Cillian De Gascun: Team sports are going to be in a very difficult position

The return of team sports will not be recommended by the National Public Health Emergency Team before a vaccine for the coronavirus or anti-viral medicine is discovered.

That's the view of Dr Cillian De Gascun, a member of NPHET and director of the national virus laboratory.

“I don’t see it being something we could recommend from a public health perspective without social distancing,” De Gascun told The Irish Times, “and assuming we are not going to have an anti-viral therapy or a vaccine for 12 to 18 months, it is difficult to recommend.

“I think team sports are going to be in a very difficult position.”

Kevin De Bruyne admits European ban could force him to leave Manchester City

---

Marcus Rashford: ‘Now isn't the time to fall out of love with the game’

---

Covid-19 exit plan: Golf clubs will only be open to members who live within 5km

---

Bill Beaumont re-elected as chairman of World Rugby

---

On Friday evening, as Leo Varadkar stepped off the pulpit at Government Buildings on his way to RTÉ for a fireside chat with Ryan Tubridy on the Late, Late Show - De Gascun began colouring in the broad strokes of the Taoiseach's speech.

"I suppose there is a possibility of an All-Ireland this year," said Varadkar.

Tubridy: “Is there?”

“Obviously that is a matter for the GAA,” he replied. “Not with spectators but it could be done. I think it’s possible.”

The caveats preventing this are multitude.

The expert medical view is a very cautious “maybe” that contact sports such as rugby and boxing will follow Gaelic games and soccer, on July 20th, by reopening for business on August 10th.

De Gascun poured cold water on international matches happening in 2020 but hesitantly agreed to the possibility of France and England coming to an empty Aviva stadium for the Six Nations in February 2021.

“I certainly don’t see the November internationals being played but it would be nice to see the Six Nations in some shape or form next year, be it without fans or with a reduced capacity.”

A testing platform, funded by sports organisations, will need to be fully operational before professional athletes on this island can safely resume their careers.

De Gascun insists that community testing, to be completed by the end of June, is essential to understanding just how infected Ireland has become since the Covid-19 outbreak.

All things are possible but, as De Gascun explained, many of them improbable.

"We are trying to learn from countries that are two, three weeks ahead of us. Obviously everyone is looking at New Zealand and what they have managed to achieve. But I don't know how they reopen their economy again with people coming in from outside. It is very challenging.

“In some respects I think we have done very well yet you look at our figures. Then again we are reporting more deaths than other countries because we are actually reporting more deaths, if you know what I mean, in different settings.

“This virus, in the right situation, can kick off again. What we don’t know at this point in time is how much of the population have been exposed or infected.”

Gavin Cummiskey: As Varadkar suggested, there’s a strong possibility of a setback during these five phases of reopening society?

Cillian De Gascun: I think you are probably right. It is hard not to see if the June Bank Holiday is glorious, people will take a chance, they'll travel, they'll gather in groups.

You hear stuff on social media about garden parties and gatherings. It is pretty difficult for people. We are very cognisant of that.

On May 18th, we will see people playing golf, tennis and sailing again?

I presume so. We didn’t make specific recommendations. Our public health advice around the sport arena is that physical distancing is still a massive part of everything we are going to do. The easy wins are the likes of golf where you are outdoors, so there is a lower risk.

A walk from car to first tee?

You don’t want them in the bar or sitting down for a bit of grub beforehand. You pull into the car park, put on your spikes and off to the first tee. You keep your distance of two metres.

It’s the social culture around golf, surfing and other sports that has to suffer?

Exactly.

We now know the when, so how can sport return in Ireland?

I really don’t know is the short answer. What we would hope to do over the coming months, after having some challenges on the testing side, is to get a greater picture of where the virus is in the community.

The other thing we need to do is a seroprevalence study, which is looking at a sample from the population to see what type of percentage of the population has been infected with the virus. We don’t have that at this point in time purely because the tests haven’t been available. We would hope to have that done in June.

If we do that study and find out 30 per cent of the population has actually been infected but just very mildly infected that actually gives you a bit of confidence, as only 70 per cent are susceptible, so we can release things more quickly, and still focus on vulnerable groups.

The majority of the elderly aren’t going to be playing active team sports. The flipside of that is we do those studies and less than five per cent of the population has been exposed to the virus. Then you have a 95 per cent susceptible cohort out there.

There are two elements to sport returning: the athletes themselves and the crowds; the mass gatherings are really difficult to see that coming on stream any time soon.

If you've got 50,000 at the Aviva or 80,000 at Croke Park and you know going in 95 per cent of them are susceptible to infection, and we have learned recently that a significant proportion of people who are infected won't have symptoms or they will be infectious before they have symptoms, it is really difficult to justify a mass gathering in that situation.

After May 18th, if we have construction and landscapers back, you let outdoor individual sports back. You could probably make an argument for cricket, if you thought about it with physical distancing. But team sports in the early stages, no, purely because of the dressing rooms and interaction on the pitch.

And contact sport on August 10th?

Contact sports we would see as the last ones to come on stream.

Pro sport is entertainment - are we likely to see them return to our televisions before people can return to pubs?

I think we will probably see team sports on TV from empty stadia before pubs open, I would imagine. I think what you will see in that situation is the players will be tested weekly.

I do want to ask you about testing pro athletes in more detail, but what about Northern Ireland - and the border - does that make sport in the Republic of Ireland dependent on progress in the north and even the UK? Am I right in saying we cannot replicate the New Zealand model on this island due to this, and how dependent are we on them?

I think you are right. Having two jurisdictions on the one island is certainly one of the challenges we have experienced that is different to other countries. There have been a number of engagements with the government and health service in the north to try and find a common ground where we can have an all-Ireland approach. There are some areas we can do that but, certainly, it is a challenge.

It will be more difficult than New Zealand. They are quite remote and they have a lot more control.

Getting sports teams back into empty stadia would be feasible but with regards the north we would need to have a good idea what is happening up there.

We are hoping to combine the prevalence study with them; they do have a similar plan. We will certainly be sharing findings so we would be able to get an idea of the prevalence of the infection in the northern population has been.

Philip Browne, the IRFU CEO, spoke a few weeks ago about the need for clarity by September around international rugby returning to Dublin. Have you or other NPHET members spoken to the big three sporting bodies on this island - the FAI, IRFU and GAA?

No is the short answer, to my knowledge. They wouldn’t engage directly with NPHET. The department of transport, tourism and sport would be where those engagements take place. I haven’t been party to that.

We are open to receiving specific requests.

The high profile one in the last couple of days has been the American Football at Croke Park - it is not a licensed event so it hasn’t officially been cancelled but as a mass gathering it would be difficult to see it going ahead.

Pro sport globally is watching the Bundesliga plan to return and despite a spike in German cases this week, as Angela Merkel’s government eased lockdown restrictions, the plan is to limit stadiums to 300 essential people - players, coaches, medics, cleaners. Is that safe before something close to zero infection in the community?

Everything is a risk balance. If the 300 people are staying more than two metres away from each other it is reasonably safe.

Professional sports organisation may have the money and capacity and facilities to do test.”

Social distancing will not be possible or adhered to in these stadiums. The capacity exists for Bundesliga players to be tested every two to five days, how do such safety measures sound - in an Irish context?

I don’t see it being something we could recommend from a public health perspective without social distancing, and assuming we are not going to have an anti-viral therapy or a vaccine for 12 to 18 months, it is difficult to recommend.

It comes back to having a better picture of how many people have been infected and how severe the disease has been.

Part of the paradox of what we are doing at the moment is that we are controlling the epidemic quite well, but the downside of that is people are not necessarily being infected; even the healthy people who are not going to get a severe illness are not being infected to a great degree either and that’s when we come to a situation where only a small proportion of the population has any sort of immunity. We do think people will have some level of immunity but that is an unanswered question at this point.

Even if you know people who have been infected and have recovered - can you allow them back into situation where they are at risk again with people who may be vulnerable?

So, I think team sports are going to be in a very difficult position. Even with testing you can do it daily but all that tells you is you are negative at that point in time and then there is a 24 hour window to interacting with other people.

At some point your test turns positive because you have been infected and the viral load is building up in your system. You reach a threshold where you become infectious and depending where that falls in your testing schedule you can’t eliminate the risk completely.

Professional clubs can certainly mitigate risk. Physios can wear Personal Protective Equipment. Without the physical distancing ... I still don’t see it as something that we would recommend. It may not be prohibited or banned but I don’t think it could be recommended on public health grounds purely because you are never going to get to zero risk.

Team sports behind closed doors is probably the first step. At some point we have to take some calculated risks because we all know we can’t stay in our current situation forever.”

The calculated risk is logical, but does that mean professional athletes and coaches have no contact with their family, must they go into isolation, is it essential that these groups enter a bubble?

I don’t think that is feasible. You can argue a professional team could do it. It would be very difficult for amateur sports, like the GAA, to do that around the country.

We could get to a situation where you have a small town or village or county that does not have a lot of the virus circulating. Maybe inside the county boundaries they could operate fairly normally.

The club GAA championship could happen?

Potentially. Maybe, like golf, they don’t share the dressing room. They come and warm-up, play the game and then shower at home.

In small club championships you could probably have a few hundred people at the game, socially distancing. But you probably cannot bring a team or bus load of supporters from Dublin down to that county.

A county championship could take place in certain circumstances if you are creative. I do not have all the answers to this situation but it is like all the businesses trying to get back to work.

What the GAA, IRFU and FAI should be thinking about is a return. It is not going to be a flick of the switch. There has to be some creative thinking what a phased return looks like.

It could look like, rocking up, playing the game and not hanging around in large numbers. You allow that to happen and wait a month and if you haven’t had a massive outbreak in your team or club or community then you say ‘Ok, this is fine.’ Then you look at the next step . . .

Before sport returns do we need to have the capacity for 100,000 tests every week?

We are about two weeks from the 100,000 per week. We are assuming that will be for people in the community with symptoms, healthcare workers, hospitalised patients and nursing homes obviously.

At this point in time we haven’t factored in a large cohort of testing the asymptomatic just because they are about to engage in some activity. I’m not saying it is something we shouldn’t be looking at, but at this point in time we are looking at the sick or the contacts of people who are sick.”

That more than covers 100,000 a week?

I think the HSE has 100,000 employees and a significant number of them are patient facing. The health service needs to answer in the next coming weeks what sort of testing we do for people who are well?

Healthcare workers account for over 25 per cent of our cases. That is something we need to look at seriously.

The 100,000 is going to be funded by the state. This is less likely to happen in sport in Ireland, although Leinster and Munster could probably afford it, so they might get a testing platform into the centre of excellence to screen their players on a weekly basis."

It will need to be funded by the sporting organisations themselves?

I would think so. To my knowledge there has been no approach on that. The 100,000 is for the health sector.

This is the reality check for Irish sport; testing sports athletes cannot be high up the pecking order during this pandemic?

It is obviously really important for society that sport returns but you’re right it certainly wouldn’t be prioritised in that respect.

But it is an open market.

In the first week of March we put together a six to eight week plan to get to 100,000 tests a week. That slipped. To listen to some of the reporting it sounds like we have slipped to six to eight months. We have slipped to eight to ten weeks. In the middle of a pandemic that’s not too bad.

Again, looking at the Bundesliga plan, each club has been assigned a lab in Germany, would that be possible in Ireland this year? Let’s just use the four professional rugby provinces as an example, would that be possible?

I think it could. At the moment we are in a case finding exercise. We want to test as many people as possible. That doesn’t need to go on forever. When we have a better feel for what and where the infection is - people talk about the second and third wave - and when we understand what that is going to be like, protecting the population and the health service, and broadly speaking 1,000 cases a day will swamp our intensive care units very quickly.

In the last couple of weeks we have been around 500 or 600 cases a day. If we get to a stage, maybe in six months’ time, where lots of people have been infected and not as many people are susceptible, and we only need to focus on those who are sick then there will be significant capacity back in the system.

We may well have a regional approach by then. Take Munster, there is laboratory capacity in Cork and Limerick. In Leinster we have lab capacity ourselves in UCD and St Vincent's are testing.

So that’s something that could work. For example, in the UCD lab we can manage comfortably 1,000 to 1,200 samples a day for the next weeks to months. So, for arguments sake, if Leinster wanted to send us 100 samples once a week, that’s nothing.

How quickly can they get the results?

They can be turned around in 24 hours. The 1,000 samples that come in on a Monday morning are finished Monday evening and resulted Tuesday morning when another 1,000 samples come in.

We didn’t have that capacity on the island two months ago and that’s why we ended up sending 30,000 samples to Germany.

One last question on the Germans. The football authorities have warned that many clubs will be in an “existence-threatening” financial position if play does not resume by June. How much influence does the threat of financial collapse come into the health advice?

It is a consideration. It hasn’t been a priority in the first three months of this year. That has been about getting the epidemic under control, insofar as we could, protecting the hospitals and our intensive care capacity - buying time to build additional capacity and learn more about the virus.

If we stay in this position for another six weeks the country might struggle to ever recover. We are conscious that the cure can’t be worse than the disease.

There have been a lot of conversations around mental health and social issues - the domestic violence issues that you are seeing on TV - all those things feed into our discussion; there has to be a society for us to come back into whenever we can lift all the restrictions.

The priority has been public health. We do have a better handle on the dynamics of the epidemic now. That puts us in a better position to balance the risk, to look at the economy and ultimately our recommendations from NPHET to the government take on board and decide what we can do.

International sport - rugby, soccer, Olympics - I spoke to the Pro14 CEO on Friday and they are still aiming towards finishing the 2020 season in October, without the South African teams, so how realistic is that? Or, looking further ahead, can you see a scenario where the France and England can safely come to Dublin in February 2021?

I think that is really difficult. In my own head I would like to think it can happen but I don’t see how at this point. Even simple things like flying again.

There is always this possibility that the first wave was horrendous and things will settle down from here. I don’t think that’s likely but you never know.

People will be risk adverse. A lot of people won’t want to get on a plane.

Let’s keep the crowds out for 2020 - can you see international sporting events happening early next year?

There is a possibility behind closed doors. Will the pubs be open to go and watch them? Ultimately this is about managing risk.

When might we get around 2,000 people social distancing at the RDS or Dalymount Park?

It comes back to what we learn from testing [in June]. We have the limitations on mass gatherings. But the phase process goes from being at home on your own to being in small groups to going to restaurants under 50 people.

Every time we take a step we will be waiting to see what the impact of that will be. If we take a step and mass gatherings go to 50, we wait three weeks and if there hasn’t been a significant uptake in disease activity in the community.

If we go to 500 people gatherings and things kick off again we step back.

Unfortunately, there is no instruction booklet for this virus. We will err on the side of caution because what we have seen in Italy, Spain and our own nursing homes is how quickly this thing can get out of hand.

We will look to see what other people and countries are doing and we will try to learn from that.

Social distancing will continue alongside the hammer and the dance ...

If the virus stays unpredictable or aggressive in the coming months we will have to be very cautious and I think sport will suffer on account of that given the nature of the beast.

Until we have a decent anti-viral or vaccine physical distancing remains a huge part of this. That’s really the new normal we are talking about.

Maybe we will be lucky and we will realise more people have been infected than we realise and just haven’t been sick. Maybe it is a milder illness than what we are seeing in the hospitals, which is the severe end.

Do you believe that is the case?

I am not convinced yet. It comes back to what the virus wants. We are a new host. It is finding its feet in a new host. We all want to find that equilibrium in three or four months. That’s not going to happen.

From a virus perspective three months is nothing. It will evolve with us, its new host, over the next number of years and settle down into something like flu or the common cold. Or it might just disappear.

Would you risk putting a timeline on anti-viral or vaccine discoveries?

Anti-virals are more realistic in the short term. We have been successful with treatments for HIV and Hepatitis C.

I do think with science and medicine, with the majority of people who are very, very bright working in an area they generally tend to get somewhere in a short period of time.

It is a bit like the man on the moon. If you have a concerted effort and money is no object - which at the moment it doesn’t seem to be from a funding perspective - I think people will get there.

It is still 12 to 18 months away. And the other thing is when it is available who gets it? Just the elderly?

The multi-millionaire athletes will get it ...

You are probably right. It was really weird in the States with the NBA. They were one of the first to shut down [on March 11th] because of a couple of high profile basketball players got access to tests, they were positive, and the league was done.

That will be the other issue: are sports stars a worthy group?

The public at large will hardly complain as they will have their sports back.

That’s true.

I remember you as a Terenure centre in the early 1990s. When did medicine interrupt the sports career?

I wasn’t picked by Leinster. I had exams in first year Med so I missed a trial match. Having gone from school where I was academically very good to college where I was academically very average, the exams were a big deal.

But you played Irish schools?

I did. With Anthony Foley, James Blaney, Jeremy Davidson, Conor McGuiness. We got a trip to New Zealand in 1992.

You played against Jonah Lomu?

Yeah, and Jeff Wilson, Trevor Leota and Carlos Spencer. Wilson slotted a penalty in injury-time to win it.

When I graduated and started my internship in 1999 I stopped playing altogether. Had it gone professional a couple of years earlier I might have given it more of a go.

To be honest I wasn’t sure I wanted rugby to be my life. I was on a really good team in Terenure and happened to be good at something without loving it. I’d rather have been good at soccer.