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Risk of myocarditis -- a heart condition with potentially permanent consequences -- associated with COVID-19 may be the biggest obstacle to the fall football season.

At a Thursday telebriefing hosted by the Infectious Diseases Society of America, the National Collegiate Athletic Association's (NCAA) chief medical officer said he was aware of 12 recent myocarditis cases affecting NCAA athletes.

Brian Hainline, MD, said -- a longstanding and important topic in the college sports world, as congenital anomalies have killed dozens of athletes over the years -- has become "more rigid" during the pandemic.

Football players and others with fall seasons have been practicing throughout the summer with the expectation, or hope, of having games to play.

Hainline could hardly contain his frustration with the pandemic's continuing spread in the U.S. "We fully expected in the spring not to be in this place come fall," he told reporters on the call. "Where we are today, it's exceptionally disappointing."

Fears associated with myocarditis have in part to announce earlier this week they would postpone their upcoming football season until the spring.

But the other three -- Big 12, Southeastern Conference, and Atlantic Coast Conference -- football in the fall, as is independent Notre Dame. They might end up postponing to the spring, too, Hainline said, but have not made final decisions yet.

The conferences are making different decisions while utilizing the same data the NCAA provided, Hainline said. The NCAA is an umbrella organization to help govern them, but the conferences have final say on their football schedules.

Most NCAA fall sports have already been canceled or postponed until the spring in full, including football at lower levels. Big-time football can generate hundreds of millions of dollars for a school and its surrounding community -- especially at larger programs such as Clemson University of the University of Alabama.

"From 2017 to 2018, the University of Oklahoma football program generated $102.3 million, and the University of Georgia a hefty $129 million, leaving the department with $84.1 million in revenue after operating expenses were accounted for," . "Many college athletic departments are highly dependent on those funds."

If schools play football in the spring, Hainline said, the NCAA would then have to ponder how that would impact players' ability to recover in time to play a normal 2021 fall season.

NCAA institutions will make further decisions about whether and when to play other sports -- including men's basketball, with a tournament that in television revenue alone annually, according to reports -- based on COVID-19 testing figures and "where we are as a country," Hainline said.

Carlos del Rio, MD, of Emory University in Atlanta, told reporters on the call that many hospitals in his home state of Georgia are already at capacity. He questioned allowing schools to do anything that would further hamstring the capacity of the medical system in states such as Georgia, where the ACC's Georgia Tech and SEC's Georgia are still planning to play football in the fall.

Del Rio is concerned about athletes catching COVID-19 during organized sports activities such as practices and games, he said, but even more so about their safety away from sports. As millions of other students arrive in college towns this month, athletes are also likely to catch the disease during social gatherings, despite efforts to prevent it.

The potential for myocarditis is particularly concerning in the context of young athletes.

Also on the call was Colleen Kraft, MD, of Emory, who discussed the impact of myocarditis on people infected by COVID-19. While the statistics -- about 20% of COVID-19 patients suffer myocarditis -- do not sound awful, she said, that represents a large amount of human suffering.

Football is arguably the most contactful of all the major team sports. Distancing is antithetical to the game. If an infected player gets on the field, it's highly likely to spread to others. Although COVID-19 is usually mild in young people, the prospect of lingering cardiac damage is not easily dismissed. Players who develop it could have their careers derailed, not to mention suffering permanent disability or even death.

Under some situations, the NCAA is considering adopting the bubble format that the National Basketball Association and National Hockey League have modeled over the last two weeks, which has worked better than many dared hope.

Major League Baseball, on the other hand, has tried to keep a normal traveling schedule with far less success; one team had a series of positive cases and hasn't been able to play for weeks. The National Football League plans to follow baseball's model when its season kicks off Sept. 10, and Major League Soccer is attempting a hybrid approach when its season restarts Sunday.

But sports are of secondary concern, del Rio said, comparing disputes over whether to play college football to debating what time the band should play as the Titanic sunk.

Said Kraft: "Our focus really needs be in the here and now, and doing things within our power to control the pandemic."

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