From Penn State's Football Doctor, a Measured Review of Sports and COVID-19

Dr. Wayne Sebastianelli, Penn State's director of athletic medicine, said that COVID-19 "needs to be respected."

Dr. Wayne Sebastianelli, Penn State's director of athletic medicine, told the State College Area Board of School Directors on Monday that he wasn't making a recommendation about whether it should go ahead with fall sports.

But Sebastianelli did offer plenty for board members to consider, including what he called an "alarming" level of heart inflammation among athletes who have tested positive for COVID-19.

"I’m just giving you other things to think about that give me gray hair, Sebastianelli said. "I've been doing this close to 40 years now, so I have a lot of gray hair, and it's thinned a lot. Because of my worries about what I'm doing to make sure I'm doing the best I can potentially to create as level a playing field in competition and safety that we possibly can."

Speaking to the State College board about its decision to continue with high school sports this fall, Sebastianelli delivered a comprehensive, measured and deliberate list of considerations beyond what has made for Thursday's headline story.

Sebastianelli, who also serves as Penn State's football team doctor, said that "roughly 30-35 percent" of Big Ten athletes who have tested positive for COVID-19 also showed some level of heart inflammation.

"What we have seen when people have been studied with cardiac MRI scans, of symptomatic and asymptomatic COVID infections, is a level of inflammation in cardiac muscle that just is alarming," Sebastianelli said. "And we don't know what it happens."

The Penn State College of Medicine later issued a statement clarifying Sebastianelli's number and referenced a New York Times story that cited a survey finding instances of myocarditis "in close to 15 percent of athletes who had the virus."

The statement also said that Penn State has found no cases of myocarditis in athletes who have tested positive for COVID-19.

"Dr. Sebastianelli was asked by a local school board to discuss high school preparations and precautions for holding sporting events during the pandemic and the potential impact of COVID-19 on the health of student-athletes," the Penn State Health/Penn State College of Medicine statement said. "During his discussion with board members, he recalled initial preliminary data that had been verbally shared by a colleague on a forthcoming study, which unbeknownst to him at the time had been published at a lower rate. The research was not conducted by Dr. Sebastianelli or Penn State. Dr. Sebastianelli wishes to clarify this point, and apologize for any confusion."

Sebastianelli's answer further explained the risks athletes face by competing in the COVID-19 era, what concerns him and what factors he believes are required to consider returning to competition.

Sebastianelli said that the incidents of heart inflammation, or myocarditis, instructed the Big Ten and Pac-12's decisions to postpone fall sports. But he added that there are further unknowns.

"You could argue with cardiologists, they'll say we don't know if that increases their risk for cardiac arrhythmia [or] poor cardiac status long term," Sebastianelli said. "We don't really understand what it would look like if it was Coxsackievirus or if you studied an influenza virus with cardiac MRI scans. We don't really know what the incidents of that inflammation would be."

He informed board members that they should be prepared for athletes testing positive for COVID-19, a situation he said was "not if but when somebody gets infected."

He praised Penn State's fall coaches, including football coach James Franklin, for the bubbles they created around their programs. Sebastianelli said breaches occurred when athletes "were off ICA [intercollegiate athletics] time" and went to a pool party or social gathering.

Sebastianelli said that doctors don't fully understand the virus' effect on the respiratory and cardiac systems.

"You could have a very high-level athlete who's got a very, very superior Vo2 max [oxygen consumption rate during exercise] and cardiac output who gets an infection with COVID and could drop his or her Vo2 max and cardiac output just by 10 percent," he said. "And that could make them go from elite status to average status."

Ultimately, Sebastianelli said, plenty concerning the virus remains unknown. That's why he used an analogy regarding lightning strikes.

"We all worry about electrical storms and competition and people being on the field," Sebastianelli said. "And if you look at the data on that, it's roughly 1 in 12,000 people who will get hit by lightning in the area during an electrical storm. And roughly 10 percent of those individuals who are hit by lightning will perish from the lightning strike.

"So roughly 90 percent of those that are exposed to lightning, if hit by lightning, will survive and not really have, in a high percentage of instances, many long-term consequences. So when we're dealing with lightning, there's no question, we stop the event. We're not going to tolerate that 1 in 12,000 times .1 [people] are going to die. That's a very low number.

"We're dealing with much different numbers with this disease that are at a much higher level of potentially causing a problem. And putting the risk and the mitigation together is really challenging for this. It's really something that we don't have any expertise with. This is a virus that acts differently than influenza and it's something that needs to be respected. I'm not saying you cancel sports. I’m just saying that it needs to be respected."

Watch Sebastanelli's full comments below.