COVID-19 Screening Clinical Pathway — Outpatient Specialty Care and Primary Care

COVID-19 Return to Sports Participation for General Pediatricians and Recommendations for Cardiology Consultation after COVID-19

The following recommendations are based on the recent expert analysis from the American College of Cardiology, review of published guidelines and literature, and local expert consensus from the Division of Cardiology and Division of General Pediatrics.

For all COVID-19 positive patients, continue to follow CDC guidelines for isolation based on pertinent individual disease criteria.

Recommendations for Pediatric Patient with History of COVID-19 Infection
Note: Recommendations are subject to change based on the latest evidence and CHOP expert consensus, as more information about the cardiac manifestations of COVID-19 in our patients becomes available.
Asymptomatic Patients and Patients with Mild Symptoms
  • Asymptomatic: testing due to exposure, incidental finding of positive test, etc.
  • Mild symptoms (as defined by the AAP  ): < 4 days of fever > 100.4°F and < 1 week of myalgia, chills, and lethargy
  • Regardless of patient’s age, patients should refrain from sports and exercise until 10 days after the positive test result and a minimum of 24 hours without symptoms without fever-reducing medications.
Patients with Moderate Symptoms
  • This category will typically include patients with moderate symptoms who are managed at home with ≥4 days of fever > 100.4°F or ≥ 1 week of myalgia, chills, or lethargy. However, this category can also apply to hospitalized patients who have only moderate symptoms and no concern for cardiac involvement.
  • < 12 years old
    • Refrain from sports and exercise until 10 days after the positive test result and a minimum of 10 days without symptoms without fever-reducing medications.
  • ≥ 12 years old
    • After 10 days from the positive test result and a minimum of 10 days without symptoms without fever-reducing medications, the primary care provider should obtain an electrocardiogram before clearance for competitive sports.
    • If the ECG is normal and there are no additional cardiac concerns, the patient can return to competitive sports.
    • If the ECG is abnormal, the patient should be referred to pediatric cardiology.
    • For patients who are not involved in competitive athletics, an ECG is not routinely recommended.
Patients with Severe Symptoms Requiring Hospitalization
  • All patients requiring hospitalization for severe acute COVID-19 symptoms should be referred to outpatient cardiology for evaluation at least 2 weeks after discharge, sooner if cardiac concerns, regardless of age or activity level.
  • Patients should be restricted from sports and exercise until the initial cardiology appointment, with anticipatory guidance that exercise restriction may last up to 3-6 months, depending on patient’s inpatient clinical severity.

For ALL patients who are cleared for return to sports/exercise

  • Whenever resuming activity (competitive sports, physical education class, recreational activities), patients should slowly advance activity over a minimum of 7 days, and monitor for further symptoms.
  • Any concern for clinical deterioration or cardiac symptoms should warrant further cardiac evaluation and discontinuation of sports/exercise until further notice.

Multisystem Inflammatory Syndrome in Children (MIS-C)

MIS-C is currently felt to be a post-infectious delayed immune response to prior COVID-19 infection. Patients with MIS-C should be followed by pediatric cardiology outpatient with return to sports dictated by pediatric cardiologist and often by multidisciplinary team.

Refer to CHOP COVID-19 clinical pathways, including further information on evaluation and management of COVID-19 and MIS-C.