Ebola and the Athlete

The South African Minister of Sport has tweeted a ‘no, thank you’ to being host.

The biennial Africa Cup of Nations (AFCON) is set to begin in January 2015. Organizers are still looking for a host.

Morocco was set to host the tournament but has pulled out because of the fears over Ebola contagion. The Republic of South Africa has already served notice that they will not volunteer to be alternative hosts:  the country’s Minister of Sport has tweeted that the RSA is “…not the Big Brother of Africa….” and will not be standing in as host for the Cup. As I understand it, the Confederation of African Football organizers are meeting November 2 to discuss solutions for what seems to be an impasse.

If sports is indeed a mirror of the culture, then it stands to reason that concerns regarding the Ebola virus would show up in sporting venues, training rooms, sport talk shows, and athletes’ twitter feeds.  The current outbreak of the virus is still largely confined to certain nations in W. Africa, but it  is the largest and most deadly one in history.  Sport, like society at large, is concerned.  How might teams handle potential exposures?  Must consideration be given to quarantining? Is it reasonable to target only those countries at the epicenter in W. Africa?  Is ‘quarantine-lite’ the way to go? Is it wise to consider having large numbers of people travel to and from one country, as in the case of hosting AFCON?

A sign of things to come?

A generation or two ago–most especially in the pre-vaccine and pre-antibiotic era–the quarantine was a standard measure for handling outbreaks of contagious diseases in communities.  My mother describes how she and her whole family were quarantined after she developed strep throat as a young girl in the 1930’s.   In the modern world, however, the quarantine as a response to controlling Ebola has already come under heavy fire, at least here in the United States.

The intersection of public health, international sporting events, and an infectious virus is not unique to this moment in time, of course.  In 2010 CJSM published a thematic issue on “Emerging Issues in Sport Medicine,” and included among the many offerings an article on International Travel and the Elite Athlete as well as an article on Public Health Recommendations for Athletes Attending Sporting Events.The 2009 CJSM published original research on a novel, web-based approach to more carefully monitor illnesses in professional rugby union players.  These documents are potentially useful resources to help teams and sporting federations formulate responses to this newest challenge.

But I want to acknowledge that the Ebola virus raises issues which require a great deal more work to determine appropriate, evidence-based interventions.  Winter is coming in the Northern Hemisphere, and we know we should be offering our athletes influenza vaccinations. We have a ‘system’ to handle the flu.  What to do with a disease like Ebola for which there is no current vaccine let alone an established treatment?  Likewise, what to do in the case of a virus which does not pose an airborne exposure risk like the flu, but has a much higher case fatality rate when the virus is contracted?

Already, popular sentiment has begun ‘making’ decisions of a sort.  The New York Times recently ran a story about the struggles the national team from Sierra Leone is having with the stigma of their country’s outbreak.  And The Guardian has run stories about how professional teams in, for instance, the Premiership may need to handle African players returning from playing overseas for their national sides.  And there is that current pressing issue:  where, or whether, to have the AFCON take place in a few months?  Potential host countries are playing a version of ‘hot potato’ with that.

Primary care sports medicine has always been a multi-disciplinary specialty, drawing from various funds of knowledge:  orthopaedic, neurological, physical medicine, internal medicine…..even integrative medicine.  In my day-to-day clinical work, I find myself needing to draw, time to time, from my knowledge of infections diseases, as when I am taking care of an athlete with MRSA.  We will be relying heavily on our colleagues in the infectious disease world as we begin to make, I hope, informed, evidence-based decisions on how to handle the Ebola virus.

Jonas Salk was born 100 years ago today.  There are modern-day Salks working on the management of the Ebola virus right now.  Athletes, and those taking care of them, are among the many eagerly anticipating the results of their labors.  It is my heartfelt wish that solutions–most especially for those in places like Guineau, Sierre Leone and Liberia, where the suffering is greatest–are arrived at quickly.