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It was public, shocking and very real. In a game against rivals Florida State on Saturday, University of Florida basketball star Keyontae Johnson, just 21,collapsed face down on the ground, unconscious. He was abducted by paramedics and taken to Tallahassee Memorial Hospital, where he was reportedly in critical but stable condition. His Gators teammates, some in tears, huddled in prayer, and after some discussion the game continued, with Florida State putting aside a comparatively insignificant victory.
While it wasn’t immediately clear what caused Johnson’s collapse, one of the details we already have is worrying enough: many members of the Florida squad, including Johnson,tested positive for COVID-19during summer.
And while I explain in a moment how these two events – the diagnosis of COVID and Johnson’s medical emergency – might be linked, we need to first step back and ask a much bigger question: given this that we already know about the spread of the virus. , why is the NCAA moving forward with basketball?
Nationally, the pandemic continues to rage. We are roughlyMore than 200,000 daily cases, a 30% increase over the past two weeks; 2,400 people die every day, up 67% over the same period. We know hospitals across the country are under criticism, with intensive care units (ICUs) nearing capacity. Staff shortages are real, health workers get sick or some even leave the profession, and hospital providers are exhausted,pleadinghelping the community to take the situation more seriously and stay home.
Anthony Fauci, the infectious disease expert leading our national COVID effort, the World Health Organization (WHO),Centers for Disease Control(CDC) —All recommended restricting large gatherings, prioritizing outdoor activities over indoor ones, and staying 6 feet or more away from those who don’t live in your same household. They recommend limiting participation in indoor training sessions, as well as wearing masks.
Playing basketball indoors goes against all of these recommendations. How much closer can you be to someone than when you are face to face holding them on, breathing heavily, bumping into each other, in the midst of dripping or flying sweat? (Anyone who considers basketball a contactless sport has never played it at the higher levels.) Travel to various cities, stay in hotels, visit various schools and facilities, and then return to their own college community – none of the above. it doesn’t make sense medically, and it’s dangerous.
It’s almost like the NCAA doesn’t know about COVID-19diffusion of droplets and aerosols, which is frankly hard to believe. Time and time again, we have seen epidemics occur in indoor environments such as restaurants, bars, church services and weddings etc. We now also understand that via aerosols, the coronavirus can spread even greater distances – 20 to 30 feet – and can linger in the air for minutes tohours, infecting others. Last week, a study byKoreareported a documented case of coronavirus transmission indoors after just five minutes of exposure without any direct contact – from 6 meters away.
“Indoor basketball increases the risk of COVID-19 in multiple and disturbing ways,” said Lupita Montoya, an indoor air quality and aerosol specialist at the University of Colorado. “Aerosol generation of players is increased by physical activity, not decreased by a mask.”
Is it any wonder that 15 to 20 college basketballcoacheshave already tested positive for COVID-19, or that several teams have players who tested positive, or that there have been a multitude of game cancellations? Keep in mind, the collegeseasondidn’t start until November 25th.Duke, USC, Florida A&M,George mason, Towson, Baylor, theConnecticut Women’s Team, Utah, the state of Wichita, Tennessee and many more have canceled games because of at least one player or staff member who tested positive for the virus.
This raises the question of why. Why are we playing college basketball, exposing athletes and coaching staff to a deadly virus? The NBA, with all its protections and testing ability, still had48 out of 546 playerspositive test in the last week of November – almost 9%. (The pro league is not bigthe same “bubble” conditions that kept players and staff from getting infectedduring the NBA playoffs earlier this year.) College players and teams, meanwhile, don’t have the same resources as the pros. What will be their percentages of positive tests? And why take this risk?
The short answer is that there is a lot of money at stake. Basketball producedover $ 1.1 billionfor the NCAA in a normal year, which includes the March Madness tournament, a huge source of income for the organization. But just as this tournament was canceled last season, this whole 2020-2021 schedule should be reconsidered.
A disturbing link
We have no idea at this point if the Keyontae Johnson collapse is related to COVID-19 or something entirely different. But you can bet his doctors will be assessing the COVID angle.
What we do know is that, in general, there are multiple possible etiologies of sudden loss of consciousness in athletes. The causes can range from something as mild as dehydration to much more serious health problems. Hypertrophic cardiomyopathy, a disease in which the heart muscle becomes abnormally thick, is a common cause of cardiac death in competitive athletes. But another culprit in incidents like this is heart disease closely linked to COVID: myocarditis.
Myocarditis is a rare disease that is usually due to either an unknown cause (“idiopathic”) or a viral disease. This leads to inflammation of the heart muscle, which can affect its ability to pump. It is known to occur more frequently inmalesthan women, aged 20 to 40, and can cause severe arrhythmias, unconsciousness, heart failure and even sudden cardiac death.
According to some scientific reports, as many7% of deathsof COVID-19 can result from myocarditis. (Others think the estimate is too high.) Arrhythmias have been shown to be quitecommonamong patients with COVID-19.
In COVID patients, myocarditis appears to result from direct infection from the virus attacking the heart, or perhaps from inflammation triggered by the body’s overly aggressive immune response. At the autopsy,researchersto havereportedthe presence of viral proteins in the heart muscle of deceased patients – viral involvement is therefore possible, although the true etiology may be multifactorial.
According to reports, cases ofmyocarditishave been seen both in patients during their acute COVID illness or hospital stay and in the many weeks or even months after infection, even in those who only suffer frommild or asymptomaticdisease initially.
The true incidence of myocarditis developing in recovered COVID patients is not known. But a non-peer reviewedstudy, involving 139 healthcare workers who developed coronavirus infection and recovered, found that around 10 weeks after their first symptoms, 37% of them were diagnosed with myocarditis or myopericarditis – and less than half of them had symptoms at the time of their exams.
Likewise, a smallstudyfrom Ohio State University reported 26 COVID-positive male and female athletes in various sports, all of whom had mild or asymptomatic COVID-19 during their illness. Using cardiac magnetic resonance imaging (MRI) scans taken between 11 days and almost two months after the athlete’s recommended quarantine, researchers found that 15% of athletes (all males) had results suggestive of myocarditis and 30% had changes consistent with heart injury. theBig tenThe conference, to which the state of Ohio belongs, reported that 35% of its COVID-positive athletes had myocarditis.
Statistically, most young people do fairly well with the coronavirus (but not everyone), but the long term is also an issue. We know of tragic cases like that of a former Florida state basketball playerMichael Ojo,died of suspected heart complications just after recovering from a COVID-19 fight in Serbia, where he played professional ball.
In college football, Indiana University offensive lineman Brady Feeney treatedpossible heart problems. University of Houston player Sedrick Williamschose to withdrawof the season because of “complications with my heart”. From the ranks of college and pro sports, there are many more stories like this.
And we haven’t even discussed the “long haul” people who experience worrying symptoms for weeks or months after their initial illness: shortness of breath, fatigue, chest pain, recurring fevers, “brain fog” and so on. Some of them areyoung and healthy peoplewhich hadBenignor even initial asymptomatic COVID infections.
My son was a college athlete. I understand how well these athletes train, how much they want to compete and how much fun and joy games bring to sports enthusiasts. I also know how important college athletics is to universities and their results, and how much is generated by TV revenue. On so many levels, I understand and pray for Keyontae Johnson’s safe recovery. But one dead player is too many, and another unconscious pitcher on the basketball court should make us reconsider completely what we’re doing here.
With the findings of myocarditis and other conditions in COVID-positive athletes, and the real potential for long-distance symptoms in previously healthy young adults, it is irresponsible to continue indoor sports at this point. We know enough now. The vaccines are on their way. Let’s postpone this six-month season in order to vaccinate the players when the shots become available.
For the 2020-21 college basketball campaign, August Madness is clearly the way to go. It may not have the same ringtone. Again, nothing about this pandemic is normal.
Carolyn Barberhas been an emergency physician for 25 years. She is co-founder of the Homeless Work ProgramWheels of changeand the author of numerous articles and a new book,Fugitive medicine: what you don’t know can kill you.
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