Pandemic Musings
In a recent phone discussion with the parents of a student-athlete I was asked one specific question; “will his continued activity make the injury worse?”
I am always eager to engage in these phone calls and in-person meetings with parents because I am confident in the processes, medical support, my knowledge and the coaches support to leave the decisions to me and our healthcare team. The collegiate healthcare playbook is filled with research, evidence-based tools, and consensus statements for concussions, musculoskeletal injuries, return to play protocols after an acute injury or a lengthy post-surgery rehabilitation. On those occasions when the resources are not handy I can contact a colleague who will have anecdotal wisdom to guide me in my circumstance.
My answer to the parents in that recent discussion was one of truth. I was able to confidently assure the parents that they can trust me, our physicians, our coaches and the truth that we are absolutely making decisions that have a very high probability of success. Most important to me in this process is the fact that I can recognize danger and step in on behalf of the student-athlete to protect them and assure their parents.
In 1906, the NCAA was founded to keep college athletes safe. In 2016 the NCAA brought forward Independent Medical Care Legislation Division I Constitution 3.2.4.16, Division II Constitution 3.3.4.17, and Division III Constitution 3.2.4.18. “An active member institution shall establish an administrative structure that provides independent medical care and affirms the unchallengeable autonomous authority of primary athletics health care providers (team physicians and athletic trainers) to determine medical management and return-to-play decisions related to student-athletes.” http://www.ncaa.org/health-and-safety
We are now 230 plus days into a world health emergency, a pandemic. This invisible virus has detoured the sports healthcare road of past experiences, comfort and predictability. Derailed are the habits of researching case studies and relying upon past experiences to provide a better outcome in the next injury or illness episode.
The new athletic healthcare landscape is in need of a halftime adjustment for the ages. The game plan we have used for decades is calling for an audible. In this pandemic healthcare providers look to science and common sense to make the decisions we are trained, educated and paid to make. However, the pace of information, public and media headlines as well as the acute financial stress upon our employers brings a conflict to the equation.
Ours is a country divided on how to respond, how to go about living tied to habits and yet find a harmony that provides a fiduciary solution as well as a public health solution. This is truly a time of conflict.
A basic premise of conflict theory is that individuals and groups within society will work to maximize their own benefits. Karl Marx believed that societal conflict is the force that ultimately drives change and development in society. Marx is noted for this statement, "A house may be large or small; as long as the neighboring houses are likewise small, it satisfies all social requirement for a residence. But let there arise next to the little house a palace, and the little house shrinks to a hut." Wage Labour and Capital (1847). In athletics, what appears to be a solution and course of action changes when the louder voice or competitor has a new solution or action or comment.
Central to this conflict for the sport healthcare provider and the NCAA designated Healthcare Administrator is to make decisions to protect the student-athlete in an environment of no pharmacological intervention (NPI) (vaccine) and very little evidence-based practices.
March 12, 2020 the predictability and order of sports healthcare changed.
We are truly in a time of ‘decision dilemma’. Global leaders (World Health Organization, CDC) provide their best directives without a vaccine while stakeholders on collegiate campus are sharing their point of view. In times of conflict leaders respond versus react. In times of confusion with good people looking for the right solution, the right mind and voice must elevate to answer the call. As an athletic trainer I look to my Code of Ethics and apply the tenants of health care ethics. Ethics within sports healthcare is the application of the core principles of bioethics to the algorithm of decisions. It is a multidisciplinary lens through which to view the pandemic and college sport and make recommendations regarding a course of action.
An ethical dilemma is a decision in which each alternative has some undesirable consequence, and right or wrong cannot be clearly identified.
Look at the Facts
“The primary and most important mode of transmission for COVID-19 is through close contact from person-to-person.” CDC May 22, 2020
“Some people without symptoms may be able to spread the virus.” CDC, May 22, 2020
“We are still learning about how the virus spreads and the severity of illness it causes.” CDC May 22, 2020
Imperial College published May 21, 2020 https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2020-05-21-COVID19-Report-23.pdf “…the reservoir of infectious individuals remains large. This reservoir also implies that interventions should remain in place longer than the daily case count implies, as trends in the number of infectious individuals lags behind. The magnitude of difference between newly infected and currently infected individuals suggest that mass testing and isolation could be an effective intervention” Pg. 16
“The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggest that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious.”
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
Conclusion
Back to that phone call with the parent of a student athlete. (pause | reflect)
I’ve acquired a foundation from those before me to fight fear with courage. Courage to place the highest value upon student-athlete healthcare. Because if I don’t, then who will?
It is my personal directive to seek the highest level of science and medical counsel.
It is my personal choice to build a solution based upon the evidence today.
It is my responsibility to offer the best decisions when all choices have undesirable consequences.
This is hard work. It is a time when I and we must work to our highest training, our best abilities. It is a moment in our life timeline to embrace the opportunity and lead.
