For Botswana athletes kicking the pig-skin, treading the race track or even shooting basket ball hoops is a life and death issue.
With death stalking athletic Covid-19 survivors , the Botswana Football Association (BFA) medical team has put together a set of return to play guidelines to mitigate risks of possible death on the field of play.
This is not paranoia. Myocarditis, a cardiac abnormality associated with sudden cardiac arrest in athletes, has been detected in a large number of Covid-19 patients.
At the ongoing Africa Cup of Nations, athletes such as Gabon striker Pierre-Emerick Aubemeyang and his compatriot Mario Lemina who had recovered from Covid-19 were forced to go back to parent clubs after tests showed they had heart lesions.
The BFA return to play guidelines however come across as a farce. Indications are that if Aubemeyang and Lamina were plying their trade in Botswana, it is almost certain that they would have slipped through the BFA return to play safety net.
Since Botswana’s football started, almost all 16 Premier league clubs have postponed their games due to players testing positive for the virus. Sunday Standard Sports investigations have revealed that most have been released from their sickbeds straight to the playing field, with hardly a minor check up, let alone organ scans.
Masitaoka medical doctor, Kelebogile Selatlhwa confirmed that they release players immediately after isolation without conducting tests for the respiratory system or organ health.
Despite the BFA return to play guidelines, with local football teams constrained by limited resources, players health care does not go beyond handing out supplements to boost their immune system. “Most teams do not have the means to offer players proper medical check-ups after isolation to ensure they do not have side effects especially heart complications,” Selatlhwa said.
Speaking to the issue of Covid-19 and its effect on the heart, the head of the Botswana Football Association (BFA) medical team, Lone Bagwasi confirmed that corona virus causes respiratory inflammation. He said this leads to an inflammatory cascade which may affect different systems in the body mostly the lungs, heart, kidneys, stomach, muscles and bones.
He however explained that there are different degrees to the covid-19 symptoms which may help indicate if a player may suffer from any side effects. He says the symptoms are characterised as being moderate, mild and severe symptoms.
“Mild or self-limiting symptoms may use oxygen leading to life- support. While moderate and severe it is where many- a- times people get infection of the heart also known as Myocarditis , however, it does not mean it may not occur on the mild stages of covid-19 like how we see our players after isolation,’’ Bagwasi said.
“The heart and the lungs are mostly engaged during physical activities to pump blood around the body and to deliver oxygen to the working muscles. With the heart infected, it may lead to a change in heart beat leading to high intensity rhythm which may cause cardiac arrest,” he said. He said players who are affected with myocarditis should not be allowed to participate in high intensity games.
“After 10 days of isolation one has to go through a gradual process which includes individual training for a week, second stage will be to resume training with ones clubs’ members. These two weeks of training are to allow the body to adopt. Post infection players may need to do an x-ray or a CTC scan which can give a better picture also an ECG or ECO can be recommended but all this can be done if there are resources. If one is in a resource limited setting something still needs to be done to allow players to be fit enough to play a high intensity game,” Bagwasi pointed out.
In addition he said simple cardiac screening can be done, looking at the severity of the symptoms. A basic ECG can be done if there are signs of myocarditis, before return to play once cleared then he can play. In cases of moderate to severe symptoms, players can do an ECO and graduate the player within the two weeks period of self-trails. Nonetheless, if tests post positive findings, player has to rest until cleared to play again, which may take three to six months to settle.
“Where we are with all this, there should be a regulated way in which things are done. We have guidelines which we have given to administrators. The BFL also recently signed our covid-19 protocols so that being said, they have to follow them. If not followed accordingly players health will suffer,” he said.
The return to play guidelines by the BFA medical team states that in case any team delegate is infected by covid-19 they should be subjected to local public health guideline, exempted immediately from football activities, upon recovery from the virus; they will undergo a gradual four week return to play program.
Guided by athlete tolerance to activity, players with positive imaging findings or cardiac markers will be out of play for no less than 3 months. This player will be subject to a medical examination (Physical assessment, blood tests including cardiac markers, chest radiography, ECG and an echo-cardiogram for cases of server COVID-19 infection before they can be cleared to return to play.
Any team that violates this arrangement may be subject to disciplinary hearing by the BFA adding that any team not meeting minimum compliance requirements as described (PCMA, regular screening and infection control) should not be allowed to resume football activities.
Even though with all this rules and regulations set in place it seems they are not being followed. According to one club which chose to comment on animosity, Covid-19 is now viewed just like an ordinary injury in the field of play.