U-M doctor calls out COVID-19 study, lands in hot debate

Venk Murthy never would have imagined he’d end up in the middle of a hot sports debate.

But with 33 keystrokes and a couple clicks, the University of Michigan associate professor of cardiovascular medicine and radiology unwittingly became one of the loudest voices in the discussion about the Big Ten’s decision to indefinitely postpone the college football season.

The funny thing about it was Murthy had no real stake in this fight before he entered the chat through the social media site, Twitter.

He didn’t care whether the games went on as scheduled or if the entire conference slate had been dismantled.

But he had serious issues with a recent German paper examining cardiac damage that had developed in patients infected with the novel coronavirus. The research centered on a rare and serious condition called myocarditis — an inflammation of the heart muscle that can cause sudden death and quickly became a concern among college athletics administrators after 12 athletes were diagnosed with it, according to Dr. Brian Hainline, the NCAA's chief medical officer.

Almost immediately following the July 27 publication of the German study, Murthy discovered numerous flaws and questioned the provenance of the statistical evidence, the abnormalities found in the control subjects, the ambiguity surrounding the findings themselves and whether the conclusions were applicable to specialized groups such as high-performance athletes. Yet the article, which appeared in the JAMA Cardiology peer-reviewed journal, went viral in the medical community. As days went by, Murthy was repeatedly confronted with it. It had been viewed hundreds of thousands of times. And three days before Murthy aired his grievances on Twitter, a top cardiologist affiliated with the Mayo Clinic, Dr. Leslie Cooper, shared the study with the Free Press while endorsing the collection of researchers behind it.

“I know the group in Frankfurt are totally reliable,” Cooper said Aug. 11. “Those guys are very, very solid imagers and they’re not dramatic at all.”

But Murthy remained skeptical of the methodology and data that has been collected as he became increasingly disheartened this research had received so much attention. Then his heart sank when he learned the study had informed a report the Big Ten had solicited that outlined medical guidelines and precautions for conference athletes with possible cardiovascular issues related to COVID-19. Dated Aug. 11, the same day the Big Ten pulled the plug on fall sports, the document was drafted by three cardiologists — Indiana University’s Dr. Lawrence Rink, Dr. Michael Emery at the Cleveland Clinic and Murthy’s colleague at Michigan, Dr. Eugene Chung.

“The football issues are important to some people but given everything that is happening in the world right now I think we have a lot of other things to be concerned about,” Murthy said. “We have to know which data are worthy of trust and building on our recommendations on. We have so little to begin with. I think it’s important to know what’s reliable and what’s not and I think there are numerous issues with this paper and frankly it’s inconsistent with some of the higher quality data that’s out there in the pathology literature.”

So Murthy went on Twitter and issued a plea.

“Time to retract or correct this paper,” he wrote on Aug. 14.

Among those who shared his message was former NFL quarterback and ESPN announcer Danny Kanell, the publisher of a Nebraska fan site and football aficionados across the country. Just like that, the esoteric world of academia collided with the in-your-face sports universe, where pass-interference and holding calls usually stoke the flames — not the median age of test subjects and whether they had underlying health problems.

In the days that followed Murthy’s thread of tweets regarding the German paper, Chung found himself playing defense against one of his colleagues.

It was not what he expected when he was roped into the Big Ten’s project last month after student-athletes had already returned to campus to begin training for the upcoming season.

“But I have an enormous respect for Dr. Murthy,” he said. “I think he gave a critical appraisal of the science.”

Chung acknowledged there were inherent issues with the study and its relevance to college athletes, who are generally 18 to 22 and in top fitness.

Dr. Eugene Chung, University of Michigan Medicine cardiologist.
Dr. Eugene Chung, University of Michigan Medicine cardiologist.

According to the journal article published in JAMA Cardiology, the median age of the 100 test subjects who recovered from COVID-19 was 49 years, and 33 of them had severe cases that required hospitalization.

“I will admit the other studies are generally in hospitalized patients, older patients,” Chung said. “And that’s because it is still new. We’re still learning every week, maybe every day. But yet the calendar keeps moving.”

Chung explained the recommendations he and the two other doctors put forth to the Big Ten were based on more than the findings produced by the German research group. He also said he believes that the growing concern over cardiac complications from COVID-19 wasn’t the only factor in the conference’s decision to shut down sports for the foreseeable future.

That much was spelled out in a letter produced by league commissioner Kevin Warren posted on the Big Ten’s website Wednesday.

Warren noted the conference’s move to punt on the season was based on the ongoing spread of infection, the shortcomings associated with prevention protocols, concerns with the amount of testing supplies and the inherent problems related to high-contact activities such as football.

But he also acknowledged that the coronavirus’ effect on the heart was a consideration.

“There is simply too much we do not know about the virus, recovery from infection, and longer-term effects,” he wrote. “While the data on cardiomyopathy is preliminary and incomplete, the uncertain risk was unacceptable at this time.”

As Chung added, “We do feel like we should err on the side of caution until we know more. … We are hearing that in this relatively healthy population there are cases of myocarditis. So, that’s a concern.”

But how prevalent is the condition in student-athletes?

And has the medical community’s heightened awareness of possible heart damage in young individuals led to more testing and diagnoses of myocarditis in a low-risk group?

These are questions that have been posed by Murthy.

“We may be screening for it extremely aggressively,” he said. “You may find things that are below the threshold than we may have found in the past. You start seeing headlines that there are people that have minor cases of COVID who are likely to have serious heart issues down the line. There are people that are interpreting it that way, which I don’t think we should be doing that. There is not really a basis to think that way yet. I also think the likelihood of having asymptomatic or mild cases of COVID with marked damage to the heart is very unlikely.”

In the report produced by Chung, Emery and Rink that was obtained by Sports Illustrated, a return-to-play flow chart is included. If athletes contracted the novel coronavirus, they are recommended to refrain from exercise for 14 days regardless of whether they have symptoms. It’s also suggested they undergo examination with an electrocardiogram and echocardiogram while having their troponin levels assessed through the collection of blood samples. But Murthy said the findings from those tests can be skewed after intensive training and could reveal abnormalities when none may really exist.

“The case of how to interpret what those tests mean in the setting of an elite athlete may be really hard,” he said.

Then again, nothing has come easy since the onset of the pandemic, including answers about the long-term residual impact of COVID-19 on the heart and other organs in the body.

Chung, who used to be the University of North Carolina team cardiologist and launched the Michigan Medicine Sports Cardiology Clinic, is hopeful more definitive information will arrive in the coming months. But Cooper, who co-founded the Myocarditis Foundation, believes it will take years to understand the effects of the virus.

“This is an area that is terrifically important right now as we get into the fall sports season and it’s also an area where we have a substantial knowledge gap,” he said.

In football, decisions are made in a blink of an eye. A cornerback chooses to go for the interception instead of playing it safe. A quarterback picks out a receiver as he stares down a blitz. A running back opts to fight for more yards instead of going out of bounds. A coach elects to go for it on fourth down rather than punt the ball away.

“Unfortunately, science likes to move more slowly,” Murthy said. “It takes usually years to get to answers. We are being asked — and rightfully — to make important decisions in the short run and that can make it hard to identify what data are worthwhile and what data are not reliable.”

The German study, in his opinion, fell short of the goal line. So, he spoke up. And that’s how a Johns Hopkins-trained cardiologist, siloed in academia, found himself in the middle of one of the biggest sports stories this year.

Contact Rainer Sabin at rsabin@freepress.com. Follow him on Twitter @RainerSabin. Read more on the Michigan Wolverines, Michigan State Spartans and sign up for our Big Ten newsletter.

This article originally appeared on Detroit Free Press: Big Ten's football postponement spills into Michigan Medicine