Lowe: The enormous risks and stakes driving the NBA’s safety discussions

Lowe: The enormous risks and stakes driving the NBA’s safety discussions

Jun 12, 2020

  • Zach LoweESPN Senior Writer

In theory, you could pull it off without a hitch: About 1,500 people test negative for the coronavirus — several times — before entering the NBA’s proposed “bubble” at the ESPN Wide World of Sports Complex in Orlando, Florida, they interact with almost no one else, and the league emerges three months later with 1,500 healthy people and one champion.

“If you have [1,500] people quarantined without contact with others, assuming none of them bring coronavirus into the bubble, then none of them will get it,” said Sandro Galea, an epidemiologist and dean at the Boston University School of Public Health. “In some respects, it is that simple.”

Of course, as Galea and other experts caution, reality is more complex. One renowned epidemiologist chuckled at the very notion of a “bubble” approaching 2,000 people. There are weak spots, potential gaps where the virus could seep in. The NBA knows. League officials consulted with dozens of experts in crafting the set of health protocols — expected to be sent to teams soon — with an eye on closing as many of those gaps as possible. They will encounter unanticipated hurdles in Orlando.

“They are going to see things on the ground they did not expect,” said Steven Pergam, an associate professor at the University of Washington and infectious disease specialist at the Fred Hutchinson Cancer Research Center.

Daily coronavirus testing and frequent temperature checks are designed to make up for any pinprick in the quarantine — a Disney staffer who introduces the virus, a corrupted hotel surface, a player or family member leaving the bubble and returning with the virus, something else unforeseen.

Exact testing and other rules for Disney staffers were unclear as of late Friday. Sources around the league have told ESPN they expect some kind of tiered system in which Disney employees who interact more frequently with players and staff — bus drivers, for instance — might be subject to more medical monitoring, including some testing. Others will be asked to maintain a safe distance and wear masks, sources said.

“The main potential weak point is how those employees interact with [NBA] staff,” said Ashish Jha, director of the Harvard Global Health Institute. “But you can manage it in ways that do not create a whole lot of risk.” Jha and other experts added that monitoring player and staff movement for purposes of contract tracing would be ideal — the German Basketball Bundesliga is doing this — but such strict surveillance is probably a nonstarter for the players’ union.

Even the most reliable coronavirus tests still return false negatives, experts said. That’s where temperature checks come in: If a player or staffer who tested negative the night before and feels fine registers a fever in the low 99s, officials can isolate that person immediately.

“The NBA’s plan is pretty good and comprehensive,” Jha said.

Testing every day minimizes the damage of any one false negative. Miss the virus one day, you’ll probably find it the next.

“Tests aren’t perfect, and you might miss it once,” said Abraar Karan, a physician at Harvard Medical School and Brigham and Women’s Hospital working on COVID-19 response in Massachusetts. “You won’t miss it testing every day.”

Even if a player somehow practices or plays one day with the virus, there is no guarantee he will transmit it to anyone else.

“The person has to be at just the right point in the infection where they are very contagious and the viral load is very high,” Karan said.

But there will always be cracks, experts said: a player/staffer who drew a false negative hours earlier, shows no fever, but has the virus and is some level of contagious. (Several epidemiologists cited an early study that found about one-third of almost 6,000 coronavirus patients hospitalized in New York City arrived with no fever.) Some team personnel speak of someone contracting the virus as a “when, not if” scenario. Others are more optimistic — provided the league can maintain the integrity of the bubble.

Living in the bubble was always going to be unpleasant. It would remove players from historic protests against police brutality and racial injustice. A league of primarily white governors organizing a quarantine of primarily black players carries uncomfortable connotations.

As the reality of all this becomes imminent, some players are expressing discomfort about living in semi-isolation for at least several weeks, according to reports from ESPN’s Adrian Wojnarowski.

Incidentally, this is one of several reasons why it was somewhere between baffling and irresponsible that the league invited two teams — the Washington Wizards and Phoenix Suns — who had basically zero chance of making the playoffs before the NBA suspended the season. Phoenix still has to jump four teams standing at least two games ahead of it just to make a play-in tournament in which the Suns would presumably face a severe disadvantage. One month of isolation for that?

(There are even executives worried that teams down 2-0 in the first round, with no home games looming, will not bring what we are accustomed to seeing as “backs against the wall” effort. I have more faith in players feeling the usual competitive juices, but that line of thought is out there.)

Phoenix and Washington are there mostly if not entirely for financial reasons: more teams, more games, more recouped money. (About half that money goes to players.) More bodies creates more potential viral hosts. It is fair to ask: If health were the No. 1 governing factor in the decision-making process of a contact sports league, would any league gather to play right now?

Several epidemiologists found the question both pressing and a little facile.

“[People] do care about more than only physical health,” said Jha, the director of the Harvard Global Health Institute.

Still: Basketball is not tennis or golf — sports of natural physical distance. It takes place indoors, where air recirculates. Even with no fans and limited media, sweaty players will bump together for hours at a time.

“The players will be breathing hard on each other, which seems likely to be able to transmit the virus based on what we know now,” said Steve Mooney, an assistant professor of epidemiology at the University of Washington. “If one player gets sick, I’d expect others will too.”

Several experts cited a study from South Korea that showed the virus spread much more easily in high-intensity exercise classes — heavy on rapid breathing — than in yoga classes taught by an instructor with coronavirus.

Some within the league have speculated that a huge gym, emptied of fans, with a very high ceiling will not carry the same risk of transmission as an office building. Experts conceded rooms with low ceilings and recirculating air are probably worse but cautioned against attaching too much significance to ceiling height.

“The primary mode of transmission is large respiratory droplets which don’t hang in the air so much as they drop by gravity,” Karan said. “So if you’re indoors, I’m not sure high ceilings are helping as much as you would hope. All of these things point to a potentially high-risk situation.”

It is unclear what the league might do if a team suffers an outbreak that removes enough key players at once as to render it unrecognizable. The current calendar — Game 7 of the Finals on Oct. 13; next season beginning in early December — offers little to no wiggle room for an extended delay of any playoff series. The NBA could push next season back, but it is wary of infringing on the 2021 Olympics (should those proceed), sources said.

Team insiders have drawn hope from the fact that no one else in the Utah Jazz traveling party contracted the virus despite playing next to and traveling with two players — Rudy Gobert and Donovan Mitchell — who had it.

Older coaches and staffers are at higher risk for worse outcomes if they catch the coronavirus, and it remains to be seen how the NBA might ask them to adjust their behavior — wearing masks, distancing measures — in Orlando. As Wojnarowski and I reported, legal experts said the league has very little basis (if any) for barring any team employee from attending Orlando. Players and staff will be allowed to opt out, though players who do so will not be paid for games missed, sources have told Wojnarowski.

No one knows what kind of long-term effects the virus might inflict even among those who show few symptoms and recover quickly. Sports scientists also are concerned about the injury risk of transitioning from three months of relative isolation into high-stakes games.

One way teams might adjust is by holding fewer traditional high-intensity practices, experts suggested. Even a walk-through might bring less risk of transmission than a full-on practice.

Coaches might balk at that. The postseason typically provides time for real practices and film sessions. But everyone is going to have to sacrifice for this thing to have a real chance.

Of course, the NBA had the option of not doing this at all — and waiting until the fall or winter to see if it might be safer. Coronavirus cases are increasing in Florida. If physical health were the only governing factor in anybody’s decision-making, everyone might remain in some degree of self-isolation.

That is plainly not what is happening around the United States as communities reopen. Some might be doing so too fast, but even epidemiologists — a cautious lot — concede that humans are built to prioritize physical health above companionship and routine (and, yes, money) for only so long.

“There are a lot of benefits of having sports,” Jha said. “An entire year and a half without sports would be painful for our country. I’m supportive of attempts to try to get sports back.”

The NBA is not the only contact sports league — not the only basketball league — to attempt to restart in a bubble-style atmosphere.

“There are trade-offs to everything we do,” Karan said. “Everything going on, including protests and reopening the economy, is about mitigating risk.”

There is a broad continuum between self-isolation at one extreme and normal, packed-together life at the other, as Julia Marcus, an epidemiologist and professor at Harvard Medical School, wrote in The Atlantic last month.

The NBA has tried to land on the appropriate spot along that continuum.

“There is a point in time where we need to start challenging the edges and doing some of the things we would normally do,” Pergam said. “These choices are not easy for anyone. The NBA has approached this in a thoughtful way. The way they have done it is about as good as it could get.”

The league might argue that players will be safer in the bubble than in regular society given the pace of reopening in some communities. But every player (and staffer) is different — with different levels of risk tolerance, different private habits. Absent the NBA’s restart, some might feel comfortable going to the grocery store and seeing friends — but not playing full contact basketball. Others might play pickup.

Commissioners across several leagues have echoed Jha’s thoughts about the healing power of sports. But for the broader population to enjoy that healing power, a small subset must quarantine away from loved ones. Are sports leagues trading the mental health of a few for that of the many (and, of course, money)?

“There are questions of the mental health of those who are quarantined — which we know is an issue — and the social value of what we are trying to achieve,” Galea said.

Some players are understandably agonizing about detouring to Orlando during such a momentous time of nationwide protest against racial injustice, sources said. Garrett Temple, vice president of the players’ union, argued this week that playing and earning their paychecks is an effective means of countering systemic oppression of black people, ESPN’s Malika Andrews reported.

Players also could find ways to protest in Orlando, including by testing the league’s commitment to its on-paper rule that team personnel stand for the playing of the national anthem — provided the league plays it to empty arenas, and shows it on television.

In about every possible way, the stakes are enormous.

“If this doesn’t go well, the fallout will not be positive for anyone,” Pergam said. “They want to protect their players, but an outbreak would be really hard to deal with. It would have long-term consequences. Fair or not, people would look back retrospectively and ask: Did we have to do this?”

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