The NBA bubble is perhaps the largest public demonstration of a space where the science of epidemiology is central to operations such as the finance office.
While the United States continues to face the aftermath of the largest pandemic in a century with around 4.25 million cases and nearly 150,000 deaths as of July 28, the NBA bubble is an important moment in modern epidemiology. It’s a great experiment on how technology, politics and human behavior affect an epidemic. And what can we do to stop it.
Milwaukee Bucks forward Giannis Antetokounmpo dribbles the ball during practice during the NBA shooting on July 27 in Orlando, Florida.
Bill Baptist / NBAE via Getty Images
“COVID-19 strikes like a protea disease, continuing to surprise and amaze even the most experienced clinicians for its various manifestations,” said Dr. Andre Matthews, assistant professor in the Department of Emergency Medicine at Emory University School of Medicine. “A consensus among doctors may very well declare COVID-19 the” greatest masker “that medicine has ever seen.”
The science of epidemiology has worked wonders for society, has greatly improved the quality of life of billions of people and saved an infinite number of lives. For example, epidemiologists have helped limit the spread of the 2014 Ebola epidemic and informed practices that have helped reduce malaria rates worldwide. Epidemiologists can track down a cholera outbreak, contaminated water supply, or help understand the spread of mumps virus on a U.S. warship.
The NBA bubble refers to the tightly controlled setting in which players live, practice and play to end the 2019-2020 season. The players were confined to a space reminiscent of a luxury boarding school, with prosecutors, escorts and rules. It contains extravagant details: the teams with the eight best records remain in the most recent of the hotels, the Torre del Gran Destino in Orlando, Florida, while other teams remain in the older hotels. Players are discouraged from spitting and licking their hands. Biometric devices are used to monitor vital signs. No guests are allowed in a player’s hotel room.
There are many rules. The policies governing entry and exit from the bubble are strictly applied. Anyone entering the bubble (players, staff or staff) is required to quarantine for up to 48 hours until they register two negative COVID-19 tests. Anyone who leaves the bubble must be quarantined on his return (up to 10 days) and will have to register two negative tests, in addition to an antibody test. Face masks are a requirement in all common settings.
Lebron James of the Los Angeles Lakers may be one of the most famous athletes in the world, but in the bubble, it is better that he does not leave without due notice.
Jesse D. Garrabrant / NBAE via Getty Images
Policies were developed as a collaborative effort among a range of experts, including epidemiologists who understand the latest sciences underlying the spread of coronavirus. These experts helped create a series of intervention-based policies – wearing masks, social distance, frequent tests – which have proven their effectiveness in minimizing the spread of coronavirus in many contexts. But the NBA is constantly re-evaluating and keeping up with the latest information on COVID-19 epidemiology so that the league can implement policy changes if necessary.
What makes epidemiology challenging in practice are the types of data it often requires: Large data sets containing information about collections of people, their disease status and other information about them (e.g., age, gender, ethnicity, residence, etc.). And since epidemics occur in the real world and not in the laboratory, ideal experiments can be difficult to find.
Epidemiology can thrive on existing large well-organized experiments, situations where groups of people are carefully studied for periods of time so that they can understand how a disease occurs and why it occurs in some populations. Famous examples include the Framingham Heart Study which has monitored cardiovascular health for several generations and the Nurses’ Health Study, which has focused on factors that contribute to chronic disease in women.
The NBA bubble has several characteristics of a large epidemiological experiment that can facilitate a better understanding of how coronavirus spreads:
Test every day. One of the biggest obstacles to COVID-19’s sophisticated understanding was the fact that the tests were not readily available. At the beginning of the United States epidemic, people suspected of having the disease had difficulty getting diagnosed. As tests will take place daily in the bubble, the NBA will be in a unique position to know the COVID-19 status of everyone living in the bubble. This will allow for rapid intervention, starting with the quarantine.
Knowledge of all subjects. The NBA bubble is a rare setting where a lot can be known about individuals in a physical space. This level of surveillance is inconvenient for some, but in the event of an outbreak, detailed information about individuals can be crucial. For example, some have begun to speculate that widespread differences in the experience of disease between individuals may have a genetic component. That is, some individuals may have a mutation that may make them more likely to experience serious illness. Since the NBA bubble is not inhabited by random individuals, it could be an opportunity to learn more about why some people have mild cases of the disease. This may include host genetics or diet, pre-existing conditions or past medical history. While the NBA bubble will be dominated by high-performance athletes between the ages of 20 and 35, it still contains a variety of players, coaches and staff who also embrace the age group. Variation is an important feature, as it can help experts identify models.
Ideal data for contact tracking. “Contact tracking” emerged as one of the phrases surrounding COVID-19. It refers to a public health practice to inform the close contacts of an individual who is positive that he may have been exposed to the disease and should enter quarantine or undergo immediate tests. It is a tried and true method that has been used for decades to track epidemics ranging from Ebola to sexually transmitted disease epidemics. It works best when it is widely adopted and when professional contact tracers have detailed information about everyone to whom an individual who has proven positive was close. The NBA bubble offers a huge opportunity for accurate contact traceability, as many contact events will be televised. For example, not only would experts have access to where a player who tests positive in the bubble resides (e.g., which hotel and which room), they would be able to study their patterns of physical contact with players from another team .
With all these features, what can we learn? The hypotheses are too many to consider: perhaps some teams will have cases, which will allow us to understand when they were infected, who they infected, where they were when they were infected, how long individuals spent among them that caused an infection.
We may learn that ventilation in some hotels may be higher, which explains why there were fewer broadcasting events in that hotel than others. Will the protection of another player in the paint be associated with a higher probability of transmission than the protection on the perimeter? Questions like this could answer the NBA bubble.
The hope is that there will be no outbreaks and that the NBA season will continue smoothly, unlike Major League Baseball. While this result would be the least eventful and the one that offered the least number of opportunities to know the spread of the coronavirus, it could also be the most significant: no event would tell us that the bubble was a success, affirming the practices implemented by the league to promote safety.
And in many ways, this lesson would be the greatest of all: in a dark summer, when COVID-19 cases continue to rise across the country, perhaps the NBA will remind us that the pandemic is conquerable when we follow science.
