By: Dr. Nirav Pandya 
Assistant Professor, Orthopedic Surgery, UCSF 
Twitter: @drniravpandya

For many of us in the medical community, we had become increasingly aware of COVID19 in the early part of 2020. Yet, March 11th still represented a watershed moment in defining just how serious this disease was – the cancellation of the NBA season after Rudy Gobert’s positive test.  The removal of something which we had come to integrate into our daily lives as fans was shocking and unsettling. The successful implementation of the NBA bubble in July gave us hope that we could return to some degree of normalcy in what was now clearly a pandemic.  Yet, nearly10 months later, we are seemingly back to where we began – multiple games cancelled and numerous players testing positive for COVID19.   

A quick look at the numbers demonstrates a contrast in COVID’s impact.  In the bubble, there were no positive tests.  Prior to the start of the current season,  48 players tested positive.  As of January 6th,  16 more players have joined the list.  Why is this occurring?  The NBA bubble was a case study in how to control a virus: test frequently, isolate / quarantine if needed, and create a pod in which it is hard for infection to be introduced.  These protections are now gone.  

Starting the season in the midst of a national surge due to the holidays doesn’t help. Having NBA players travel more frequently than their NFL and MLB counterparts places them at greater risk of exposure.  Playing indoors without any degree of social distancing for extended periods of time is a set-up for failure.  Yet, fans are increasingly confused amongst a slate of cancelled games, and players embedded in health and safety protocols. 

To understand the various NBA protocols surrounding COVID, a quick refresher on how the disease transmits is critical.  COVID is spread from person to person via respiratory droplets. Using CDC guidelines, if a player is COVID positive they typically must isolate (not come in contact with anyone) for 10 days from the time symptoms started and not have had a fever for at least 24 hours. Then the clearance process can begin for each athlete to return to play.  For players who were asymptomatic, the return process could be quite rapid. For players who had more severe symptoms, it could be several days if not weeks before they regain the strength needed to play at the elite level of the NBA  

The tricky part is dealing with the players who may have come in contact with someone who was COVID positive. For contact to be considered significant enough to warrant quarantine (not leaving your home), you have to be within 6 feet of a person for at least 15 minutes.  This clearly means that playing a basketball game against other grown men will likely lead to a lot of exposure.  As a result, players identified as having been exposed have to wait until their quarantine period is over and/or test negative before they can play.  Even more important to note (and the reason why players need to quarantine for extended periods of time after exposure) is that a single negative test doesn’t mean you are disease free.  It can simply mean the virus has not replicated at a high enough level to be detected (but can still spread) early on during infection.    

This is where the NBA (unlike the NFL and MLB) can be impacted significantly by only 1-2 players testing positive. With contact tracing and testing needing to occur, multiple players can be sidelined while awaiting clearance. This can profoundly impact a roster of 12-15 players. In a very short period of time, 7-8 players may only be available to play 48 minutes of elite level professional basketball.  This not only makes a team instantly less competitive, but also tremendously increases injury risk for those players who have to significantly increase their minutes played. In essence, the NBA has gone from load managing players to a situation in which players will have their load mismanaged due to excessive playing time if COVID hits their team hard. 

To be honest, there is no easy solution. We all want basketball to continue (and I am as big of a fan as all of you), but it may be time to pause the season for a 14-day period to allow the league to re-calibrate and prevent further spread.  From a 10,000-foot view, we are asking athletes to play a non-socially distanced sports, travel across the country, and return to their homes/communities in the middle of a surge. Hospitals are over-whelmed, ICU’s are filling up, and healthcare systems are being pushed to the limit.  COVID isn’t a fan of the Warriors or the Rockets; it’s a fan of susceptible hosts.  Players are embedded within their community as well and have families who may be at risk and/or who can spread to those around them.  We also still don’t know the long-term effects of COVID19 on the body, particularly the heart and lungs.  We can throw our arms up when our teams lose and be upset when a player has to sit out games when they are recovering; but for many of the players who test positive returning to high level athletic activity carries risk. 

We need sports in our world to give us a sense of normalcy in a chaotic, scary time.  Sometimes the best way to do that is to recognize the limitations of what we are faced with, and reverse course.  There is light at end of the tunnel DubNation.  Vaccines are rolling out and new treatments are available to decrease the severity of the disease. In the meantime, let’s mask up, watch Wiseman grow, and appreciate what will hopefully be a playoff run when cases are under control.