Playing in Orlando ‘Bubble’: Team Physician for Miami HEAT, Inter Miami on COVID-19, Injury Risks

The Miami HEAT kicked off its return last week within the so-called NBA Orlando “bubble,” where the pandemic-shortened 2019-2020 season is back underway. The NBA’s 22 teams inside the league’s bubble environment at Walt Disney World are playing eight seeding games, with the playoffs set to tip-off on Aug. 17.

Harlan Selesnick, M.D., orthopedic surgeon at Miami Orthopedics & Sports Medicine Institute.

Harlan Selesnick, M.D., orthopedic surgeon at Miami Orthopedics & Sports Medicine Institute, and the Miami HEAT’s team doctor since the franchise started back in the late 1980s, is currently in Miami. But he could be called upon to join the HEAT during the playoffs. Dr. Selesnick is also the team physician for the new soccer franchise, Inter Miami, and was there in Orlando for the return to MLS (Major League Soccer) action.

Extraordinary measures are being taken to protect players, coaches and staff from COVID-19, explains Dr. Selesnick. But there’s also the possibility of injuries you don’t normally see throughout a regular season because of the extended layoff due to the pandemic, he adds.

“Generally,(the players) come into a training camp in shape and then they go throughtraining camp,” says Dr. Selesnick. “That’s a whole lot differentthan three or four months being stuck in your apartment, (with) a minimalamount of running or things outside. And then trying to play right away.”

Dr.Selesnick was the subject of an interview on WLRN’s radio broadcast, Sundial, about his role as team physician,concerns about COVID-19 and injuries, and the challenging logistics ofrestarting the NBA season in a “bubble.” Here are some of thehighlights from the interview:

Question: So, you’re working with a majorleague soccer team, Inter Miami, and they’re playing in a tournament inOrlando. And it’s an effort to get sports back during the pandemic. But I’mwondering: as a doctor, how do you feel about sports trying to continue as thevirus is spreading the way it is?

Dr. Selesnick:
“Everyone has concerns, and so there’s really two areas of concern … as a physician. The first area, of course, is minimizing the risk of COVID-19 spreading to other teammates, and ultimately, to their families or coaches, and staff members … The second risk is: Remember, guys really didn’t train for three to four months. Now you’re asking them to go back and try and play with less training than they’re used to having. And the injury risk is probably more significant.”

Question: So, there’s that extra layer —  the fact that they have not been on theirschedule,  and so the chances of themgetting hurt go up a lot?

Dr. Selesnick:
“Well, no one knows how much, but it’s certainly a concern. And you know, in any of the sports that are going back, you have the trainers, and the strength and conditioning coaches … work on stretching and flexibility. When you’re dealing with soccer, there’s a lot of overuse injuries, in terms of hamstring injuries and things like that. Proper conditioning can decrease that risk. Heat exhaustion is an issue for — not so much the teams in Miami and Orlando — but some of the northern teams that came down to the Orlando bubble. And the NBA also has those same concerns about not having a usual training camp, not coming into training camp in shape — and then subsequently trying to get ready in two or three weeks to play at a very competitive level.”

Question: So, the MLS and the NBA are inOrlando and they’re playing in this bubble — I keep hearing this term. Thisbubble … it’s basically how the teams isolate to keep the virus out. But howdoes it work and how would you describe this bubble?

Dr. Selesnick:
“Well, there’re separate bubbles between the NBA and major league soccer. I’m a little bit more familiar with how the NBA bubble was set up. David Weiss, who’s an attorney for the NBA and deals with the team physicians, has done an unbelievable job, in terms of trying to make it as safe as possible. They’ve consulted with infectious disease experts from a number of institutions in the U.S., as well as even with Dr. Fauci (Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases) himself. Before (Miami Heat) training camp even began, the training facility was limited to four players at a time. One player working out themselves in one corner of the gym having no interaction with anybody else, just kind of working on shooting … that went on for a couple weeks.

“Beforethey went into the bubble, every one of the players was tested, essentiallyevery day, for COVID-19 to make certain that nobody was going to be COVIDpositive when they arrived in Orlando. And if someone did test COVID positive,they would be kept out of the bubble until they, subsequently, would have twonegative tests, be asymptomatic for a number of days, and also have acardiology screening because COVID has been shown to have some cardiac effectsin some patients.

“The players have to go through evaluation by a cardiologist — get an EKG and an echocardiogram — before they would be allowed back into the bubble. When they get to Orlando, the players would then be tested again — two separate tests, 24 hours apart, and be quarantined until those tests were also negative. And then they would be allowed into a situation where whenever they’re interacting with anyone else, they would have to wear masks, maintain social distancing, hand washing and then they were allowed to begin practicing with those parameters, as well as limiting exposure to players on other teams.”

Question: As the team doctor, you’re used tospending a lot of time with the players. But how does it work. With Inter Miamiand with the Miami Heat, how much time are you going to spend in Orlando withthe teams?

Dr. Selesnick:
“For Inter Miami, I actually went up for the first game. But to do that, I was tested 72 hours in advance — 24 hours in advance here in Miami. I drove straight up to Orlando and was tested there, and quarantined until the test came back negative. Then I was allowed to cover the game as the venue medical director. Then I came back. As far as the NBA goes … they have a much longer quarantine period and different rules. They found NBA doctors with the ability to take some time off — some former NBA doctors, some regional doctors. Anyone that is willing to cover all the teams and commit to at least a month at a time is allowed in the bubble as a physician.

“So,I’m not going to be able to have a whole lot of interaction or being at thegames, which is something we’re not used to. When it comes to the playoffs, ittends to be important to have your own team physician there to make sure thatit’s safe for your player to play, that someone’s not pulled out that couldplay, that someone that has a laceration doesn’t take too long to have itsutured or whatever. So that can affect the outcome of games. There areconcerns with that. The hope is that maybe when we make it to the second roundof the playoffs, things will open up a little bit and I’ll be able to go upthere.”