COVID-19 and combat sports: when and how to begin bouts again?

COVID-19 and combat sports: when and how to begin bouts again?

Nitin K Sethi, MD

Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (U.S.A.)

 

DISCLOSURES: NKS serves as Associate Editor, The Eastern Journal of Medicine and Editor-in-Chief, ARP Journal of Combat Sports Medicine. He also serves as Chief Medical Officer of the New York State Athletic Commission (NYSAC). The views expressed are his and do not necessarily reflect the views of the NYSAC.

 

Professional boxing and mixed martial arts (MMA) are popular sports with a worldwide fanbase. COVID-19 (coronavirus disease 2019) is the infectious respiratory disease caused by SARS-COV 2 virus (Severe Acute Respiratory Syndrome coronavirus 2). On March 11th,2020 The World Health Organization (WHO) declared COVID-19 a pandemic considering the over 118,000 cases of the coronavirus illness in over 110 countries and territories around the world and the sustained risk of further global spread. 1 In order to control the spread of COVID-19, heath care authorities in different countries recommended isolation of sick persons, quarantine for those who may been exposed to the virus and social distancing. 2 Social distancing also referred to as physical distancing meant keeping space between people outside of their homes. A distance of at least 6 feet (2 meters) was recommended and people were asked not to gather in large groups, avoid crowded places and mass gatherings. Widespread cancelation or postponement of sporting events including boxing and MMA bouts followed. The most common sited cause for cancelation was fear of contagion. The encyclopedia describes contagion as the communication of disease from one person to another by close contact. By canceling events, State Commissions, promoters and combat sport’s governing bodies made the tough but responsible decision to protect all the concerned parties namely the athletes, their camps, Commission officials, production crews and the fans at the venue.

 

The global death toll from COVID-19 has been devastating. COVID-19 has infected more than 2 million people and killed at least 132,276 worldwide as of April 15th 2020 according to the coronavirus resource center at Johns Hopkins University. 3 The pandemic affected each and every one of us fundamentally changing the way we live our lives. The pandemic has peaked in many European countries and the United States. While deaths continue to mount, new cases and admissions are declining. Governments are now turning to the complex question of how and when to open different states and countries to business and normal life. For combat sports to resume this summer we should explore the possibility of initially holding events “behind closed doors”. Only the athletes, cornermen, referee, judges, Commission officials, ringside physicians and TV production crew would be present at the venue. The rationale for holding an event behind closed doors will be to reduce the risk of COVID-19 transmission from person to person by restricting the number of people at the venue to under 50. In the past month many SARS-COV 2 diagnostic test kits have become available. Some of these can be administered at the point-of-care with a turnaround time of 24 hours. It is proposed that all (not just combatants) present at the closed door event undergo a coronavirus screening questionnaire and be tested for SARS-COV 2 in the week leading up to the event. Social distancing should be practiced at the time of the weigh-ins and also the event itself. Corner men, referee, judges, Commission officials, ringside physicians and TV production crew should wear a surgical face mask (N 95 respirator is not warranted), gloves and eye-protection during the course of the event.

 

We should acknowledge that even if an event is held behind closed doors and all those present (not just the athletes) are tested for the coronavirus, the risk of transmission from person to person remains. Controlling the spread of the COVID-19 pandemic is far bigger than any boxing or MMA event. It is a matter of social responsibility and an obligation to act for the benefit of the society at large. By adopting some of the above practices a cautious start to combat sports events can be contemplated.

 

 

COVID-19 and telemedicine: old barriers come down and new ones come up

COVID-19 and telemedicine: old barriers come down and new ones come up

Nitin K Sethi, MD

Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (U.S.A.)

 

In the space of a few weeks the COVID-19 pandemic has changed the way medicine is practiced in the United States. In order to control the spread of COVID-19, the Centers for Disease Control and Prevention (CDC) and department of health (DOH) of various states recommended isolation of sick persons, quarantine for those who may been exposed to the virus and social distancing.  Social distancing also referred to as physical distancing meant keeping space between people outside of their homes. A distance of at least 6 feet (2 meters) was recommended and people were asked not to gather in large groups, avoid crowded places and mass gatherings. All non-essential staff were advised to stay home and work remotely if the facility to do so was available to them. Hospitals across the country were forced to make some drastic changes in order to prepare for the expected surge of COVID-19 patients. In New York City, hospitals canceled all elective surgeries, closed in-patient epilepsy and stroke units and canceled all outpatient clinics. Patients were discharged from the hospitals. Beds especially ICU beds and other resources such as ventilators were reserved for COVID-19 patients. Physicians working in these hospitals were advised to adopt telemedicine in order to primarily maintain continuity of care for their existing patients. Barriers which over years had started to shackle the physician-patient relationship and physician autonomy in the practice of medicine came tumbling down. The Health Insurance Portability and Accountability Act (HIPAA), a US law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals and other health care providers was relaxed to state that covered health care providers will not be subject to penalties for violations of the HIPAA Privacy, Security, and Breach Notification Rules that occur in the good faith provision of telehealth during the COVID-19 nationwide public health emergency.   While physicians were encouraged to practice telehealth through their existing electronic health record (EHR) software, other modalities for pursuing telehealth were approved. Telehealth could be pursed via Zoom, WhatsApp or FaceTime. For physicians and patients who are unable to use any of the above modalities, a telephone encounter could be carried out. The above measures are a welcome relief to both physicians and patients as it helps maintain continuity of essential medical care during the COVID-19 pandemic. But just as the old barriers seem to come down, new ones started to come up. The HHS Office of Civil Rights (OCR) recommended the following: “OCR expects health care providers will ordinarily conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic. Providers should always use private locations and patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances. If telehealth cannot be provided in a private setting, covered health care providers should continue to implement reasonable HIPAA safeguards to limit incidental uses or disclosures of protected health information (PHI). Such reasonable precautions could include using lowered voices, not using speakerphone, or recommending that the patient move to a reasonable distance from others when discussing PHI.”  Overnight it seems new documentation guidelines came out with respect to televisits. We were told that physician documentation should include time start/end, participants on call and physical location of the patient at the time of the televisit. There had to be documentation of verbal consent that the patient understood that this is a billable visit. Patient could not have a phone visit within 7 days following last evaluation and could not be scheduled for an in-patient visit within 24 hours after a telephone visit else the physician could not bill for the televisit. We were informed of new billing codes and Medicare and Commercial Insurance rates for different time duration visits (5-10 minutes, 11-20 minutes, >21 minutes). A flurry of e-mails from the compliance specialists, medical billing specialists and office managers followed informing us of what we could or could not do.  It has been said that the COVID-19 pandemic is going to change the world as we knew it. When it comes to the practice of medicine the rules are expected to change too. While some old barriers have thankfully fallen, unfortunately new barriers have come up. It seems removing the shackles is easier said than done.

 

 

COVID-19 and combat sports-to fight or not to fight?

COVID-19 and combat sports: to fight or not to fight?

Nitin K Sethi, MD
Department of Neurology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (U.S.A.)

 

DISCLOSURES: NKS serves as Associate Editor, The Eastern Journal of Medicine and Editor-in-Chief, ARP Journal of Combat Sports Medicine. He also serves as Chief Medical Officer of the New York State Athletic Commission (NYSAC). The views expressed are his and do not necessarily reflect the views of the NYSAC.

 

Professional boxing and mixed martial arts (MMA) are popular sports with a worldwide fanbase. COVID-19 (coronavirus disease 2019) is the infectious respiratory disease caused by SARS-COV 2 virus (Severe Acute Respiratory Syndrome coronavirus 2). On March 11th,2020 The World Health Organization (WHO) declared COVID-19 a pandemic considering the over 118,000 cases of the coronavirus illness in over 110 countries and territories around the world and the sustained risk of further global spread.  In order to control the spread of COVID-19, heath care authorities in different countries recommended isolation of sick persons, quarantine for those who may been exposed to the virus and social distancing.  Social distancing also referred to as physical distancing meant keeping space between people outside of their homes. A distance of at least 6 feet (2 meters) was recommended and people were asked not to gather in large groups, avoid crowded places and mass gatherings. Widespread cancelation or postponement of sporting events including boxing and MMA bouts followed. The most common sited cause for cancelation was fear of contagion. The encyclopedia describes contagion as the communication of disease from one person to another by close contact. By canceling events, State Commissions, promoters and combat sport’s governing bodies made the tough but responsible decision to protect all the concerned parties namely the athletes, their camps, Commission officials, production crews and the fans at the venue.

Some promoters have explored the possibility of holding a combat sports event “behind closed doors”. Only the athletes, cornermen, referee, judges, Commission officials, ringside physicians and TV production crew would be present at the venue. The rationale for holding an event behind closed doors is to reduce the risk of COVID-19 transmission from person to person at the venue. It was further proposed that all athletes be tested for SARS-COV2 before entering the ring or cage. The term “behind closed doors” is used primarily in association with football (soccer) to describe matches played where spectators are not allowed in the stadium to watch. Soccer matches are played behind closed doors to punish a team when its fans display rowdy behavior and clash with the rival team supporters and is included in the FIFA Disciplinary Code. 3

Amid the COVID-19 pandemic should combat sports events be held behind closed doors? Crowd less bouts are rarely heard of in combat sports. Passionate frequently blood hungry fans vociferously and voraciously support their prizefighter and are as much a part of the sport as the athletes themselves. Combat sports athletes fight not just for fame and money, they fight for their fans in the venue. Holding a crowd less event takes the very essence and vibe out of a combat sports event. Just like water is the elixir of life, so is the combat sports fan to the sport itself. Even if an event is held behind closed doors and all those present (not just the athletes) are tested for the coronavirus, the risk of transmission from person to person remains. Controlling the spread of the COVID-19 pandemic is far bigger than any boxing or MMA event. It is a matter of social responsibility and an obligation to act for the benefit of the society at large.