Cardiopulmonary Considerations for High School Student-Athletes During the COVID-19 Pandemic: NFHS-AMSSM Guidance Statement

 [bib_ref] Incidence of thrombotic complications in critically ill ICU patients with COVID-19, Klok [/bib_ref] [bib_ref] Association of cardiac injury with mortality in hospitalized patients with COVID-19 in..., Shi [/bib_ref] [bib_ref] Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19), Inciardi [/bib_ref] [fig_ref] Figure 1: COVID-19 supplemental questionnaire [/fig_ref] [bib_ref] The resurgence of sport in the wake of COVID-19: cardiac considerations in..., Baggish [/bib_ref] [bib_ref] Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the..., Belhadjer [/bib_ref] [bib_ref] Myocarditis in athletes is a challenge: diagnosis, risk stratification, and uncertainties, Eichhorn [/bib_ref] [bib_ref] Cardiac involvement in recovered COVID-19 patients identified by magnetic resonance imaging, Huang [/bib_ref] 

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Any "close contact" (ie, family or household member) with confirmed COVID-19 infection | | Student-athletes with underlying medical conditions that place them at higher risk of severe COVID-19 illness, such as uncontrolled or moderate to severe asthma, a serious heart condition, obesity, diabetes, chronic kidney or liver disease, or a weakened immune system 8 | | Student-athletes with prior symptoms suggestive of (but not confirmed) COVID-19, especially if symptoms were severe or required hospitalization new Covid-19 infeCtions - - Schools should consider a daily tracking tool to confirm student-athletes are appropriately self-monitoring and have not developed symptoms of COVID-19. In addition, it is suggested that schools establish a COVID-19 response team to help develop and implement policies and procedures for a safe return to sport in their school and to assist in COVID-19 symptom screening, reporting, and contact tracing. - - Student-athletes should not attend school, sports practices, or competitions if feeling ill and should be referred to their medical provider for possible COVID-19 testing if they present with any of the following symptoms: fever, new cough, difficulty breathing, shaking chills, chest pain, gastrointestinal symptoms (nausea, vomiting, or diarrhea), loss of taste or smell, sore throat, or an unusual rash or painful discoloration of fingers or toes. - - Student-athletes who test positive for COVID-19 with or without symptoms should be isolated per public health guidelines. No exercise is recommended for at least 14 days from diagnosis and 7 days after all symptoms have resolved. - - After symptom resolution and prior to sports participation, student-athletes should be evaluated by a medical provider to assess for residual symptoms and the need for additional testing. Written medical clearance prior to sports participation is recommended.

## Emergency action plan
Every school is reminded to have a well-rehearsed emergency action plan (EAP) for every sport at every venue to facilitate a coordinated and efficient response to SCA. [bib_ref] The inter-association task force for preventing sudden death in secondary school athletics..., Casa [/bib_ref] [bib_ref] Design and implementation of an emergency action plan for sudden cardiac arrest..., Pelto [/bib_ref] [bib_ref] Sudden cardiac arrest on the field of play: turning tragedy into a..., Siebert [/bib_ref] - - Every school should maintain an on-site automated external defibrillator (AED) program that allows retrieval and use of an AED within 3 minutes of collapse at school athletic venues and buildings. - - Potential first responders to SCA, including coaches, are encouraged to be trained in cardiopulmonary resuscitation (CPR), the recognition of SCA, and use of an AED. - - Each school should conduct and document an annual EAP practice drill for SCA among anticipated first responders (ie, athletic trainers, school nurses, coaches, and administrators). - - AED devices should be maintained according to manufacturer guidelines, including monthly readiness checks and scheduled battery or lead replacement.
[fig] Figure 1: COVID-19 supplemental questionnaire. [/fig]