A team physician for the Washington NFL team has spent the past four weeks sleeping in a spare child-sized bed in his home, and he expects he’ll do so for the next two months. When John Tabacco returns home from serving his community in Virginia during the COVID-19 pandemic, he takes extra measures to protect his wife and three young kids.
Across the country, in Santa Clara, Calif., the most anticipated part of 49ers team doctor Anthony Saglimbeni’s day is now seeing how many coronavirus test kits his primary-care practice will receive. Some days it’s zero; other days, it’s two or three. Once, they received a dozen. The ebb and flow means that a patient may come in with identical symptoms as someone Saglimbeni tested just a few days earlier, but if he doesn’t have any kits, this patient won’t get tested.
“It’s a very odd time,” said Tabacco. “You like to think you are prepared for most problems you encounter, but there’s this overwhelming sense that there’s a growing surge of a problem that we don’t have too many answers for and not a lot of empirical evidence about.”
For health professionals, fighting this surging pandemic has become an all-hands-on-deck call. Which is why, in March, a few days after free agency opened, the NFL Physicians Society decided to suspend all football-related medical visits, including physicals for free agents and draft prospects. "At a time of the most serious pandemic in our lifetime, we believe medical resources should focus on those who are ill or in need of care,” Anthony Casolaro, co-head physician for Washington and the president of the NFLPS, wrote in a letter to the league and players association. “We look forward to examining players when it is appropriate to do so.”
The NFL has forged ahead with business, with some free agents, like new Buccaneers QB Tom Brady, receiving physicals from third-party doctors to finalize deals; other transactions, such as DeAndre Hopkins’s trade to Arizona, haven’t yet been announced because an exam is still pending. But a driving purpose behind Casolaro’s order, sent March 23, was to enable exactly what Tabacco and Saglimbeni are doing: Freeing up team doctors to use their training, skills and resources to help their communities during the COVID-19 crisis.
Tabacco’s practice in Falls Church, Va., where he works alongside DC United team physician Timothy Muir, has become something of a COVID-19 triage center over the past month. Part of his day is spent checking in with his regular patients who are high-risk, either because of their age or pre-existing conditions. Tabacco schedules telemedicine appointments with this population, virtually checking blood sugar levels and blood pressure, or adjusting medicines, to make sure conditions like diabetes and high blood pressure are under control so these patients would have a better outcome if exposed to the coronavirus. The other part of his day is spent outside in the parking lot, doing curbside check-ups of people who drive up with symptoms like fever or cough that they are concerned might be COVID-19.
“If we can prevent some of these people from going to the emergency room, that helps ER docs,” Tabacco said. “Working with sports teams, we know all about teamwork, and we need to help free up ICU and ER beds.”
Saglimbeni has taken on a similar role at his practice since Santa Clara County issued a stay-at-home order on March 17 after a surge of cases in the Bay Area. During a pandemic, an individual patient’s health concern can become a public-health situation. Here’s one example: One of Saglimbeni’s patients, who works as a therapist, had a potential exposure to someone diagnosed with COVID-19. The patient identified his close contacts, and Saglimbeni and his staff provided those 15 people drive-up testing. “We got our gowns on and swabbed people in the parking lot, like you see on TV,” Saglimbeni said.
Tabacco and Saglimbeni, who are internal medicine doctors, would normally be spending part of their days shuttling back and forth to the Washington and San Francisco team facilities. When players come in for a free agent or pre-draft visit, the team physician and the team orthopedist usually work together to conduct an in-person physical exam and interview, which have been discontinued during the pandemic. “Tony Casolaro put that order in place, which was so wise and freed up resources and time,” Tabacco said of his colleague on the Washington medical staff.
Tabacco’s new daily routine includes putting his N-95 mask in Tupperware at night, to help his clinic preserve the precious personal protective equipment, and racing to the basement when he gets home to change clothes and scrub his hands before seeing his kids. One of Tabacco’s primary-care patients, whose symptoms he had been monitoring virtually, started experiencing shortness of breath and needed to be admitted to the hospital. When he checked in on him a few days ago, Tabacco feared the patient may soon have to be intubated because of his low blood-oxygen levels, but by the next morning he was relieved to learn the man’s condition had improved significantly. Nights spent like this are a contrast to the debates Tabacco hears on talk radio during his drives home about when sports might resume.
“All I can speak about is how I think of it,” Tabacco said. “We are in the middle of a fight right now that demands all our attention, and if we give it all of the attention it needs, the outcome will be good. If we were to get distracted or think of what happens in a few months, it wouldn’t be helpful for anyone. We really are focusing all of our efforts toward the fight we are in now and try to not think about the next steps until we are ready for it.”
Saglimbeni is also the team doctor for the San Francisco Giants, so he went from NFL combine medical exams in Indianapolis to joining the Giants in Arizona before MLB made the decision to suspend spring training. In place of April baseball, he’s been on calls with Giants executives about being one of the MLB teams to participate in a research study investigating the incidence of asymptomatic carriers in the community. (Healthy team employees would be tested next week for both IgM antibodies, which indicate an acute infection, and the IgG antibodies that help the body remember past infections, to help advance the understanding of the virus by collecting data in several cities). He points out the mental-health toll of life, and sports, being disrupted, but he’s also been experiencing firsthand the challenges on the front lines of confronting this virus, between waiting for test kits and the mother of one of his employees having to sew gowns for his staff.
“It just keeps proving, more and more, that we have no idea what this COVID-19 is. We’ve never seen it before,” Saglimbeni said. “So every month, every few weeks, we have shifted how we are looking at it, because we have learned more. It would be ignorant at this point to say, I think [sports will return] at a certain time because this virus will die out. There are indications that plateaus are starting to happen, and plateaus are better than spikes, but they could be prolonged. That might mean better control of it, but it doesn’t mean it’s gone.”
Some duties as team physicians remain. Next week, Saglimbeni has a call with 49ers brass to discuss the medical grades assigned draft prospects based on the medical information collected at the combine. Tabacco is also still fielding calls from veteran Washington players who have medical questions for themselves or their families.
“I’ll pop on the phone,” Tabacco said, “and then run back out to the fire, which is the mounting line of cars up front or 20 calls with people who have fever or cough.”
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