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Dodgers, Rams Physician, Neal ElAttrache, M.D., Talks COVID-19

by Elizabeth Hofheinz, M.P.H., M.Ed.

Even as players and fans adjust to the idea of games with empty bleachers, many are wondering what all it takes to get a team back to normal.

An extraordinary amount of planning in an ever-changing environment, says Neal ElAttrache, M.D., Director of the Kerlan-Jobe Sports Medicine Fellowship and Head Team Physician for the Los Angeles Dodgers and the Los Angeles Rams. “Much of what will happen is determined by what the situation is in various geographical areas. As the political leaders are ultimately in charge, we drew up a protocol for the resumption of professional sports and presented it to the mayor of Los Angeles. He, in turn, is being guided by what’s happening at a county and state level. In general, if a state or county government is not aligned with some aspect of a ‘back to normal’ plan then things will be more complicated for a mayor or vice versa.”

While everyone is interested in safety, there are competing interests at work, the key to returning to sports as with the rest of the working population is to find that practical balance between public safety and returning to life “The closer someone is ‘to the ground’ the more realistic they are…the more they want to get people back to work.”

Exacerbating the challenge, says Dr. ElAttrache, is that there is a range of health issues amongst all involved in professional sports. “It is important to recognize that there is a safe population and a vulnerable population within each sport. While the players are in tip-top shape, people surrounding the players—coaches, managers, support staff—could have any number of medical issues, including comorbidities. Therefore, any plan must be far-reaching enough to protect the entire community. Basically, what we put in place will be a parallel system to the one we used in the medical system when determining when to return to elective surgery.”

“It is vital that we have the proper testing in place so that we know the status of people coming in to work together. As you’re testing for the virus or doing PCR [polymerase chain reaction] or antigen testing, you have to know how often you must do it and what do when someone comes in testing positive. Are you going to be responsible for contact tracing? Take a room full of 25 athletes working out together, all of whom have been relatively isolated. Then someone comes in who is outside of that group and everybody in the workout room needs to be tested.”

In that case, says Dr. ElAttrache, contact tracing is fairly easy…it’s much harder when a team is on the road.

Concerning traveling, he notes, “The logistics of road games are under discussion and will to a great extent depend on local penetration of the virus. It will be hard to play in venues where the pandemic is more active, leaving you with locations like Florida, Texas, Arizona, and California where it is relatively under control. In every situation, we will work with local medical systems to ensure that all precautions are taken.”

A bright spot in all of this is that unlike most workplaces, professional sports has a decent handle on many of its employees. “We are very familiar with the medical histories and medical conditions of our players. From the moment agents begin assessing their talent to the draft or a trade, their medical status is transparent. Aside from the military, very few workplaces have such information on employees’ health.”

And that certainty is reassuring in a time of anxiety-producing flux.

“The medical condition of coaches and managers is less well known,” states Dr. ElAttrache. “It is an ideal time to step back and examine the traditions of various sports competitions. Is it really necessary for a 65-year-old manager to sit on the bench next to a 25-year-old player in order for that manager to be effective? Probably not. Frankly, it may be even better for the manager to sit and watch the game on a closed-circuit TV.”

Well, since unanticipated change was forced up us, you might as well meet it with planned change.

“Even if XYZ has been a tradition since 1900 is it really the best way? And it would be good to examine who exactly needs to be in physical contact with teams in the clubhouse. The fact is that this is a congregation of different types of people with different risk factors—and this will be looked at more and more closely as we move forward.”

“The NCAA is interesting because from an ethical perspective, schools can’t have one set of rules for athletes and one set for the student body. The only way to get NCAA level competition restarted is when they can create the same safety environment for everyone. That is not the case with private industry.”

And on the professional sports side…

“Just recently the Rams have come out with their next schedule, which was built from a lot of discussion with all stakeholders,” says Dr. ElAttrache. “The politicians seem to have an attitude of, ‘Let’s see what happens as we go through the time leading up to August and September.’ So they are allowing for conditions ‘on the ground’ to evolve. I don’t think it is out of the question to have a delayed sports season, but the fan experience would definitely not be the same.”

On a positive note, Dr. ElAttrache states, “I think we will see a natural attenuation of the virus and progressive immunity in the population before a vaccine is ready. And if people know that we have reliable medicines that you can take prophylactically—or that you can mute the expression of the disease if someone is exposed—then things will open up.”

Sports, playing…those are signs of normalcy. Dr. ElAttrache thinks that sports can be a beacon during these unfamiliar times.

“I think sports can help lead the country out of the darkness and if done right, can give a bit more confidence for people to go out and socialize. The level of fear that has arisen in our country is disturbing. We need to find some way to change that as we identify how to keep people safe.”

Batter up…but back up first…

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Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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