Dear NBA. COVID-19 incapacitates, and causes permanent lung damage to even young and healthy players. Please take care!

Nikhil Autar, Tumor Vaccine Immunology Researcher
Bachelor of Medical Research (WSU).,
Bachelor of Medicine, Bachelor of Surgery (WSU 2023).

Permanent Lung Damage is Almost Certain To Occur in Many COVID19 Patients.

Even mild infection can incapacitate healthy people for MONTHS.

It’s almost certain that COVID19 causes permanent lung damage in a large proportion of seriously ill patients. Young, fit and healthy people, including athletes, are not spared, and indeed, likely to suffer most (at the very least, they suffer for the longest). There’s a bit of evidence that those putting their body through extreme strain are more inclined to suffer worse outcomes when it comes to pneumonias. I felt my favourite stars, in my favourite sport, that I can no longer play due to severely damaged lungs, should know this information. Though important causes like the recent Black Lives Matter marches are indeed of concern, to both protect themselves, and the millions of young and old fans they have, it would be amazing if players could help spread this message – to distance, where possible, and do things like wear masks. Trust me – permanent lung damage sucks. I’m 26 and likely will never play basketball again.

This medical journal of Australia review of radiological findings of COVID19, suggests up to 17% of severely ill or critical patients¹ , not just those requiring ventilation, have evidence of fibrosis –  permanent lung scarring in the lungs. A more recent analysis of 38 patients’ autopsies showed all patients who did require critical care had signs of this². Though younger people do survive COVID-19 more, the question is at what cost?

A 15 year follow up of SARS coronavirus patients also confirmed that as many as 4.6% of a mostly healthy population had decreased lung function after any level of SARS infection². Some are suggesting that this likely isn’t progressive fibrosis, which is good news in that it is not likely to cause long term inflammation in the lungs³, but a recent study in the Lancet suggests otherwise – and indeed, cites higher rates of developing fibrosis than earlier thought⁴. Also, permanent disability and lung function is demonstrated through previous coronavirus outbreaks’ data, and through studies on radiological findings of the current pandemic – which suggests as many as 17% of severely ill patients are demonstrating signs of fibrosis¹ (this number are likely to rise on follow up.

Elite athletes are at higher risk of contracting COVID-19. Not only can exercise direct this particularly pneumo-toxic virus deeper into lungs, which may lead to higher chances of developing cytokine storms, and a more severe version of COVID-19⁵, extreme exertion may reduce innate immunity, making players more prone to developing disease⁶.  Not only is there this chance of permanent lung damage which could affect entire careers, It also appears that even mild infection commonly leads to a 20-30% decline in lung function that lasts for months¹² – longer than the common flu – which could impact these very finals.

PLEASE – keep yourselves safe! Not just for your own sake, but also for others.

Children, though less likely to suffer from severe illness, are being admitted to ICUs in 0.58-2% of cases, according to CDC numbers in the US⁶, and the most comprehensive study on paediatric outcomes out of China⁷. It’s also evident that infants under 1 are at significantly higher risk of ICU admission (4x that of other children)⁷, and thus, exposure to this permanent damage. Not only is this linked to permanent lung damage, ICU admission causes severe trauma and PTSD too.

Many children follow sports stars religiously. Hopefully getting messages out to them and their families will keep, and the world at large, will keep them more safe.

It is concerning to see that sending children back to school is being encouraged by governments such as Australia⁸, against medical consensus. Opening up is occurring in the US too.  Young people are similarly being asked to sacrifice themselves to attain ‘herd immunity’ around the world, athletes are being sent back into action. Though many are wary, as evidenced by Novak Djokovic’s diagnosis and disregard for social distancing, many aren’t spreading the right message, and may well be putting their teammates’ careers at risk.

Not are there much higher rates of ICU admission and deaths being seen in 20-44 year old age groups (up to 12% for the former)¹⁰, long term deleterious side effects of this through things like lung fibrosis is likely, and could have even worse economic outcomes in the long run too.

It’s not to say we shouldn’t reopen. But we should definitely be encouraging safe habits like mask usage and social distancing – staying in unless necessary, or if public health bodies say it’s okay to – to minimize the damage. Not only to athletes’ careers, but to the world as a whole. This disease could be worse than we imagine. I just hope we can encourage eachother to stay safe.

I am an ex cancer patient, and extensive treatment has caused significant, permanent lung damage to me. My lung function is similar to levels seen in early studies of patients who were followed up after SARS-CoV-2 infection (a 20-30% reduction). I likely will never get to play basketball, or run, again. And though data as to extent of pulmonary fibrosis isn’t available yet, this data makes it clear that fibrosis is occurring. This is not something we want to expose multiple young generations to.

References;

1. Peter G Gibson, Ling Qin and Ser Puah, COVID-19 ARDS: clinical features and differences to “usual” pre-COVID ARDS, Med J Aust, Published online: 24 April 2020, accessed May 2020, available at https://www.mja.com.au/journal/2020/covid-19-ards-clinical-features-and-differences-usual-pre-covid-ards
2. Zhang, P., Li, J., Liu, H. et al.Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res 8, 8 (2020). https://doi.org/10.1038/s41413-020-0084-5
3. Pulmonary Fibrosis Statement on COVID-19, Pulmonary Foundation Press Release, accessed May 2020, Available at https://www.prnewswire.com/news-releases/pulmonary-fibrosis-foundation-statement-on-covid-19-301035924.html
4. P Spangnolo, E Balestro, S Aliberti, E Cocconcelli, D Biondini, GD Casa, N Sverzellati, TM Maher, Pulmonary fibrosis secondary to COVID-19: a call to arms?, Lancet Respir Med. 2020 May 15, doi: 10.1016/S2213-2600(20)30222-8 [Epub ahead of print]
5. P Matricardi, RD Negro, R NIsini., The First, Comprehensive Immunological Model of COVID-19: Implications for Prevention, Diagnosis, and Public Health Measures, Version 1 : Received: 22 April 2020 / Approved: 24 April 2020 / Online: 24 April 2020 (10:25:27 CEST)
6. S Estruel-Amades, M Camps-Bossacoma, M Massot-Cladera, FJ Perez-Cano, M Castell., Alterations in the innate immune system due to exhausting exercise in intensively trained rats, Sci Rep 10, 967 (2020). https://doi.org/10.1038/s41598-020-57783-4
7. Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T., Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020, MMWR Morb Mortal Wkly Rep. 2020 Apr 10; 69(14): 422–426.
8. Dong Y, Hu Y, Qi X, J Fang, J Zhongyi, Tong S., Epidemiological Characteristics of 2143 Paediatric Patients With 2019 Coronavirus Disease in China, Paeiatrics, Pediatrics April 2020, e20200702; DOI: https://doi.org/10.1542/peds.2020-0702
9. Birmingham K., South Australian parents encouraged by Education Department to return children to school amid coronavirus pandemic., ABC News, April 22, Accessed May 2020., Available at https://www.abc.net.au/news/2020-04-22/sa-parents-urged-to-send-children-to-school/12174872
10. Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12–March 16, 2020. MMWR Morb Mortal Wkly Rep 2020;69:343-346. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e2
11. Doherty B, Taylor J, Remeikis A., NRL Announces 20-Round Competition Restarting on 28 May – as it Happened, The Guardian, 28 April, Accessed May 2020., Available at: https://www.theguardian.com/australia-news/live/2020/apr/28/coronavirus-australia-update-latest-bondi-beach-reopens-to-swimmers-as-new-cases-drop-to-single-figures-live-news?page=with:block-5ea7da968f086f39b4ca135d
12. Cheung E., Coronavirus: some recovered patients may have reduced lung function and are left gasping for air while walking briskly, Hong Kong doctors find., South China Morning Post. Accessed May 2020, Available at https://www.scmp.com/news/hong-kong/health-environment/article/3074988/coronavirus-some-recovered-patients-may-have