Is a 2021 season going to happen?

[jersey shore lax]

I wanted to weigh in on the original topic of if people thought there will be a 2021 season. I hope there is but I do not think there will be. The fate of all athletics is in the hands of 18 - 22 year old students that can not do the right thing. They are going to party's with too many people attending, they are indoors and out doors and the tragedy will not be with illness or worse for the students but for their teachers, coaches, administrators, periphery staff and family's of those people as well as the students own family's.

[Matnum PI]

Jersey, agreed, and... I think PCow is venting some (i.e. He doesn't really think they're stupid) and with all the great info he just shared, He could say "Matnum PI is by far the stupidest" and I'd brush it off. This information is great.

[Matnum PI]

Thank you. I do not like hijacking a lacrosse thread with all of this but this is just about the extent of my online presence and I need to vent.

Echoing MD, there's no way you're hijacking this thread. This is the explicit subject of this thread. And, thankfully, we're able to have this discussion free of politics. (Hopefully I didn't just jinx this.) PCow, please, share away. I'm forwarding all of this to my wife and... Your words are really helpful.

[wgdsr]

Are you a cardiologist ?

I’m not, so forgive me for calling a report that 35% of athletes who tested positive bad news and then a report refuting the earlier # as good news.

Of course, if you are telling us myocarditis is not actually a serious issue for an athlete I’m going to want to know what your medical bona fides are for that one.

As just a layman, my understanding is that an athlete needs to not push their heart, not exercise hard, until the problem has resolved. Do that and most would be ok, no cardiac event. But stress the heart? Not a good idea.

Now here’s what I do know, based on being an athlete, playing ball full speed puts a strain on ones heart.

This is long, skip if you wish. I have spent the last 6 months gritting my teeth while being surrounded in all walks of life by extraordinarily ill-informed yet dogmatically assured conversations and opinions about COVID. I just can't take it any more.

My sub-specialization is not cardiology but I am board certified in Internal Medicine which covers cardiology. I also have a PhD in epidemiology, biostatistics and clinical investigation so, yes, my bona fides are bona fide. The problem isn't you as a laymen not understanding the science, the problem is you and everyone else immediately trumpeting sensational trash studies so that this one would have been tweeted hundreds of thousands of times and then when the inevitable retraction comes out it is re-tweeted about 500 times. This has happened over and over and over to the extent that now the hysteria has become ingrained and casually accepted. COVID is a serious disease and should be taken seriously. It is stupid to be out right now in bars without masks. It would be incredibly stupid to stage an indoor concert right now. It is also stupid however to wear a mask on a beach or while walking on hiking trails or when you are walking through the parking lot at Stop and Shop. This isn't cautious or prudent, it is stupid and ignorant. You do not catch respiratory viruses walking past someone outside but in this era, and not specific to COVID, the most extreme or outrageous take or advise gets the most attention. This leads to the myocarditis garbage.

The problem is people who don't know what they are talking about OR who do but who are looking for attention or publications conflating myocarditis, the clinical disease, with myocarditis, the histopathologic finding. Myocarditis is diagnosed in clinical medicine via serologic tests, echo, or MRI. Those are ordered when a patient is having symptoms. When they have symptoms of myocarditis and have confirmatory tests, then they receive the diagnosis. It is NOT diagnosed via blanket MRI screening in asymptomatic patients. Someone pasted a study looking at this with influenza above. It is very likely (and indeed has been shown) that is you were to start screening asymptomatic influenza patients with MRI you would see widespread evidence of myocarditis. If you screened patients with Coxsackie, which along with other enteroviruses is the most common cause of viral myocarditis and cardiomyopathy, adenovirus, EBV, etc., you would see thousands of college athletes with "myocarditis" every year. They likely would have sat out practice a day because they felt sick (from the virus in general) and then returned without issue.
The definition of myocarditis is histological, the inflammation of myocytes, the predominant cell type in the heart. That may sound scary (and what "sounds scary" is as deep an analysis as way too many people are looking for with COVID) but by no means necessarily need be so. The idea that dire associations are necessarily attached to this is due to doctors sloppily (or intentionally) trying to translate nuanced medical discussions into a vernacular for widespread consumption. Whenever someone is describing these MRI findings as "damage to the heart", that is what is happening. True injury to myocytes results in the leakage of enzymes. This most commonly happens when that area of the heart is ischemic, when it has too little blood flow from the blockage of a vessel (such leakage can indeed also happen with myocarditis). This is why, in the small number of cases where they actually have seen elevated cardiac enzymes someone inevitably says it is "the same type of damage as with a heart attack!". Cue the sturm and drang. Cancel the season for safety! Except, if you were to measure these in most college lax players after they finished their pre-season conditioning runs you would see little elevations as well. The test is extraordinarily sensitive and small elevations are worth noting only when they are in the proper clinical context. There is recent data suggesting 90% of patients who have tested positive for COVID are not contagious due to their extremely low levels. That may well be an exaggeration but a huge number of positive cases are only testing positive due to massive amplification cycles (beyond what is done in looking for other viruses) with PCRs. When you apply exquisitely sensitive tests, be they cardiac MRIs, troponin measurement or 40-cycle PCRs, you are going to come up with massive numbers of clinically meaningless "positives". It is again OBVIOUS, requiring no medical training, that there is no wide-spread serious cardiac effects of COVID on the young or else they would be dying and, from a epidemiological perspective, they just are not.

So. Yes, having asymptomatic, barely detectable histopathologic myocarditis on an MRI is in fact likely not a serious issue for an athlete. Anyone who is having chest pain, easy fatigue-ability, dypsnea on exertion, shortness of breath when laying flat or fevers should not practice. The same would hold regardless of what infection they had. I understand that once it is seen and documented there will be a very strong pull to hold that athlete out, even if complete asymptomatic. Anyone who seeks to do so though should understand what they are talking about.

jeezus, pcow. preach. try finding amplification cycles and sensitivity of tests nowadays in the media swallowed daily.
where's the real science on what is actually going on so even the scientists and the rest of our competing hordes can make heads or tails? are Ct amplifications of pcr's up from ~30 substantially in the last several months? are we measuring who's shedding?
are all masks created equal? evidently.

it'd be great to get answers on myocarditis here. or just go with coctail party talk and move to the next news cycle. the b1g and pac12 didn't really help matters by being vague some time ago and not clarifying their position.

but everybody's an expert. small wonder it's a sheet show of public discourse.

[Matnum PI]

Sports are frankly a tough call from my perspective. The proximity itself, because it is fleeting, isn't the issue (the second baseman isn't catching it from the runner running past him). It is the exchange of sweat, spit, etc that gets wiped around. The more of this, and teh more you are panting into each other's face (O and D linemen), the greater the chance of transmission.

Not simple. Maybe this'll be the impetus for getting rid of face-offs.

[pcowlax]

Sports are frankly a tough call from my perspective. The proximity itself, because it is fleeting, isn't the issue (the second baseman isn't catching it from the runner running past him). It is the exchange of sweat, spit, etc that gets wiped around. The more of this, and teh more you are panting into each other's face (O and D linemen), the greater the chance of transmission.

Not simple. Maybe this'll be the impetus for getting rid of face-offs.

That would be a very “2020” argument against the moto grip!

[Matnum PI]

If we're trying to avoid breathing into each other's faces, how do we stand on the sideline and scream, Alright, you two, straight to the center of the field for the... Face-Off! Doesn't make sense...

[CTlaxfan1]

Sports are frankly a tough call from my perspective. The proximity itself, because it is fleeting, isn't the issue (the second baseman isn't catching it from the runner running past him). It is the exchange of sweat, spit, etc that gets wiped around. The more of this, and teh more you are panting into each other's face (O and D linemen), the greater the chance of transmission.

Not simple. Maybe this'll be the impetus for getting rid of face-offs.

That would be a very “2020” argument against the moto grip!

CT just canceled football. I was hoping it would serve as a trial run for the Spring sports.

[Matnum PI]

I've stopped writing down when a state's HS soccer season starts (an easier hurdle to clear than football) because I've had to cross it out so many times when the date actually comes. Currently, it's September 4th and Arizona Girls are playing soccer. Some teams in IN, KY, OH, SD, MO, KS, ND... Teams that would never dawn on you to be nationally ranked are getting press because... No one is playing. It's amazing. In my lifetime, soccer always happens.

[a fan]

It is also stupid however to wear a mask on a beach or while walking on hiking trails or when you are walking through the parking lot at Stop and Shop. This isn't cautious or prudent, it is stupid and ignorant.

Respectfully, why is it stupid and ignorant? Who does it hurt? This is like making fun of someone having their seatbelt on in a parked car while they make a phone call....who on Earth does that seatbelt hurt?

Health professionals are trying to simplify things, and understandably so. This is actually part of the problem you're complaining about....you're complaining about unclear messaging, and the trash science that follows.

What's more clear:

1. if you're out in public, wear a mask...or:
2. If you're just walking past someone outside, you don't need a mask. Unless you stop and talk to them for more than 30 seconds, then wear a mask.

It is again OBVIOUS, requiring no medical training, that there is no wide-spread serious cardiac effects of COVID on the young or else they would be dying and, from a epidemiological perspective, they just are not.

Respectfully, I don't think it's obvious at all.

Why aren't lingering health problems a possibility? I'm curious. You're telling me that with this virus that's less than 12 months old, you're SURE that the only two possible health outcomes are: drop dead from Covid complications or, recovery completely with no long term problems.

Since you were kind enough to share your professional opinion, can you tell me why you're sure there's no way that there are long term issues with getting Covid19? Thanks in advance.

[Farfromgeneva]

Agenda?

Well there was a time when there were just a handful of "major" stations and they provided news as a service, not as a profit making entity. It was limited in time and scope and usually only had time to report events without much perspective. With the growth of 24 hour news - there are two major changes - the push for ratings (i.e., sensationalism) and the need to fill 24 hours with blather - since reporting events will only take up so much time. Now adding social media to the mix where ANYONE can seemingly be a provider of "news" and it's beyond comprehensible.

This goes for both ends of the spectrum, left and right.

So profit motive? What about this, if your contention is news was “Superior”, as in more agnostic, before the internet?

https://en.m.wikipedia.org/wiki/Yellow_journalism

Are we ok with Walter Cronkite editorializing the Vietnam war as agnostic?

[FMUBart]

Stupid is as Stupid does..

[Matnum PI]

Why aren't lingering health problems a possibility?... Since you were kind enough to share your professional opinion, can you tell me why you're sure there's no way that there are long term issues with getting Covid19?

I'd imagine that lingering health problems are always an issue with any virus, disease, etc. and... There is a point where a doctor says, You have a clean bill of health. Obviously something may be hiding behind an aorta or whatever but rationally, there has to be a point where a doctor runs all the tests that are relevant, both for short- and long-term health, and then, you have to give the patient the thumbs up.

[pcowlax]

It is also stupid however to wear a mask on a beach or while walking on hiking trails or when you are walking through the parking lot at Stop and Shop. This isn't cautious or prudent, it is stupid and ignorant.

Respectfully, why is it stupid and ignorant? Who does it hurt? This is like making fun of someone having their seatbelt on in a parked car while they make a phone call....who on Earth does that seatbelt hurt?

Health professionals are trying to simplify things, and understandably so. This is actually part of the problem you're complaining about....you're complaining about unclear messaging, and the trash science that follows.

What's more clear:

1. if you're out in public, wear a mask...or:
2. If you're just walking past someone outside, you don't need a mask. Unless you stop and talk to them for more than 30 seconds, then wear a mask.

It is again OBVIOUS, requiring no medical training, that there is no wide-spread serious cardiac effects of COVID on the young or else they would be dying and, from a epidemiological perspective, they just are not.

Respectfully, I don't think it's obvious at all.

Why aren't lingering health problems a possibility? I'm curious. You're telling me that with this virus that's less than 12 months old, you're SURE that the only two possible health outcomes are: drop dead from Covid complications or, recovery completely with no long term problems.

Since you were kind enough to share your professional opinion, can you tell me why you're sure there's no way that there are long term issues with getting Covid19? Thanks in advance.

I understand the word "stupid" may sound offensive but I deliberately used that rather than "unnecessarily cautious" or some such. I used stupid because I feel wearing a mask in situations where there isn't even the remotest possibility of it helpful does hurts others (out of ignorance yes, not out of malice) in a way that sitting in a parked car with a seat belt does not. Assessing in an even handed manner and balancing the costs and benefits of shutting down much of society and industry while attempting to slow (not stop, never stop) the spread of COVID is extremely difficult. There are plenty of people and arguments that are overly dismissive of the risk and way too sympathetic only to economic considerations. I don't want to sound in any of these posts like I think I have all the answers or some privileged understanding. But I do get to hear hundreds of people telling me what they are doing about COVID and why they are doing it. A huge number of people are completely terrified by aspects they "know" about its spread, severity and impact that are just not true. And that unfounded terror is crushing society. I have actually seen some fellow doctors wearing masks in a massive parking lot at work and asked them why they are doing it. Of course it is not to protect them from the virus but instead they want to set a good example for patients that see them walking, so that those patients will get used to wearing masks and therefore wear them in situations where it actually is appropriate. The problem I have with this is that everyone doesn't understand this is why they are doing it. People see a doctor in a mask with no one within 200 yards and think masks really are necessary even in that setting and so they start to wear them literally any time they are outside (which is insanity based on indoor vs outdoor transmission). And others see them wearing them outside and it becomes a preference cascade. And next thing you know society is treating this clearly very serious, inordinately challenging disease as something even worse than it is. Many businesses were shut (and remain shut) for no plausible scientific reason. But in the face of something so serious that it is a reasonable if perhaps overzealous-for-just-keeping-everyone-safe-personable-choice-reasons to wear a mask in the woods or even when driving alone in your car (we have all seen that), then it becomes acceptable to talk and act as though we are living in The Andromeda Strain. And then any situation where "safety" and economic activity can in any however implausible way be said to be in conflict, all decisions must fall to safety. The economic/mental health/long-term mental health! impacts of the months long shut down of many aspects of society are not as in your face as someone on a vent but are astronomical. Spreading irrational fear is harmful to others in a way that sitting in your car with a seat belt on is not. Be safe, be reasonable, but don't live in and contribute to the spread of fear.

As for why it is obvious that 30-35% of athletes are not actually getting myocarditis (the clinical disease). When the above (or other reports of large numbers of young people with this) are put out, myocarditis is inevitably described as a very serious, deadly condition (and it absolutely is when clinically impactful). When I say obvious what I mean is that it is clear that one of those two things are wrong. Widespread serious cardiac disease results in widespread cardiac symptoms, now. The almost complete absence of this in the young shows that it either is not common or it is not severe. As for the long-term affect, of course, 6 months in, you are absolutely right, I cannot know for sure and if I sounded overly confident of the future I was wrong. What I do know is that tens of thousands of people who play sports have had viral infections over the years that would have resulted in a diagnosis of "myocarditis" if they had all had asymptomatic screening MRIs. They kept on playing and were fine. Later in life? I don't know. Certainly when some older people are diagnosed with a cardiomyopathy (basically a weakly contracting heart and the long-term consequence of myocarditis you would be worried about), there is no known readily apparent cause (therefore labeled idiopathic). Could some of them had had a viral infection years ago that caused a sub-clinical myocarditis? Yes. Could playing through that maybe have increased the chances of this eventually manifesting years later? Unlikely but not impossible. And.....? We have to live. There is no evidence that asymptomatic or mild cases of COVID affect the heart more than any other comparable virus (serious cases are clearly to be approached differently). Do we give every athlete a cardiac MRI? When? It could be negative today and you could have a sub-clinical infection 6 days from now. Athletes have died due to strenuous activity as a result of having hypertrophic cardiomyopathy (Hank Gathers and others), a generally inherited condition. Do we image the heart before any kid is allowed to play sports? I have kids myself. I would never advocate anything that might have any reasonable chance of harming them just so that they could have fun or play a sport they love (or so that I could go back to debating WEST-1 PGs on here). I don't want to sound flippant. But they have to live their life. And for now, I have to go back to work!

[a fan]

The economic/mental health/long-term mental health! impacts of the months long shut down of many aspects of society are not as in your face as someone on a vent but are astronomical. Spreading irrational fear is harmful to others in a way that sitting in your car with a seat belt on is not. Be safe, be reasonable, but don't live in and contribute to the spread of fear.

This is a cultural thing...and America is far from homogenous when it comes to its culture.

So when you see a mask, you think that this is spreading fear. When I see a mask, I see people taking the minimal precautions needed to get the economy reopened fully as soon as humanly possible. And when I don't see masks, as a small business owner....all that tells me is that the public side of my business won't open until spring 2021, when a vaccine is distributed, and people relax.

American culture isn't set up to handle a pandemic. In Japan, as you know, folks wear medical masks if they have a cold as a matter of courtesy, no fear. Americans view masks as a violation of their freedom. To me, this is silly, but I realize that I'm not part of that segment of our culture.

As for the long-term affect, of course, 6 months in, you are absolutely right, I cannot know for sure and if I sounded overly confident of the future I was wrong.

Thank you for your frank answer. I was simply curious about the idea that something you saw told you there wouldn't be long term consequences. I admit that I am worried at the thought of millions of Americans having post-Covid issues. Hopefully? There aren't any.

Yes. Could playing through that maybe have increased the chances of this eventually manifesting years later? Unlikely but not impossible. And.....? We have to live. There is no evidence that asymptomatic or mild cases of COVID affect the heart more than any other comparable virus (serious cases are clearly to be approached differently). Do we give every athlete a cardiac MRI? When? It could be negative today and you could have a sub-clinical infection 6 days from now. Athletes have died due to strenuous activity as a result of having hypertrophic cardiomyopathy (Hank Gathers and others), a generally inherited condition. Do we image the heart before any kid is allowed to play sports? I have kids myself. I would never advocate anything that might have any reasonable chance of harming them just so that they could have fun or play a sport they love (or so that I could go back to debating WEST-1 PGs on here). I don't want to sound flippant. But they have to live their life.

I agree!

Really appreciate you taking the time to answer this layman's questions. Thank you very, very much.

[DALaxDad]

pcowlax, thanks for the info.

[MDlaxfan76]

pcowlax,

You have an interesting take on the preference wave to wear a mask creating fear, presumably irrational fear, rather than a sense of security that others are all together taking steps to protect us all.

Other societies indeed wear masks as a courtesy, automatically doing so when in close crowded situations and automatically if visiting a doctor's office, not for oneself but as a social assurance and courtesy. (my insights in this are from my son who has lived in China the past two years, traveled all around Asia). It was rather simple for them to intensify this behavior due to the pandemic as it was already 'normal' to see someone in a mask.

Here in the USA, we've made this into a sort of political football quite stupidly (I'll use your word) creating a bias in many to not wear a mask at all or to do so in a slipshod way. And that does indeed have a serious public health cost.

Here's where I might well be able to meet you in the 'middle'.

I'd say that lambasting and shaming someone who is not wearing a mask when clearly not putting someone else in direct risk at that moment (your examples being such) is unhelpful, indeed may create hardened backlash. Don't scream at someone for walking across a parking lot without their mask on yet before going into a store.

But at the same time I totally disagree about your fellow doctors choosing to present as visible an example as they can that mask wearing is not hard to do, they do it, so should others. They know they're seen, so they send the message that they care, so should others.

We actually DO want that preference wave to tilt to a bias to wear a mask. And public impressions matter...from each of us and from our leaders and media figures.

But don't scream at someone not actually putting others at risk. Who among us hasn't forgotten their mask as they walked to a store and had to turn around to go back to the car first...it happens and it ain't a sin.

[viper]

Agenda?

Well there was a time when there were just a handful of "major" stations and they provided news as a service, not as a profit making entity. It was limited in time and scope and usually only had time to report events without much perspective. With the growth of 24 hour news - there are two major changes - the push for ratings (i.e., sensationalism) and the need to fill 24 hours with blather - since reporting events will only take up so much time. Now adding social media to the mix where ANYONE can seemingly be a provider of "news" and it's beyond comprehensible.

This goes for both ends of the spectrum, left and right.

So profit motive? What about this, if your contention is news was “Superior”, as in more agnostic, before the internet?

https://en.m.wikipedia.org/wiki/Yellow_journalism

Are we ok with Walter Cronkite editorializing the Vietnam war as agnostic?

Yes Walter Cronkite did editorialize and it changed the path of American involvement in the war. It was also a VERY rare occurrence at the time (almost unheard of) which is why it was such a striking moment. Having said that - in this day and age - tv news people are editorializing continuously (to the point where they make things up) about anything and everything.

Regarding the Yellow Journalism context - the comment was about network television - not print media.

[stupefied]

Just a anecdote. Doc friend told me the country should be much more concerned about young people texting while driving than worried about them resuming sports.

[Matnum PI]

and drinking and driving and unprotected sex and... if we had to pick one, we'd be in trouble. thankfully, we do not.