Project Restart and COVID-19 – how do we reduce risk for ethnic minority athletes?

Preliminary evidence has raised concerns regarding the disproportionate risk of adverse COVID-19 outcomes among people of ethnic minority groups. By proactively considering risk, we can protect those engaging in football or indeed any sport at any level. The challenge is implementation for both social players and for those who play football as their occupation.

As the coronavirus disease 2019 (COVID-19) pandemic continues its rapid spread globally, several aspects of modern day life have been affected. On Friday 13th March 2020, the English Premier League was “postponed until no earlier than 30th April 2020”.1 The suspension continued beyond this date and non-contact training began on 26th May 2020 as part of ‘Project Restart’, over 8 weeks since it was first postponed. There is significant apprehension, particularly amongst ethnic minority players. This is evidenced by the Watford team captain, Troy Deeney, raising concerns around ethnic minority risk and the subsequent downstream risk to his young son on 19th May 2020.2

 

Higher risk cohort?

During the 2017-18 Premier League season, the proportion of players from ethnic minority backgrounds was 33%.3 The ONS also provide data on occupational risk, including sports players, of which 13,800 exist across the United Kingdom, 9% are from ethnic minority groups and report a high proximity to others but low exposure to disease risk.4

Preliminary evidence has raised concerns regarding the disproportionate risk of adverse COVID-19 outcomes among people of ethnic minority groups.5 Specifically, the largest cross-sectional analysis to date has found that increasing age, male sex, increasing deprivation, urban location, and black ethnicity are most associated with SARS-CoV-2 test positivity.6 Furthermore, occupational risk assessed in health workers has shown ethnic minority healthcare workers have an increased risk of mortality compared to White healthcare workers.7 Lastly, Office for National Statistics (ONS) data has demonstrated black males are 4.2 times more likely to die from a COVID-19-related death than White ethnicity males and females.8 Importantly, although some of the differences between ethnic groups in COVID-19 mortality may be attributable to socio-economic factors, this does not account for all the differences that are seen.8

Clearly, ethnicity is a proxy for certain health, socio-economic and structural conditions of social life which, as we have discussed above, leave black communities in the UK (and US) prone to higher COVID-19-related mortality rates than their white peers.9 The extreme levels of physical conditioning techniques and nutritional surveillance that accompanies a career as an elite-professional athlete,10 suggest that black footballers may not be prone to many of these causal factors. It is unlikely that we would see the same levels of disparity in mortality rates between black and white footballers that we have seen in other types of work – we are not however suggesting that there would not still be a noteworthy disparity.

Importantly, Deeney’s pointed remarks to the safety of his black-heritage son reminds us that black footballers do not exist in a social-vacuum but are often directly plugged into the very ethnic minority communities where the impact of COVID-19 is much more lethal. This point is especially applicable to black women and young black male professionals who, because they seldom possess the same financial clout as that accrued by their established male peers in the English Premier League, are more likely to live in households alongside their parents, grandparents and family members – black people who are at high risk.

Ultimately, the risk remains very unclear for ethnic minority footballers. Equally the impact of the COVID-19 pandemic is not limited to the men’s game and elite women’s football players are likely to have similar concerns.11 Across all corners of the game, from grass roots football to elite level, data collection is needed to inform risk assessments. In order to reduce risk in the interim, social distancing, handwashing and personal protective equipment all still have a crucial role. The challenge is implementation for both social players and for those who play football as their occupation. The key is supplementing these approaches with risk profiling for individuals, such as that being increasingly recommended for healthcare workers.12 The response needs to be urgent as footballers are certainly not immune to this risk, with Serie A (Italian Premier League) for example noting their first footballer to test positive for COVID-19 being followed by 5 further players and a team doctor testing positive within 24 hours.13

Conclusion

  • Footballers are a part of society and we need to acknowledge this and support them as we have done those in other occupations and parts of society. Admittedly they are healthy, though the unpredictability of the COVID-19 pandemic has provided little comfort for those across the spectrum of health and disease.
  • As Deeney rightly raises, “additional screening” to help collect data to determine a personalised risk profile for players may be necessary to provide us with a greater understanding as to the dangers or indeed safety of returning to Premier League/Elite football.
  • By proactively considering risk, we can protect those engaging in football or indeed any sport at any level.

Authors and Affiliations

Jatinder S. Minhas1

Christopher A. Martin2,3

Paul I. Campbell4

Manish Pareek2,3

@DrJMinhas

@drpaulcampbell1

@drmanpareek

1Department of Cardiovascular Sciences, University of Leicester, UK

2Department of Respiratory Sciences, University of Leicester, UK

3Department of Infection and HIV Medicine, University Hospitals Leicester NHS Trust, UK

4School of Media, Communication and Sociology, University of Leicester, UK

Corresponding author:

Dr. Manish Pareek

Email: mp426@le.ac.uk

Contributors All authors discussed the idea and contributed to writing the blog.

Competing Interests None declared.

References

1) Joint statement from FA, Premier League and English Football League https://www.premierleague.com/news/1646728 (Accessed 19th May 2020)

2) BBC News. Troy Deeney: Watford captain says he will not return to training.

https://www.bbc.co.uk/sport/football/52721397 (Accessed 19th May 2020)

3) Talk Sport. https://talksport.com/football/269320/proportion-british-bame-players-has-doubled-premier-league-began-talksport-special-report/ (Accessed 19th May 2020)

4) Office for National Statistics 2020 https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/articles/whichoccupationshavethehighestpotentialexposuretothecoronaviruscovid19/2020-05-11 (Accessed 19th May 2020)

5) Pareek M, Bangash MN, Pareek N, et al. Ethnicity and COVID-19: an urgent public health research priority. The Lancet 2020;395:1421-2.

6) de Lusignan S, Dorward J, Correa A et al. Risk factors for SARS-CoV-2 among patients in the Oxford Royal College of General Practitioners Research and Surveillance Centre primary care network: a cross-sectional study The Lancet Infectious Diseases 2020

7) Cook T, Kursomovic E, Lennane S. Exclusive: Deaths of NHS staff from COVID-19 analysed. (Accessed 19th May 2020)

8) Office for National Statistics 2020 https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020 (Accessed 19th May 2020)

9) Campbell, P. I. (April 15, 2020) ‘Coronavirus is hitting ethnic minority communities hard on every front’ The Conversation https://theconversation.com/coronavirus-is-hitting-bame-communities-hard-on-every-front-136327 (Accessed 19th May 2020)

10) Campbell, P.I. (2020) Education training, retirement and career transition for ex-professional footballers: ‘From being idolised to stacking shelves’ Bingley: Emerald

11) Clarkson BG, Culvin A, Pope S et al. Covid-19: Reflections on threat and uncertainty for the future of elite women’s football in England. Managing Sport and Leisure 2020.

12) Khunti K, Singh AK, Pareek M, Hanif W. Is ethnicity linked to incidence or outcomes of covid-19? BMJ 2020;369:m1548.

13) Corsini A, Bisciotti GN, Eirale C, et al Football cannot restart soon during the COVID-19 emergency! A critical perspective from the Italian experience and a call for action. British Journal of Sports Medicine 2020.

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