How coronavirus is affecting White Sox: Q&A with team physician Dr. Nik Verma

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article_body => "Back on March 12, Dr. Nik Verma was getting ready to head to the airport.<\/p>\nAs the head physician for the White Sox, it\u2019s common for him to be on a plane headed for Phoenix in the spring.<\/p>\n\u201cI'm generally there somewhere around 20 days during the time frame that (the White Sox) are in Arizona (and go) back and forth to manage my own practice here in Chicago and then take care of the team in Arizona,\u201d Verma said.<\/p>\nBut by the time he was set to leave, spring training had been suspended. The sports world had been rocked by the COVID-19 pandemic the night before, as Utah Jazz star Rudy Gobert tested positive and the NBA suspended its season.<\/p>\nLike everyone else, Verma\u2019s job changed rapidly that day. As the director of the Division of Sports Medicine for Midwest Orthopedics at Rush Hospital, he has a practice to run. But as the head physician for the White Sox, and a member of the Major League Baseball Team Physicians Association, he also has to monitor players\u2019 health from afar and make sure they are ready for a season that right now has an unknown Opening Day.<\/p>\nIn a lengthy chat with NBC Sports Chicago on Monday, Verma detailed <a href=\"https:\/\/www.nbcsports.com\/chicago\/white-sox\/white-soxs-top-doctor-thinks-there-will-be-baseball-year\" target=\"_blank\">why he believes baseball games can be played this summer<\/a>. Below is the rest of the conversation, touching on many topics, including the White Sox involvement in an important COVID-19 antibody study. The interview has been lightly edited for length and clarity.<\/p>\nThese are circumstances that none of us have ever really seen before, whether we're talking baseball or way beyond baseball. I'm curious what your role has been as the head team physician dealing with these circumstances and trying to communicate with members of the team.<\/strong><\/p>\nWhere we've left it is that for our 40-man guys, anybody who wanted to stay in Arizona was able to do so. The remainder of the team was able to go back home or to other areas where they felt most comfortable, either based on families, situations or commitments. It really became an effort to try to design individual programs for how do we manage guys who are just kind of (in their) routine? How do we take care of guys who left camp with an injury or are recovering from an injury? And then how do we deal with issues that may have come up when people were home, either through their normal training protocols or other?<\/p>\nWhat we've done is our strength and conditioning team and our head athletic training team are in contact with players, either on a daily or every other day basis, just to check in to say, \"Hey, how you doing? Any issues we can help you with? How are things going?\" We actually have our nutritional staff working with them directly, and we have our sports psychologists and sports performance staff working with them as well to say, \"How are you dealing with this situation in general? Is there anything we can do to help you with anxiety or the mental health side or all the other things that go along with what all of us are dealing with, not specific to baseball players?\"<\/p>\nAnd then for myself, we really get involved if there's an issue that happens where either a player has been recovering from an injury or a player's developed symptoms when they've been at home. And for me, that looks very much like what I'm doing with you right now, which is a tele-health visit \u2014 understanding the problem. I can generally get probably 70 percent of the information I need just from understanding how their symptoms started, where they are, what kind of symptoms they are, are they happening during throwing, batting? Were they acute or repetitive in nature? And then we need to make a triage decision and much of this depends on where people are in the country. Somebody that is in a spot that has very little penetration of COVID-19 may be in a position where they can go in and see a doctor and get an MRI scan. Somebody who is in one of these hot-spot areas may need to say, \u201cWe're going to sit on this for two weeks and wait until it's safe and appropriate for you go get an MRI scan.\u201d And then we start thinking about decision-making about when is it time to get somebody back to either Chicago or Arizona for an in-person evaluation by myself or one of the trainers, based on the acuity of the symptoms? So we're really running a triage shop very much the way that we're dealing with our own patients and deciding when it's safe to see them in person or not.<\/p>\nLike any human being right now, if a player even gets a cold, they might start getting worried that it might be COVID-19. Have there been any players that have been in that situation where they're feeling symptoms and they want to talk to a doctor?<\/strong><\/p>\nI don't want to disclose any significant personal issues. I'll just tell you that as far I know, there has not been any player in the MLB system that has tested positive as of yet. We all have protocols in place that have come down through Major League Baseball and the Major League Baseball Team Physicians Association about how we manage that situation. Frankly, it's really no different than the way that we manage that situation in our own patients. A lot of it depends on the access to testing, the availability of testing and the criteria of testing that exists within a local area. So here in Chicago, as we went through the \u201csurge,\u201d testing was really only available to people that had symptoms but also met a certain disease severity level. You have to have a certain limit or minimum symptoms in order to be available for testing, simply because there weren't enough tests to be done. So fortunately, the MLB group is a group of generally younger, healthier individuals where even absent their participation in baseball, their risk of severity of illness from COVID-19 is fairly low. So we're managing those patients by appropriate precautions, appropriate screenings and then if their disease-severity is sufficient enough, referral to a local testing site to undergo testing.<\/p>\nMichael Kopech had just gotten out there in a game and thrown 11 pitches, he looked great, throwing over 100 mph, and then two days later, everything shut down. Whether it's him or any other player dealing with an injury right now, how do you make sure a player is ready for an unknown target date?<\/strong><\/p>\nYeah, it's hard to do. I'll be honest with you. I would say if there's any bit of a silver lining around this, as we were going through spring in the early part when everybody anticipated or really had no awareness of how rapidly the situation would change, there were a lot of players who had nagging injuries. (Lucas) Giolito and (Yasmani) Grandal and a couple guys had some stuff going on, and we were always kind of on a very tight timeline about the season starting and when we could get these guys back and how to do it safely. Those are players now that have had the luxury of time where we really expect them to be completely healed from non-surgical injuries as they come back and be 100 percent.<\/p>\nYou know, guys like Kopech I'd put into that bucket, as well. He's a guy who was essentially well within the criteria for returning to normal participation. We'll probably still have to think about all the other metrics that we go by in terms of endurance and frequency of starts, number of throws, getting his head back into the game, pitching in front of crowds, all those types of things, but he's not somebody I would worry about tremendously. He's somebody I would say could be treated just like every other pitcher is going to be treated as we ramp back up.<\/p>\nOur strength and conditioning coaches and our training staff has done an amazing job of staying in touch with players and giving them appropriate at-home regimens. There are guys you talk to who are just going out to the park down the street from them to throw their bullpens, just to make sure they are staying active and keep their arms in shape. The pitchers are really the primary concern, obviously. As we go back, I think we're really going to have to make some educated decisions based on how long we've been away, what the anticipated time of the season looks like, whether the season is going to progress with normal game volume or whether we're going to see higher game volumes with less off days. And those factors are going to have to be measured in terms of what we need to do to make sure that players are ready to go safely before we start regular game participation.<\/p>\nAre you concerned that there could be additional injuries that pop up if a \"second spring training\" must be rushed to get games in?<\/strong><\/p>\nI wouldn't say concerned is the right word. I think everybody is cognizant of the fact that we have to be thoughtful about it, right? And fortunately, I feel very strongly that Major League Baseball and the players association, the team physician\u2019s association, the players themselves, owners and management, everybody in baseball has really always been on the right side of the injury argument. We all recognize the burden of injury to the game. Clearly the financial aspect of injuries to the game is significant. So I think everybody is aware of that potential problem, and I think everybody is on the right side of making sure that we do this not only to get the season in because we all want to play baseball, but to do it to preserve player health. There are lots of different ways you can do that in terms of maybe expanding the roster from 26 all the way back up to 40 or whatever it may be in order to \u2014 if we are going to play an accelerated schedule \u2014 make sure that player safety is one of the highest priorities of how you do that.<\/p>\nI'm fascinated by the COVID-19 antibody study. The news of this came out last week. MLB participated in it. What can you tell us about the White Sox involvement in the study, and why is it so important?<\/strong><\/p>\nWell, the first thing I want to make clear is that this wasn't a study that was done in any way to try to prioritize MLB or to do testing in MLB to try to make sure that MLB players were ready to play baseball. What happens is when you're a researcher and you're looking to do a study on this on a national level, the hardest part of getting any study like this off the ground is how do I get through the logistics, right? If I'm in Stanford in Northern California, or USC in Southern California, how am I going to find researchers in Illinois or New York or Miami to be able to do this? That\u2019s where the interest in partnering between MLB and the researchers and both of those institutions was born.<\/p>\nAnd the reason was that they could engage Major League Baseball, they could engage the Major League Baseball team physicians and say, now we've got a resource in all the major metropolitans throughout the country and we've got a captured audience of baseball team employees and team physician staffs that we could say, \u201cOK, we're going to send you 200 tests. We want you to get 200 people and get them tested and get them back to us within a week.\u201d And so that's where it was a really cool collaboration between the two to say, \"We've got a national problem, we need some national answers, we need a national platform on which to conduct this study, let's partner with Major League Baseball and get a study that would probably take, reasonably, eight to 12 months in normal times to get done, and get it done in three weeks.\" And so that's where the affiliation was born.<\/p>\nThe test went beyond players to all employees of the team. Were players receptive, though?<\/strong><\/p>\nEverybody was receptive to it. We probably had more trouble figuring how who to give the test to than we did finding people that were willing to participate. And that just goes to show you, A. everybody is interested in understanding more about this problem and B. everybody is interested in trying to work together as a society and a community to try to provide answers to this problem.<\/p>\nFor us, for the White Sox, testing was done in Arizona and Chicago. We had about 100 tests done in Arizona, which included all of our front office staff that remain there, all of our team physician staff that remain there \u2014 so there are dietitians and nutritionists and food service staffs, etc. \u2014 and then all of our players that are still in Arizona were eligible to test. In Chicago, any team employee, and then on our side, any team physician staff or team medical staff. For example, our X-ray techs that help us with the team and help us with MRIs and CTs and X-rays, they were invited to participate. All of our physicians in our group were invited to participate. So we just basically took anybody that had a White Sox affiliation and said how many tests can we get done in a short period of time to make this valuable? Because the data really reflects the national prevalence of this disease within the major metropolitan areas where baseball teams exist.<\/p>\nIs it too soon for results?<\/strong><\/p>\nIt is. There was an earlier study that was done by the same research group that looked specifically at California itself that seemed to suggest that the prevalence of the disease is somewhere around four percent in California. I think within the next 10 days we should have results that start coming out that tell us what it looks like nationally and what it looks like in all the areas where Major League Baseball teams participated.<\/p>\nThis wasn't an issue for the White Sox, but there were a couple of pitchers \u2014 Chris Sale and Noah Syndergaard \u2014 that needed Tommy John surgery as the pandemic was all unfolding. Nationally, there was a recommendation that all non-essential surgeries should be put on hold. Why were they still able to get their surgeries done?<\/strong><\/p>\nI think as you go through this, obviously the optics are bad. Everybody looks at that and says, \"Wow, here's a bunch of rich athletes that are getting priority treatment over everybody else.\" But I think the devil is really in the details in terms of how we define what's being done. And frankly, that looks very different even today in New York than it does in Idaho or Jacksonville, for example. And there are a couple key concepts that need to be understood and those are the differences between elective surgery, essential surgery and emergency surgery.<\/p>\nSo I'll just tell you, for example, here in Chicago, we went from doing elective surgery to essential surgery, and then really when we were in the height of the epidemic and not really knowing what was going to be the burden of disease in Chicago, we went to a point where were only doing emergency surgery, which means unless you had a life-threatening situation like an emergency coronary bypass or something of that nature or you had a fracture that had to be treated or you were going to risk losing your limb over it, cases weren't being done. And that includes things like tumor resections for people that were dealing with cancer. So that's where we went to in Chicago and now we're coming back towards, \"How do we start defining essential surgery?\" And essential has many different terms.<\/p>\nFrom an orthopedic standpoint, that includes things like pain, function, significant financial hardship. So we like to talk about baseball players, but I would put it in real-person terms. If you have an electrician or a plumber that falls and tears his rotator cuff and needs surgery in order for them to go back to work, provide essential services to the community and provide for their family, those are people that are now being considered to have surgical procedures as being \"essential.\" So that's really no different whether you are an electrician or a plumber or a baseball player, that based on the status of the disease on the ground, the availability of all the protective gear and the fact that we're not taking away protective gear from frontline environments, the fact that we have anesthesia staffs who are not necessarily needed right now on the frontline environments, and the fact that we have appropriate precautions in place where we're not putting our staff at risk, we can start to do those types of cases again. And I think at the time when those two individuals that you mentioned had their surgery, they had surgery in places where it was still appropriate to do that based on the local disease burden on the ground.<\/p>\n<\/p>\n<iframe src=\"https:\/\/art19.com\/shows\/6a5920aa-aab0-4e95-8af1-49bd0b17c545\/embed?theme=dark-custom&primary_color=%23ffffff&playlist_type=latest\" style=\"width: 100%; height: 200px; border: 0 none;\" scrolling=\"no\"><\/iframe><\/p>\n<a href=\"http:\/\/bit.ly\/2OmHoHH\">Click here<\/a> to download the new MyTeams App by NBC Sports! Receive comprehensive coverage of your teams and stream the <a href=\"https:\/\/www.nbcsports.com\/chicago\/white-sox\">White Sox<\/a> easily on your device.<\/em><\/p>\n"
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Back on March 12, Dr. Nik Verma was getting ready to head to the airport.

As the head physician for the White Sox, it’s common for him to be on a plane headed for Phoenix in the spring.

“I'm generally there somewhere around 20 days during the time frame that (the White Sox) are in Arizona (and go) back and forth to manage my own practice here in Chicago and then take care of the team in Arizona,” Verma said.

But by the time he was set to leave, spring training had been suspended. The sports world had been rocked by the COVID-19 pandemic the night before, as Utah Jazz star Rudy Gobert tested positive and the NBA suspended its season.

Like everyone else, Verma’s job changed rapidly that day. As the director of the Division of Sports Medicine for Midwest Orthopedics at Rush Hospital, he has a practice to run. But as the head physician for the White Sox, and a member of the Major League Baseball Team Physicians Association, he also has to monitor players’ health from afar and make sure they are ready for a season that right now has an unknown Opening Day.

In a lengthy chat with NBC Sports Chicago on Monday, Verma detailed why he believes baseball games can be played this summer. Below is the rest of the conversation, touching on many topics, including the White Sox involvement in an important COVID-19 antibody study. The interview has been lightly edited for length and clarity.

These are circumstances that none of us have ever really seen before, whether we're talking baseball or way beyond baseball. I'm curious what your role has been as the head team physician dealing with these circumstances and trying to communicate with members of the team.

Where we've left it is that for our 40-man guys, anybody who wanted to stay in Arizona was able to do so. The remainder of the team was able to go back home or to other areas where they felt most comfortable, either based on families, situations or commitments. It really became an effort to try to design individual programs for how do we manage guys who are just kind of (in their) routine? How do we take care of guys who left camp with an injury or are recovering from an injury? And then how do we deal with issues that may have come up when people were home, either through their normal training protocols or other?

What we've done is our strength and conditioning team and our head athletic training team are in contact with players, either on a daily or every other day basis, just to check in to say, "Hey, how you doing? Any issues we can help you with? How are things going?" We actually have our nutritional staff working with them directly, and we have our sports psychologists and sports performance staff working with them as well to say, "How are you dealing with this situation in general? Is there anything we can do to help you with anxiety or the mental health side or all the other things that go along with what all of us are dealing with, not specific to baseball players?"

And then for myself, we really get involved if there's an issue that happens where either a player has been recovering from an injury or a player's developed symptoms when they've been at home. And for me, that looks very much like what I'm doing with you right now, which is a tele-health visit — understanding the problem. I can generally get probably 70 percent of the information I need just from understanding how their symptoms started, where they are, what kind of symptoms they are, are they happening during throwing, batting? Were they acute or repetitive in nature? And then we need to make a triage decision and much of this depends on where people are in the country. Somebody that is in a spot that has very little penetration of COVID-19 may be in a position where they can go in and see a doctor and get an MRI scan. Somebody who is in one of these hot-spot areas may need to say, “We're going to sit on this for two weeks and wait until it's safe and appropriate for you go get an MRI scan.” And then we start thinking about decision-making about when is it time to get somebody back to either Chicago or Arizona for an in-person evaluation by myself or one of the trainers, based on the acuity of the symptoms? So we're really running a triage shop very much the way that we're dealing with our own patients and deciding when it's safe to see them in person or not.

Like any human being right now, if a player even gets a cold, they might start getting worried that it might be COVID-19. Have there been any players that have been in that situation where they're feeling symptoms and they want to talk to a doctor?

I don't want to disclose any significant personal issues. I'll just tell you that as far I know, there has not been any player in the MLB system that has tested positive as of yet. We all have protocols in place that have come down through Major League Baseball and the Major League Baseball Team Physicians Association about how we manage that situation. Frankly, it's really no different than the way that we manage that situation in our own patients. A lot of it depends on the access to testing, the availability of testing and the criteria of testing that exists within a local area. So here in Chicago, as we went through the “surge,” testing was really only available to people that had symptoms but also met a certain disease severity level. You have to have a certain limit or minimum symptoms in order to be available for testing, simply because there weren't enough tests to be done. So fortunately, the MLB group is a group of generally younger, healthier individuals where even absent their participation in baseball, their risk of severity of illness from COVID-19 is fairly low. So we're managing those patients by appropriate precautions, appropriate screenings and then if their disease-severity is sufficient enough, referral to a local testing site to undergo testing.

Michael Kopech had just gotten out there in a game and thrown 11 pitches, he looked great, throwing over 100 mph, and then two days later, everything shut down. Whether it's him or any other player dealing with an injury right now, how do you make sure a player is ready for an unknown target date?

Yeah, it's hard to do. I'll be honest with you. I would say if there's any bit of a silver lining around this, as we were going through spring in the early part when everybody anticipated or really had no awareness of how rapidly the situation would change, there were a lot of players who had nagging injuries. (Lucas) Giolito and (Yasmani) Grandal and a couple guys had some stuff going on, and we were always kind of on a very tight timeline about the season starting and when we could get these guys back and how to do it safely. Those are players now that have had the luxury of time where we really expect them to be completely healed from non-surgical injuries as they come back and be 100 percent.

You know, guys like Kopech I'd put into that bucket, as well. He's a guy who was essentially well within the criteria for returning to normal participation. We'll probably still have to think about all the other metrics that we go by in terms of endurance and frequency of starts, number of throws, getting his head back into the game, pitching in front of crowds, all those types of things, but he's not somebody I would worry about tremendously. He's somebody I would say could be treated just like every other pitcher is going to be treated as we ramp back up.

Our strength and conditioning coaches and our training staff has done an amazing job of staying in touch with players and giving them appropriate at-home regimens. There are guys you talk to who are just going out to the park down the street from them to throw their bullpens, just to make sure they are staying active and keep their arms in shape. The pitchers are really the primary concern, obviously. As we go back, I think we're really going to have to make some educated decisions based on how long we've been away, what the anticipated time of the season looks like, whether the season is going to progress with normal game volume or whether we're going to see higher game volumes with less off days. And those factors are going to have to be measured in terms of what we need to do to make sure that players are ready to go safely before we start regular game participation.

Are you concerned that there could be additional injuries that pop up if a "second spring training" must be rushed to get games in?

I wouldn't say concerned is the right word. I think everybody is cognizant of the fact that we have to be thoughtful about it, right? And fortunately, I feel very strongly that Major League Baseball and the players association, the team physician’s association, the players themselves, owners and management, everybody in baseball has really always been on the right side of the injury argument. We all recognize the burden of injury to the game. Clearly the financial aspect of injuries to the game is significant. So I think everybody is aware of that potential problem, and I think everybody is on the right side of making sure that we do this not only to get the season in because we all want to play baseball, but to do it to preserve player health. There are lots of different ways you can do that in terms of maybe expanding the roster from 26 all the way back up to 40 or whatever it may be in order to — if we are going to play an accelerated schedule — make sure that player safety is one of the highest priorities of how you do that.

I'm fascinated by the COVID-19 antibody study. The news of this came out last week. MLB participated in it. What can you tell us about the White Sox involvement in the study, and why is it so important?

Well, the first thing I want to make clear is that this wasn't a study that was done in any way to try to prioritize MLB or to do testing in MLB to try to make sure that MLB players were ready to play baseball. What happens is when you're a researcher and you're looking to do a study on this on a national level, the hardest part of getting any study like this off the ground is how do I get through the logistics, right? If I'm in Stanford in Northern California, or USC in Southern California, how am I going to find researchers in Illinois or New York or Miami to be able to do this? That’s where the interest in partnering between MLB and the researchers and both of those institutions was born.

And the reason was that they could engage Major League Baseball, they could engage the Major League Baseball team physicians and say, now we've got a resource in all the major metropolitans throughout the country and we've got a captured audience of baseball team employees and team physician staffs that we could say, “OK, we're going to send you 200 tests. We want you to get 200 people and get them tested and get them back to us within a week.” And so that's where it was a really cool collaboration between the two to say, "We've got a national problem, we need some national answers, we need a national platform on which to conduct this study, let's partner with Major League Baseball and get a study that would probably take, reasonably, eight to 12 months in normal times to get done, and get it done in three weeks." And so that's where the affiliation was born.

The test went beyond players to all employees of the team. Were players receptive, though?

Everybody was receptive to it. We probably had more trouble figuring how who to give the test to than we did finding people that were willing to participate. And that just goes to show you, A. everybody is interested in understanding more about this problem and B. everybody is interested in trying to work together as a society and a community to try to provide answers to this problem.

For us, for the White Sox, testing was done in Arizona and Chicago. We had about 100 tests done in Arizona, which included all of our front office staff that remain there, all of our team physician staff that remain there — so there are dietitians and nutritionists and food service staffs, etc. — and then all of our players that are still in Arizona were eligible to test. In Chicago, any team employee, and then on our side, any team physician staff or team medical staff. For example, our X-ray techs that help us with the team and help us with MRIs and CTs and X-rays, they were invited to participate. All of our physicians in our group were invited to participate. So we just basically took anybody that had a White Sox affiliation and said how many tests can we get done in a short period of time to make this valuable? Because the data really reflects the national prevalence of this disease within the major metropolitan areas where baseball teams exist.

Is it too soon for results?

It is. There was an earlier study that was done by the same research group that looked specifically at California itself that seemed to suggest that the prevalence of the disease is somewhere around four percent in California. I think within the next 10 days we should have results that start coming out that tell us what it looks like nationally and what it looks like in all the areas where Major League Baseball teams participated.

This wasn't an issue for the White Sox, but there were a couple of pitchers — Chris Sale and Noah Syndergaard — that needed Tommy John surgery as the pandemic was all unfolding. Nationally, there was a recommendation that all non-essential surgeries should be put on hold. Why were they still able to get their surgeries done?

I think as you go through this, obviously the optics are bad. Everybody looks at that and says, "Wow, here's a bunch of rich athletes that are getting priority treatment over everybody else." But I think the devil is really in the details in terms of how we define what's being done. And frankly, that looks very different even today in New York than it does in Idaho or Jacksonville, for example. And there are a couple key concepts that need to be understood and those are the differences between elective surgery, essential surgery and emergency surgery.

So I'll just tell you, for example, here in Chicago, we went from doing elective surgery to essential surgery, and then really when we were in the height of the epidemic and not really knowing what was going to be the burden of disease in Chicago, we went to a point where were only doing emergency surgery, which means unless you had a life-threatening situation like an emergency coronary bypass or something of that nature or you had a fracture that had to be treated or you were going to risk losing your limb over it, cases weren't being done. And that includes things like tumor resections for people that were dealing with cancer. So that's where we went to in Chicago and now we're coming back towards, "How do we start defining essential surgery?" And essential has many different terms.

From an orthopedic standpoint, that includes things like pain, function, significant financial hardship. So we like to talk about baseball players, but I would put it in real-person terms. If you have an electrician or a plumber that falls and tears his rotator cuff and needs surgery in order for them to go back to work, provide essential services to the community and provide for their family, those are people that are now being considered to have surgical procedures as being "essential." So that's really no different whether you are an electrician or a plumber or a baseball player, that based on the status of the disease on the ground, the availability of all the protective gear and the fact that we're not taking away protective gear from frontline environments, the fact that we have anesthesia staffs who are not necessarily needed right now on the frontline environments, and the fact that we have appropriate precautions in place where we're not putting our staff at risk, we can start to do those types of cases again. And I think at the time when those two individuals that you mentioned had their surgery, they had surgery in places where it was still appropriate to do that based on the local disease burden on the ground.

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