requiring such clearance,” ACPS spokesperson Jackie Johnson told Mainstreet Daily News in an email.

The move is a significant change for ACPS, which earlier this week said it was still reviewing its policy of not requiring additional testing for students returning from a COVID diagnosis. Up until now, student athletes only needed to quarantine and test negative before they could return to participating in their sport.

According to Steve McClain, senior associate athletics director at UF, athletes returning to play after battling COVID-19 are screened using the guidelines set by the SEC.

Fourteen medical experts in areas of sports medicine, emergency medicine and infectious disease specialties are listed as members of the SEC Return to Activity and Medical Guidance Task Force. The task force has met weekly to provide guidance to the SEC, “with a priority placed on the health, safety and wellness of student-athletes (SAs), coaches and staff members, as it prepares for membership decisions related to the return of athletics activities, including team gatherings, practices, conditioning and competition.” 

Its latest guidance, a 35-page document issued Jan. 12, has a section dedicated to possible cardiac complications from COVID-19 infections and what tests are to be completed on student athletes recovering from COVID-19.

“Given the concern for possible cardiac complications from COVID-19 infections (i.e. acute myocarditis), cardiac testing and a period of re-acclimation to exercise will be required prior to returning to full participation in sport,” the report states.

The SEC requires cardiac testing that can include an Electrocardiogram (EkG), Serum Troponin level, and Echocardiogram (ECHO) to access the athlete’s condition before they return to play.

The SEC also outlines the re-acclimation process for athletes as, “a minimum of a 4-day period of re-acclimation to exercise will be required to monitor for any signs or symptoms of cardiac complications (i.e. chest pain, shortness of breath, presyncope, syncope).”

In the fall of 2020, local schools canceled dozens of football games throughout Alachua, Gilchrist, Levy and Marion counties when student athletes tested positive for COVID-19. Those positives forced hundreds of students and teachers in recent contact with those athletes into quarantine.

When those student athletes finished quarantine and tested negative for the virus, they went back to the play without ACPS required testing for common post-COVID-19 complications—such as lung damage or inflammation affecting the heart.

Where governing bodies don’t put down rules, coaches are often left to make difficult decisions. In the face of rising positive case numbers, P. K. Yonge girls basketball coach Willie Powers kept his team out of games in Columbia and Gilchrist counties over the holidays, citing a lack of mitigation efforts. 

“You have to look at it game by game,” Powers said about declining to bring his teams to a tournament in Trenton, where face masks are not enforced. “You’re danged if you do, danged if you don’t.”

Powers said coaches have to play their teams in the Florida High School Athletic Association (FHSAA) so that senior athletes can gain stats to compete for scholarships, while also weighing trying to be as safe as possible.

The Scientific Medical Advisory Council exists to aid in that mission of keeping kids safe. The council is made up of six UF medical professionals who advise Alachua County Public Schools and the Alachua County Health Department on COVID-19 protocols.

On Jan. 19, the ACPS posted the Winter/Spring Sports Safety Considerations guidance from the FHSAA that addressed how sporting events must be hosted. It did not address any recommended testing of student athletes recovering from COVID-19.

“Each school hosting an event is responsible for implementing the school district’s masking and social distancing policies,” the policy reads. “If a team fails to comply with these guidelines OR has an outbreak of COVID-19 within the team resulting directly from team activities, the team’s season may be discontinued.”

During the football season, stadium stands in Alachua County were packed beyond the capacity restrictions and those schools not following the rule of reduced attendance were put on notice by the ACPS athletic director.

Up until now, followup tests to ACPS student athletes recovering from COVID-19 had to be ordered on a case-by-case-basis by the player’s family. 

Dr. Jason Zaremski, co-medical director of the Adolescent and High School Sports Medicine Outreach program at UF, advises parents to exercise caution when their son or daughter contracts COVID-19 and considers returning to active competition afterward. As a starting point, he recommends reading the American Academy of Pediatrics’ guidance posted online.

“Individuals who test positive for COVID-19 should not exercise until they are cleared by a physician,” the guidance says. “It is suggested they visit with their primary care physician (PCP) who will review the local 14-point pre-participation screening evaluation with special emphasis on cardiac symptoms including chest pain, shortness of breath out of proportion for upper respiratory tract infection, new-onset palpitations, or syncope and perform a complete physical examination.”

Zaremski also pointed to three other resources: The British Journal of Sports Medicine guidance on graduated return to play following COVID-19 infection; Centers for Disease Control and Prevention guidelines for youth sports administrators; And a guidance statement from the National Federation of State High School Associations (NFHS) and the American Medical Society for Sports Medicine (AMSSM). 

The latter statement, which published in Sage Journals, recommends each athlete obtain medical clearance before participating in sports.

“Ongoing symptoms related to COVID-19 should be explored, including the presence of chest pain or shortness of breath with exertion, palpitations (heart racing), excessive fatigue, or decreased exercise tolerance,” the NFSHS/AMSSM statement says. “Every student-athlete with a prior confirmed diagnosis (positive test) for COVID-19 should undergo an evaluation by one’s medical provider prior to sports participation.”

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