Leading Italian doctor warns against complacency should action resume

ROME－While soccer leagues around Europe are still debating whether and when to resume playing, the leader of the continent's Federation of Sports Medicine Associations is calling for a detailed series of tests to clear athletes before they return to training.

Maurizio Casasco, who is also president of the Italian Federation of Sports Medicine, said guidelines recently published by his domestic federation should be extended for all of Europe－especially if UEFA intends to resume the Champions League and Europa League anytime soon.

"There needs to be a common protocol," Casasco said in an interview with Associated Press. "At both the national and European level, if there's a competition being contested the rules have to be the same for everyone. … And not only for soccer but for all pro sports."

The protocol developed by the Italian federation starts by dividing athletes into two categories: Group 1 for those who have already tested positive for the virus or shown symptoms associated with it; Group 2 for those who haven't tested positive, including athletes who were in contact with people who tested positive but who remained asymptomatic.

First, athletes in both groups will be tested for the virus. Those who test negative will also be tested for immunity－and those shown not to be immune will be retested every four days.

Athletes in Group 1 then have to pass strength tests while at rest, during and after physical exertion. Next up is a Doppler echocardiogram, then a Holter monitor (a 24-hour echocardiogram), followed by spirometry breathing tests, a full range of blood exams, a lung X-ray and, finally, clearance that the athlete is no longer infected.

Once cleared for training, athletes in Group 1 would need to gradually increase their activity levels over a specially observed 15-day period.

Athletes in Group 2 have fewer tests: strength, Doppler echocardiogram, spirometry and blood.

The protocol was developed by an eight-person commission that included Ranieri Guerra, the assistant director general for the World Health Organization.

"It's going to have a cost but I think it needs to be followed," Casasco said. "We work with athletes but the rules need to be applied to all of team staff members, too. Anyone who comes into contact with the locker room: equipment managers, physical therapists, coaches, club managers. Everyone."

At least 15 Serie A players have tested positive for COVID-19 and team physicians at Inter Milan, Fiorentina and Sampdoria have been hospitalized with the virus.

The government-ordered lockdown in Italy is scheduled to expire after May 3, so Casasco suggested the protocol tests should begin May 4.

"You can't start training until everyone has been tested; otherwise you risk creating a new hot spot," he said. "And obviously you can't just gather everyone together to perform the tests. The protocol has to be performed individually."

So while soccer officials in Italy have discussed resuming training on May 4, the protocol would require several more days before official practices could start.

Then, Casasco estimated, athletes would need"20 to 25 days" of training before competition can restart.

"The athletes are not completely at rest. They're probably at about 40 percent of their fitness, because they're training at home," he said. "It's not like they're sitting at the beach."

Competition, of course, raises other risks by bringing athletes into contact with more people on road trips－even if they would likely play in empty stadiums.

Casasco is also wary of leagues placing games too close together, followed by a short offseason before the next campaign begins.

"That will produce a greater risk of muscular injuries," he said.

The biggest question for the protocol, though, is whether it will be followed or not. While Casasco also leads a medical and scientific commission put in place by Serie A to deal with the coronavirus crisis, there is nothing to bind the top Italian soccer league or other competitions to follow the protocol.

"We haven't issued laws," Casasco said. "We're just a scientific commission that has issued recommendations and created guidelines."

While Serie A clubs are anxious to complete the 12 rounds remaining in the season to avoid millions in lost revenue, government health officials are hesitant to give the go-ahead.

"Soccer is a contact sport, therefore it carries a risk of transmission," said Giovanni Rezza, the director of infectious diseases for Italy's national health institute.

Rezza added that constant monitoring of players seems "a bit of a stretch", adding that he's not in favor of resuming games.

Sandra Zampa, the government's undersecretary for health, added that she doesn't see getting soccer going again "as a priority" and that "we won't see full stadiums until there is a vaccine".

But Casasco, who is also president of a confederation of small and medium-sized businesses, said resuming activities is preferable while the vaccine search continues.

"I think this virus is going to have a long life," he said. "Either you have a vaccine or medicine to combat it, or you can fight it with the precautions already in place. … Because we'll never have zero risk until we have the vaccine."

AP via Xinhua