How coronavirus compares to MRSA

The sports world’s response to the coronavirus pandemic has been unprecedented, but outbreaks have always been a part of sports.

The most prevalent infectious scourge in sports is Staphylococcus aureus, a bacterium responsible for a medical condition commonly referred to as “staph infections.” One variant of staph infections, known as methicillin-resistant Staphylococcus aureus, or MRSA (pronounced “MER-SA”), is dangerous. In 2017, MRSA accounted for more than 300,000 hospitalizations and an estimated 10,000 deaths in the United States.

Staph infections and MRSA have exposed how sports are vulnerable to these kinds of diseases. The coronavirus is just the latest example of sports’ experience with outbreaks.

The bacterium that causes MRSA is contagious, but doesn’t generally cause the same widespread outbreaks as the coronavirus does. Instead, MRSA causes outbreaks under specific conditions, typically in crowded places with inadequate hygiene, skin-to-skin contact and shared equipment. These are conditions that are characteristic of sports settings.

MRSA has made a significant imprint on the NBA. Former LA Clippers forward Blake Griffin, for example, had to undergo elbow surgery for an injury associated with MRSA in 2015. In 2006, an outbreak of MRSA in the Boston Celtics locker room led to an infection of captain Paul Pierce’s finger. And Grant Hill had a major bout with MRSA after ankle surgery in 2003, so serious that he confessed that it made him want to retire. His experience with MRSA inspired him to become a public advocate for MRSA education, treatment and prevention.

The path of disease for staph infections and MRSA is complex, from a relatively harmless bacterium that lives on the skin of many people to a highly invasive bloodstream infection. The coronavirus, in comparison, infects cells of the upper airway and lung, which explains the coughing and pneumonia associated with the disease. Viruses, in general, specialize in taking over cells and are often capable of causing large, rapid and widespread outbreaks.

While the MRSA experience in basketball is notable, football is the sport in which MRSA infections have been prominent. Professional football players are seven to 10 times more likely than those in the general public to have the bacteria associated with MRSA in their skin. The NFL has had several highly consequential outbreaks. Four years ago, tight end Daniel Fells had to retire from the NFL after a long battle with MRSA; he had an infection that it almost led to the amputation of his foot. And then there is the famous Washington Redskins outbreak from 2004 and 2005, which infected six to eight players.

NFL teams have taken varying approaches to mitigate and prevent these MRSA outbreaks: Some have required players to shower after games, disinfected equipment and massage tables, replacing entire training facilities and adding germ-killing coatings on lockers. Sports leagues have been wise to adopt more rigorous infection control methods, and it appears that many have been effective. The Celtics, for example, were aggressive in their response after Pierce’s infection in 2006. The Celtics implemented a system to test anyone involved in basketball operations, from the training staff to the front office, for staph infections (treating those who turn up positive). They also have strict and specific guidelines for cleanliness and hygiene, wound treatment and reporting of injuries.

Unlike MRSA, the coronavirus has no boundaries. The virus can spread between athletes in a locker room and even between athlete and fan: Utah Jazz center Rudy Gobert may have transmitted an infection to a fan during an autograph exchange. To date, more than a dozen other NBA players have tested positive for the coronavirus, including several high-profile names, including Donovan Mitchell, Kevin Durant and Marcus Smart. This is likely only a sample of the total number of players who are infected, and the list will almost certainly grow as more players are tested.

“People can catch the virus when they are in close proximity to others that carry the virus. The disease primarily spreads through tiny droplets of bodily fluids, such as saliva or mucus, from an infected person when sneezing or coughing,” said Dr. Senay Yitbarek, a postdoctoral fellow at the University of California, Berkeley and an expert in infectious disease. “These droplets can come into direct contact with other people or can infect those when touching an infected surface and subsequently touching their face.”

While the treatment options for MRSA are limited, they do exist and include courses of antibiotics such as sulfamethoxazole-trimethoprim, sometimes given intravenously, if the health care provider fears that the infection has spread to the bloodstream.

“Once those options have been exhausted, it can make infections almost untreatable,” said Dr. Andre Matthews, an assistant professor in the department of emergency medicine at the Emory University School of Medicine. “It is also so prevalent now that even for some common skin infections, we err on the side of caution, and assume that we’re dealing with MRSA.”

As limited as these options are, they are better than the current treatment options for the coronavirus, for which there are none. People with the coronavirus should receive supportive care to help relieve symptoms, according to the Centers for Disease Control and Prevention. For now, the only way to address the coronavirus pandemic is with social distancing. This explains the NBA’s decision to cancel games and suspend the season indefinitely: It limits possible contact between people. There are fewer drugs readily available to treat viral infections. For viruses such as the coronavirus, the best long-term solutions are often vaccines. Vaccine trials are underway, and researchers are investigating several antiviral drugs for possible use against the coronavirus, but it is difficult to know when they will be available.

The coronavirus pandemic breaks the artificial line between the people who play the sport, those who support the athletes, coach or patronize the sport in the stands. The truth is that neither the coronavirus nor MRSA is the last of the sports outbreaks.

The microbes that affect us are much like the athletes whom we admire: adaptable, clever, able to succeed in any arena or setting.