As the cases of COVID-19 continue to steadily mount—an “apocalyptic” surge in New York City alone—and the virus’s body count grows, multiple states have banned doctors from performing elective surgeries in the hope of husbanding the desperately needed health-care professionals, medical supplies, and equipment.
The crisis, though, hasn’t stopped two star pitchers from going under the knife.
Over the last week, it was revealed that the New York Mets’ hurler Noah Syndergaard and Chris Sale of the Boston Red Sox tore their ulnar collateral ligaments. The prescribed treatment, Tommy John surgery, removes the damaged ligament and replaces it with a healthy one from the player’s own body.
Normally, this is a fairly routine procedure, one that no one would question. Now, it reads like yet another example of the wealthy and powerful being afforded privileges unavailable to the vast majority of Americans.
That perception is both accurate and inaccurate. Three professors of epidemiology who spoke with The Daily Beast explained that Syndergaard and Sale are, in all likelihood, not impinging on the ability of health-care professionals to respond to the virus, nor are they diverting resources.
Denying the two MLB stars care would not be medically justified. More to the point, while the sense of outrage is understandable, barring them from getting their highly valuable bodies stitched up at this moment in time wouldn’t do anything to alter the jarring and gross inequities present in the U.S. health-care system.
As an expert in medical ethics told The Daily Beast: “Unfortunately that’s the way our system works.” If athletes were somehow prevented being operated on, she said, “it wouldn’t make things better for less advantaged people.”
In the case of Syndergaard, fixing his right elbow qualified as “essential” treatment, according to The Wall Street Journal. A spokesperson for The Hospital for Special Surgery in Florida where Syndergaard’s surgery will take place told the paper: “The procedure in question—acute ligament injury with progressively worsening ulnar nerve symptoms—is defined as essential care.” The New York Post also reported that the surgery did not violate the standards set by Florida Gov. Ron DeSantis on March 20 prohibiting “non-urgent or non-emergency procedure or surgery.”
Sale, too, will undergo the same procedure as Syndergaard, though it’s unclear where and when it may happen. Red Sox Chief Baseball Officer Chaim Bloom said he would be operated on “soon,” the Boston Herald reported. The team declined to provide an answer when the Boston Globe asked if the surgery had already taken place. Bloom told reporters on March 19 that the team is “mindful” of how other Americans have been prevented from undergoing elective surgeries. As such, “we’re going to make sure that we do it in a way that doesn’t place any undue burden on everybody who is suffering as a result of the outbreak,” he said.
Asked how the determination was made that Sale’s surgery wouldn’t result in an “undue burden” on the unnamed medical facility, a spokesperson for the Red Sox told The Daily Beast: “We don’t have any further comment right now.” The team then cited Bloom's previous quote, adding: “As is customary we’ll have a follow up announcement when the time is appropriate.” Reached by email, a spokesperson for Major League Baseball pointed to Bloom’s comment when asked if the league had provided any overall guidelines to teams regarding upcoming surgical procedures.
It’s understandable why teams might not want to cough up all the details right now.
Not when professional athletes’ ability to secure rapid and immediate tests for the novel coronavirus has come under sharp scrutiny, even in instances where they were asymptomatic. Fifty-eight members of the Utah Jazz traveling squad were tested by the Oklahoma State Department of Health immediately after center Rudy Gobert’s test came back positive on March 11. The entire traveling unit was notified of the results in as timely a manner as possible. At the time, those 58 tests represented 60 percent of the state’s peak daily testing capacity. Other Oklahomans, however, have waited days to receive results or were denied a test altogether despite showing obvious symptoms of COVID-19.
A number of MLB players received treatment prior to the bans on elective procedure being enacted. San Francisco Giants relief pitcher Tyler Beede underwent Tommy John surgery on March 20 in Arlington, Texas. The surgery took place two days before Texas Gov. Greg Abbott signed an executive order delaying non-life-threatening medical procedures. As is the case in Florida, medical professionals are charged with making that determination. Also on March 20, two San Diego Padres pitchers, Andres Muñoz and Reggie Lawson, also underwent Tommy John surgery. Two days prior, Joey Wentz, a prospect in the Detroit Tigers’ organization did as well. It is unclear what hospital performed the procedure on Muñoz and Lawson, but Wentz, like Syndergaard, was treated in Florida by Dr. David Altchek.
In the NBA, the Dallas Mavericks guard Jalen Brunson had surgery on his shoulder at the Carrell Clinic, an orthopedic facility in Dallas and the Los Angeles Clippers forward Terrance Mann required treatment for a damaged ligament in his hand on March 18. Johnny Bucyk, a 70-year-old ex-NHL great, had his planned hip replacement surgery delayed indefinitely.
All of these treatments occurred after March 14, when Centers for Disease Control and Prevention recommended that hospitals cancel any and all elective procedures, particularly in parts of the country where the virus was running rampant. Cancer patients represented a “gray area,” Dr. Arooj Simmonds, the co-executive medical director of surgical services at the Seattle-based Swedish Medical Center, told the Times.
That same day, U.S. Surgeon General Jerome Adams tweeted: “Hospitals & healthcare systems, PLEASE CONSIDER STOPPING ELECTIVE PROCEDURES until we can #FlattenTheCurve!" [all-caps his]. Other patients in need of non-urgent medical care have voluntarily avoided hospitals to avoid risking exposure.
But a high-profile surgeon in Los Angeles who has served as the head physician for two pro teams, and has offered consultation services to many others, defended doctors’ decisions to go ahead with the elective Tommy John surgeries.
“I know that I’m going to get criticized for taking care of these kinds of guys, but it’s essential to their livelihoods,” Dr. Neal ElAttrache told the San Francisco Chronicle. “If you have somebody’s career at stake and they lose two seasons instead of one, I would say that is not a nonessential or unimportant elective procedure.”
Jeffrey Klausner, a professor of epidemiology at the UCLA Fielding School of Public Health echoed ElAttrache’s position. “In most of the country there is actually not substantial transmission,” he said.”Local hospitals should be making decisions… Every epidemic is local and people really need to look at the local data to make decisions.” In Palm Beach County, where Syndergaard is being treated, only 1,187 residents have been tested as of Thursday. To date, Gov. DeSantis has resisted ordering all Floridians to shelter in place.
Still, as an orthopedic and sports medicine-centered facility, it is unlikely, even in the event of a dramatic uptick in COVID-19 cases, that the Hospital for Special Surgery would be commandeered. “It makes sense to me if that hospital is not going to be used to treat people for respiratory diseases, that hospital should continue with its regular medical and business activity,” Klausner said.
Timothy Brewer, also a professor of epidemiology at UCLA, concurred with his colleague. “To the extent that we’re capable of providing health care without causing any detrimental effects to our response to the pandemic, it would be reasonable to allow that health care to happen.”
George Rutherford is a professor of epidemiology and biostatistics at the University of California, San Francisco School of Medicine. Reached by phone, Rutherford said the question of athletes and elective surgery raises two separate issues that need to be considered. “One is whether we should be doing elective surgery before a potential surge or not,” Rutherford said. “And the second is who gets prioritized to get that elective surgery.”
With regards to the former, Rutherford doesn’t consider it a problem, save for treatment that required an extensive hospitalization time and utilization of resources. “If it’s simple outpatient surgery or one night then out, I can’t imagine that that hurts anything,” he said. (Rutherford, an Oakland Athletics fan, then quipped: “If they’re a [New York] Yankee, absolutely not.”) In San Francisco, however, “We’re cleaning out hospital beds right and left to make room for people so this isn’t the place,” he said. “In other places, where they may be lagging behind, I don’t see that it does any harm.”
He continued: “In terms of prioritizing who gets it, that’s an ethical question.” The principles of bioethics are based on “distributive justice,” he explained. Meaning, “everybody would have equal access to the procedures,” and someone’s grandmother would be just as likely as a ballplayer to have her elbow repaired.
Brewer similarly stressed: “I’m very much of the opinion that we’re all in this together and we should be treated the same. We should not have one set of rules around how we deal with COVID for VIPs and a second set of rules for everybody else.”
Dr. Molly Cooke is a professor of medicine at UCSF and an expert in medical ethics. She’d read about Syndergaard’s surgery and when asked if the seeming ease at which athletes are receiving treatment violated any ethical guidelines, she sighed deeply. Her impulse as a human being is to say "people shouldn’t be getting these elaborate procedures done when children can’t get immunized. but the problem is in our fragmented health-care system,” she said. “Forbidding people from getting fancy procedures doesn’t result in routine care for children,” let alone ensure that all severe COVID-19 patients would receive a respirator.
“I wish that it did,” she said, “but that’s not the case.”