How COVID Affected the NBA Playoffs

Not quite in the way you think.
NBA Logo with Virus Glitch
Photo Illustration by C.J. Robinson

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From a health and safety perspective, the NBA’s bubble experiment has been a rousing success. Rapid-response COVID-19 tests combined with strict, commonsense safety protocols have, since July, protected every player, coach, and team employee from catching the coronavirus at Walt Disney World. But in the four months that led up to the season’s resumption, over 30 NBA players were diagnosed with COVID-19 and then entered the bubble after a period of recovery. (For confidentiality reasons, the NBA declined to provide an official count; GQ’s estimate is drawn from various media reports and press releases made by the league before the season resumed.)

What do we know about how COVID-19 affected these players on and off their court? And to what degree did these pre-bubble cases affect the outcome of the playoffs?

We know that the NBA was very cautious about protecting players from long-term health complications. Each player who tested positive for coronavirus had to pass a series of physical examinations before they could work up a sweat with their teammates, including electrocardiograms that detect changes in the heartbeat. “The NBA has done cardiovascular screenings for years,” according to Dr. Matthew Martinez, a representative for the NBA player’s association and a cardiologist for Major League Soccer and the New York Jets, so the league had a reference baseline for those tests.

There turned out to be no heart-related abnormalities due to COVID-19, which was a pleasant surprise for Martinez: “[In July], we thought we would find a lot of them,” he said. “We have not found that. And by using that screening protocol we have not had any significant events or complications, like a rehospitalization or a new cardiac symptom in those who were screened and deemed to be safe to play,” he said. Players who contracted COVID-19 are collected in a database and will continue to be monitored: “We learned a lot, and I think we’ll learn more over the next 3-6 months as we kind of plow through the data to identify any new changes that occur going forward. But right now there’s no signal that suggests that’s going to change in the next 3-6 months.”

Dr. Heather Strah, a pulmonologist at Nebraska Medical Center, said “We don’t know what kind of permanent scarring happens to people’s lungs.” And a study published in JAMA Cardiology earlier this month found that four out of 26 athletes who had COVID-19 at Ohio State had “CMR findings suggestive of myocarditis,” which is an inflammation of the heart that can have serious consequences. But Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for health security, told GQ he doesn’t know “what the clinical significance of the Ohio State cardiac MRI findings may be because it’s a very small study.”

So there’s no medical evidence that asymptomatic or mildly symptomatic players who recovered from the virus in time to play in the bubble were at a competitive disadvantage because of anything COVID-19 did to their bodies. “Was it physically taxing to just have the virus?” Dr. Martinez said. “That’s a good question to ask. I don’t know the answer to that.”

But what about recovery time? Players who caught COVID-19 were instructed to refrain from physical activity for at least two weeks. The upshot from that safeguard has potentially affected players even more than the actual illness. According to Jeff Stotts, a certified athletic trainer who tracks NBA injuries as the operator of InStreetClothes.com, nearly a third of all players who reportedly tested positive for COVID-19 suffered a soft-tissue muscle injury.

The highest profile example is Russell Westbrook, who looked nothing like the regular season’s All-NBA point guard once he got to the bubble. After testing positive for coronavirus—he announced his diagnosis on July 13, two weeks before the first bubble game—Westbrook’s symptoms were nothing more than a stuffy nose. But the amount of time he had to rest after testing positive was a bigger problem.

“It’s very frustrating for me, honestly man, coming to Houston and then catching COVID,” the All-Star told reporters after Houston was eliminated. “I had to sit back 20 days, 21 days without working out.” Westbrook played a whopping 44 minutes in his first game back, and felt soreness in his right quadricep four days later. He missed eight of Houston’s next nine games and averaged just 17.9 points once he returned to action in the middle of the first round.

David Alexander, a trainer who currently counts 35-40 NBA players as clients, including LeBron James and Chris Paul, saw Westbrook’s issue coming: “When these guys had to quarantine, even if you were able to get your trainer on Facetime, which I was doing with a lot of players, it’s still not the same to what they’re used to in preparation of their body,” he said. “The guys that got it I think were at an extreme disadvantage because of the resources that were taken away from them. I wouldn’t say it was the COVID directly. It was the quarantining issue of what they had to do when they did test positive.”

Dr. Strah likens it to 70-year-old studies of army recruits who had their muscle strength tested after three weeks of being bedridden. “Based off of that very old data, ICU doctors tell ICU patients that they can anticipate 3 to 4 days of recovery for every one day in the ICU,” Dr. Strah said. “The same would be true if you’re a very high level athlete. You can decondition very quickly despite being in great shape to begin with, and it will take one to two days for every one day that you’re out, to get back to where you were. Even if you’re not hospitalized.”

Sacramento Kings forward Harrison Barnes tested positive right before he was set to leave for the bubble. For the first five or six days after he learned he had COVID-19, Barnes experienced no symptoms. Then he lost his sense of taste and smell and experienced some fatigue: “It was a big adjustment just because you go from sitting around the house all day to practices and then games at a very high level,” he said.

Sacramento’s medical staff warned Barnes that even though research was still developing, working out too soon could lead to complications. “The research behind that was still developing but they were saying I had to be cautious. So thankfully I built up enough bank in terms of conditioning and things like that to not go back to completely zero,” he said. “But it was difficult, just not being able to work out because that’s habitual, something you do every single day. My biggest thing was if I would’ve felt anything awry related to breathing, a pain in my chest, anything like that, at that point I would’ve not played. But I didn’t feel any of that, thankfully.”

Justin Anderson was stunned by his positive test, which came as he was training in Atlanta, about to sign with the Brooklyn Nets. The symptoms followed soon after a second test confirmed his diagnosis: “Two days in a row, I think I slept 17 hours out of a 24-hour day,” Anderson said. “All I wanted was water. I didn't want to get out of bed. I remember not being able to stand up straight because my back muscles ached so bad.” Although he entered the bubble 25 days after his first positive test, Brooklyn’s medical staff warned the 26-year-old about jumping back into physical activity too fast. “They said ‘you don’t want to overwork because this can set you back even further with some serious issues,’” he said.

Anderson believes the two prior months he’d already spent working out in preparation to land with a team made a big difference. “I actually felt better than I thought, I think because of my preparation,” he said. “I talked to a couple other guys who were late additions and they were basically not doing much during their quarantine, that first seven-week period. So they couldn’t really bounce back from that two weeks or three weeks, however long it took to recover from COVID, because they didn’t have a base.” Anderson credits the Nets for being patient with him. “If I had to come in and play 35 minutes right away, then my story right now might be a lot different,” he said.

Anderson thinks that players who tested positive for COVID-19 were at a competitive disadvantage. “Absolutely. And it’s not an excuse at all. It’s our reality. It’s OK if some players had a competitive advantage. With COVID you just take a pitfall physically, maybe mentally a little bit, and then you have to figure out a way to come back up. I think those guys were definitely at a disadvantage, but we’re all competitors.”

It's impossible to draw firm conclusions about how coronavirus affected the playoffs. There are myriad variables at play and every person who contracts the virus responds differently. But timing does matter. The Los Angeles Lakers had two positive tests way back in March and none since, while the Rockets could have used a healthy Westbrook for their second-round matchup with the Lakers. Eric Bledsoe did not begin practicing with the disappointing Milwaukee Bucks until a week before their first game, and the New Orleans Pelicans, who were a trendy pick to make the playoffs but fell far short, revealed that three of their players tested positive one week before the team traveled down to Orlando.

But at the same time, players like Bam Adebayo and Nikola Jokic tested positive in July and elevated their games to even higher levels inside the bubble. The effect is case by case.

The NBA and its teams will know more about the coronavirus and how it impacts high-intensity athletes by the time next season begins, but there won’t be a solid answer for every serious question. With no vaccine available and cases rising by the thousands all across the country just last week, it’s only natural to assume that players will contract the virus in the outside world, removed from the artificial cocoon in which they just spent the hardest stretch of their professional lives. They are no longer getting a regular test, nor is everyone they’re in contact with on a daily basis.

So far, there haven’t been any serious complications, and a few doctors interviewed for this story believe that if coronavirus is like any other viral infection, those who were asymptomatic or had mild symptoms are not likely to develop any long-term health issue. But the word “likely” can be terrifying in this context.

“At the end of the day you don’t know what’s going to happen if you tested positive and now you're feeling good and then you get a player, let’s just say like a Russell Westbrook, that plays as fast and hard as he does and his heart rate is up at 170,” Alexander said. “We don’t know if he’s going to have a heart attack. And that’s the problem. That’s the thing with this disease.”

Until more data is collected, physically-debilitating precautionary measures will become part of how the NBA operates. It’s a frustrating byproduct of navigating the unknown. “Doing any kind of activity in the COVID-19 pandemic era has some level of risk,” Dr. Adalja said. “And people are going to assume risks based on what values they want to pursue. But so far there don’t seem to be any insoluble problems with the athletes returning to play, yet.”