Some NBA players feel COVID effects long-term

“The scary part is we don’t know why that is yet.” 


Jayson Tatum guzzles a drink and stares into the Zoom. It’s 11 p.m. on a Tuesday night. The 23-year-old Celtics star has just scored 29 points in a hard-fought loss to the Jazz. In minutes, there will be a bus to an airport and a flight to Cleveland for another stop in Boston’s run of five games in seven nights. 

There’s never a chance to catch a breath in this COVID-condensed season. Tatum admits that there are some games that are “better than others, conditioning-wise, just with my breathing.” 

Tatum battled COVID-19 in January when many Celtics were infected. After 16 days in the NBA’s COVID-19 protocols, Tatum returned and started racking up big point totals. But a month after getting sick, Tatum told reporters that at times he had trouble catching his breath and fatigued quicker than normal. Tatum’s play has been excellent for most players, but perhaps a half-step behind the trajectory he was on before COVID. In December, Vegas odds gave Tatum a seven percent chance of being this year’s NBA MVP. Today it’s under one percent. The Celtics entered the year with big aspirations and are a middle-of-the-pack team. 

68 days after testing positive, something is off.

“I don’t feel the same that I did before I had it,” Tatum says beneath his mask.

Dr. Philip Skiba has worked with elite athletes for two decades. Marathon runners, NFL players, and NBA players … everyone, he says, from “your grandma running the local 5K to the fastest runners on the planet.”  

The director of sports medicine at AdvocateAurora, and sports physician for the University of Illinois-Chicago, Skiba says the long-term effects of COVID-19 have stumped doctors and wishes he had better answers for players like Tatum—who is not a client, but sounds like one. “He’s not the exception,” Skiba says. “I see that at least a half dozen times a week.”

“A lot of it is a mystery,” Skiba says. “It’s like having a fleet of Ferraris. It requires a certain amount of know-how and mechanics to be able to take care of that fleet. And right now, no one's got the owner's manual.”

After the Celtics’ loss to the Jazz, Tatum rose from his chair and headed for the airport. Two of his teammates, Tristan Thompson and Romeo Langford, would stay behind because of COVID-19 protocols.

Every team has been impacted by COVID-19 this season. According to a study by that analyzed the NBA’s official injury reports, all 30 teams have listed at least one player under the COVID-19-related “Health and Safety Protocols” designation. The Celtics and Mavericks have seen the most time spent in protocol (94 player-days for Boston; 91 player-days for Dallas).

Until this week, the Golden State Warriors had only experienced a single player landing on the report—Eric Paschall, who was held out of a January 12 game against the Indiana Pacers due to an inconclusive test. That changed on Wednesday when it was announced that the Warriors would be without James Wiseman and Paschall indefinitely due to protocols. 

All in all, 129 players have appeared on the NBA’s COVID-related protocol list, or about four players per team this season, according to Fansure. A total of 56 players, nearly half of the total list, have been in protocols for at least 10 days. There’s no way to know the full list of players who tested positive. Per an agreement with the NBPA, the league doesn’t publicize positive tests; it’s up to the player and team to release that information.  

Chicago Bulls guard Tomas Satoransky appeared in protocols for nearly a month (28 days). Former All-Stars Jimmy Butler, Karl-Anthony Towns, Jrue Holiday, and Pascal Siakam have all missed large chunks of the season to protocols. 

In Fred VanVleet’s first game back after two-and-a-half weeks sitting out with COVID, he had the worst shooting night of his career. On Tuesday, he described his time in isolation: "I just felt the sickness, I could just feel it in me, I could feel it in my bones and my blood and my muscles,” adding he “wouldn’t wish it on anybody.”

Dallas guard Josh Richardson, who spent 20 days in protocols, told reporters: “Covid is tough. It’s hard to really understand the toughness of it until you go through it.”

Phoenix forward Dario Saric spent almost three weeks in protocols: “It was hard. I can’t lie.”

Portland forward Nassir Little told The Athletic that he lost 20 pounds in three weeks and wondered if he would ever play again. “I’m not trying to sound morbid or anything, but it was to the point where it was like, you just don’t want to feel anything. It was really that bad. You just wished it would stop. It was consistent, 24/7 … just miserable pain. My back was hurting so bad, my headaches were terrible, I couldn’t eat anything.”

The NBA’s official injury reports understate the impact of COVID. As a matter of policy, the NBA doesn’t list postponed games in its injury reports even if players are still in COVID-related protocols. For example, the Washington Wizards had five games postponed due to COVID-19 protocols, so Davis Bertans “only” appeared for seven days in official protocols. But Bertans was sidelined for 17 days, not seven. (Fansure’s tracker only counts days missed for postponed games if a player appeared in protocols both before and after the postponed games).

Bertans is ordinarily one of the best shooters on the planet. Following his return, Bertans endured the worst shooting slump in his career, converting just 23 of his 77 3-pointers (29.9 percent) in his first 10 games back. A month passed before he started performing at career levels.

Bertans was one of six confirmed positive tests on the Wizards. Weeks after getting his players back, Wizards coach Scott Brooks told reporters his team was still not right.

"I think they’re still working through it," Brooks said. "We can see it. Some guys get winded quick. It’s nothing like anybody has ever dealt with."

A local fireman arrived at Skiba’s office after overcoming a mild case of COVID-19. Once his symptoms subsided, he felt OK and went back to the station. 

Then an emergency call came in, and he couldn’t pick up the fire hose. The confused shame nearly brought him to tears.

“Doc, I can’t train. I can’t haul the hose,” Skiba recalls him saying. “I wasn’t that sick. What’s wrong with me?”

Skiba checked his lungs, heart and other organs. Nothing out of the ordinary.

“I don’t have a good answer for it,” Skiba says. “These guys are not wimps. They’re embarrassed to come in and see me. And it’s just terrible. I’m the guy who’s supposed to know. And I don’t. We just don’t.”

Athletes of all kinds are looking for answers. Skiba has become quite prominent in the sports medicine space on Twitter for his work on COVID-19. He has been hearing from athletes—including NBA players—through Twitter direct messages.

Mostly he advises NBA players to proceed with an extremely conservative approach. 

Skiba has seen several instances of endurance athletes coming back too soon, which sets them back for months. He’s seen collegiate runners who regularly used to post sub-15-minute 5Ks who still can’t clock in under 30 minutes months after COVID.

“The scary part is,” Skiba says,” we don’t know why that is yet.” 

Last spring, trainers and sports medicine staffers went into overdrive sharing data and anecdotal observations in order to outline some sort of best-practices document. What they found early on was that COVID-19 tended to be more debilitating to conditioning and return-to-play than seasonal flu. According to one longtime NBA trainer who spoke with TrueHoop, players who had COVID-19 showed a longer time getting back to pre-sickness levels than what they had previously seen with the flu.

“We always applied a rule of thumb that if you were sick for six days, you’re looking at another 12 to 13 days before you’re feeling normal,” the trainer said.

But they were seeing very different recovery periods for COVID-19.

“In COVID cases,” the trainer said, “if you’re out two weeks, it could be five or six weeks before you really feel like you’ve got your reactivity and your legs under you and the wind that you’ve had. You’re chasing it for a while.”

NBA players are hard-wired to stay in shape and get shots up, which makes any prolonged shutdown a difficult sell—especially when symptoms are mild. 

“It's very tough,” the trainer said. “And even even the guys that have symptoms, as soon as they start feeling a little better, they want to do something.”

The NBA has implemented an extensive cardiac exam before players can return to the floor, but the trainer admits that they can only screen for so much. Lung biopsies would provide a more thorough check on the respiratory system but the trainer says it’s not part of the return-to-play protocols.

Several teams have been surprised that it has taken a while for players to get their wind back. How long will it take? NBA teams are calling Jeff Stotts to figure that out. As the operator of injury tracking website InStreetClothes and the co-founder of an injury database company called SMART, Stotts has consulted with teams over the years, helping them with data on injuries and average timetables for certain injuries.

This is the first time he’s dealt with so many calls about an illness. “What are you seeing with COVID-19?” they’ll ask.

Stotts wishes he could offer more clarity. “The league hasn’t made a distinction between a positive test and contact tracing, which has made things difficult on my end,” Stotts says. “It’s understandable from a privacy standpoint, but it’s been frustrating to not be able to parse what’s what.” Stotts has resorted to tracking media availabilities and writing down confirmed cases by hand.

What he’s found is astounding. 

In the fourteen seasons since 2005-06, Stotts has identified 307 confirmed cases of respiratory illness in the NBA including the flu, cold and upper respiratory infection (Stotts excluded last season for consistency purposes). In that sample, players, as a group, missed an average of 26.5 games a season to respiratory illness.

40 games into this season, that number is 213 games lost, or eight times as much as a normal.

Part of that is COVID-19 protocols that mandate at least seven to 10 days of strict quarantine. But even after that is over, many players have had an extended recovery timetable.

Stotts hasn’t tracked performance deficits because of COVID-19 because he hasn’t been able to parse exactly which players tested positive. Even if we knew which players tested positive, explaining their performance is a whole separate challenge.

“And even if it’s a confirmed positive, is the lag in performance a result of schedule fatigue or the disease?”

Skiba believes the NBA has “done a pretty good job” considering the circumstances. But he worries about NBA players returning to play too soon. The financial and competitive pressure to get back onto the court is immense, and at odds with Skiba’s advice.

Skiba has found that high-performance athletes should return with a slow and gradual approach. Even if they feel fine, they shouldn’t assume their respiratory system is ready.

“If I put a bulletproof vest on you that is 90 percent effective, you still don't walk in front of a machine gun, right? And that's kind of the challenge we have. A lot of athletes behave as though they're indestructible. And so we see people with really significant disease and profound deficits in performance long-term.”

Vaccines have arrived in the NBA. One benefit: Players may soon be able to spend less time locked in hotel rooms, and more time with friends and family. Another: To avoid a disease that, in some cases, has enduring and mysterious effects on health and performance. 

“What scares me the most is the unknown unknowns,” Skiba says. “We don’t know what we don’t know. A lot of these people have COVID come in, and we test them. And they test pretty normal. And that's scary because you're telling me as the patient that you don't feel right, you're not playing up to par, you're tired all the time. I'm testing you and your heart and lungs can be working just fine. Your oxygen delivery systems can be working just fine. So what's this all about?

“And that's just …  you want to be able to say, here's what your problem is. Here's how we're gonna fix it. And we just don’t understand what that is.”


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