No Spike in Cardiac Arrests, Deaths in Young Athletes During COVID-19

Despite claims to the contrary, the COVID-19 pandemic did not spark an increase in sudden cardiac arrests or deaths among young competitive athletes in the United States, according to data from the National Center for Catastrophic Sports Injury Research (NCCSIR).

The number of cases reported in athletes from the youth up to the professional level was not significantly different when comparing numbers in the 3 years prior to the pandemic with those in the first years of the pandemic (203 vs 184; P = 0.33), a research letter published this week in JAMA Network Open shows. The findings were similar when accounting for a temporary drop in sports participation in the months after the SARS-CoV-2 virus first started spreading.

“Initially with the COVID-19 pandemic, there was concern about how the virus might affect the heart, and you saw that in hospitalized patients, mostly with comorbidities,” senior author Jonathan Drezner, MD (University of Washington, Seattle), told TCTMD. “And as you remember, in 2020, a lot of sports were delayed or sometimes even canceled because of that concern. Research in athletes with SARS-CoV-2 infections eventually showed that the virus thankfully wasn’t as risky for heart injury and myocarditis as initially feared.”

Still, reports of young athletes suddenly dropping dead began to spread widely on social media and elsewhere, with the implication that COVID-19 itself or the vaccinations were to blame. That phenomenon has been deemed misinformation by Drezner and others, and prior studies have indicated that COVID-19 vaccination does not increase risks of out-of-hospital cardiac arrest among young people or sudden cardiac arrest/death among athletes.

In the current study, with lead author Camilla Astley, MSc (Universidade de São Paulo, Brazil, and University of Washington), the investigators explored the question of whether there was a rise in sudden cardiac arrest and/or death among young athletes with the onset of the pandemic.

“And the answer is very clearly no,” Drezner said.

Indeed, despite some limitations of the analysis, it’s “an important study to counter the prevailing misinformation about COVID and young athletes and vaccines,” commented Benjamin Levine, MD (UT Southwestern Medical Center, Dallas, TX), a member of the American College of Cardiology’s sports and exercise cardiology council.

Digging Into the NCCSIR

For the study, Astley, Drezner, and colleagues examined numbers of sudden cardiac arrests and/or deaths reported through the ongoing surveillance program led by the NCCSIR during a prepandemic period (2017-2019) and during the first years of the COVID-19 pandemic (2020-2022). “Since there’s no mandatory reporting system in the US for sudden cardiac arrest in an athlete, we use basically all possible sources, including systematic search of media [and] social media; collaborations and reporting from national and state athletic associations; direct reporting to the center; and collaboration with some other foundations that do similar work,” Drezner explained.

Over the entire 6-year span, there were 387 sudden cardiac arrests/deaths reported, most of which (70%) occurred during exercise, but “there was no uptick in cardiac arrest in athletes in the 3 years after the pandemic started compared to the 3 years before the pandemic,” Drezner said. The average age of the cases was 16.5 years, and 86.3% were male.

The proportion of cardiac arrests that resulted in death did not differ between the prepandemic and pandemic periods (52.2% vs 45.7%; P = 0.20).

The specific cause of death couldn’t be determined in 73.2% of cases. Myocarditis was the confirmed cause of death in seven cases total, three before the pandemic and four after SARS-CoV-2 began spreading.

COVID has legion effects and was a horrible pandemic. It hurt and killed a lot of people. Benjamin Levine

The researchers acknowledge some limitations of the analysis, including the possibility of missed cases, variability in sports participation during the pandemic, and incomplete data on specific causes.

Nonetheless, “there’s just no scientific evidence that there’s been an increase in sudden cardiac arrest in athletes from the COVID-19 pandemic more so compared to any other year before the pandemic,” Drezner said.

“We do know that the COVID vaccine has documented cases of vaccine-induced myocarditis. It’s relatively rare and seems to occur most in adolescent males. And that risk is well documented,” he added. “Thankfully, those cases mostly resolve and don’t go on to have catastrophic events like cardiac arrest. And so when we look for cases of cardiac arrest and death in our young athletes, we have not seen a rise in myocarditis either.”

In the athletic setting, a SARS-CoV-2 infection is now treated much like any other viral illness, with management dependent on the severity of the infection, Drezner said. And COVID-19 vaccines remain optional, he added, with some athletes opting to take them and others choosing not to.

It’s important to remember, Levine said, that “COVID has legion effects and was a horrible pandemic. It hurt and killed a lot of people, and many of the people had severe COVID with systemic inflammation and coronary and pulmonary and vascular thrombosis and have suffered severe structural injury to the heart and lungs. And those are people who need specialist evaluation and to be followed carefully.”

But young competitive athletes are different group, and after recovering from COVID-19,  “many people, as long as there’s no evidence of inflammation, normal heart function, and no arrhythmias, can return quite soon, even within a few weeks of infection,” he said.

There is some evidence that there was a transient increase in out-of-hospital cardiac arrests among younger adults at the beginning of the pandemic, Levine noted, “but as we learned how to manage it and we vaccinated people quickly so they didn't get serious infections, that risk steadily was reduced. . . . This is just an example of a big win for the medical community and should be reassuring to people going forward who might get COVID.”