Thoughts on COVID-19 and the Future of MLB

Lots of speculation from fans regarding how soon we will see MLB games this year, if at all.  I'll offer my thoughts here.  Again, I will try to base my comments on facts as we know them.  Again, any opinions I express are my own and not necessarily those of my practice group or leadership of the medical profession.  As always, I highly recommend maintaining awareness of WHO and CDC as well as state and local guidelines and instructions, and following them as much as possible.

One question that has come up is whether games could be played now in empty stadiums.  The rationale is that younger healthier players are low risk and it is safe for them, or something to that effect.  My answer is that may be a consideration down the road after we get past the current peak and are in a position closer to China or South Korea with very few new cases being reported.  Until then, we need to maintain a complete shutdown.

Fact:  If you plot a graph of Case Fatalities vs age for the 1918 Influenza Pandemic, you see three distinct peaks:  Young children and the elderly are two of the three, but the other one is at approximately age 25-40.  It is believed that the reason for this middle peak is an intense immune response in the lungs causing fatal respiratory failure.  Interestingly, the majority of fatalities in the middle group occurred within a few day of onset while fatalities for older persons tended to occur after about 10 days and are thought to be due to secondary infections.

 Fortunately, we are not seeing a lot of fatalities in young children with COVID-19.  While the average fatality age is around 80, we are hearing and seeing alarming anecdotal reports of large numbers of people age 30-50 with critical illness and death.  I personally know of at least 3 such cases within 3 degrees of separation from my own family.  So while there are differences in risk, everybody is at risk to some degree and there may be a risk peak around age 30-35.

One more point:  I read just today that Hong Kong thought they were out of the woods and relaxed the restrictions and almost immediately had a resurgence.

IMO, MLB will need to remain shuttered until we are close to zero new cases.  At that point, they could consider training and playing without fans and with rigorous screening of players and staff. That is a minimum of 3 months away. If control of the pandemic is maintained, they could gradually open up the games to fans.  I would estimate there will have to be limits for as long as 18 months to 2 years.  If they look at seat placement, they could make limited seating available as long as the seats are at least 6 feet apart with rigorous screening on entry into the park and control of traffic entering and inside the park.  As to whether it's worth that trouble and potential liability, I will have to let MLB management decide that.

I will say this,  as things stand right now, I do not envision myself risking attendance at any sporting event or entertainment venue or large conference or destination vacation for at least the next calendar year and possibly as long as two years.

The one caveat to all of the above is if an effective vaccine is developed and widely distributed, we could all go back to business as usual(until the next pandemic arises, and it will), but that is likely at least 9-12 months away too.

*********************************************************************************

In answer to comment #2, the one young man who died was 34 years old.  He had asthma(Asthma is quite common in young adults) and a remote history of testicular cancer.  No word on whether he was treated with chemotherapy.  It is possible he had residual immune suppression if he was.  The other 3, who are still alive but requiring ventilation support(one age 32 and 2 in their early 40's), have no known underlying disease.

Underlying disease has a wide range of severities.  Hypertension, obesity and asthma are considered risk factors for fatal outcomes.  Those are all quite common in people age 30-50.

While older people and people with "underlying disease" are higher risk,  deaths are not limited to them and some of the underlying diseases which increase risk are not at all uncommon even in younger people, and are not necessarily ones you would think would make them die from a virus.

Point is, we cannot afford to just throw older people and younger ones with "underlying disease" under the bus while everyone else carries on with normal activities.

*********************************************************************************

A sliver of good news out of Italy:  Number of new deaths has dropped for 2 consecutive days.  Let's all hope and pray that trend continues.  Italy started their nationwide "lockdown" 2 weeks ago with a prediction of results in about 2 weeks.  Unfortunately, U.S. cases and fatalities are still rising exponentially and we are nowhere close to a true "lockdown" anywhere, let alone nationwide.