Since the beginning of the COVID-19 pandemic, Safe Sports Network has stayed up to date on the latest research to ensure the safety of our staff and student-athletes. Based on the best available evidence and recommendations from the State of NH and the CDC, Safe Sports has enacted various policies and procedures which can be found here.



The content listed on this website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

If you think you may be having a medical emergency, call your doctor, go to the emergency department, or call 911 immediately.



Since the onset of COVID-19, there has been a lot of unknowns regarding long term health effects from the Coronavirus disease. One of the growing areas of concern recently has been cardiac health. Currently, the prevalence and clinical implications of COVID-19 cardiac pathology is unknown, but it has suspected correlations to myocarditis (inflammation of the heart) and other cardiac injury. Myocarditis preceded by a viral infection is one of the leading causes of sudden cardiac death in sport. Because of this, and the many recent cases of myocarditis found in young athletes in recovery from COVID-19, special considerations should be taken to assist in identifying when an athlete is safe to Return to Play (RTP) after a positive COVID-19 diagnosis.


Safe Sports Network has developed a COVID-19 Return to Play Protocol as a safety precaution for any youth student-athlete returning to sport after testing positive for COVID-19. This applies to both symptomatic and asymptomatic student-athletes. The recommendations within this protocol are consistent with those from the American College of Cardiology, American Academy of Pediatrics, the National Federation of State High School Associations and the American Medical Society for Sports Medicine, as well as guidelines for Graduated Return to Play (GRTP) as set forth in the British Journal of Sports Medicine, and through consultation with the Safe Sports Network Medical Director.


Click on the buttons below to view a specific portion of our COVID-19 Return to Play Protocol

Quarantine/Isolation and Physical Rest:

A student-athlete who has tested positive for COVID-19 shall remain in isolation for at least 10 days and follow all instructions given to them by the State Health Department and School District. During this isolation period, all student-athletes should engage in physical rest and should not engage in any exercise outside of activities of daily living.

Evaluation & Clearance by Medical Provider:

Once the COVID-19 positive student-athlete has completed the recommended quarantine/isolation period and has been released by the State Health Department, they should undergo an evaluation by their medical provider, prior to returning to any physical activity. All Safe Sports Network student-athletes are required to provide written medical clearance to their school’s Athletic Trainer prior to beginning the Graduated Return to Play (GRTP)


Cardiac Testing:

The clearing physician may determine further tests are necessary before the student-athlete can return to sport. If so, the following tests may be useful for any student-athlete who had mild, moderate or severe symptoms


  • Troponin: A blood test to detect levels of Troponin in the blood. When there is damage to the heart muscle cells, troponin is released into the blood.
  • Electrocardiogram (ECG): Records the electrical signal from your heart to check for a variety of heart conditions.
  • Echocardiogram (echo): Uses ultrasound to assess how your heart muscle and valves are working and their shape and size.


Further cardiac testing may be deemed necessary by a Cardiologist to confirm suspicion of myocarditis


  • Cardiac Magnetic Resonance Imaging: Imaging that uses radio waves, magnets, and a computer to create detailed pictures of the heart anatomy and function


Graduated Return to Play (GRTP):

The GRTP can be started after 10 days from diagnosis, as long as the student-athlete has been symptom free for 7 days and received clearance from their medical provider. The GRTP will take a minimum of 7 days to complete. The student-athlete may progress to the next phase after 24 hours and no return/development of symptoms, including excessive fatigue. The supervising clinician (e.g., Athletic Trainer) should monitor heart rate, rate of perceived exertion, fatigue, breathing patterns and muscle soreness during each phase. Student-athletes with persistent return of symptoms should be referred to their physician to undergo further evaluation and testing to exclude heart or lung disorders, if deemed necessary by the physician.


Estimation of Maximum Heart Rate:

In order to complete the following GRTP, student-athletes must estimate their Maximum Heart Rate (Max HR). Please use the following formula to estimate your Max HR:


  • 220 – Age = Max HR
  • For example, a 16-year old’s estimated Max HR would be 204 beats/minute (bpm)
    • 220 – 16 = 204 bpm


GRTP Phases:


Phase 1:


  • 2 Days of Light Activity
    • Less than 15 minutes ( <70% Max HR)
    • Activities can include walking, light jogging, stationary biking. NO strength training.
    • Goal: Increase Heart Rate


Phase 2:


  • 1 Day Aerobic Exercise
    • Less than 30 minutes ( <80% Max HR)
    • Activities can include simple movements and running drills. NO strength training.
    • Goal: Gradually increase load and manage any post viral fatigue symptoms


Phase 3:


  • 1 Day Simple Sport Activities
    • Less than 45 minutes ( <80% Max HR)
    • Activities can progress to more complex training activities
    • Goal: Increase exercise coordination and assess functional skills


Phase 4:


  • 2 Days of Sport Specific Training
    • Less than 60 minutes ( <80% Max HR)
    • Activities can progress intensity in sport specific training
    • Goal: Restore confidence and assess functional skills


Phase 5:


  • 1 Day of Normal Training Activities
    • Full duration of at least one training session/practice
    • Goal: Restore normal training progressions


Phase 6:


  • Return to Competition with no Restrictions

Continued Monitoring Post COVID-19:

After completing the COVID-19 Return to Play Protocol, the student-athlete should be monitored for several weeks. Children younger than 21 years of age are also at risk of developing Multisystem Inflammatory Syndrome (Mis-C) several weeks after COVID-19 infection. Student-athletes should be continually monitored for the following signs and symptoms, even after successful completion of the GRTP:


  • Persistent fever
  • Abdominal pain
  • Vomiting or diarrhea
  • Skin rash
  • Hypotension (low blood pressure) or shock


Presence of any of the above signs or symptoms warrant immediate medical care.