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Could sports leagues soon let athletes play through COVID-19?

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On Saturday in Dublin, Ohio, golfer Jon Rahm was 24 hours away from $1.7 million. He had cruised through the first three rounds of the Memorial Tournament with a six-stroke lead. He was locked in. He was healthy. Until he was informed that, despite what his body told him, he wasn’t healthy.

Rahm, who reportedly hadn’t been vaccinated prior to a COVID-19 exposure earlier in the week, tested positive for the virus, the result coming in the middle of his third round. He was forced to withdraw from the tournament and forfeit his likely winnings. His stunning, emotional exit prompted all sorts of questions, including: If Rahm felt well enough to play, and if his competitors were either protected by vaccination or unconcerned by the virus to an extent that they would refuse vaccination, why couldn’t Rahm play on?

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With vaccines now widely available to U.S. adults, some even posed the question more broadly: Could sports leagues soon relax their isolation requirements and begin to allow COVID-positive athletes to continue competing?

Some players believe they should. Washington Nationals pitcher Max Scherzer recently advocated for updated rules that would allow vaccinated players who test positive to play if asymptomatic.

And some epidemiologists acknowledge the legitimacy of the thought. “It’s a really good question,” said Cameron Wolfe, an infectious disease professor at Duke University who has advised major sports organizations throughout the pandemic.

But a Major League Baseball official told Yahoo Sports that the league has not considered allowing players who test positive for COVID to remain around their team and play. Nor has the NBA, according to John DiFiori, the league’s director of sports medicine.

“In order for us to consider something like that, there has to be a lot more information than what we have right now,” DiFiori told Yahoo Sports in an interview.

The NBA, NFL, MLB and other sports organizations have recently relaxed some protocols for vaccinated players and staff. The NFL, for example, will no longer test vaccinated players daily, nor make them wear masks, nor subject them to quarantine after exposure to COVID-19. The updates fall in line with CDC guidance, and most experts believe they’re responsible.

But DiFiori and several other doctors who spoke with Yahoo Sports detailed a few reasons why a relaxation of rules that require COVID-positive players to isolate is unlikely in the near future.

Protecting the unvaccinated

The MLB official and independent experts pointed to CDC guidelines that still state: “Fully vaccinated people should not visit private or public settings if they have tested positive for COVID-19.”

Major sports leagues aren’t necessarily beholden to those guidelines, but in many cases have crafted protocols that fall in line with them. In some cases, leagues and teams also must comply with local public health directives. Most, if not all, U.S. counties and states currently instruct people who test positive for COVID to isolate.

And there’s a reason for that. Public health authorities haven’t shifted responsibility for COVID-related risk to unvaccinated Americans because millions of them aren’t unvaccinated by choice. The vaccines haven’t yet been approved for kids under 12, and have proven less effective in immunocompromised adults.

“We're not at a point yet where we can say, ‘If you're unvaccinated, that's on you,’ ” said Kathleen Bachynski, an epidemiologist at Muhlenberg College. “Until we get to higher overall community level of [vaccine] coverage, we still have to think in terms of protecting unvaccinated people.”

As vaccination rates within professional sports teams rise, the risk of intra-team outbreaks decreases. Some experts believe that perhaps, someday, depending on the nature of the sport, if most or all players are immunized, an infected team member could keep competing and not worry about infecting any peers — like they might if they had another mild illness.

But, Bachynski said, “it would depend also on the network that the players and staff are plugged into.” Several experts point out that sports teams aren’t bubbles. “You're not just with other vaccinated people all the time,” said Sankar Swaminathan, a University of Utah infectious disease specialist who advised the Pac-12 and NCAA. “So as a public health requirement, if you have COVID, you should isolate. And that applies to athletes as well as everybody else.”

Besides, leagues are still wary of protecting their own. None has mandated vaccination, nor negotiated with their players’ associations to push unvaccinated players to assume COVID-related consequences. “If a player is unvaccinated, we don't want to put them at risk,” DiFiori, the NBA doctor, said. “We are still of the mind that we want to keep everyone healthy and safe as much as we can.” And that includes COVID-positive players themselves.

DUBLIN, OHIO - JUNE 05: Jon Rahm of Spain gets shuttled away after testing positive for COVID-19 after the third round of the Memorial Tournament presented by Nationwide at Muirfield Village Golf Club on June 5, 2021 in Dublin, Ohio. (Photo by Ben Jared/PGA TOUR via Getty Images)
Jon Rahm gets shuttled away after testing positive for COVID-19 after the third round of the Memorial Tournament. (Ben Jared/PGA TOUR via Getty Images)

Is exercising with COVID harmful?

Another consideration that experts mentioned is the potential risk related to physical exertion while infected with the virus. Throughout the pandemic, most professional and amateur sports organizations have told COVID-positive athletes to refrain from vigorous exercise for seven-to-10 days, even if asymptomatic.

As a result, there’s little to no data on the effects of exercise within those seven-to-10 days.

“We don't know yet how the virus will affect someone if they continue to train and compete immediately after they become infected,” DiFiori said. “We don't know, if they do, if it worsens the overall illness. And in addition, we don't know if it increases the risk of complications.”

Before even considering updated protocols that would allow athletes to play through COVID, “we have to be able to answer those questions, or have some level of reassurance that athletes would not run any increased risk that would be otherwise avoidable,” DiFiori said.

Some experts believe that this is an overly cautious approach. “If somebody's feeling fine enough to exercise,” said Sandro Galea, dean of Boston University’s school of public health, “yes, [COVID is] adding challenge to your respiratory function ... but you're not making [the sickness] worse.”

Others, though, say uncertainty remains. “That really should be something that one is fairly careful with,” Swaminathan, the Utah professor, said. “You wouldn't want to play and end up with a long-term complication that compromises your health or athletic ability.”

Testing will relax

Experts mostly agree that for the foreseeable future, as long as COVID-19 exists, a positive case will require isolation. “I'm just not sure that anytime soon, people are gonna walk into their workplace and say, ‘I have COVID, but it's OK, you're all vaccinated,’ ” Galea said. “I'm not sure we'll get to that place where someone like Rahm would be considered cool to just keep playing if you know he has a contagious disease.”

But, several experts said, we could get to a place where the next Rahm doesn’t even know he has the contagious disease.

“A point where COVID itself doesn't have such systems around it,” Galea said. “And I think we're heading there. I don't think that point is too far away.”

Some experts pointed out that new variants could emerge and undercut the efficacy of vaccines, prolonging the timeline and changing the public health calculus. But if vaccination rates within sports teams continue to rise, and if COVID-19’s prevalence across America continues to fall, the virus becomes less and less likely to penetrate a locker room and spread within it. As that likelihood ebbs, “there's less of a reason to go searching constantly for cases,” explained Zach Binney, a sports epidemiologist at Emory University.

So, Binney said, “I suspect that over the rest of this year, you're gonna see people relax on the testing. ... It's going to be a gradual process, I think. You go from testing every other day to testing weekly, and then eliminating testing.”

Some leagues have already begun this process exclusively for vaccinated players and staff, a process that Binney called “perfectly fair.” It incentivizes vaccination, which in turn decreases both risk and the need for testing for all involved.

Vaccinated individuals can still contract the virus, and can still test positive, and can, in the case of athletes, be forced to miss games. But the vaccines “profoundly” reduce the severity of infections, as Wolfe, the Duke epidemiologist, said. The removal of testing requirements for asymptomatic vaccinated players, therefore, accomplishes much of what a relaxation of the isolation requirement would.

Wolfe also sees a future in which the 10-day isolation period could be significantly reduced, in which a player who tests positive on a Monday could, perhaps, return to competition later that week.

“I think there's gonna be some data that hopefully starts looking at, if I'm vaccinated [and contract the virus], what's the length of time that I shed for? How infectious to people around me am I? Is that different than if I just get COVID as an unvaccinated individual?” Wolfe explained.

“Because we do know that the vaccine translates to less infectivity to those around you,” he continued. “We don't yet have perfect information as to whether I'm still infective for the same length of time ... or whether I'm only infective for a single day or two, and then it all goes away.

“And if that can be quantified, then you could make an argument that, look, usually the isolation in 2020 was for 10 days before someone would be allowed to go back to doing what they do. But here, Person X is already vaccinated, therefore we know that their isolation can afford to be much shorter.

“Those sorts of things are unknown at the moment. And I would like to think that we'll get more information.”

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