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Tuesday, March 17, 2020

COVID-19, the NBA, and Unanswered Questions

It was surreal to watch in real time last Wednesday night as an NBA game, an NBA season, and then life as we know it disappeared before our eyes. I feel like we are all now living in an X-Files movie, but Mulder and Scully are not here to seek the truth.

So many questions, and so few answers.

I understand that as soon as one NBA player became infected with COVID-19 the league had to shut down, at least temporarily, to evaluate the situation. NBA Commissioner Adam Silver is being hailed as a visionary, but it is more honest to say that he is a realist. How can a season continue with possibly five or six teams under quarantine? Anyone with sense knew that as soon as one NBA player tested positive for COVID-19 the season had to be suspended.

I don't understand why ESPN was in such a rush to publicly announce the name of the infected player, possibly before he even had an opportunity to communicate this news to his family. It is OK to mention Rudy Gobert's name now, because he has gone public to talk about the situation, but that was not the case when his name was first broadcast by ESPN.

SIRIUS XM NBA Radio's Jason Jackson and Amin Elhassan--the former used to work for ESPN, while the latter is still employed by the network--had a thoughtful, in depth discussion of why it is meaningless (and, at times--like this time--harmful) for a media member to report something "first" as opposed to being both accurate, and also sensitive to larger issues. It was sufficient for ESPN to report that a player had tested positive. As Elhassan noted, the NBA and/or the player would have revealed the rest in short order. Elhassan pointed out a recent, and even worse, example of being "first" as opposed to being accurate, and being sensitive to larger issues: the initial "reporting" about the helicopter crash that took Kobe Bryant's life was a confused and confusing mixture of wrong-headed speculation pertaining to who exactly had perished. It was falsely reported that Bryant's former teammate Rick Fox was on the helicopter, and it was also falsely reported that more than one of Bryant's daughters were aboard. Being "first" and wrong is worse than meaningless. It is irresponsible, if not evil.

I understand that once the NBA suspends its season, most other sports organizations are going to follow suit.

I don't understand why Gobert's situation is not being studied more closely by medical professionals who are trying to figure out how to deal with COVID-19 (if Gobert's situation is being studied, I apologize for suggesting otherwise). The initial, breathless reporting--including referring to Gobert as "Patient Zero"--suggested that Gobert was going to singlehandedly infect, if not imperil, a large number of people, including the players and support staff from the Utah Jazz plus opposing players and other people with whom he came into contact after becoming infected. Much was made of Gobert intentionally touching reporters' microphones/recorders just two days before he tested positive; much less has been made of an interview given by a reporter covering the Jazz who stated that medical officials told all of the media members covering the Jazz that what Gobert did had a very low risk of transmitting COVID-19. That is not meant to suggest that what Gobert did was anything other than stupid, reckless and possibly dangerous, since he had no way to properly assess the potential consequences when he engaged in those actions. However, media coverage focusing incessantly on what Gobert did without providing any proper medical context to the actual risk is misleading at best, and panic-inducing at worst.

Presumably all of those people who came in close contact with Gobert have been tested, and it turns out that only one other person directly connected to Gobert has COVID-19: his teammate Donovan Mitchell (whose name I mention only because Mitchell has also gone public to discuss the situation). Note that even though there was a report that a fan who received an autograph from Gobert at a Utah Jazz game has COVID-19, medical officials have stated 1) that Gobert was not infected/contagious at the time he signed the autograph, and 2) that interaction was not likely to have transmitted the disease even if Gobert had been infected at that time.

I wear many hats--father, lawyer, basketball commentator, chess player--but I am not a medical doctor or an epidemiologist. I don't pretend to have any expertise about how contagious COVID-19 is, or how deadly it is. So, what follows are honest, sincere questions, with no subtext. If a medical doctor or epidemiologist reads these words, feel free to post a comment to enlighten me and my readers.

If COVID-19 is as contagious as it is depicted to be, and if Rudy Gobert had the kind of sustained, direct contact with so many people that one can reasonably assume that he had after he became contagious but before he was isolated, then why is there only one infection directly connected to him? Whole countries are being shut down, and millions of lives are being disrupted on the premise that this disease is highly contagious. More than one media outlet has reported that one person in New York singlehandedly infected over 100 people.

Shouldn't somebody with medical expertise be looking into why Gobert is not very contagious, and why this other person supposedly is so contagious? Do we not have all the facts? Did Gobert somehow infect more people than we know? That seems doubtful based on how many people connected to him have already been tested. Is the one person in New York possibly not responsible for infecting over 100 people? If Gobert only infected one person, but this other individual infected over 100 people, then what actionable knowledge can we gain from those two situations to limit the spread of this disease? Alternatively, if this other individual only infected one or two people, then other method(s) of disease transmission involving the rest of the folks incorrectly linked to that individual presumably would have implications for the effort to slow the spread of the disease.

Gobert felt well enough to play NBA basketball on the night that he tested positive. By all accounts, Donovan Mitchell is doing fine, too.

Are people who are younger than a certain age and reasonably healthy seriously at risk?

I understand the concepts of "flattening the curve," and the importance of minimizing how many people get sick so that the healthcare system is not overwhelmed--but shutting down the entire country will also have a serious impact on the economy, on mental health, and ultimately on physical health. An autopsy can prove if someone who died had COVID-19. An autopsy cannot prove that someone who died would have lived if not for the transformative disruptions of society that are increasing on a daily basis to mitigate the spread of a disease that we do not understand very well.

Is it possible that protectively isolating the elderly and the most vulnerable without shutting down the whole economy would lead to a better outcome, both in terms of disease mitigation, and the mitigation of other negative outcomes?

I don't know the answers to any of these questions--but I know that these are very important questions, and that they need to be answered intelligently not only to deal with this crisis, but to deal with whatever the next crisis will be.

I extend my deepest sympathy to all the family and friends of those who have died as a result of COVID-19, and to all those who are suffering as a result of the mass disruptions of society, and I hope that there are better days ahead for all of us as soon as possible.

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posted by David Friedman @ 1:39 AM

15 comments

15 Comments:

At Tuesday, March 17, 2020 3:57:00 AM, Anonymous Anonymous said...

Good questions, Dave.

 
At Tuesday, March 17, 2020 11:53:00 AM, Anonymous Anonymous said...

David,

These are all interesting questions, and it would be great if an expert would post on here and answer them.

I want to ask you more specifically about the following question you posed:

"Is it possible that protectively isolating the elderly and the most vulnerable without shutting down the whole economy would lead to a better outcome, both in terms of disease mitigation, and the mitigation of other negative outcomes?"

Would it not be extremely difficult to isolate such a large proportion of the population? Where would they be isolated? Who would look after them?

 
At Tuesday, March 17, 2020 2:38:00 PM, Blogger beep said...

As you noted media report things "first" more often than accurate information and it doesn't matter whether it's heli crash or such awful disease, so my assumption (maybe wrong) is that media overblown the effect this NY person had on spreading the virus.

As far as I see, living in partially shut down country, this virus is quite contagious, but on the other hand it's relatively easy to avoid with basic hygiene and limiting exposure. Then high hygiene standards in professional sports may be the reason few people caught it from Gobert.

Gathering all elderly in one place is asking for big problems imho. Individual quarantine is much better solution here.

 
At Tuesday, March 17, 2020 3:52:00 PM, Anonymous Anonymous said...

I don't know, it really doesn't seem that contagious nor worse than the flu overall though mortality rate is higher though we don't know how many actually have it.

If 1 person is infecting 100 people in NY, then how many people are each of those 100 infecting, and so forth? There should be tens of thousands infected in NY at the very least by now.

Does anyone know where Gobert got it or where they think he got it?

 
At Tuesday, March 17, 2020 11:07:00 PM, Blogger David Friedman said...

Anonymous:

Just to clarify, I was not suggesting that the elderly and/or immunosuppressed all be isolated in one place together, but rather that contact with them be limited and "social distancing" be practiced with them--as opposed to shutting down the whole economy for an indeterminate period. Right now, we are telling the whole country to stay home, and the government is shutting down (by decree, or by "recommendation") private businesses en masse.

 
At Tuesday, March 17, 2020 11:12:00 PM, Blogger David Friedman said...

Beep:

Again, as I mentioned in the comment above, I did not mean to suggest that the elderly be quarantined together in one place. It seems to me that their contacts with the larger society could be sufficiently minimized and controlled without shutting down the whole economy. It also seems to me that the potential catastrophic impact of shutting the country down for an indeterminate period has not been sufficiently considered. If the economy tanks, that will also have a negative impact on the elderly and the immunosuppressed.

I am not sure what the right answer is--or if there even is one "right" answer--but I just have a lot of questions about what is happening, and how it is being portrayed in the media.

 
At Tuesday, March 17, 2020 11:21:00 PM, Blogger David Friedman said...

Anonymous:

Yes, there are many unanswered questions about how contagious it is, how it is spread, and how serious it is for an otherwise healthy person. Without knowing the answers to those questions, it is difficult to formulate the best plan of action. It seems like right now we are taking the approach of "shut everything down for who knows how long, and hope that the virus dies out during the shutdown." Maybe that will work, maybe it won't work, or maybe some other less drastic approach would work better.

I think that it is obvious that no one knows for sure how Gobert got it. No one really knows for sure how anyone is getting it, or how contagious it is. It has been reported that shortly before he tested positive Gobert was in close contact with family members/friends who had traveled overseas. I have seen no definitive confirmation of who he was in contact with, let alone if those people have tested positive or can be proven to be the people from whom Gobert contracted the virus.

 
At Sunday, March 22, 2020 12:55:00 AM, Blogger Kyle Falls said...

Hi David,

Like you, I am very skeptical of the narrative the media has portrayed for the pandemic and I am even more concerned with how the government has handled it. I could give my perspective on these questions, but I defer to Dr. Paul Offit (https://en.wikipedia.org/wiki/Paul_Offit), a specializing in infectious diseases, vaccines, immunology, and virology. He is the co-inventor of a rotavirus vaccine.

Here are 2 excellent interviews with him that answer some of your questions and more:

1. https://youtu.be/MAeaFoSuJho

2. https://youtu.be/o2mSr3MnrUQ

I trust that you will be very pleased with his take and anyone who doesn't listen is doing themselves a massive disservice. I also recommend listening to Michael Osterholm, a public health scientist and a biosecurity and infectious-disease expert.

Here are 2 excellent interviews with his perspective:

1. https://youtu.be/V1xBiBVH7U4

2. https://youtu.be/E3URhJx0NSw

He also provides great insight.

 
At Sunday, March 22, 2020 1:09:00 PM, Blogger David Friedman said...

Kyle:

Thank you for sharing. These videos are very informative.

 
At Sunday, March 22, 2020 10:05:00 PM, Blogger Kyle Falls said...

David:

Do you feel they answered most of your questions? I like that neither of them are the "experts" on TV looking to make headlines nor are they conspiracy theorists. I'm no medical professional by any means (I work in software), but I do have the ability to critically think and very little adds up.

I appreciate Dr Offit's aggressiveness in his disagreement with the media and government's approaches. I wish people like them were advising our political leaders.

I've done a ton of other research in regards to what it looks like in other countries and why the estimates for infections and deaths look the way they do. Please let me know if you like me to share.

 
At Monday, March 23, 2020 12:38:00 AM, Blogger David Friedman said...

Kyle:

The videos confirmed my suspicion that not enough thought has been put into some of the measures that are being enacted, and that these measures may cause more harm than good.

Every action/inaction has consequences, but measures are being enacted that may or may not prevent one kind of harm while definitely causing other harms that may be greater.

If you have research supported by credible/verifiable evidence then I am interested in seeing it. I am not interested in so-called models that do not explain the basic assumptions underlying the models (not that this is what you are offering, but just clarifying I am not interested in "models" that are pure, unfounded speculation).

 
At Monday, March 23, 2020 3:28:00 PM, Blogger RFU said...

I found this to be quite informative - but lack of evidence makes it hard to answer these questions definitively. That's why social distancing at least for next few weeks while U.S. ramps up testing is still worthwhile, imo.

https://www.statnews.com/2020/03/17/a-fiasco-in-the-making-as-the-coronavirus-pandemic-takes-hold-we-are-making-decisions-without-reliable-data/?referringSource=articleShare

 
At Tuesday, March 24, 2020 2:01:00 AM, Blogger David Friedman said...

RFU:

I think that social distancing for the elderly and/or immunosuppressed makes sense. We know that the cost for shutting down society for several weeks will be trillions of dollars, so I am less convinced that based on scant evidence a total shutdown is preferable to a more targeted shutdown. I agree with the analogy that this is equivalent to an elephant that is being attacked by a tiny cat jumping off of a cliff to its death; the cure is worse than the disease, because that cat was not going to fatally harm that elephant.

The notion that this disease is highly contagious and/or highly deadly to otherwise healthy people does not seem to be proven. If either or both were true, then wouldn't Rudy Gobert have infected many, many people, at least some of whom would face deadly consequences? Based on the public reporting, 58 members of the Utah Jazz' traveling party were tested, and Donovan Mitchell was the only other positive (and we don't know if Gobert infected Mitchell, if Mitchell infected Gobert, or if both were infected by someone else). Several NBA teams have been tested, with few positives being found, and none of the players seem to be seriously ill.

The situations where this disease has spread rapidly and/or been deadly seem to involve some combination of (1) an elderly and/or immunosuppressed population, (2) inadequate health care, (3) inadequate segregation of people who are known to be ill, and (4) people who have underlying conditions that make them susceptible to getting severely ill.

Every day, we are bombarded with coverage of how many people died that day of COVID-19--but we are not also told how many people died that day of the flu, or any other disease. If all of those numbers were publicized, this situation would likely be viewed much differently.

 
At Tuesday, March 24, 2020 11:05:00 AM, Blogger RFU said...

Hi David,

I don't necessarily disagree with the questions and points you raised, which I found to be very thoughtful. As the article highlights, we are now making decisions without full information and it's natural we all feel differently. For instance, I have a public health background and have many friends working in hospitals, including in Italy, and I know how much they are suffering, so flattening the curve makes sense to me. I also came across some analyses that a high percentage of hospitalized patients from COVID-19 from those within the age range 30-50, so targeted social distancing would have its limitations and could still overwhelm the health system.

But I am also very very concerned about the economic impact, especially on the poor and less resourced, in countries such as the U.S. where there is limited safety net. Even if we have perfect information, we may still need to weigh the pros and cons of shutting down the economy vs. overwhelming the health system, which is a bit of a judgement call.

But now that social distancing is implemented, I do hope the governments are really working together and using the time wisely to ramp up increase in testing and hospital capacity so that we will be more well prepared after a few weeks. That's my hope at least.

Lastly - just wanted to say I am a big fan of your site even though I didn't comment much (I did a few times but somehow my comment never got posted). Stay safe and healthy!

 
At Wednesday, March 25, 2020 11:25:00 AM, Blogger David Friedman said...

RFU:

I agree with you that it is important that governments and health agencies use this time wisely to increase testing and hospital capacity. Otherwise, we will not have received much benefit from the suffering (economic and otherwise).

I appreciate that you are fan of my site. I am not sure why your comments did not go through in the past.

 

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