The (Miami) Dolphin and the Coronavirus

Jum Kiick's retired high school jersey

Source: By Brettalan. Own work, CC BY-SA 3.0

What does a retired running back with dementia have in common with the 130,000 Americans who have died so far from the novel coronavirus? The answer may not be obvious at first, but both are examples of “building the plane while flying it”—or, in this case, trying to provide quality care for patients who are battling a disease we don’t yet fully understand.

By the time former Miami Dolphin Jim Kiick died last month at 73, his family had gone public with his deteriorated condition. Unable to provide even basic self-care, Kiick lived out his final years in an assisted living facility. Suspecting that his extensive brain damage was tied to his football career, his family donated Kiick’s brain to the Concussion Legacy Foundation to help support research into the effects of traumatic injury on the development of chronic traumatic encephalopathy (CTE).

I’ve spent a good portion of my career investigating the effect of trauma on the brain. We’ve learned so much over the past decades about what happens to brains that suffer repeated injury. “Dementia pugilistica” was first described in 1937 as affecting boxers (before that it was referred to as “punch drunk”), but we know now that these injuries are a problem outside the boxing ring as well. Soccer players who head the ball, hockey players who get smashed, and basketball players (particularly women) who hit their heads during play are all vulnerable to the permanent brain damage we now call CTE.

There is, however, much we still don’t know. How much force does it take to cross the line from a bump on the head to an actual traumatic injury? What kind of force is the worst—we know a rotational hit is worse than a straight linear one, but how much worse, and how much rotation? What number of small head injuries is the critical mass that could lead to CTE? We don’t yet have the complete picture on the quantification of trauma, and how the quality and quantity of injuries might be linked to the development of CTE.

As an independent sideline consultant to the New York Giants, part of my responsibility is keeping players with a suspected concussion off the field until they have recovered—because we do know that getting a new injury before a prior one has healed has a multiplier effect. We have some good clues to whether or not a hit caused a concussion, but we don’t have a perfect gauge. There is no reliable test for concussion, and no way to diagnose CTE except on autopsy. So although there is gathering evidence that trauma can lead to dementia (and common sense would support that theory), there is no solid scientific evidence to back that up. Yet.

So why does that remind me of the COVID-19 pandemic? As a scientist, I believe whole-heartedly in evidence-based medicine. Knowing that many a “common-sense theory” ended up having no basis in reality, I know that solid, research-backed evidence gives us the best chance at making real progress against all kinds of diseases and conditions. After all, the flat-Earth theory was common sense while humans could only see as far as the horizon; once we could travel around and even above the Earth, we had real evidence to the contrary.

Neither CTE nor COVID-19 research has yet provided great evidence about the disease process. We may not be completely Earth-bound on them, but we have not yet reached the heights from which we will one day see the bigger picture. We make incremental findings; we advance the research one step at a time. With the pandemic claiming lives at such an alarming rate worldwide, we are of course anxious and eager to accelerate our understanding of how the virus attacks, how to treat it, and how to prevent it—but we must do all that learning while treating sick patients who are right in front of us. Yes, we are flying the plane while building it.

The way to keep flying, in both cases, is to keep building. We need to use the best information we have available at any given moment to make informed choices, knowing full well that those choices may change as we learn. Back in early March, that meant doing our best to avoid touching shared surfaces to avoid viral transmission on contact. Now we know more about droplet and aerosol transmission, so we’ve added masks, social distancing, and work-from-home arrangements to our armament against the virus. Until we have more and more solid evidence, that’s the best we can do.

We do the same things now for head injuries—we re-engineer helmets and study whether helmet-wearers take more risks. We do blood tests and eye-tracking studies on patients with concussions and try to find a path from those findings to better solutions. We don’t know everything there is to know about traumatic brain injuries, but we can take reasonable precautions: We raise the age when kids can tackle, limit heading the ball in soccer, and strive to develop better sideline assessments. And we study tissue samples from donated brains, which is why the Kiick family’s donation is so very important.

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There are so many people trying hard to make sports safer for everyone. Human history tells us that play provides an important social glue—and we are feeling the void right now with so many sports on hold during the pandemic. While we continue to search for safer ways to play to protect our brains, we also need to be mindful to stay safe from the virus. We miss watching and participating, but we continue to value health and safety overall. We observe, we learn, and we continue to fly as we build the plane.

Listen to a fascinating discussion I recently had on my podcast with Dr. Barry Kosofsky about kids and concussion (and why being a "bobblehead" increases risk).