Dr. Jimmy Robinson is Endowed Chair of Sports Medicine and professor of family medicine for The University of Alabama College of Community Health Sciences. He also serves as the head team physician for The University of Alabama.
In addition, Robinson directs the College’s Sports Medicine Fellowship, and is a practicing sports medicine and family medicine physician at University Medical Center, which CCHS operates.
He has cared for athletes of all ages and skill levels for nearly three decades. He works with high school, collegiate, professional and international athletes. He served as a team physician for the United States Olympic Team in 200 in Sydney, Australia, and as a team physician for the Youth Olympic Games in Switzerland earlier this year.
Robinson sat down recently with Dr. Richard Friend, dean of CCHS, to talk about high school and college athletics during COVID-19.
Friend: Tell us about your roles at University Medical Center and the College of Community Health Sciences.
Robinson: My role at UMC is as chair of the Department of Sports Medicine and we have several physicians in that group – Dr. Ray Stewart, Dr. Brett Bentley and we just added Dr. Russ Guin. We take care of all types of musculoskeletal injuries (at UMC). We see a variety of patients, both from UMC but also from the community, and we see a lot of athletes. We see UA athletes and local high school athletes. The role (that I have) was created years ago. Dr. Bill deShazo was the team physician for UA back when Bear Bryant was the head coach and Dr. deShazo was also Bear Bryant’s personal physician. When he decided to retire, I basically stepped into his role. I had done my (medical) training and came back to Tuscaloosa and was in private practice, but I still worked with the resident physicians and medical students at CCHS. I have been taking care of athletes at UA and local high schools since 1989. I am also medical director for the Alabama High School Athletic Association.
Friend: You’ve also done work for the Olympics. Tell us about that.
Robinson: I have been involved with the U.S. Olympic and Paralympic Committee for years. I went to the 2000 Olympics in Sydney, Australia. And this past January, I went to Switzerland for the Youth Olympic Games and was one of the team physicians for the U.S. team there.
Friend: At UMC we’ve made a lot of changes as it relates to Covid-19 and have worked tirelessly to provide a safe environment for our patients, our colleagues and our students. How has Covid-19 impacted your practice at UMC?
Robinson: When the outbreak first happened and schools and the University were shutting down, we certainly had a decrease in the number of patient visits. Obviously, the main reason was because we had a decrease in sports. Sports were basically cancelled, so we had less sports-related medical illnesses and sports-related injuries and our numbers went down. However, through the summer months, we’ve seen athletes on a regular basis because they are still training, both at the high school and the University level. So, they are coming in with various complaints – musculoskeletal and medical complaints, and same with (patients from) the community. Actually, I would have to say a positive to what has come out of COVID-19 is that we’ve seen a lot more people get outside. They’re probably tired of being quarantined so they are getting outside and doing a lot more walking, running and recreational activities outdoors where they feel safer. I think we got a lot of people off the couch with this virus, and I think that’s a good thing. But because everyone was outside, we still did see various injuries in the Sports Medicine Clinic at UMC.
Friend: As college and high school sports start to ramp back up, are there any particular types of injuries that athletes need to be aware of as they get back into practice?
Robinson: A lot of that depends on what athletes have been able to do while sports have been shut down. If they have been able to continue to train then, hopefully, their musculoskeletal system is still well-tuned and their cardiovascular system still up to beat. The problem is that some of the athletes really haven’t done anything. So, they have to get ramped up and re-acclimated not only to the heat and the environment but also to the high-intensity exercise they were doing. We certainly did this at the University and also at the high school level. We had a period of time where athletes were mandated to take it slow. At UA and through the SEC, we had at least a four-week ramp-up period for the football team and they had to get back into weight training and conditioning drills before we could actually start any kind of practice.
Friend: Are there any activities or sports that are not going to be allowed during Covid-19?
Robinson: I don’t know if there are any that won’t be allowed. We have risk stratified all sports. For instance, at The University of Alabama, the high-risk sports would be football, soccer, volleyball and men’s and women’s basketball. Then we have an intermediate group of sports and that would be baseball, softball and gymnastics. And then we have low-risk sports, which would be swimming, track and field, golf and tennis. Each of those sports have a little bit higher risk of being able to transmit (COVID-19) from one athlete to another.
Friend: What kinds of things can people do to limit their exposure to COVID-19? For athletes and those in the populations you treat who have been exposed to COVID-19 and become positive, what kind of symptoms are you seeing?
Robinson: We’ve had a few positive athletes at The University of Alabama, and for those (positive) athletes, we have been monitoring them very closely. We check on them on a daily basis to make sure they’re not developing symptoms. As you know, there’s a concern about myocarditis (inflammation of the heart) that has popped up in the last week. This is not something new. Every viral illness that we take care of on a daily basis runs the risk of viral myocarditis. But it is something that, because of the severity of (COVID-19) and the concern that people who are hospitalized and who might have a higher rate of cardiac problems, we’ve been more fine-tuned to it. Most of our athletes have had no (COVID-19) symptoms whatsoever, or very minimal symptoms. We’ve not had any athletes who have been severely ill. But we do test them and make sure they’re not having any symptoms of heart conditions, and we have run blood tests and EKGs. As far as precautions and (efforts to prevent COVID-19 infection), to be honest with you, I think our athletes are a lot safer in our athletic facilities than they are at home. There’s hand sanitizer everywhere. They get screened every day – they are asked a series of questions and have their temperature taken. It’s mandatory to wear masks. There are people walking around checking to make sure everyone is wearing their masks and wearing them properly. The spacing in the meeting rooms and weight room is such that athletes are never closer than six feet from each other. With all the cleaning done when they’re lifting weights, and all the cleaning we have the athletes do with hand sanitizer, I think the risk of transmission in our locker room, training room and weight facility is going to be a lot less than it will be if they get with a group of friends, go out to eat dinner and socialize.
Friend: Now I’m going to ask the million-dollar question. Is there going to be UA Crimson Tide football this season? And will there be SEC football this season? We’ve already seen some conferences cancel their schedules. Can you give us any indication about what we might expect?
Robinson: As of 2:30 pm on August 14, we will be playing football at The University of Alabama. Now, I can’t tell you what’s going to happen at 2:35 pm, but at 2:30 pm we will be playing, and the SEC will be playing. This is based on several different factors. One is that there is a medical advisory group for the SEC that I’m a member of that has been meeting three times a week, going over precautions, looking at the other conferences, and looking at different ways to help with the health and safety of our athletes and prevent transmission of (COVID-19). Part of this is whether we are going to be able to test athletes, and as it stands right now, we will have the ability to test our athletes on a regular basis – up to three times a week. All SEC teams are doing the exact same things so that we will have an even playing field. One of the reasons why other conferences pulled the plug on playing fall sports had to do with the ability to test, and some of the conferences in some of the areas of the country don’t have the ability to test like we are able to here. It also had to do with their public health departments. Certain local and state health departments were more stringent than others and stated that if any athlete tested positive for COVID-19, the entire team would be in quarantine for 14 days. Obviously if that happens, not only are you going to have the 14 days of quarantine, but you’re going to need a ramp-up period for the athletes to get back. So, they might miss two or three games because one person tested positive. Probably the biggest unknown for us is our ability to determine who is a close contact to somebody who is positive. Our theory has been that if we test more often, the risk of having athletes quarantined after a game or during practice will be better. That’s one of the reasons why we’re moving forward, and one of the key factors is going to be the ability for us to test. If we’re not going to be able to get testing supplies, we’re not going to be able to do this. Then there’s the ability of our local healthcare system to manage surges that occur, which people are anticipating may happen when students return to school, both at the college and high school level. But we don’t know that for sure yet. We don’t know what the virus is going to do during these next couple of weeks and months. If we see concerns, if we see a problem, (and in the interest of keeping the public, the community and our athletes safe) we’re going to be quick to pull the plug ourselves.
Friend: I know it’s really good for our student athletes and for the Tuscaloosa economy to have football. But let’s talk about spectators. What do you think is going to happen with Bryant Denny Stadium and spectators? Is there a safe way to have spectators at the games?
Robinson: I think there will be. Certainly, we’re not going to have a full house like we do on most Saturdays. It would have to be a reduced capacity, and we don’t know what that reduced capacity is going to be right now. But it’s going to be much less than what we are used to. I would expect that we will mandate facial coverings for everyone entering the stadium. I expect we will have social distancing and seating arranged where families are seated together but spaced apart from other people. We’re looking into other screening opportunities, whether it’s temperature checks or health checks when they come into the stadium. We want people in the stands to feel just as safe as our athletes do.
Friend: Let’s shift for a minute and talk about professional sports. In the NBA, we’re seeing the bubble concept, where everybody is located on one campus and gets frequent (COVID-19) testing. Can you talk about that, and also what the NFL is doing to keep players safe?
Robinson: The bubble is really a good concept if you’re able to do it. It has very strict guidelines where only certain people are allowed into the area, and that includes the living area, eating area and playing fields. People in (the bubble) get screened and tested on a regular basis, and anyone who has symptoms or tests positive is immediately isolated from the rest. There have been one or two (positive) cases that have come up and come to find out that they may have been outside the bubble for a period of time and that might have been where they were exposed. Right now, we’re not seeing any kind of outbreak with the athletes there. But that’s a very hard concept to do at the collegiate and high school levels, especially because the athletes are also students. Not only are they doing athletic activities, they have to go to class. And I don’t know how you can maintain a bubble situation if athletes are having to go to class. The NFL is not necessarily doing a bubble, but they are doing frequent testing. As it stands right now, it looks like the NFL is probably going to test daily. They have the ability to do that financially if they can secure the number of tests. Obviously, those teams are smaller than the teams we take care of based on numbers, but they’re going to be able to test daily and the thought is they’ll be able to pick up a positive test before there’s any transmission. We’ll have to see how that works. The good news is that football is an outdoor sport where both air and the sun can minimize risk of transmission and so we’re hoping that that helps. Basketball is an indoor sport, so you have to worry about air circulation, the close contact with athletes and no exposure to sunlight or outside wind circulation, which can really minimize droplet transmission.
Friend: In medicine, we have seen some new and innovative techniques and medications come online because of COVID-19. What kinds of things in athletics and sports medicine have come about as a result of this pandemic?
Robinson: People have tried to attach a face shield to the inside of the face mask. It comes in two parts: the normal visor that you see in professional sports, where it covers athletes’ eyes; and a lower segment that (is thought) will prevent transmission of droplets. The problem with these visors is that they are extremely hot, and players do not like them. They feel like the air around their face is a lot hotter and they have trouble breathing on these hot and humid days. So, I’m not sure how much that is going to help. And if somebody is positive for the virus, that mask does not prevent somebody else from being quarantined because of a close contact. We’ve been using a lot of different face coverings for athletes for their workouts – the neck gators. The athletes seem to like those because they can breathe through them well. However, they don’t do well when they get wet. But inside in the locker rooms and the meeting rooms, it’s a very easy thing that they can pick up and put over their face. Still, it’s hard for them to exercise and do the kind of activities that they normally would do with those on.
Friend: Let’s talk about high school. Obviously, high school athletics in the state, and all over the country, don’t have the same resources that universities have. Do you see the Alabama High School Athletic Association allowing fall sports?
Robinson: As of now, (they) are actually practicing football on a regular basis and the first set of games are next week. The thought is with adherence to the best practices that the Alabama High School Athletic Association has put out, which includes screening before they come to the facility, face coverings, hand washing and social distancing in the locker room and weight room, we’re hoping to minimize the risk. In general, the athletes are low risk for any severe disease. So, you worry about athletes getting the virus and bringing it back to their family members, who might be at higher risk. Again, we actually feel that the athletes have a greater chance of getting this virus out in the community and bringing it back to their family than they do on the playing fields. With the way that the locker rooms and the equipment are being cleaned, the way athletes are getting screened, the masking and social distancing, I really feel they are safer on the playing fields. We’re not going to eliminate the risk. Just like we can’t eliminate the risk of concussion. Just like we can’t eliminate the risk of sudden cardiac death on the football field. We have it every year, and it’s the third leading cause of sudden death of athletes on a normal year. So, we can’t eliminate the risk. But if we can mitigate it and just slow it down, or prevent a large outbreak and large spread, that’s our goal.
Friend: Any predictions about what the rest of 2020 will look like, particularly the fall and athletics?
Robinson: I think most of us are ready for 2021 because, hopefully, it will be better. For 2020, we’re hoping to maintain our football season both at the high school and collegiate levels, and professionally. Some of the other fall sports we’re a little more worried about, especially with how we’re going to be able to maintain those sports with the guidelines put out by the NCAA.
I don’t necessarily have any predictions. I’m just hopeful. And I’m hoping that everybody in the community is doing the right thing. I hope the students, when they return to The University of Alabama, adhere to our guidelines, with the face coverings and social distancing, and that everybody plays their part. I think if we all do that, we’re going to see a decline in the rates of (COVID-19) infection and a decline in the rates of death and serious illness. And that’s what we’re all looking for.