While NBA teams are in the Orlando bubble, a question that has persisted since the beginning of the coronavirus pandemic is not only what happens if a player tests positive for the virus, but also what persistent effects could follow.
“There are unknown effects it has on lung capacity, unknown effects it has on heart health,” said an NBA general manager of a team entering the bubble, speaking on condition of anonymity. “What if a 24 year old captures him in Orlando and, in 14 days, puts him in quarantine and is well, but then he has these eternal heart problems? [Or he] it gets rewound so easily or becomes a little too susceptible to fatigue. … These are all the unknowns. “
There is a multi-step process for anyone who is positive and includes a two-week period – from the first positive test if the player remains asymptomatic or from symptom resolution – after which a doctor will make a decision that isolation may end. The player will then perform a cardiac screening according to the CDC criteria.
Each case will be handled according to your needs, but John DiFiori, NBA director of sports medicine, told ESPN that the timing for a player’s return from a confirmed positive case is at least two weeks.
“Everyone must understand that if anyone is positive, it is very likely that they will not return to court for at least two weeks – at least,” said DiFiori, who is also the head of primary sports medicine and is a doctor at the Special Surgery Hospital. of New York City. “It may be a little longer than that, depending on the individual circumstances, and therefore you will need some time to recondition.
“Those who have been out of training for two weeks will need time to recondition,” DiFiori continued. “These things are important for everyone to understand. The players, the coaches, the medical staff understand that if a player is positive, he will need time to cancel the management of the infections, and to recover the necessary time, therefore to start reconditioning for their sport. “
Matthew Martinez, a National Basketball Players Association cardiologist consultant, echoed ESPN separately at that point and said that rest is the key after a confirmed positive test because doctors believe that “the amount of heart damage can increase if you continue to exercise in the face of an active infection. “
Martinez said, “So you’re someone with low-grade fever and you have a few symptoms. And a week later, you’re okay. Do you have cardiac involvement? Now, if you’re a normal person, like me, and you’re going to do yours [two to three-mile runs] every day … it’s a different discussion than if you are a professional athlete.
“So this is why we worry that that high level of exercise intensity may increase the risk of having an adverse event when there is heart damage related to a virus.”
Any player who tests positive for the virus must undergo a “Pre-participation cardiac screening COVID-19” in accordance with the CDC protocols before starting the activities organized by the team, according to the league’s health and safety protocols.
The reason why the league and NBPA focused specifically on the heart is the myriad, but according to a note from the June 15 teams, the basis for cardiac screening during the pandemic is linked to the recommendations of the American College of Cardiology’s Sports & Exercise Cardiology Council, together with feedback from cardiologists consultants for both teams and those working with NBPA and NBA.
“They reflect a current consensus approach, recognizing that the full clinical picture of COVID-19 and potential effects on cardiac health, including in particular myocarditis, are not yet fully understood and could be changed in the future to reflect new information,” League has written in the memo.
Recommendations from the American College of Cardiology’s Sports & Exercise Cardiology Council indicate that “Acute heart injury … occurs[s] in 22% of patients hospitalized with COVID-19, 2 which is significantly higher than the prevalence of approximately 1% in acute non-COVID-19 viral infections “.
He also claims that myocarditis – an inflammation of the heart muscle – caused by an invasion of myocytes caused by the virus “could cause cardiac dysfunction, arrhythmias and death.”
DiFiori said that much of what the league and its partners have learned about how the virus affects the heart comes from studies on hospitalized patients with COVID-19.
“These data show that there are probably two different ways in which the virus can affect the heart,” said DiFiori. “One of these is a direct effect of the virus itself on the heart muscle and heart function, and the other is a kind of indirect response in which the virus stimulates a massive inflammatory response and that the inflammatory response can affect heart function.”
Regarding coronavirus, DiFiori said: “We know that individuals who contract viral diseases of a number of different types can develop myocarditis. It is quite rare, but we also know that exercise and training with a possible underlying concern for myocarditis can be important concern. So, we must be very careful with this possibility. “
Are the hearts of NBA players more at risk?
“We have no reason to believe that any athlete is at greater risk of heart complications and heart complications related to coronavirus than anyone else,” said DiFiori. “There is no reason why we know he would suggest it now.”
Martinez, who is also director of the Center for Sports Cardiology and Hypertrophic Cardiomyopathy at Morristown Memorial Hospital, said doctors also believe that pre-existing conditions such as hypertension, diabetes or a previous heart attack can increase the risk of COVID complications.
“In the NBA, we care a lot about the player’s cardiac safety and evaluate the risk-increasing diseases such as hypertrophic cardiomyopathy in which the heart muscle thickens due to a genetic predisposition,” Martinez continued. “For this disease, NBPA and NBA continue this tendency to take player safety very seriously.”
DiFiori acknowledged the questions that the virus may have persistent respiratory effects, especially for athletes.
“There have been discussions and considerations between the sports medicine community and cardiology and pulmonology specialists,” he said. “I think the reason we have focused more on the cardiac side now is because of the potentially serious immediate consequences in the short term of not handling this aspect very carefully.”
He added: “Myocarditis is a serious heart condition that you want to avoid and be managed very carefully if it develops.”
If cardiac screening were to reveal something unusual, then the next steps would be determined based on what was found, DiFiori said.
“It would be highly individualized, depending on the circumstances,” he added. “You can’t really summarize this in a small, clean package because it would obviously involve further diagnostic evaluation.”
As for any long-term problems, DiFiori added: “I think it is very difficult, I think, to advise anyone, whether you are an athlete or not, about potential long-term problems. The only thing we would like to say is to listen to your doctor and manage it appropriately. “
He added, “If you’re not feeling well, don’t try to make it. This isn’t a situation where someone, whether you are an athlete or not, should try to push or minimize the symptoms or try to ignore the symptoms and try to go through to try to continue working or continue practicing a sport. “
An NBA athletic training official from a team within the bubble pointed out that if a positive player shows symptoms, he would almost certainly not be able to perform any training or rehabilitation that would allow him to play immediately after two weeks or otherwise. for a long time they could be out.
The league and the NBPA have generally focused more on the heart in recent years and part of these efforts are related to the health selections that the NBPA has set up for retirees in the wake of numerous NBA retirees who suddenly die from heart problems. .
“Basketball players have the highest incidence of sport-related sudden cardiac death (SCD) in the United States among all groups of athletes,” reported a study by the NewYork-Presbyterian Hospital / Columbia University Medical Center. “The most common cause of [sudden cardiac death] for American athletes, hypertrophic cardiomyopathy (HCM), a condition that causes the wall of the left ventricle to thicken, forcing the heart to work harder with each beat. “
DiFiori noted that the league has contributed to the publication of numerous studies in recent years based on data collected in the context of routine cardiac screening, but is still learning more about the virus.
“It has been around for six or seven months now,” he said, “and we are learning that it is truly unique, and we don’t have a very good model in terms of other viral diseases that seem to be able to be constantly applied. And, therefore with this in mind, we must be very, very cautious in our approach. “
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