Examining the resumption of sport

It is approaching a year now since the world was shaken by the COVID-19 pandemic. Never in history had every individual in the world been simultaneously affected by a single event. By the end of March 2020, all sporting activities ceased globally while efforts were being made to understand the virus and how to combat it. Initially, lockdowns and suspension of sporting activities were employed. When it became clear that the virus was here to stay, efforts were shifted towards how to resume sport. The first international sporting event to resume in July 2020 was Test cricket with the West Indies’ tour of England. That was through a carefully constructed biosecure bubble that saw players from the Caribbean, many of whom were in countries which had no airlift, being transported to one of the most infected countries in the world, but into a secure environment. Within months, the West Indies Women's team similarly toured England while the Caribbean Premier League was successfully held in another biosecure bubble that saw over 200 persons from 18 countries and every continent coming into Trinidad and Tobago. That competition, too, had no adverse incident. Since then, many similar tours have been successfully organised within biosecure bubbles all through expertise available locally and in the region.

During this time, methods were being analysed to determine how to safely resume sport around the world. Sports were stratified into low, medium, and high risk based on their propensity to spread the virus. Those sports, which were, by and large, individual such as golf, swimming, and field events were deemed low risk. Tennis, track events, cricket, and similar team sports were medium risk, and football, basketball and netball were high risk based on the level of close contact between the players. Whereas it is known that a six-foot distance is generally safe between people, this is not so among people who are running, panting, shouting, and then coming into close contact. Often, distances of over 15 feet need to be employed.

Two approaches to return to sport have been adopted: the use of biosecure bubbles and the use of frequent testing as a screening method. Whereas biosecure bubbles have proven to be the better, they are expensive to maintain, are dependent on the integrity of the persons within the bubble, and do restrict the freedom and socialisation of those within the bubble. But they also protect persons the best. It is becoming clear that prolonged bubbles have adverse effects, and many countries are looking at rotating bubbles whereby persons “bubble in” and “bubble out” after short periods so that they can rejoin their families for a period before going through the stringent process of being re-entered. So far, apart from a failed cricket tour of England to South Africa, all of these bubbles have done very well. Apart from cricket, qualifiers for the European Championships in football last year successfully used this method and the Australian Open Tennis competition is doing so at the moment.

It does involve complete isolation of persons within the bubble from those outside. Any half-breed attempt at modifying this formula has failed as was seen in many professional sports in North America and Europe last year.

The idea of multiple testing as a screening method must be taken in context. This is being employed by the elite sports leagues in North America as well as elite football leagues in Europe such as the English Premier League. The idea is that you test people once or twice a week, knowing that some people will be positive. These people are turned away and asked to remain in isolation till they recover while teams continue to play with those who are available. It has led to many teams playing with depleted squads and even the cancellation of games on a weekly basis because teams are unable to put forward a squad. It is based on the premise that persons who are positive will recover, without adverse effect to themselves, their families, or to their team members. By and large, this is not an incorrect premise as those infected are young, fit athletes, most of whom recover without any sequalae. There have even been figures quoted as to the very low transmission rate on a football field when this method is employed.

However, one needs to apply closer scrutiny to what happens outside of those simple steps of testing and turning away. This method is employed among those who live in mansions, where they can completely isolate themselves, not only from society, but from their families. They travel to practice and matches in private transport, and by and large, secluded from the community. The proponents of this method being used in Jamaica seem to forget that side of the story. Indeed, most of our Premier League footballers do not have the luxury of living in large houses, in seclusion from the community, and most have to rely on public transport to get to and from practice and matches. With these minor details, the method of frequent testing will not ensure low spread as persons are only negative at the time of the test, but on returning to their communities, they are once again exposed to the risk of getting infected like anyone else.

The argument that even if they do get infected they are unlikely to be adversely affected holds true. Indeed, 80 per cent of persons infected are asymptomatic (not showing symptoms such as fever, fatigue, loss of taste smell, sore throat, etcetera). The problem is that these persons, if they have the virus, can spread it to members in their community, including the elderly members of their immediate family such as parents and grandparents with whom many reside. It is the risk that these vulnerable persons are exposed to by the athletes that is of concern.

Many have proposed that there is no need for testing, and all they need to do is to take a person's temperature. If it is high, you deny them entry, and if it is norma,l allow them to enter. Once again, no regard is paid to how they got to the grounds, who they were mixing with before, and the details of their reality. What is further inexplicable is this reliance on a high temperature when it is known that only 20 per cent of persons have symptoms and not all of them have high temperatures. Whereas taking the temperature is a screening method, it certainly is not a means of identifying persons with the virus. It also ignores the fact that a person with the virus may not have a positive test until a week after getting the virus but is still able to spread it. And that is a positive test, not a high temperature, which the overwhelming majority of infected persons will not have.

Sports need to be resumed as there is no immediate end in sight for this virus. Whereas most countries, even in the Caribbean, have commenced their vaccination programmes, this will take many months when it eventually starts in Jamaica. What is to be seen is the reaction of the virus to the vaccine and whether mutations will render the vaccines ineffective. Already, we are seeing where the South African variant has “beaten” one of the vaccines. What many also do not realise is that the vaccine prevents you from getting grossly ill (keeps you out of hospital). It does not prevent you from spreading the virus to others (except for one about to enter the market). Hence social distancing, mask wearing, and physical distancing do not disappear once you have got the vaccine.

Lack of sport in Jamaica is affecting the physical, mental, and social well-being of our society. Any sporting event that could be televised locally would have a positive effect not just on those participating at the venue, but across communities in our country. But one brush cannot be used for all sports. Once again, attention must be paid to those that are low-risk sports, and perhaps those are the ones that should start in an organised manner. We then extend to the medium-risk sports. High-risk sports, unfortunately, will have to consider full biosecure bubbles to start given the current state of community spread and rising number of cases. This may be reconsidered when both of those are under control, but with frequent waves caused by our porous borders, this may not be any time soon.

Effort must be made to assist those sporting bodies that are putting together their plans for the resumption of sport. It is clear that many do not have expert advice and, therefore, can put forward plans like just taking temperatures without any testing of participants. Others have had to have camps cancelled and have seen spread when travelling as there is clearly a lack of understanding of protocols that are now well developed and proven.

Instead of asking individual bodies to come up with plans, it is probably better for templates to be set out by the relevant government ministries and ask persons to conform to them.

Global return to sport was initiated through expertise that resides within Jamaica and the region, and yet Jamaica is still struggling to return to sport when most countries have found a way. It is imperative that the return to sports be led by those in authority as opposed to them acting as a regulatory authority with sporting bodies left to develop plans and seek their own expert advice.

To say sport cannot resume in Jamaica is not true. But to say that we can take shortcuts to well-established protocols or to adopt methods used elsewhere without full understanding of all factors surrounding those methods is irresponsible.

Dr AkshaiMansingh is an orthopaedic surgeon and sports medicine physician with 24 years' experience and is also dean of the Faculty of Sport at the University of The West Indies.