Canadian superstar Alphonso Davies resumed training this week, according to a photo he shared on social media, but the timeline for his return from a bout with myocarditis remains uncertain.
Davies last played competitively on Dec. 17 and has been sidelined entirely since early January, when routine follow-up testing after he contracted COVID-19 revealed the inflammation of his heart muscle.
Myocarditis enlarges and weakens the heart, can create scar tissue, and forces the heart to work harder to circulate blood and oxygen throughout the body. This type of inflammation can have wide-ranging effects — including fatigue, shortness of breath, heart palpitations and chest pain — though the vast majority of myocarditis cases overall are both mild and temporary.
Often, the exact cause of a case of myocarditis isn’t determined. However, viruses like SARS-Cov-2, the one that causes COVID-19, are commonly associated with the condition.
Bayern Munich manager Julian Nagelsmann, who Davies plays for in the Bundesliga, said at the time of his diagnosis that the ultrasound indicated his case wasn’t “so dramatic” but would still require time to properly heal.
In the intervening months since then, Davies has continued to make progress.
“The best case scenario for Phonzy is that his heart muscle inflammation is gone. However, if everything goes very, very well, he will miss three, maybe four weeks, because he is only allowed to undertake very moderate efforts the first week,” Nagelsmann said through an interpreter Saturday.
“Next week on Friday we have to do another MRI scan to check how he’s doing. The fluid from the pericardium is gone, everything looks good. We’re pleased and very happy with how it’s turned out and hope he finds his feet again quickly.”
The cautious approach aligns with medical best-practices for living with the condition, as severe cases of myocarditis — though rare — can be permanently damaging and lead to heart failure, heart attacks, arrhythmias or even sudden cardiac death. In athletes, myocarditis has been implicated in a significant portion of sudden cardiac death cases, up to 22 per cent, though a fatal outcome is still exceedingly unlikely overall.
What does the science say about athletes returning from myocarditis?
Medical literature on Covid-induced myocarditis in elite athletes is still emerging, given the small real-world sample sizes available due to the relative scarcity of athletes like Davies, and has been largely centred on prevalence of the condition and helping to craft return-to-play guidelines as opposed to charting long-term impacts.
One study, published in 2021, looked at 145 student-athletes from the University of Wisconsin who were recovering from Covid asymptomatically or with mild to moderate symptoms. Of these athletes, only two, or roughly 1.4 per cent, showed evidence of myocarditis.
This finding was largely reflected in a May 2021 cohort study, a type of research that looks at a group of people at different intervals over a prolonged period of time, examining 1,597 competitive United States collegiate athletes which found 37 of them — 2.3 per cent — were diagnosed with clinical and subclinical myocarditis.
Studies like these have helped inform a general belief that persistent myocarditis affects one to five per cent of athletes who contract COVID-19, making Davies developing the condition an extremely rare outcome of his infection.
Typically, if athletes are diagnosed with myocarditis, they are taken out of play for at least three months to give the heart a chance to heal, according to Nature, one of the foremost scientific journals in the world.
Editor’s Note: The COVID-19 situation, in sports and around the world, is constantly evolving. Readers in Canada can consult the country’s public health website for the latest.
How does this development fit into Canada’s bid for a World Cup berth?
When healthy, Davies is one of the most dynamic players on Canada’s roster, an electric scorer who is widely viewed as being among the best left-backs in all of soccer. His return, whenever it happens, instantly amplifies the country’s push for Qatar.
But it remains to be seen when his recovery will allow him to be part of the qualifying process — if it does at all.
Nagelsmann previously said it was “looking good” that Davies would be back for Champions League quarterfinals, which are slated for April 5-6 and April 12-13. That timing would mean Davies misses Canada’s last three qualifiers.
Canada, sitting atop the eight-team final round-robin in CONCACAF with a 7-0-4 record, has nearly secured its place in the World Cup. The team is set to play Costa Rica on March 24, and will then host Jamaica on March 27 in Toronto before finishing off in Panama on March 30.