The COVID-19 (novel coronavirus) epidemic has ground the NBA and majority of the sports world to a halt. Yesterday, that reality hit home for the Lakers as two players tested positive for COVID-19 — the team hasn’t released any details and will rightfully allow the players to choose if they want to announce it or not — and in the evening, California Governor Gavin Newsom implemented a statewide “stay at home” mandate.

To get a better understanding of the virus and it’s potential impact on the Lakers’ players and league at-large, I consulted with a trusted epidemiologist and infectious disease expert — they have an PHD in epidemiology from UC Berkeley and consult for multiple hospitals in the Bay Area but did not want to be named for the sake of privacy — to shed light on common questions and topics, including why leagues and sporting events were shutdown, if athletes are at higher risk of getting the virus or having serious symptoms, and when the NBA may fire back up.

For a video essay version of this piece, you can watch the following video:

If you can’t watch that, below is an FAQ and breakdown on what’s going on.

Sporting Events and League Shutdowns

When the specter of COVID-19 first appeared on US soil, the NBA and other professional sports leagues were leaning towards playing without fans present in the arenas. However, once direct personnel tested positive — the first confirmed NBA case was Utah Jazz center Rudy Gobert — the sporting world realized the true gravity & seriousness of the situation, shutting down play for the indefinite future.

It was absolutely the right move.

These postponements and cancellations are critical to stop the spread of COVID-19 because small gatherings — let alone ones with upwards of 20,000 people — are a breeding ground for spreading the virus and then all those fans, players, staff, coaches, etc. potentially become vectors themselves to spread it to their family, friends, and communities. Large gatherings are basically the last thing you want to do during a pandemic

It’s critical to break the chains of transmission via social distancing and curb the exponential spread. That applies even if you’re asymptomatic (not showing symptoms), with early research in China showing that nearly 80% of COVID-19 transmission came via people who were asymptomatic at the time.

For more on the importance of social distancing, “flattening the curve”, and/or answers to general FAQs on COVID-19 you can watch the video I made below or, even better, check out the Centers For Disease Control (CDC) website or World Health Organization (WHO) website.

Are athletes at higher risk of being infected?

Athletes may be at more risk for picking up COVID-19 because high-level athletes are often immunosuppressed during the season due to the high quantity and intensity of physical and mental activity, fatigue, constant changes in sleep and schedule, and generally a very high stress environment — particularly for top tier teams in top markets that come under heavy scrutiny, media coverage and relentless microscopic over-analysis.

Further, athletes, staff and team personnel are potentially at higher risk simply due to a higher quantity of exposure to potential vectors for COVID-19. Examples include interactions with fans and media members and thousands of high-use touch points (door handles, bathrooms, etc) while traveling for games. Even players’ families may have more interaction with the community at large, which results in potential transmission risk back to the player.

Additionally, players, staff and personnel are often in confined group settings such as team meetings, locker rooms, training, traveling and partaking in meals together, which further increases potential exposures and spread. That’s doubly true for the Lakers who — according to many accounts — are an extremely tight-knit team with players constantly hanging out and going on social outings.

Further, players are in close quarters on the court and can be directly exposed to COVID-19 through an opposing player who may have picked up the virus. Accordingly, the Lakers’ may have been directly exposed when they played the Brooklyn Nets on March 10th who eventually had four players test positive for COVID-19, including Kevin Durant. It’s also quite possible they may have picked up the virus somewhere else, and the players have been kept separate over the last week or so since the season was suspended.

The confirmed cases are what triggered the Lakers to test the majority of players the morning of Wednesday, March 19th with remaining players and any personnel or staff who may have come in close contact with the confirmed cases soon to be tested.

Are athletes at risk for severe symptoms?

All that being said, elite athletes typically have resilient immune systems due to their fitness, overall health and younger age which means even though they may be infected, it’s highly unlikely they’ll have severe symptoms. Additionally, athletes, staff and personnel have access to early COVID-19 testing and elite, concierge medical care which further limits any probability of developing severe symptoms.

To that point, the NBA’s Utah Jazz were immediately tested for COVID-19 while in Oklahoma City after Gobert’s case came back positive, and used up nearly 60% of the state’s daily testing capacity. Since then, we’ve learned that many NBA teams are using private testing labs.

We’ve yet to hear of any athletes with serious symptoms, which lines up with the risk profile for COVID-19, which really hits people over 60 and/or those with underlying conditions the hardest. JaVale McGee was the one player who concerned me with his history of asthma and extended bout with pneumonia last season that clearly impacted his fitness afterwards, but reports are he isn’t one of the Lakers who tested positive.

When will the NBA and sports be back?

There are so many variables still in play so the only viable, honest answer here is “we don’t know.”

For example, lets say the Lakers’ players, staff, personnel and close contacts all go through an extended quarantine, come back with negative COVID-19 tests and all touch points — stadiums, training grounds, homes, transport, etc. — are thoroughly disinfected.

If that’s the case, you still have to wait for COVID-19 to play its course in the general population — otherwise you again risk league personnel becoming infected — and that timeline depends on how stringent and proactive government quarantine and isolation mandates eventually become, and how quickly testing capacity is increased to isolate and quarantine hot zones.

For example, the Chinese government mandated strict quarantines and significantly ramped up testing which has led to a significant decline in new cases. Accordingly, the Chinese Basketball Association plans on returning behind closed doors in the first week of April, approximately eight weeks after being suspended on February 1st.

However, Western countries haven’t gone to the same lengths, which has led to very similar COVID-19 case trajectories as Italy, which is now considered the epicenter of the virus.

In the US, the CDC is recommending eight more weeks of no events with greater than 10 individuals, and multiple states and counties have issued three week mandates shutting down all non-essential activities.

With that timeline, a best case — albeit unlikely — scenario is that the NBA starts up in mid-May. However, according to recent reports, the NBA is eyeing a return at some point in June with the league searching for arenas — possibly practice facilities — through August.

Unfortunately like many things when it comes to medicine and disease, league return dates are truly a fluid “wait and see” scenario.

League precautions after returning

When leagues do get back, fully expect for the games to be played without fans and with essential personnel only for the foreseeable future to guard against any re-introduction of COVID-19.

Further, I imagine the leagues will continue to monitor and mandate strict distancing measures for players, staff and other personnel — possibly with family as well — until COVID-19 has completely run its course in the general population. You have to have an abundance of caution or risk another shutdown.

The Upshot

COVID-19 has placed sports on the back-burner and the safety and health of the world population at the forefront. It’s a situation that needs to be taken very seriously and we’re seeing the NBA, amongst other leagues, do just that.

We’ll assuredly hear of a number of athletes who become infected with COVID-19, but they’ll more than likely only have mild symptoms. In other words, the Lakers players will more than likely be just fine. The larger concern is if any of these guys came into contact with and potentially spread the virus to high-risk populations.

In addition to potential governmental mandates, each and every one of us can follow experts’ advice and limit our own exposure to COVID-19 via social distancing and fundamental sanitation measures to break chains of transmission.

I know we’re all bummed about the hiatus and re-arrangement of calendars, but those are small blips in the grand scheme of things. Stay safe, stay calm, stop hoarding water and toilet paper, stay in control of what you can control, and possibly use this relative downtime to reset and work on habits such as sleep hygiene, fitness, nutrition, reading, reaching out to family and friends, and so on.

These are difficult times full of change but it’s short-term sacrifice for the long-term good. We’ll get through this and have a newfound appreciation for basketball that only seems to come from having it taken away.

General FAQ

In addition to the sports-specific questions, I asked the epidemiologist a series of general questions about COVID-19 questions, including how to protect ourselves and others, common symptoms, and key topics such as “flattening the curve”.

If you’re interested, I’ve included them all below.

What is COVID-19?

COVID-19 — CO standing for corona, VI for virus, D for disease, and 19 for the year of discovery — is a virus within the general family of viruses termed “coronavirus” that get their name from crown-like spikes on their surface. Corona is latin for crown.

COVID-19 is also known as “novel (new) coronavirus” because it hasn’t been seen before in humans, with some researchers alleging that the virus was passed from bats to humans through an intermediary host, pangolins, which are highly valued in China for their meat and scales.

Other examples of coronaviruses that spread from animals to humans include Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS).

How does it spread?

COVID-19 is spread through “droplet transmission,” typically when a carrier coughs or sneezes within six feet of an unaffected individual, or an unaffected individual touches a contaminated surface and then touches one’s own nose, mouth, and/or eyes. Studies are showing that COVID-19 can last up to four hours on copper surfaces, up to 24 hours on cardboard, and up to 2-3 days on plastic and metal.

How can I protect myself and others?

There are two keys to protecting yourself:

The first is to wash your hands with soap and water for at least 20 seconds, especially after you’ve been in a public place or after blowing your nose, coughing, or sneezing. Further, avoid touching high use objects like door handles. If you don’t have soap and water, use a hand sanitizer that contains at least 60% alcohol.

The second is known as “social distancing”. Avoid going to large gatherings or crowds and if you are out, maintain a six-foot barrier between you and other individuals.

Both of these are incredibly important to break the chain of transmission especially in the early stages of containment where even one less exposure and transmission can result in exponentially less cases down the line. The research indicates that implementing strict social distancing before 1% of the population acquires a virus during a pandemic can be particularly impactful in the medium and long-run.

To help protect others, use a tissue or the inside of your elbow when you cough or sneeze, clean AND disinfect frequently used surfaces daily (including phones and keyboards), wear a facemask if you’re sick or have been exposed to a potential COVID-19 carrier (if you’re neither of those, you don’t need a facemask as there’s no research showing it reduces transmission to you and buying them for that purpose strains an already existing shortage of facemasks for medical providers), and ideally, just stay at home.

What are the signs & symptoms?

The key symptoms of COVID-19 are fever, a dry cough, and shortness of breath. The dry cough and shortness of breath speak directly to COVID-19’s impact on the respiratory system.

If I have symptoms, what can I do?

If you have symptoms, the best advice right now is to quarantine yourself at home for at least 14 days in order to avoid potential transmission to anyone else. If you live at home with roommates, spouse, or kids, separate yourself from them.

If you develop severe symptoms such as difficulty breathing, persistent pressure or pain in the chest, confusion, severe lethargy, and/or bluish lips or face, seek immediate medical attention.

Even if you don’t have symptoms but find out that you’ve been around someone who may have COVID-19, isolate yourself for 14 days in order to potentially stop the spread.

Ideally, individuals with symptoms would be getting tested and then quarantined in separate housing — for example, China has quarantine hotels set up — but testing capacity is currently woefully short in numerous countries, including the U.S., which has the lowest per capita testing of any country early in the outbreak.

Who’s most at risk?

Populations at the highest risk of becoming severely ill and dying include those who have a compromised immune system, which includes people over 60 and those with existing illnesses such as heart disease, lung disease, diabetes, or obesity (which is often clustered closely with the first three). Each underlying condition results in cumulative risk.

To put that risk into perspective - nearly two-thirds of adults in the US have one underlying health condition, 40% have two, roughly 25 million have diabetes, and nearly 33% are considered obese.

In accordance with those risks, California has mandated at home isolation for those older than 65 and/or those with chronic illnesses. A similar plan may also go into effect in Britain as well.

Additionally, there’s some evidence that frontline medical providers such as ER docs and nurses are at increasing risk for infection, especially when overtaxed and over-fatigued.

This isn’t to say younger populations can’t become severely ill, they’re just less likely to. Overall, death rates from COVID-19 are at nearly 1% compared to the .1% for normal seasonal flu (influenza).

Does the body develop immunity?

As with other viral infections, it’s likely that the body will develop antibodies to fight off the virus and protect them from re-infection. However, we also know that immunity tends to wane over time.

Is there a vaccine coming soon?

Even though researchers have recently been able to isolate COVID-19’s genome and human trials are beginning, a vaccine is very likely still at least 1 to 1.5 years away from being finalized, produced and distributed.

Will COVID-19 subside as the weather warms up?

Influenza subsides in the warmer months but we have no indication, information or knowledge if that’s the case with COVID-19. Of course you hope that’s the case, but it’s a fool’s errand to depend on an unknown or factor it into disease trajectory.

Why’s COVID-19 so hard to contain?

The hardest part about containing COVID-19 is that it has an extended incubation period, meaning symptoms may take up to 14 days to appear — although in nearly 95% of cases, symptoms appear in at least 10 days — whereas influenza has an average incubation period of 2 days.

That’s potentially 12 extra days of going about your normal business and unknowingly spreading the virus. To that point, early research is showing that each person with COVID-19 infects 2.2 other people, which is nearly double the rate of influenza.

If lower-risk populations don’t take appropriate precautions, they can be carriers of the virus that helps it spread to the high-risk populations. Early data is showing that nearly 80% of cases are mild or asymptomatic and data coming from South Korea — which has the most robust testing of any country — shows the 20-29 year old demographic as having the highest proportion of affected individuals.

Why is containment critical?

Containment is critical because COVID-19 has an exponential growth curve, meaning there are greater increases as time passes. This exponential pattern has been seen in nearly every affected country thus far, characterized by a relatively low number of cases and deaths early on — possibly creating a false sense of security — that eventually explode. The reported cases are also very likely dampened by a lack of testing capacity.

Further — and this is the most critical piece to reducing the number of deaths — is reducing sharp spikes in cases so hospitals aren’t overwhelmed and can actually meet the demand for beds and needed equipment (such as respirators). You may have heard this called “flattening the curve,” and it simply means spreading the number of cases out over more time, preventing the dire situation where MDs have to essentially begin choosing life or death for patients, as has been reported in some hospitals in Northern Italy.

That danger is a key reason why countries such as Italy, Spain and France have mandated a minimum 14-day country-wide shutdown and quarantine. Even Austria — which has only 8 million people — has banned gatherings larger than 5 people.

Social distancing in particular is critical RIGHT NOW in those countries because each is currently in the asymptomatic phase where thousands and thousands of unaffected carriers continue to spread the virus and cause exponentially more down-stream effects. Accordingly, certain states in the US — notably Ohio, California, Illinois — are shuttering all non-essential establishments.

Dr. Rajpal Brar has a doctorate in physical therapy from Northern Arizona University, and runs his own sports medicine and performance business, 3CB Performance, in West LA and Valencia, CA. He also works at a hospital — giving him experience with patients in the immediate healthcare setting and neurological patients (post stroke, post brain injury) — and has been practicing for 1.5 years. Brar is additionally training at UCLA’s mindful awareness research center (MARC), and analyzes the Lakers from a medical perspective for Silver Screen and Roll and Laker Film Room. He can be found on Twitter at @3cbPerformance.