Reflections on COVID-19 From A Physician/Boxing Promoter

It was around 11:00 AM on Saturday, March 14^th. The event center lobby was dimly lit. Marshall Kauffman and I stood across from each other in stunned disbelief. Minutes earlier we were coordinating various efforts in preparation for the Kings Promotions event scheduled that evening at the Wind Creek Casino in Bethlehem, PA.

We were anticipating one of our biggest crowds in some time with a main event worthy of television and an undercard chalk full of top-tier local talent. As boxing fans first, promoters second, we couldn’t have been more excited.

Then “BOOM!”!

Just like a left hook you don’t see coming, one that lands square on the button while you are in the middle of throwing your own, the event was shut down by state officials in conjunction with casino management. Short of this happening with a line of people standing outside the gates, the timing couldn’t have been worse. 

In hindsight, it was probably the right thing to do but I’ll be damned if emotion doesn’t triumph over reason almost every time.

The current situation we’re now experiencing with the Coronavirus escalated slowly in the US over the preceding months and then very quickly within the course of the week leading up to our event. By Thursday of that week most large gatherings, which included boxing events in the US and around the globe, had been cancelled or postponed. Unfortunately for us, we already had fighters and their teams flown in from across the country and beyond. Cancellation or postponement at that moment would have been a disaster.

We knew the event was teetering but assumed if we made it through the weigh-ins we would be good to go. Well, we were wrong. 

In the short time that has passed since the event I think I’ve experienced all or most of the stages of grief from the loss of boxing in my life and the social isolation resulting from this lockdown: denial, bargaining, anger, and now something approaching acceptance.¹ 

Dr. Foy and Kauffman have partnered up, and work off of each others’ strengths. Foy says work off your strengths during this shelter in place-lockdown-period of uncertainty, and know we will all get through this challenge.

In the days leading up to and immediately following our event, I hadn’t been thinking much about Coronavirus from a physician or scientist’s standpoint but mainly from my perspective as a promoter. My hospital still hadn’t made plans for “the surge” and our everyday lives were still operating normally. I heard accounts though of what might be coming. 

Twitter was lit up with horror stories from Italy’s front lines where hospitals were being overwhelmed, tough choices were reportedly being made about withholding mechanical ventilators for older patients to save them for the young, and healthcare workers themselves were getting sick and dying. I knew people who knew people but I didn’t know anybody myself. 

However, in the course of only a week, my hospital has made rapid changes in preparation for a “surge” of sick patients affected by Coronavirus. So far there’s been a trickle of cases along with predictions that a “surge” could hit any day. We all hope not but are preparing for worst case scenarios and some of the changes we’ve adopted aren’t bad, regardless. 

But despite the fact that things remain slow in Pennsylvania, especially outside Philadelphia, cases are increasing rapidly in other areas of the country, particularly New York and New Jersey. The absolute percentage of the population with confirmed Coronavirus infection remains low but it’s very difficult to extrapolate where it will end and how it will impact local health systems. 

My best summary of the current situation after a week of personal reflection and investigation is: a lot of uncertainty.  The biggest unknowns remain 1) the overall percentage of individuals in the population that are currently infected or have been infected and recovered and 2) the risk of dying for those infected. The main obstacle to knowing this information, which might seem basic, is the relative lack of testing in the US population and even global populations until very recently.

In the case of a new infection, the only way to know how common it is and thus, how deadly, is to test a representative sample of the population for evidence of infection. Since this wasn’t done in the US and most other countries abroad, initial testing was mainly performed on those with the worst symptoms. This has the effect of artificially inflating the deadliness of a new infection. This is called “selection bias” (see figure).

There is little doubt in my mind that selection bias has contributed to overestimates of this Coronavirus’s risk, the main question is how much? Based on the best evidence available (a picture that is rapidly evolving), the answer is a lot – like we are potentially off by multiple orders of magnitude! That doesn’t mean the virus isn’t a big deal or that current efforts aimed at mitigation aren’t important but it is cause for optimism.

I suspect over the coming weeks we will continue to get mixed signals on the virus in the US. As testing supplies increase across the country we will see rapid rises in infection rates. It will take time to sort out what represents true increases in infection versus false increases that simply reflect an increased level of testing. I suspect the truth will lie somewhere in between. We should also learn more about whether current efforts to mitigate the spread of infection are effective.

Where I have little doubt is that this lockdown has profoundly hurt the boxing community in general, and many individuals I consider friends. The list includes promoters, trainers, gym owners and most of all, fighters. Whether these individuals derive their income solely from boxing-related activities or not, most are out of work and won’t be eligible to collect unemployment. I know individuals who will lose their businesses and have to file bankruptcy. I know several who will not be able to pay their rent and may be forced back into living arrangements that increase their susceptibility to drug-related violence and crime. 

The economic fallout from these policies are more real to me, at this time, than is the possibility of a public health crisis from Coronavirus infection. And while the latter undoubtedly represents a threat to the nation so do consequences stemming from this lockdown. Public health and economic health are closely interrelated. We need to change our frame of thinking here from a case of “public health versus economic health” to one of “public health due to Coronavirus versus public health due to the economic shutdown.” Addressing both is critical.

In the coming days, I hope government passes a stimulus bill that puts money back into the hands of individuals as quickly as possible as well as businesses, both large and small. 

I also hope we strategically and systematically begin to ease some of the most restrictive aspects of the current lockdown. But even with this, I suspect sporting events will be among the last areas to return to business, especially in areas hit hardest by the Coronavirus. 

In light of this, the boxing community needs to stick together more now than ever. Reach out to those you know who are being hit hardest by this and offer support, there are many ways to be supportive. 

My personal tip to fighters, try to let go of personal anxiety related to uncertainty about your next fight date and instead, get enthusiastic about the idea of an “active recovery.” Set a new goal over the next 4 to 6 weeks that allows your boxing parts to heal while gaining strength and endurance in a new dimension – it will make you a better athlete. Something simple and cheap that you can do with respect to social distancing is to train to race a 10k. I’m not talking about running to just run but training with a plan. Training plans for novice, intermediate and advanced levels can be easily found online. 

Times are tough but we will survive. What other choice is there? Try to stay positive and use this time to be productive. 

About the author:

Andrew Foy is co-owner of Kings Promotions and a practicing cardiologist. He is an Assistant Professor of Medicine and Public Health Sciences at Penn State Milton S. Hershey Medical Center and College of Medicine. He is the author of over 60 peer-reviewed publications and provides lectures in the College of Medicine on health systems science as well as skepticism and critical appraisal of medical research.  

Endnotes

1. I didn’t Wikipedia the “stages of grief” while writing this so if I left a few stages off or inserted one that doesn’t exist cut me a break. I’m a cardiologist not a psychologist.