sport
SI Survey: Doctors Say They’d Play in the NBA and NHL, but not NFL and MLB
Professional sports are back, but are they safe?
Leagues say yes. And the vast majority of athletes have chosen to compete. But doctors surveyed by SI tell a more complex story: They worry COVID-19 could cause many serious health problems down the road, and say that sports played outside a bubble are not worth the risk—even for young, healthy athletes who get paid millions to play.
Sports Illustrated asked doctors with expertise related to COVID-19 around the country: If your full income came from playing in one of the four major U.S. men’s professional sports leagues, how likely would you be to play?
The results were stark. Roughly 90% of the 146 doctors who responded to SI’s survey said they would definitely or probably play in the NBA (which has built a locked-down “bubble” in Orlando) or the NHL (which has two bubbles in Canada). But majorities said they probably or definitely would not play in the NFL (62%) or Major League Baseball (59%) under current protocols.
One doctor called MLB’s plan “a traveling infection hub.” Several doctors said MLB’s COVID-19 outbreaks—which have forced 14 teams to postpone 42 games—were easy to predict. Yet doctors said they would be even less inclined to play in the NFL, which has a similar plan to MLB’s, but for a more physically intimate sport. Parveen Garg, a cardiologist at USC, echoed several other doctors when he said, “You’re going to run into worse issues than what MLB’s been facing.” Only 8.3% of doctors said they would “definitely” play in the NFL if their full income depended on it. Before training camps began earlier this month, 67 players decided playing wasn’t worth the risk, opting out of the season (compared with the six, 10 and 19 players who opted out of the NHL, NBA and MLB, respectively). In light of the turbulence MLB has already experienced, many of the doctors SI spoke to doubted that the NFL will be able to play its full slate of 256 regular-season games, plus the playoffs and Super Bowl.
Top medical officials for the NFL and MLB say the doctors we surveyed don’t understand or appreciate their protocols. “I think if you go to a facility and you see what is being done and then you look at all of the aspects of the protocol, you begin to realize the lengths we’ve taken to ensure the safety of everyone that’s involved,” says Allen Sills, the NFL’s Chief Medical Officer, who is also a neurosurgeon at Vanderbilt. Both leagues say that they expect some positive tests, but their rules are stringent enough to keep infections to a minimum.
They also say protocols will evolve as circumstances do. MLB has tightened its restrictions as the season has progressed; the NFL released new gameday plans just last week. Gary Green, MLB’s medical director and a physician in sports medicine at UCLA, says, “If we’re able to complete the season, then what we put in place was successful.”
Doctors we interviewed say the plans are still too risky. They disagree about the number of likely positives, and also about the gravity of each one. They all have backgrounds in epidemiology, cardiology, pulmonology or nephrology; they have studied disease spread and/or the potential long-term ramifications of COVID-19. Their answers spawn from two widely accepted principles in the scientific community: One is that if you don’t completely lock down, there will be outbreaks. The other is that, with COVID-19, what doesn’t kill you can make you weaker. The death rate for pro athletes who get the disease is very low, but there is a range of possible short- and long-term effects. Most doctors we surveyed are so concerned by the potential for health problems—and by how much remains unknown about the virus—that, even if they were offered millions to play football or baseball this year, they said they would probably stay home.
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Benjamin Linas is an epidemiologist and associate professor of infectious diseases at Boston University. He is also a fantasy football team owner. Later this month, after his fantasy league holds its annual player auction, team owners will place side bets on when the NFL season will get shut down and which team will have the first outbreak. Linas—who said he would “definitely” play in the NBA or NHL, but would probably not play baseball or football—has a simple explanation for his skepticism.
“The reason is the bubble versus not the bubble,” Linas says. “The NBA and NHL have demonstrated if you really require it, you can do it.”
After some early positive tests and quarantines, the NBA and NHL bubbles have been virtually virus-free. Doctors mostly praised this system: They said that the strict lockdown should be able to keep infections at bay, and daily testing should catch any breach before it becomes an outbreak.
In Europe, where the virus is far more under control, many pro teams have been able to return to normal play and travel. But in the U.S., where the virus is still spreading rampantly, several doctors said anything short of a controlled clean site is probably doomed.
MLB eschewed a bubble largely for logistical reasons. “There’s no place that has five major league fields within a half-hour drive,” says Green. “That’s an ideal world, and it’d be great if we had a bubble and we had multiple fields where we could play and do that. But we have to operate in the real world.” He says MLB is considering instituting a bubble for the playoffs, when there are fewer teams to sequester.
The NFL’s Sills says his league has a “virtual bubble.” But other doctors say there is no substitute for an actual bubble. Shuta Ishibe, a nephrologist at Yale, says, “You just don’t know what everybody else is doing outside the [site].”
Baseball’s Marlins had an outbreak after (according to the team) players left their Atlanta hotel to get coffee. The Cardinals and Reds had outbreaks, as well. Most teams have had players test positive. The NFL has 32 teams, with 71 players on each, including practice squads, plus coaches and support personnel. Expecting that many people to be vigilant about social distancing for four months seems naive—and even if they are vigilant, there still might be outbreaks.
Efstathia Andrikopoulou, a cardiologist at the University of Alabama–Birmingham, says, “If you [live] at home, you have to control for not just who you are interacting with but who everyone else at home is interacting with.” She points out that the start of the NFL season coincides with the opening of the school year. Many schools are remote-only, but many are not. If NFL players follow every league protocol but still send their kids to school, they could expose their whole team to the virus. “Then it’s just anything goes,” Andrikopoulou says.
And even when the protocols appear to be working, teams are vulnerable to what UCLA pulmonologist Scott Oh calls “COVID fatigue.” As communities across the country have curbed the virus’s spread, people have often become less disciplined in social distancing and mask-wearing, leading to a resurgence. Athletes would be no less vulnerable to such a natural inclination.
Both MLB and the NFL spent extensive time developing comprehensive plans for the virus. But those plans, however well-intentioned, struck many doctors as incomplete, with too much focus on the games themselves. Gilbert Perry, a cardiologist at the University of Alabama–Birmingham, says, “The biggest risk is in the locker room and practice.” Critical-care doctor Scott Stephens of Johns Hopkins says, “It’s kind of sanitation theater. It probably doesn’t matter how quickly you clean the baseball. It matters how far you are apart from the guy who is infected, and whether you are wearing a mask.”
Stephens also says MLB’s up-to-48-hour lag time before getting test results reduces the effectiveness of testing. (The NFL has said it expects to receive results within 24 hours.) “You gotta dump water on it right away,” he says. “If you don’t, it’s going to explode in a hurry.” Linas says, “It’s always catch-up. They keep chasing tails.”
University of Washington epidemiologist Jen Balkus said she thinks it is inappropriate for leagues to devote resources to staging games while the nation fights the pandemic. But Balkus was the exception. Several doctors told SI they are huge sports fans and want the games back. They just don’t have faith in any plan that doesn’t include a bubble, and bubbles are hard to build.
“Baseball might be O.K.,” says Rich Krasuski, a cardiologist at Duke. “It’s a socially distanced sport anyway. It’s when somebody goes to a bar that you get in trouble. Football is not a socially distanced sport by a long shot, and it’s hard to bubble because of the size [of teams].”
SI did not survey doctors about college sports, largely because there are so many variables, with schools and leagues forming different protocols. (The Big Ten, Pac-12 and several other conferences have already canceled or postponed fall sports; several conferences plan to stage games despite outbreaks on numerous teams.) But Krasuski, who has season tickets for Duke’s football and men’s basketball teams, says, “I’m skeptical we’re gonna have a college basketball season.”
Stephens, the critical-care doctor, sees the NFL shutting down.
“I don’t have a crystal ball, but my guess is there is no way they finish the season,” he says. “I would be shocked. … [I’d be] happy to be shocked. It may not even be the players. It may be the referees. All the infrastructure people. The grounds crews. There is so much of a chance of a really significant outbreak.”
His pessimism about finishing the NFL season is widely shared. But that is not doctors’ main concern, and it is not why they answered the survey as they did. They have seen what the virus can do, they have suspicions about what it will do in the future and they are extremely determined not to get it.
“When you have lived this and taken care of these patients, it is very apparent how serious this is and how sick patients can get,” Stephens says. “All of us are really pretty careful about it.”
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One doctor called MLB’s COVID-19 plan “a traveling infection hub.” The Mets are among the teams that have missed games due to positive tests.
Erick W. Rasco/Sports Illustrated
The national conversation about COVID-19 has often been framed around the death rate, creating a perception that patients either die or recover fully. Every doctor who spoke to SI painted a very different picture.
“One of the guys I work with got it in March,” Duke cardiologist Stuart Russell says. “He still gets short of breath walking fast. He’s a normal, healthy 40-year-old. And who the heck knows what it’s gonna be over the next 10 years?”
Linas says, “Just from patients I have taken care of, a month out, there is no way they would have been able to go back to an NFL career. They were short of breath going up a flight of stairs, and they did get better. [These are] generally fit people who had quote-unquote ‘mild‘ COVID, didn’t go to the hospital, and didn’t need oxygen, and a month later they’re still short of breath.”
Garg, the USC cardiologist, says, “I don’t think the concern would be, ‘I’m gonna get the virus and I’m gonna be in the hospital and die.’ That’s possible, but I think you’re also grappling with this possibility that the virus could induce permanent damage in your lungs or your heart. That would hurt your ability to be a professional athlete. You’d also be concerned for your long-term health. There’s some serious impact even on young athletes who get this virus.”
Concerns about long-term health issues, particularly related to the heart, were central to the Big Ten’s decision to cancel its fall sports season, including football. Yale nephrologist Shuta Ishibe says, “Of course death is the worst thing. But there are chronic things that you don’t want. … There’s a significant amount of patients who get acute kidney injuries from this virus. Oftentimes the ones who go into the ICU require dialysis. Most of them have good outcomes in the sense that their kidneys will recover, but would I want to be on dialysis? No. We don’t know if they’ll recover to baseline. If not, your potassium intake would be limited. That affects quality of life.”
Red Sox pitcher Eduardo Rodríguez had COVID-19 earlier this year and then developed myocarditis, an inflammation of the heart, ending his season. University of Chicago cardiologist Atman Shah says, “He may just be the first one.” A recent study of recently recovered COVID-19 patients showed myocardial inflammation in 60 of 100 participants, “independent of preexisting conditions, severity and overall course of the acute illness.”
This might be of even greater concern for some elite athletes than for the average person. Oh says that according to the CDC’s framework, even though NFL players are fit, many linemen are technically obese, which is a risk factor for complications from the virus. “Particularly linemen, who are in each other’s space constantly,” he says. “The biggest players are at the biggest risk.”
Shah says the walls of the average U.S. man’s heart is between 0.9 centimeters and 1.1 centimeters thick. Elite athletes, especially larger ones, push themselves so hard that the walls often grow to 1.4 or 1.5 centimeters wide. When athletes retire, their biceps might atrophy, but the walls of their hearts do not. That increased thickness puts stress on the heart, putting them at greater risk for developing heart disease later in life. What happens if that athlete also gets COVID-19?
“We have no idea,” Shah says. “This is human experimentation on a scale we have never seen in our lifetimes. We have no idea what this does for reproductive abilities. We have no idea if there is a sterility effect—viruses in pregnant women have all kinds of effects. It’s easy when you’re 18 or 19 to say, ‘I’ll deal with it later.’”
It is also easy for a doctor to say, “I wouldn’t play.” Several of them acknowledged that the decision would be difficult. They tried to imagine themselves as healthy athletes with a relatively short time frame to chase a dream and all that comes with it. A seven-figure paycheck can change a person’s quality of life forever—even their life expectancy. But the flip side is that, if an athlete gets COVID-19 and loses even 5% of their long-term lung function, that could take the athlete from best in the world to fringe pro, depending on the sport.
Kamran Atabai, a critical-care specialist at the University of California–San Francisco who has treated between 50 and 100 COVID-19 patients, answered that he would “probably” play football. But there is a caveat: “If I was a young person and it was millions of dollars, especially in football [with short average careers], I think the risk-benefit ratio would probably make me play,” he says. “It’s not that I think it’s safe to play. If I had already made enough money to be fine forever and it was football, I wouldn’t do it. If I was Tom Brady, I would never be playing this season.”
Oh says, “If he’s got a $10 million contract, it’s like, You’re rich versus richer—take the year off.”
Garg says, “I think the problem we’re running into here is we just found out about this virus, like, eight months ago. We have no idea what will happen five years from now or three years from now because we don’t know anyone who’s had it that long. All we are seeing is that this is not like the flu. There’s vascular inflammation that occurs. This virus actually damages the vessels in our body. We’re seeing things we don’t usually see. We can only speculate.”
As the pandemic has progressed, he says, he has become less concerned about the period of acute infection. Hospitals have become better at managing care for patients in the throes of the virus. But the more he learns about the long-term effects, the more worried he becomes.
“We’re seeing some sporadic case reports of people who aren’t shaking it,” Garg says. “We do CT scans of these people a few months later and find permanent changes in their lungs. We don’t have enough time to know what’s going on. So my concern level is unfortunately going up a little bit because we’re realizing that, whoa, there may be some stuff that isn’t going away.”
The NFL’s Sills says, “We’re certainly aware of potential complications of this illness, just as we’re aware of potential complications of other illnesses that our players can have. I think this is a risk-benefit calculation that every person makes for themselves. For me personally, I would have no problem with playing under the current protocols.”
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Doctors are bullish on the NBA bubble, which has given stars like Giannis Antetokounmpo a platform to shine.
David E. Klutho/Sports Illustrated
On Sept. 10, Michael Matthay is scheduled to testify via Zoom before the National Academy of Sciences, Engineering and Medicine. The topic: various possible long-term effects of COVID-19.
Matthay, a pulmonary specialist at University of California–San Francisco, says, “We don’t have the data yet on long-term effects. You generally need at least a year to see.” But some COVID-19 patients develop acute respiratory distress syndrome (ARDS), and Matthay helped lead a study of ARDS, which was published last year. His team found ARDS patients “have consistently demonstrated a decrement in physical function” and that “long-term complications remain common and problematic for survivors.”
Matthay is a huge sports fan. He has attended seven Red Sox fantasy camps. He told his wife, when Giants catcher Buster Posey was weighing an opt-out, “This is a bigger decision than you realize.” He understood that Posey probably needs to add to his counting stats to make the Hall of Fame.
“Listen, I love sports,” Matthay says. “But I’m also a physician.”
If he were 23 years old and could make $10 million playing in the NFL this season, would he?
“I would not.”
Seven hours after Mattay testifies, Kansas City and Houston are scheduled to kick off the NFL’s 101st season before a limited crowd—up to 22% of capacity—that is supposed to socially distance. Chiefs lineman Laurent Duvernay-Tardif will not be on the field that night. He holds a doctorate in medicine, he has helped fight the virus at a long-term care facility in Quebec this offseason—and he has elected not to play football this year.
PREVIEW
ABOUT Benfica returns to competition, after a break from national team commitments, with the reception of Chaves this Friday, March 29, at 18:00 at the Estadio da Luz, in the game of the 27th round of the championship. Betkliche League.
Already preliminary press conferencewhich took place on the Benfica campus, Roger Schmidt emphasized that the team is in good shape meet with Chaveza rival who has nothing to lose when faced with the threat of relegation.
At the start of the decisive stage of the season, the coach remembered and praised that the Reds were still fighting for three trophies (Betklić League, Portuguese Taça and Europa League) and this was necessary. “We must use this opportunity and this moment to accelerate our highest level in everything.“, emphasized Roger Schmidt, distinguished Coach's Award at the ceremony dedicated to the 120th anniversary of the Club.
“We are in good shape, the first game is always demanding, but we are ready to play it.”
Roger Schmidt
What was it like preparing for this game against Chavez without any international players?
It was a typical international break, some players were with their teams, and I think it was a good opportunity for us to rest a bit and then get back to training. We did it very well and are excited to play again. Playing at home after the national team break is always a good start. All the national team players returned in good shape, a little tired, but without injuries. I'm happy with that, my biggest fear is always that they will get injured. We are in good shape, the first match is always demanding, but we are ready to play it. The decisive phase of the season begins and everything we have done over the last eight or nine months of this season had to be prepared for these weeks. We have six or seven weeks left to play, we still have three competitions to play and it really is a special season. When you can still win three trophies at the end of March, it's a very good season. Our task is to use this opportunity and this moment to accelerate to the highest level in everything. So, anything is possible. We have this expectation. For tomorrow [sexta-feira, 29 de março]Chavez and I know that this team is always difficult to play against. They are facing relegation, they have nothing to lose at our stadium. This is a good team, they have a good coach, and we have to solve this problem.
How did you feel when you left the Club’s 120th anniversary ceremony?
On Tuesday [26 de março], The gala was impressive. It always gives us a feeling of how great the Club is and how much love and passion there is in it. I'm always pleased to see that and how Benfica treats their history, former players and everything else. It's always something special and I'm so glad to be a part of it. We want to take this opportunity to please everyone around Benfica and within Benfica.
“Playing at home after the international break is always good”
Are you considering resting Otamendi and Di Maria for this game against Chavez before the two matches against Sporting? Is Ba suitable?
Of course they could rest. The question is: “Would it be beneficial for them to rest?” Both players like to play consistently and quickly. Sometimes they need a rest, like I gave Angel a few times. [Di María], when he played a lot of games in a row and there were big games ahead of us. Sometimes it makes sense to keep them out, but they are both key players for us and have performed at the highest level all season. I always have to make a decision about what is best for us and the players. Are they ready to play at this pace? They have shown this over the last 15 years. Are you ready to return to the club after the national team games and play again? They have also shown this over the past 15 years. I have no doubt that they are ready for tomorrow. [sexta-feira], play. Alex Ba is fine, we still have a little problem with load management, he had a problem and we want to be careful that it doesn't happen again. He's fine now, it was good not to play for the national team, he trained again and we tried to rest him at the right time. He's ready to play.
Di Maria has been going through a turbulent time for several days now: he and his family have received death threats. Is the player 100% physically and mentally ready for this game and the rest of the season?
What happened to him and his family shows how crazy the world is. It is catastrophic and catastrophic if something like this happens. It is clear that receiving such messages affects the player and the individual. We try to support him as best we can. He is professional and experienced enough to handle such situations, but such situations are completely difficult and rare, especially in a family. This is the worst thing that could happen, but we talked about it. He is trying to live a normal life. Of course, when something like this happens, some thoughts arise in your head, so we will try to support you as best we can.
“It’s time for all of us to show a very good attitude and performance on the field.”
In the last game of the championship, he said that a player who does what Kökçu did cannot be in the team. So, have you spoken to him? Can we expect him to be in the team for this game against Chaves?
As I said during the challenge with Casa Pia [26.ª jornada], my concern was to focus on the game. It would have been better not to mention him in this interview. He returned today [quinta-feira], we talked about it and it was actually exactly what I expected. It was not his intention to create this noise and negativity around our team. I already said before and after the Casa Pia game that I have complete confidence in him as a player, in terms of quality and also in his character. You made a mistake, this interview did no good to anyone. It was not good for us, for him and for Benfica, that's very clear. Now we have to deal with this. Even when players make mistakes, they are still my players, and sometimes I have to support them in difficult times. This is what we have to do, we've talked about it and now it's time to talk about it on the pitch. It's time for all of us, not just him, to demonstrate a very good mentality and performance in field. Everything that is not good for us, that can distract our attention a little, should be excluded. We have resolved this situation domestically and it is time to look forward. I'll be back tomorrow with the team [sexta-feira].
Kökçu was in the Turkish national team. Do you feel that your role in the national team is different from your role in Benfica?
I think I've said everything about Orkun. [Kökcü]. National teams and clubs are always different. These are different players, different tactical approaches. I don't think much about the choice. National team coaches have their own ideas, their own goals, and they must use the players as they see fit. I'm focused on what's happening here on our team, not just with Orkun. [Kökcü], but in general. Players who make it to national teams love to do it because it's a great honor for everyone. The national teams are preparing for summer competitions… These are two different things, and I am completely focused on the Club.
“Everything we did over the last eight or nine months of this season had to be prepared for these weeks.”
As for Juan Bernat, who was seen in training, will he be fit enough to contribute by the end of the season?
All of us, including himself, expected a different season. He is a very experienced player. Unfortunately, he came in with a minor injury, but he recovered and played a few minutes for us in five or six matches. Not full games, but a few minutes. He has been injured since the end of October, for five months now. I think now is not the time to think too much about next season, we need to think about it. He's working hard to get back on the field. He returned to training with the team this week, the first time in five months he has returned and we hope that he stabilizes with the workload, the football load and, of course, that he makes an impact in the last six or seven years. weeks. This is his situation at the moment. We are on a good track and we hope it will have a good impact at the end of the season.
Statements by Sergio Conceiçao after receiving the Golden Coach of the Year award at the Golden Dragons Gala
Golden Dragon cost: “I represent many people in this Golden Dragon. The first time I went to Olival with the president in 2017, he named the four essential pillars of FC Porto: rigor, competence, ambition and passion. Looking at it and being with it every day. My players, who don’t usually wear a formal suit as they do today, but the most competitive suit that is required, which is Pepe’s suit, give me great joy when I get up and go to work.”
Technical team and others: “With a super competent technical team, a health department, where there is not only Dr. Nelson Puga and therapists, but also an optometrist, pedologist, a number of people who work daily so that the players do not miss anything. and so that year after year they can get better and win, which is what we want.”
Techniques: “Victory. Not forgetting the people in the kitchen, in the restaurant, the people involved in analysis and observation, the equipment technicians, because today everyone is a technician… [risos]🇧🇷 Lawn techniques too, because I am very picky about the height of the lawn. I think that every detail is important and matters. Finally, a number of people who contribute to making this possible. This is not mine, this belongs to the people of Olival, who are always led by our great, my friend and godfather, the president.”
A family: “Finally, to paraphrase our Gonzalinho [Borges], I want to dedicate it completely to my family, which is not easy, and parents, as always. Not being among us, they will certainly be very proud, not least because they have received two more extremely important people in the life of the club and that together they are up there watching us so that FC Porto becomes bigger , was getting better. , become stronger and win. And let’s keep it up. Is always. Because we deserve it. We are also honest, serious, dedicated and competent workers.”
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