How do you envisage sports being conducted after the lockdown is lifted ? The masks may remain mandatory; as also the social distancing. You will have to stay 6 feet away from colleagues and strangers. Even your own family if they live elsewhere. So how do you play cricket? What rules do you modify? How far behind does Dhoni have to stay behind to ensure a stumping does not go waste? Ashwin and Kuldeep Yadav may become a trifle ineffective. How far away do the slip fielders position themselves from one another. The questions become starker with contact sport. You could watch the beautiful game from your homes, but how does the soccer player stay 6 feet away from the defender? Do you change the architecture of stadiums for athletics? How do you get the 100 m race run and ensure the athletes are in their lanes 6 feet away form one another? These are complex issues that need to be anticipated right now. Maybe the think tanks want to vaporise sports away for good. As you can see running a 5000 m or a cross-country race will become a near impossibility. Runners do get to jostle as they compete in these races that are both fascinating and thrilling to watch. Boxing and wrestling will evaporate away. German Bundesliga has done a first, organised a football match in a stadium devoid of spectators. The Germans have done it by testing all players and officials. We had the eerie spectacle of a goal being scored and the players rejoicing as they stood adequately apart from one another. However Augsburg’s head coach Heiko Herrlich had been penalised for leaving his hotel to buy toothpaste from a local supermarket, he was denied permission to attend the first ever football game his team was playing (in the Bundesliga) in Covid-19 times. It was to be his first game as head coach. Herrlich will be permitted to rejoin his team affairs after he tests negative twice for the virus. Toothpaste can become radioactive in a post Covid-19 world.
Tennis could carry on. So could badminton, table tennis, gymnastics, the long jump and high jump. Even pole vaulting and the throws. So also archery and shooting. But sports entailing proximity are more or less out. The knowledgables will turn to the magical vaccine. The solution they will say is quite simple. Get vaccinated and do your sport, represent your school, club or country. The catch that most people do not seem to understand is that making an effective vaccine is easier said than done. HIV has been around for more then 30 years, it has killed more than 30 million people, but even today we do not have a vaccine against it. The situation is the same with hepatitis C, no vaccine yet after decades. There is no vaccine against malaria or TB. Both have been around for hundreds of years. As I write there are not more 2-3 development trials testing a vaccine against TB, which kills more than 3000 people in one day. Note that Covid-19 has not resulted in 3000 deaths in 5 months in India. TB kills more than a million or 10 lakhs in a year. We have however more than a 100 trials scrambling to develop a Covid-10 vaccine. The vaccine against common flu has never been fully effective. The efficacy ranges form 20 to 60% only. The flu virus keeps mutating. Also despite the flu vaccine being around, more than 60,000 people died from it 2017-18 in the US alone. So getting a vaccine will not be a panacea.
Right now the company that is leading the charge to make the Covid-19 vaccine is a US based company called Moderna. Interestingly Moderna has never manufactured a vaccine ever before. Also it is trying a method that has not been employed previously. It hopes to inject a person with a messenger RNA that will coax the cell in ones body to make components of the SARS-CoV-2 . The messenger RNA is supposed to nudge or order a human cell to either make the spike or the nuceleocaspid component of the corona virus, but not the entire virus. By making only bits of the virus the vaccine will never get lethal, but elicit the immune system to kick in antibodies against SARS-CoV-2. The idea is dazzling on the drawing board but we however have to wait for it to work. A vaccine not only must be effective but be without serious hazards. Usually it takes years to develop a vaccine, as mentioned earlier many dangerous diseases are yet to prevented by an effective vaccine. It is being bandied about that the vaccine will be present as early as September. This is impossible. A vaccine has to first tested in animals and then in human volunteers. One has to wait to see if major side effects like paralysis, epilepsy or cancer may present as side effects. The list of ill effects is long and need not be mentioned here. But they have to watched out for.
Conjuring a vaccine in 6 months makes for sexy reading, but would entail too many corners getting cut. Maybe for all you know a vaccine is already there. We are merely going through the motions of developing one. This is too far fetched. Suffice to reiterate that an effective vaccine takes time to make, and once it is rolling it still may not be effective in the entire population. A direct intervention against this virus makes greater sense.
What does the sportsperson do even with a vaccine in her? The American College of Cardiology has hurriedly made guidelines about how an athlete can get back to competitive sports after bout of Covid-19. The society seems oblivious of the fact most contact sports shall be impossible anyway in the future. The guidelines imagine a world that has gone back to what it was till the November of 2019. The guidelines rely entirely on the protocol subsequent to spell of myocarditis, published in 2015. But makes absolutely no mention of issues related to masks or social distancing. The advisory albeit essential seems to miss the point that sports will be the first casualty of the new world.
The guidelines emphasise that the physician will have to first decide who has and who has not been infected with SARS-CoV-02. The problem is that almost 50% of infected people do not have symptoms. This means to know whether an athlete has been infected in the past a serological test for presence of antibodies will have to be done. I do not need to remind you that of the symptomatic people almost 80% have mild symptoms. Around 15% get sick enough to need hospitalisation while 5-6% need ICU treatment. How do we go about with people known to be infected? They will have to wait for 3-6 months before resuming serious raining. The waiting period is not decided as yet. After 3 -6 months each athlete will need a thorough cardiac evaluation. Covid-19 affects the heart in almost 20-25% in a variety of ways. There can be myocarditis, pericarditis, ischemia, myocardial infarction type 1 and 2, arrhythmias and even heart failure. SARS-CoV-2 can directly attack heart muscle or indirectly by producing an inflammatory state. Blood vessels (endothelium) can be damage or blood become more coagulable. All this happens in the acute phase. When the athlete wishes to resume competitive or leisure activity it has to be ensured the heart has healed.
The ECG is a must and this must ideally not show any residual ischemic changes. An echocardiogram will be needed to ensure the heart muscles have recovered, the left ventricle ejection fraction has a normal ejection fraction. All cardiac biomarkers and inflammatory markers should have returned to normal. Troponins should be normal and also the brain natriuretic peptides (NT-pro-BNP). CRP, ferritin and D-dimer shouts also have fallen to normal levels. Holter monitoring will need to be done to rule out high grade ventricular premature beats or ectopy.
Obviously in the presence of ongoing myocarditis sports cannot be recommended. These rules are applicable for all types of viral myocarditis, not necessarily for Covid-19 alone. Cardiac MRI or endocardial biopsy could be reserved for specific cases. Cardiac MRI in the acute phase picks up more water in heart muscle and later the presence of gadolinium suggestive of myocarditis, active or healed. I do not know of any data on cardiac MRI in Covid-19 as of now.
I used to love to run as a boy, in fact I still do. Most if not all young people cannot do without some sport or the other. I don’t know for how long you can deny them a good game of cricket or foot ball. Will millions of young people have to wait for a vaccine before they can play or watch a game? The current men’s world record is 9.58 seconds, set by Jamaica’s Usain Bolt in 2009, who gets to break this ? The Indian cricket team will have to be tested both for the virus and antibodies. The BCCI, I am sure, must be working on this. It could buy the best antibody tests available in the world to pick up previous infection. The BCCI has the muscle if not the vaccine. Welcome to the manifestly abnormal post Covid-19 world.