For 14 days, a camera glared at the door of Ekpe Udoh’s hotel room, waiting for him to slip up. The former NBA big man underwent a strict quarantine in China in hopes of resuming his season with the Chinese Basketball Association’s Beijing Ducks before the league was postponed again in mid-April due to the coronavirus.
According to Udoh’s agent, Brandon Grier, Udoh passed the time alone on his exercise bike, reading, watching sermons and calling loved ones. “It was very mentally taxing,” Grier said. “You don’t want to compare it to a prison sentence, but that’s the closest thing many of us will experience to prison.”
With over a billion dollars at stake, the NBA and players union continue to tinker their way toward a proposal to resume the season. The league is facing an age-old philosophical quandary — freedom vs. security — that needs a tangible answer in the coming weeks.
As of now, none of what’s left the conference calls or what’s been leaked to the public sounds as draconian as a 14-day solo quarantine.
I asked Grier, who tested positive for COVID-19, what he would choose. “That’s a tough question,” he said. “Experiencing what I experienced, I don’t think anybody would just flippantly sign up for that if they knew how bad it was, and knowing the risks of people dying, but [a] 14-day strict quarantine by yourself is tough. In the grand scheme of things, it’s not that bad when you’re talking about death as a possibility, so me being who I am, I would choose the strict quarantine.” But he also knows that wouldn’t be everyone’s choice.
“In terms of the quarantine on the level that Ekpe did?” Grier continued. “I don’t think most people could do that with free will.”
Free will, according to Los Angeles Lakers forward Jared Dudley, is what the NBA is relying on. To hear him tell it on a conference call with local reporters, players would be allowed to leave the proposed “bubble” where the NBA would finish the season. They would be tested upon re-entry, the stipulation being that anyone who tested positive for COVID-19 wouldn’t be allowed to play.
Two medical experts told Yahoo Sports the proposal Dudley relayed wasn’t a good idea, that it would rely entirely too much on the accuracy of tests when false negatives remain so prominent.
In consultation with medical experts, Yahoo Sports laid out what a physically safe return of the season might look like. It isn’t exhaustive, nor does it account for all eventualities, but hopefully it highlights the gulf between the proposals sneaking out of meetings and the recommendations of health experts. Some ideas would be difficult to execute; some are viable. As the NBA weighs mental vs. physical health, let’s hope the question of whether this is all worth it remains on the table.
The bubble before the bubble
For reasons we’ll explain later, the Walt Disney World Resort in Orlando is a safer place for the league to resume games than Las Vegas. To get to Orlando, those associated with the NBA will have to fly in from at least 29 other cities across America, where over 1.6 million people have tested positive for the virus.
In the absence of a strict quarantine that confines people to their rooms, potential carriers from all over the country would be using the same elevators, pressing the same buttons and touching the same door handles, potentially creating contamination hot spots. There’s a reason the Olympics were canceled, and Udoh was confined to the same room for two weeks.
Under a strict quarantine, you would get off the airplane and, without interacting with anyone, be ushered straight into your own hotel room. You wouldn’t leave for 14 days. The hotel staff, also staying in the bubble and being tested regularly, would leave meals outside your room.
Not all the hallways have cameras, but some do. Besides, there’s security in the lobby of every hotel, so you wouldn’t go unnoticed if you tried to leave. If you want to quarantine with your family, that’s fine, but you’ll have to sit tight for an extra week to prevent the possibility of the virus incubating in your companions before being passed to you.
That means you’ll miss the first few days of training camp. Teams will conduct training camp inside Disney World since ramping up at home only to travel andbe confined to a hotel room for two weeks doesn’t make much sense.
“The closer you can get to something like that being acceptable, the higher chance that everybody will make it through the two-week period [negative for the virus],” said Dr. Maciej Boni, an Associate Professor at the Center for Infectious Disease Dynamics at Penn State.
If everyone obliges, the bubble might be coronavirus-free after few weeks.
It’s a big “if”, contingent on execution and luck. Quarantining would likely be the hardest part, but it would make everything else that comes after easier.
“If you get through that two-week period and there’s zero infections, [NBA commissioner] Adam Silver can feel confident that he’s going forward with a well-thought-through plan to restart the playoffs with as little risk as possible, assuming there’s a true bubble,” Dr. Boni said.
Embrace the great outdoors
Disney World seems like the most likely destination. Here’s why that’s good: Vegas would have confined everyone in a smaller, predominantly indoor space that’s tougher to isolate from the outside world.
Yahoo Sports’ Keith Smith, who originally explored the idea of finishing the season in Disney World, super-imposed the borders of the park onto a map of New York. It’s basically the size of Manhattan, and there’s a ton of outdoor space.
Contact tracing has found that most cases happen in indoor clusters where people interact in the same public spaces. “The Vegas setting, it’s certainly not as tight as a correctional facility or a nursing home, and certainly the individuals are healthier, but perhaps more like a cruise ship,” said Dr. Susan Hassig, Associate Professor of Epidemiology at Tulane University. “You know how quickly it can spread on a cruise ship.”
You don’t want the coronavirus penetrating either bubble, but it would likely spread farther and faster in Vegas.
“Transmission is easier indoors,” Dr. Boni said. “The more outdoor activities you have — eating outdoors, picnic tables with appropriate distancing, that’s better than the indoor version. Indoor air recirculates, and indoors you tend to go back to the same places and touch the same things, whether it’s a faucet or doorknob.”
On that note, the NBA and Disney might want to consider building outdoor courts.
Right now, the only suitable NBA courts in Disney World are indoors. It would take legwork, and they couldn’t use them everyday, thanks to a climate that oscillates between too rainy and too hot, but it could be a real difference-maker (and it would look cool).
The game itself is when social distancing rules go out the window, the only place in the bubble where contact and the exchange of sweat and air particles are guaranteed. Timothy Brewer, professor of epidemiology at the UCLA Fielding School of Public Health, said, “[Players are] also breathing hard. The harder you breathe the more likely you are to aerosolize droplets. Just like coughing leads to more droplets than talking, breathing hard will lead to more droplets being produced than regular breathing.”
Brewer continued: “A basketball game typically goes on for over an hour so that is a prolonged period where people are going to be in close contact with each other,” citing the CDC’s guidelines on how the virus spreads. “That would create a higher risk for transmissions as opposed to either playing outdoors or not allowing people within six feet of each other.”
A bubble, not a campus
The individual risk tolerance that Silver and the players are mulling has collective consequences. One player’s willingness to take a chance ups the risk for the colleagues he is in contact with, and the NBA’s collective decision-making affects the communities around them. Disney World, nestled between Orlando and Kissimmee , is surrounded on all sides by smaller towns and municipalities, where players could contract and spread the coronavirus for days before tests pick it up. The rate of false negatives, depending on the timing and type of tests, falls somewhere between 5 and 25 percent.
“If someone is infected outside the bubble, they typically will not show symptoms for five or six days, and they will likely test negative in the early stages of their infection,” Dr. Boni said. “On average, the incubation period is about five or six days long. But it can be as long as 14 days — this is not uncommon — which is why a 14-day quarantine is recommended after someone has been exposed.”
Last week, Silver likened the potential setting to a campus environment, which would jibewith Dudley’s remarks.According to The Athletic, the NBA is searching for tests. But it can’t buy and test its way out of following the rules.
If Dudley is right, a player could leave the bubble, get the coronavirus, re-enter and play in at least two or three games before a test would show he was positive — games that would be pored over by fans like the Zapruder film, featuring over 20 other players, refs and coaches, several of whom he’d been in close, extended contact with. All those people would have to be tested and quarantined too.
So much rests on who tests positive. Players, in this ecosystem, are super-spreaders. That’s why the burden of action (or inaction) will ultimately fall on them.
To keep everyone inside, the NBA would likely have to build a makeshift hospital with fully equipped medical crash cart units, as well as a pharmacy. Food, delivered less regularly, wouldn’t be as fresh. Giannis Antetokounmpo’s body wouldn’t notice the difference, but older players like Dudley and LeBron James might. They’ll need to get creative and scramble together what they can for their recovery regimens. Lucky for James, his trainer, Mike Mancias, is employed by the Lakers. Other players likely won’t have that option.
Oh well. Some things you have to live without.
Resuming the season safely would be a huge undertaking. And with all that, it still might not work. Bubbles, after all, are fragile. They can pop at the slightest change of direction.