Even as the sports world staggers back to some normalcy this month, much is still unknown about the coronavirus that paralyzed it: how it started, how it spreads, how dangerous it is, how it can be treated.
Over 2 million cases have been documented in the United States, with 116,000 deaths reported. A recent surge of hospitalizations in states with relaxed social-distancing guidelines has experts worried about a potential second wave. On Monday, the agent for Ezekiel Elliott confirmed that the Dallas Cowboys star was the latest high-profile athlete to test positive for COVID-19.
With the NFL’s 32 franchises expected to reopen team facilities by late July, the specter of the pandemic has the league scrambling to implement appropriate protocols by the start of training camp. That fear might be most pronounced in Owings Mills, where the Ravens’ Mark Andrews could emerge as a case study for at-risk players.
The Pro Bowl tight end is in many ways an unlikely candidate for severe infection. He’s remained active in the Ravens’ offseason workout program. He told reporters in March that he’d been vigilant about social distancing. At age 24, he’s considered more likely to have a milder case of the disease.
But Andrews is also one of just two known NFL players with Type 1 diabetes, a chronic health condition in which the body’s immune system mistakenly attacks the insulin-producing beta cells in the pancreas. While people with diabetes are not more likely to contract COVID-19 than the general population, experts and research indicate that some could be more vulnerable to dangerous complications.
“We’re still learning. I think there’s a few things we do know — not so much that people with diabetes are more likely to get COVID, but when they get COVID, they’re more likely to have a more significant disease and higher risk of serious complications.”— Dr. Robert Gabbay, incoming chief scientific and medical officer for the American Diabetes Association
According to data released Monday by the Centers for Disease Control and Prevention, among confirmed cases of the virus, 30% of patients with underlying health conditions had diabetes. Nearly 20% of people with preexisting conditions — most often heart disease, diabetes or lung disease — died from the infection, compared with the less than 2% who did not suffer from chronic illnesses.
“We’re still learning,” Dr. Robert Gabbay, the incoming chief scientific and medical officer for the American Diabetes Association, said in a telephone interview. “I think there’s a few things we do know — not so much that people with diabetes are more likely to get COVID, but when they get COVID, they’re more likely to have a more significant disease and higher risk of serious complications.”
Even as scientific research has accelerated to confront the virus, much of the knowledge so far draws from imperfect data samples, or from findings not yet peer-reviewed. A May study by French researchers, which found that one in 10 coronavirus patients with diabetes died within the first seven days of hospitalization, and that one in five needed a ventilator to breathe, had a pool composed overwhelmingly of patients with Type 2 diabetes, which is prevalent among those affected by obesity. Nearly 90% had Type 2, compared with just 3% with Type 1.
Experts believe a link exists between blood sugar levels and the risk of severe disease among those with COVID-19. Gabbay said early research suggests that people with well-regulated blood glucose — having too much or too little can lead to health problems — tend to have less serious infections than those with poor maintenance.
Still, the potential complications are worrisome. Dr. Rita Kalyani, an associate professor of medicine in the division of endocrinology, diabetes and metabolism at the Johns Hopkins University School of Medicine, said researchers have observed a rise in diabetic ketoacidosis, a serious condition that results from having high blood sugars for too long. Elevated glucose levels also can make infections more difficult to fight off, Kalyani said.
Andrews, though, has long been mindful of his health. It’s his job not only to catch passes and block defenders but also to be vigilant about his blood sugar. Around the facility and on game day, Andrews wears a continuous-glucose monitor. His Dexcom G6 sends real-time blood sugar information to his phone and the Ravens’ athletic-training staff.
Dr. Jay Skyler, the deputy director of clinical research and academic programs at the Diabetes Research Institute, said that if Andrews’ blood sugar is well managed, he doesn’t have “any greater risk by having Type 1 diabetes and playing football than anyone else.”
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“I don't think there's any difference for a physically fit person with a well-controlled blood sugar to be concerned about any excess risk of COVID,” said Skyler, also a professor of medicine, pediatrics and psychology at the University of Miami Leonard M. Miller School of Medicine. “I don't think he's at any greater risk than a tight end who doesn't have diabetes. There's no evidence to say that.”
The hope across the NFL is that when Andrews and nearly 3,000 other players report for training camp in six weeks, they’ll enter an environment with their health and safety guaranteed. (The Ravens did not respond to a request for comment on this story.)
According to the NFL Network, NFL Players Association medical director Thom Mayer announced on a conference call Monday with agents that the league intends to test players for COVID-19 about three times per week and plans to isolate players who test positive. Mayer also reportedly said there’s a 90% chance the NFL will have reliable saliva testing available before players return to team facilities.
As the league’s health protocols have evolved over the past three-plus months, NFL officials have relied on input from the CDC and other public health experts. A leaguewide memo sent last week detailed new social-distancing guidelines for team facilities, including rearranging locker rooms to ensure 6 feet of separation between team members, limiting strength and conditioning workouts to small groups, and conducting virtual meetings whenever possible.
“My advice to someone like Mark Andrews with diabetes would be the same as someone without diabetes, really, in terms of the precautions to prevent getting the virus in the first place,” Kalyani said.
Andrews’ job will make that difficult. If the league’s testing is insufficient, he’ll risk coming into contact with asymptomatic or presymptomatic players on practice fields and in NFL stadiums. Gabbay said scientists will know more about how the coronavirus affects those with diabetes by the time players strap on their helmets for training camp. But he acknowledged that a player like Andrews, in a contact sport like football, has only imperfect options.
“Obviously, staying 6 feet apart is not how you play football, so that’s impossible,” Gabbay said. “But considering some personal protective equipment, wearing a mask over their mouth and nose, is probably worth considering. ... I don’t know how that would affect performance, but that seems like a pretty reasonable way to deal with what we know is still some risk.”