Podding the Bubble - Part 3: Will the NBA Bubble Burst?

Podding the Bubble is a three-part mini-series taking a deep dive look into the biosphere created by the NBA in Orlando. Part 3 puts the NBA's plan into the context of what other major sports leagues are doing, and of the pandemic at large as it stands today. And with the help of global health expert and noted bioethicist, Dr. Zeke Emanuel, we try to answer the question: Was all of this a good idea?
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The following is a full transcript of a podcast episode from the mini-series, Podding the Bubble. Listen to the original audio on the Crossover NBA Podcast, the Open Floor podcast, or the Coronavirus + Sports podcast. Subscribe to all SI podcasts for free wherever you listen to shows.

Luis Miguel Echegaray: Welcome to a new series from SI, where we dive deep inside the return of the NBA and life inside the bubble. I'm your host Luis Miguel Echegaray.

Luis Miguel Echegaray: Today, predicting the outcome. Was the bubble a good idea? And now that we have seen the first two weeks of life inside the bubble, how can the league ensure health and safety for all involved? And finally, what are the most important factors to consider as this competition intensifies. From Sports Illustrated, this is Podding the bubble.

Luis Miguel Echegaray: We've learned a lot in our journey to understand how the NBA Orlando campus came to be, what life in the bubble was like for players and media, and what to expect from the product on the court. Now, as we look ahead to whether this grand sports experiment will work, we need to understand what's going on outside the bubble as well. We'll be talking to Dr. Ezekiel Emanuel, a bioethicist WHO adviser, a key architect of the Affordable Care Act, and the host of Making the Call podcast. Back in April, during the height of the national coronavirus shut down, I spoke with Dr. Zeke Emanuel for SI's Coronavirus and Sports Podcast. When we first talked, Dr. Zeke told us to expect an overall timeline of 12 to 18 months for sports to return. So we caught up with Dr. Zeke on the eve of the NBA has returned to action to understand fully, where are we now with the public health crisis in the country, and will the NBA bubble hold? Dr. Zeke will offer his thoughts on the ethical and medical aspects of the bubble and what to maybe anticipate. He will aim to basically do something he's rather good at, predicting the outcome from an ethics perspective. You'll hear a lot of our conversation throughout this episode. Dr. Zeke, it's a pleasure to have you here, thank you so much for joining us.

Dr. Ezekiel Emanuel: Good to be back with Sports Illustrated.

Luis Miguel Echegaray: At some point Dr. Zeke, you could say I told you so, because last time we spoke, it was really in the backdrop of something that you brought up publicly about how this country will need a 12 to 18-month plan in order for things to really return back to normalcy. The NBA returns with a bubble in Orlando, Florida. And we will talk about all of this, but the first question I have for you, Dr. Zeke, is paint a picture for us of how the health crisis has evolved or rather devolved, I guess, over the course of of three months. Where are we right now as to when we spoke?

Dr. Ezekiel Emanuel: So the first thing to say is the good news. You know, we know that steroids work and saving lives of seriously sick people with COVID. We know that Remdesivir decreases hospitalization for people who are seriously ill. And we're well on our way towards testing and evaluating the effectiveness of vaccines. We've got one vaccine in an effectiveness trial. That's the Oxford AstraZeneca vaccine. We've got two knocking at the door and we'll start trials imminently in the next few days, probably by the time the podcast is broadcast. That's the really good news. I guess one other piece of good news is that New York City, which was a hotspot, I think, when we were last talking, has really successfully mitigated its crisis and is down low and I think could serve as an effective model. The bad news is, you know, we have more cases than ever, every day being produced. And that's not, as President Trump says, because of testing. It's because we have more cases. 30 or 40 states, depending upon the day, are hitting records in terms of new cases. The death rate was going down and it's now turned around and is going back up. That's not good. And we have, I think, expended or spent or wasted the most valuable thing we have, which is the American people's perseverance and willingness to tough this out, mostly because we just haven't had a plan. We haven't been able to do what Europe, Canada has done, which is when we get to the top of that curve, come down and come down very far so that the rate of transmission is low, the number of new cases is low, and it's safe to open up slowly, mostly with outdoor events, outdoor restaurants, outdoor activities of small groups, so that if any cases arise, we can actually suppress them. Instead, you know, places like Georgia and Alabama and Arizona and Texas and Florida rushed in, opened up indoor items like indoor dining, indoor bars, beauty parlors, tattoo parlors and places where large groups of people could congregate. And we've seen the consequence, you know, big explosions and numbers of cases, big explosions in terms of hospitalizations, and then three or four weeks later, deaths. It was all predictable, unfortunately. And in some ways, we're right back where we were three months ago.

Luis Miguel Echegaray: So in that list of states that you were talking about, you, the last one you said was Florida and Florida is the host state of the NBA bubble. And, you know, the NBA is not the only one we've had the WNBA and also MLS, who's already more than halfway through its tournament. All of this is happening in the state. What is your view when it comes to hosting sporting events in a state that's not a New York? Actually, that's you know, that's a state that's going even upwards when it comes to positive infections.

Dr. Ezekiel Emanuel: Well, I think it's it's a risk and, you know, it's a bubble. And to the extent that you can actually successfully sequester people and keep them inside the bubble, what's happening outside shouldn't matter. That's the whole point of a bubble. On the other hand, you've already had someone breached the bubble. People want some relief. And that's your problem. I believe these players are you know, they've already shown you they're tempted to break the bubble even for minor things like getting food. That's where the risk is going to be. They're going to interact with someone. They're going to go to a bar. They're going to do something that is going to increase the chance of transmission. And that is the problem.

Chris Mannix: Well, from a safety perspective, it's looking good.

Luis Miguel Echegaray: NBA senior writer Chris Mannix.

Chris Mannix: Their processes are pretty solid. Their protocols are pretty solid. And I think everything is in a good place right now for the NBA.

Ben Golliver: I do think that, you know, boredom will set in, cabin fever will set in.

Luis Miguel Echegaray: That's Washington Post national NBA writer Ben Golliver and the host of SI's Open Floor podcast.

Ben Golliver: You know, it already feels a little bit like Groundhog Day. You know, just kind of going through the same thing every day, every day. And when you don't have the ability to even go to a grocery store or you don't have the ability to, hey, I'm there, take a drive out to the ocean or, you know, do some of the, safer type of trips that people are able to do during quarantine. Those kinds of feelings set in.

Chris Mannix: Right now, players have assigned seats on the bench. It took the players I saw about one quarter to say, "screw it", I'm not sitting in my assigned seat. And they just got up and sat anywhere. And look, I understand that there's not a huge need for social distancing players on a bench when they're out there, not social distancing on the court. So I think there are some subtle things that will change and evolve with the NBA. But there's gonna be somebody that tries to burst the bubble, somebody, whether it's a woman or otherwise. Somebody is going to try to sneak somebody in, I'm just convinced that's going to happen, not the next couple of weeks, but maybe you get into early, early September, maybe it happens. I think the saving grace for many players, is that after the first round, you can bring friends and family in and that's when they'll have a little bit more normalcy to their lives. But the NBA is doing everything they can to protect that bubble. The integrity of this bubble is paramount to the NBA because, you know, there's so much money on the line finishing this season.

Luis Miguel Echegaray: We're hearing a lot Dr. Zeke, about just a rigorous and almost military thinking when it comes to the league and how he wants to make sure that what you're saying doesn't happen, that players don't break the rules, that they stay inside this bubble, that they follow the rules. And if they do that, then hopefully things will be okay. It's also human nature for somebody, especially a player, when they're 23, 24 years old, living in a three months situation. It's just bound to happen that somebody might make a mistake. Would you say that that is the hardest obstacle that the NBA faces? A player or a staff member breaking the rules and therefore really risking, you know, a positive infection?

Dr. Ezekiel Emanuel: Well, I don't know the hardest, you want me to pick that the absolute hardest, but, you know, the NBA is doing a very good job of trying to ensure that everyone who comes into the bubble is covered free. Right, you've got the quarantine, you've got the testing. So they're doing as rigorous a job as you can to try to make sure that they don't have people who are COVID positive. So then the really big risk is, as you put it, someone is going to break the quarantine, go out, potentially run into someone who's covered positive, especially given the frequency of COVID in Florida. And they're going to get infected themselves and spread it before they have been tested. And that's a, you know, I can't say that, you know, that whether it's the absolute biggest risk the NBA faces, but it is one of the top ones, I would agree with that.

Luis Miguel Echegaray: What would you say is another risk?

Dr. Ezekiel Emanuel: Well, another risk is anyone who's going to come in, bring in food, bring in new basketballs, bring in whatever they need brought in on a daily basis. That's another place you could see risk entering this scenario.

Luis Miguel Echegaray: Do you think that it was a good idea to do this? Because ultimately, when it comes to sports, at least money is the driver, right? This is not a coincidence, the reason why the NBA is doing this in Florida, it's because of its strong, powerful relationship with Disney. You know, hence the financial advantages. But do you think it was smart to do this? And why would the bubble not work?

Dr. Ezekiel Emanuel: My God, you sports journalists are cynical. Money! You don't think it's the love of the game. So I do think that there's got to be some love of the game going on here, I certainly hope so. And I hope it's not only money. And let me say, I want to qualify for people. I do love basketball. I love watching basketball, I was just watching, you know, right before everything hit in February, I went to a Seventy Sixers game, that was just fantastic and thrilling. But I'm not a huge fan, I'm not obsessive. I could probably not tell you any single player on any team. You know, that the last time I was really a big fan was, you know I'm a Chicago boy. It was the Bulls and Jordan and everything. But I know and understand that sport is a huge part of American society. And there are people for whom this is a very big issue. We are all being deprived of our regular parts of life. And so I think restarting sports is important. And I've written that, you know, we have to restart sports. We have to be willing to take some risks to restart sports. So I'm all for the NBA doing this, restarting. You know, I have disagreements about how much testing they're doing and other things. But do we need to have the NBA restart? Do we need to have the WNBA restart? Would it be good if the NFL restarted? Yes, this is this is a critical part of American life, and I think it's important.

Luis Miguel Echegaray: Well, that's a very good point. The return to normalcy is just as important as the need for attention to make sure that everybody is safe. And by the way, cynicism in a sports journalist is it's almost part of our DNA. Dr. Zeke. So I guess the money question is, would this being you know, one of the conversations that we had is would this be a better situation, if we dealt with it in a state that wasn't as fragile as Florida, you know, does it make a difference to make some of that tournament like this in a state that perhaps has a better control? Does it matter?

Dr. Ezekiel Emanuel: Look, I mean, you have to balance several things. One thing you need to balance is can you actually create a bubble? And where is it best to create a bubble? New York City is probably not the best place to create a bubble. Just guessing. So the question is, yes, Florida has a high transmission rate and that's bad. And that introduces a lot of risk. If people get outside the bubble. But you have to ask yourself, where can you actually create a bubble that is most likely to be effective? And that may, in fact, be the various facilities that the NBA, the WNBA are using.

Luis Miguel Echegaray: Here's SI's NBA writer Rohan Lakhani.

Rohan Lakhani: One way or another, I think that this bubble is going to serve as an example for how this country needs to move forward. And I think that is really what I'm looking forward to is if it works. Now, we have a concrete example of what wearing masks does, what contact tracing does, what you know, frequent testing does. We need that, we need an example of those things because it's not happening at a large enough scale in this country. On the flip side, even if it doesn't work, then I think we still have an example of we can't rush things back. You know, these people poured hundreds of millions of dollars into this idea, trying to make it work and they still were not able to because that's how unpredictable this virus is. And I think, you know, one way or another, my ultimate hope is that it gives people an example of how this virus is going to be, you know, quote-unquote, defeated until there's a vaccine.

Luis Miguel Echegaray: How do you think the players react if the health risks escalate in the bubble? And how does the tournament and the league react?

Rohan Lakhani: You know, Adam Silver said that that he is willing to pull the plug on this if there is a major outbreak. No one knows what that exact inflection point is. I almost think that if the NBA feels like they can contain it, if there's a situation where they can kick out only one team and everyone else can keep playing. I think they will. I think they will just try to finish the season with that national TV money come in and kind of get through this campus situation. But I don't know that speculation because, again, we don't know what that put that breakpoint is for them. If it's a situation where they can only shut down one team, part of me believes they would push forward and just kind of accept the result in conversation about the competitive integrity, you know, and kind of just chalk this season up to, hey, this was always going to be a weird season.

Luis Miguel Echegaray: Dr. Zeke, is there a line do you think, where the NBA would just pull the plug? One player in a team perhaps isn't enough? It would just be about sending that player home or even, you know, just quarantine. But is there a line? Do you think, where the league would say, OK, we can't do this, we have to pull the plug?

Dr. Ezekiel Emanuel: I suspect then again, I haven't spoken to them, so I'm just speculating here. If you end up with multiple players, four players on a team positive and four players on a second team positive or something like that scenario where, you know, not only are you going to it's not like sending one player home until they've got a team and it's really not going to affect their ability. But you're really knocking out the team and therefore you're knocking out the player. That actually is gonna be their nightmare scenario. I would think.

Luis Miguel Echegaray: What is your you know, you have your own podcast, you talk about this on a daily to an audience, what is you know, last time we talked, there was this 18 month prediction, what is the number one thing that you're thinking about right now when it comes to this pandemic?

Dr. Ezekiel Emanuel: Well, I'm thinking. So I would say that there are two major things. First, you've got to be thinking about if we get a vaccine in the next six months, for example, we figured out one that's moderately effective and seems to last a long time. Then you've got to be worried how are we going to deploy it? And, you know, I think there's been so much focus on warp speed. Let's get that vaccine, that we haven't focused enough. And I think that the political administration hasn't focused enough on. Well, once you've got it, you've got to produce it. You've got to put it in vials and make sure it's sterile. You've got to distribute those files and then you have to administer it into people's shoulders. And by the way, you have to do that for something like 230 to 250 million Americans. Just think about that. That's a huge, daunting task. So that keeps me up at night. And there are lots of stages there that I think could be serious barriers to actually effectively distributing the vaccine, because that's what you need to do to get back to normalcy. Have 250 million Americans immune to this thing through a vaccine. And if the vaccine requires two doses, then you have to give something like, you know, 450 to 500 million shots. And that is a just humongous, mind-boggling number. And I don't think this administration has thought it through at all. The second thing that keeps me up is, that you know, the fall is going to be challenging, seriously, seriously challenging. Universites going to bring back people. Cold is going to start in the north and you're going to have people going inside in October, November. That is a recipe for spread. We're seeing this, one of the reasons that it's spreading in the south now is it's 116 degrees in Phenix. Where are people? They're not outside sunning themselves, they're indoors with the air conditioning and indoors with recirculated air is how you end up with infections. So those are things that worry me that we're going to have a big explosion of cases in the fall. It's very, very depressing that people have their ability, their patience, their willingness to stick it out has been taxed. And the contradictory messages that the administration are giving people are undermining their willingness to, you know, read charge over the summer and be willing to confront this again in the fall. That bothers me, so I worry that, you know, say Trump loses, you get a new administration trying to get people to do the right thing to beat, bring the transmission rate down so we can really get a handle on this thing. May not be possible given how, you know, burned out, basically the American public will be.

Luis Miguel Echegaray: Do you think that the NBA restart reflects the declining willingness to stick this out? So, you know what I mean is there is still this push to like we talked about, you know, just this passion to return to normalcy. And I think sports is a very good example of that.

Dr. Ezekiel Emanuel: I don't know when I wrote, but I think sometime in April, we wrote an article for The Washington Post about bringing the NFL back and we suggested a bubble. Exactly, you know, a similar bubble, a shortened eight-game season. I am a big fan of that, I think it's not a symbol of exhaustion. It's a symbol of what can we do in this time when we are at home restricted in what we can do, to bring back a sense of normalcy. You know, having games on TV so people can watch them. I think that would be fantastic. It would make the time more bearable. Having new television series, having new movies coming out, not just watching reruns. That I think is going to help people get through the tough times. By the way, you could get through the tough times by, you know, listening to my podcast and reading books. There are lots of ways of doing it. But I think fundamental to many people is, you know, watching TV, watching movies, watching sports. I understand that. And I think we should encourage that, not discourage it. So I am all for bringing the sports back, because I think it can make some of the tough moments more bearable for lots and lots of people.

Luis Miguel Echegaray: Yeah, no, it's a really good point, it's all about mental perseverance. Can some things really help you along the way? Absolutely.

Dr. Ezekiel Emanuel: Knowing that we're in it. We're stuck at home when we get out a little bit. And those NBA players, they're stuck inside their bubble. I think that creates a kind of you know, understanding, a kind of you know, shared experience that we have with NBA players. I think it actually heightens people's ability to put up with it, knowing what the players are putting up with.

Luis Miguel Echegaray: See, that's what I like talking to you, Dr. Zeke, you're such an optimist that I just I rub it off and it's so, for lack of a better word, is so contagious and it's so great. His podcast is "Making the Call". He's a former Obama White House health policy adviser. Key architect of the Affordable Care Act and a great human being, dr. Ezekiel 'Zeke' Emanuel, thank you so much for joining us.

Dr. Ezekiel Emanuel: It's been a pleasure to be here and good luck. And I hope this NBA experiment is a big success.

Luis Miguel Echegaray: Many other leagues have returned since the pandemic. But the return of the NBA feels even more emphatic due to its global appeal, the larger than life personalities led by an overwhelming majority of black athletes. The NBA is in a position to show the sports world what it can do. Not just during coronavirus, but also at a time when we fight for social justice. Will the bubble stay intact? Who knows? But for now, NBA fans only know this. The league, their stars and their message are ready for the limelight.