D6 EZ SU THE WASHINGTON POST.MONDAY, AUGUST 10 , 2020
FROM NEWS SERVICES
AND STAFF REPORTSThe NFL reached an agreement
with the NFL Referees Associa-
tion on protocols related to the
novel coronavirus and opt-out
provisions for the 2020 season,
the NFLRA announced.
According to the NFLRA, any
game official or replay official
with coronavirus-related con-
cerns can opt out of the season by
Thursday and receive a $30,000
payment. The opt-out decision
would be treated as a leave of
absence and the official would
have guaranteed job protection to
return for the 2021 season, ac-
cording to the NFLRA.
“ There is nothing more impor-
tant than the health and safety of
our members,” Scott Green, the
NFLRA’s executive director, said
in a statement Saturday. “Al-
though there will undoubtedly be
some risk for our officials, we are
pleased to have finalized a plan
with the League that provides
additional benefits and protec-
tions during this unprecedented
season.”
The NFLRA also said that any
positive coronavirus test by a
game official during the season
would be treated as an injury
suffered during a league-sanc-
tioned or required activity and the
official would be entitled to pay,
medical expenses and benefits.
More than 60 NFL players opt-
ed out of the season by T hursday’s
deadline. Under an agreement be-
tween the league and the NFL
Players Association, a player with
a high-risk medical condition is to
receive a $350,000 stipend for
this season if he chooses to opt
out. A player not considered at
high risk is to a receive a $150,000
salary advance.
— Mark Maske
l RAMS: Defensive tackle
A’Shawn Robinson is sidelined in-
definitely with a non-football in-
jury, Coach Sean McVay said.
The Rams put Robinson on the
active/non-football injury list Sat-
urday, and McVay discussed their
new signee’s prognosis Sunday
without disclosing the nature of
Robinson’s condition, which isn’t
coronavirus-related.
McVay admitted Robinson’s
condition was “something that
kind of surprised us” when the
player reported to training camp.
Robinson is participating in the
Rams’ team meetings, and he
doesn’t need surgery or another
medical procedure.
McVay made it sound likely
that Robinson will miss playing
time this season.
Robinson agreed to a two-year,
$17 million contract with the
Rams in March after leaving the
Detroit Lions as a free agent. Rob-
inson was expected to replace
Michael Brockers as the run-stop-
ping center of the Rams’ defensive
line after Brockers left as a free
agent for the Baltimore Ravens.
But Brockers unexpectedly re-
turned to the Rams on April 3
after his deal with Baltimore was
scrapped, which left Robinson’s
role this season in flux.
l JAGUARS: Jacksonville is
down two more defensive line-
men, bringing its total to five just
a week into training camp.
The Jaguars placed defensive
tackles Brian Price (knee) and
Dontavius Russell (hip) on in-
jured reserve, adding to a depth
problem created when defensive
end Lerentee McCray and defen-
sive tackle Al Woods opted out of
the season because of the pan-
demic.
Also, defensive end Yannick
N gakoue, the only franchise-
tagged player in the league to not
sign his tender, is seeking a trade
and skipping team activities.
Jacksonville also agreed to
terms with three players: defen-
sive tackle Caraun Reid, d efensive
back Tramaine Brock a nd defen-
sive lineman Carl Davis.
l PATRIOTS: New England
traded an undisclosed 2022 draft
pick to the Lions for cornerback
Michael Jackson.
Jackson was d rafted in the fifth
round in 2019 by the Dallas Cow-
boys. He began his career on the
Dallas p ractice squad before be-
ing signed by Detroit.
Jackson joins a Patriots team
that is looking to add depth in the
secondary after Patrick Chung
opted out of the season because of
concerns about the coronavirus.
l DOLPHINS: Miami signed
wide receiver Chester Rogers,
providing a reinforcement at a
position where two players earlier
opted out for the season.
Rogers started 22 games with
the Indianapolis Colts from 2016
to 2019.
— Associated Press
NFL NOTES
Referees
reach deal
on opt-out
provisions
BY NICKI JHABVALA
More than 14 months after he
tore two ligaments in his left
knee, Washington linebacker
Reuben Foster was activated
from the physically unable to
perform list Sunday and will get
his first chance at a full practice
with the team.
The team also activated tight
end Logan Thomas from the
n ovel coronavirus reserve list. He
takes the roster spot left vacant by
running back Derrius Guice, who
was arrested Friday on domestic
v iolence-related charges and was
waived by the team.
Foster, 26, has yet to play a
game or participate in a full prac-
tice for Washington since he was
claimed off waivers from San
Francisco in November 2018.
Washington’s decision to acquire
him was met with sharp criticism
because Foster had just been ar-
rested twice on domestic violence
charges, and his career, dating
from before he was drafted, had
been riddled with off-field trou-
ble and significant injuries. He
has played 16 NFL games since he
was drafted in 2017, the last of
which was in October 2018.
Although Washington’s previ-ous staff compared Foster to Ray
Lewis based on his potential, it
also admitted he may never suit
up for the team. Foster was placed
on the commissioner’s exempt
list because of his arrests in 2018
and wasn’t reinstated until April
2019, when charges were dropped
and an NFL investigation found
insufficient evidence to support
his s uspension.On the first day of organized
team activities with Washington
in May, he tore the ACL and
lateral collateral ligament in his
left knee and suffered nerve dam-
age. He missed the entire 2019
season after undergoing surgery.
The team declined his fifth-
year option in April, but defensive
coordinator Jack Del Rio and
linebackers coach Steve Russpraised his work throughout the
offseason.
“Reuben has been fantastic,”
Russ said recently. “I mean, he’s
back there taking mental reps.
He’s making the calls. He’s lining
up. He’s putting himself in that
position. He’s saying out loud
what he’s going to do.... I see
Reuben making all the calls with
his hands whether I asked him ornot, and I can see his lips moving
whether I asked him a question or
not. So, I told him, I don’t have to
ask you a question for you to be
able to answer it. And I really like
where Reuben is. I like his intent.
I really like his focus. I like his
discipline right now. And obvi-
ously we’re rooting for him. We
are his biggest fans.”
Foster rejoins a defense in flux
as it switches from the 3-4 scheme
to Del Rio’s 4-3. His fit in the
system, and with the team, will
gain clarity in the coming weeks.
Thomas, 29, was placed on the
coronavirus list at the start of
training camp, meaning he tested
positive or came in contact with
someone who did.
Coach Ron Rivera has likened
Thomas’s athleticism to that of
former Carolina Panthers tight
end Greg Olsen and has ex-
pressed high hopes that the con-
verted quarterback can become a
productive piece of Washington’s
offense.
“Pete Hoener, our tight ends
coach, felt very strongly about
this guy’s abilities, mostly be-
cause he thought he was a very
smart and savvy football player,”
Rivera said in April. “He’s a tre-
mendous athlete. And he’s just
learning and getting the position
right now.”
Washington is set to begin the
second phase of its training camp
ramp-up period Thursday. The
first padded practice is scheduled
for Aug. 18.
[email protected]Foster, Thomas join Washington’s active roster
TONI L. SANDYS/THE WASHINGTON POST
Reuben Foster tore multiple ligaments in his left knee during offseason training activities last year.Linebacker is coming off
a serious knee injury
suffered in May 2019well again,” Nagel said.
While the data is not conclu-
sive, Nagel said, “I think we will
see quite a few infected athletes
having a reduced fitness for quite
a while.”
Myocarditis, Kim said, is a vari-
able disease. The way it presents,
the severity and the long-term
effects are difficult to predict. One
certainty, Kim said, is that when it
is diagnosed, athletes need to be
restricted for a minimum of three
months. And so even relatively
mild cases could be disruptive for
an athlete.
“This is a disease process that
really does require our respect,”
Kim said. “If an athlete made that
determination that they wanted
to opt out because of [concerns
about heart complications should
they contract the virus], it
wouldn’t be inappropriate. The
majority are going to be fine. To
outright tell an athlete, ‘Oh, don’t
worry about it; if you get it, you’ll
be fine,’ I think that would be
misinformation passed on to
them.”
But the biggest cause for con-
cern for cardiologists is the no-
tion that covid-19 could lead to an
increase in a condition that, in
rare instances, leads to sudden
death. While cases will be scarce,
doctors said, the consequences
demand alarm.
“The problem with the heart is
if you’re wrong, you’ll end up...
dead,” Schneider said. “That’s
what is so scary about the heart. A
misjudgment can be fatal. That’s
why it’s going to have a huge
impact on sports. That’s why we
need to get kids to stop spitting.”
[email protected]sound of the heart called an
echocardiogram and a blood test
for a protein called troponin that
would reveal cardiac injury.
“We were concerned to begin
with, and our original guidelines
were out of an abundance of
caution,” Emery said. “Now our
more recent MRI data from last
week continues to raise that cau-
tion level even higher.”
The way covid-19 may affect the
hearts of even healthy people has
been particularly concerning.
This past week, Winslow dis-
charged from Stanford’s hospital
a “perfectly healthy” 23-year-old,
thin and athletic, who had covid-
19 six weeks ago. She had been
admitted because of a rapid heart
rate. Tests revealed her ejection
fraction — the volume of blood
that leaves the heart each time it
contracts — was at 52 percent.
Normal is 65 percent. Doctors
saw abnormalities in the motion
of the walls of her heart.
“I’d like to caution young peo-
ple: Please, please do not deliber-
ately get infected or even be cava-
lier in risk-taking in your behav-
ior,” Winslow said. “Not to scare
people or anything, but this is
very real.”Understanding consequences
The impact of the coronavirus
on the heart could also have a less
frightening impact on athletes.
Eike Nagel, one of the German
study’s authors, said in an email
that the specific effect on athletes
is still unknown but that the
leading opinion is they should
exercise caution. “We believe they
should refrain from high-end
competition until they feel reallybefore a playoff game in 1993 and
later died of it. Hank Gathers, a
23-year-old at Loyola Mary-
mount, died in 1990 of cardiomy-
opathy, a form of heart failure
often begot by myocarditis. Myo-
carditis causes about 75 deaths
per year in athletes from 13 to 25,
according to the Myocarditis
Foundation.
In early August, the Red Sox
ruled out starting pitcher Eduar-
do Rodriguez, who tested positive
for the coronavirus at the start of
the team’s summer camp, for the
season after an MRI exam
showed he had myocarditis.
“That’s the most important
part of your body, so when you
hear that... I was kind of scared a
little,” Rodriguez told reporters.
“Now that I know what it is, it’s
still scary.”
This past week, the mother of
Indiana offensive lineman Brady
Feeney, Deborah Rucker, posted
on Facebook that her son had
experienced heart issues, among
other ailments, in the wake of a
positive coronavirus test. She told
the Indianapolis Star that doctors
from the school gave Feeney an
electrocardiogram and did blood-
work. The screening raised con-
cerns, Rucker said, and Feeney
will see a cardiologist for further
evaluation.
Cardiovascular experts say
testing should be standard. In
May, Kim and Emery helped write
guidelines for the American Col-
lege of Cardiology for athletes
returning to play after recovering
from covid-19. They stressed the
importance of cardiovascular
screening. Athletes, they said,
should undergo an EKG, an ultra-with more of them than the heart.
“It’s turned out, now that we’re
getting more long-term data, the
virus also affects the heart,”
S chneider said. “And perhaps in a
very serious way.”
Jonathan Kim, a sports cardiol-
ogist at Emory University, called a
recent study out of Germany pub-
lished in the Journal of the Ameri-
can Medical Association particu-
larly concerning. Researchers
gave 100 patients who had recov-
ered from covid-19, two-thirds of
whom had suffered mild or no
symptoms, cardiac MRI exams.
The tests showed 78 percent had
some kind of cardiac abnormality
and 60 percent showed inflam-
mation consistent with myocardi-
tis.
The study was composed of
middle-aged people, and Emery
said he would expect athletes as a
group to fare better. But the re-
sults — that people with mild
symptoms could suffer heart
complications as a result of
c ovid-19 — still startled him and
his colleagues.
The findings were bad news for
everyone in a general way and
scary news for athletes in a specif-
ic way. An infection of the heart
can cause myocarditis, an inflam-
mation of the heart muscle. Myo-
carditis can lead to arrhythmia,
cardiac arrest and death, espe-
cially in people who don’t know
they have it and perform rigorous
exercise.
Among the mercifully rare in-
stances of sudden death among
athletes, myocarditis is one of the
most common causes. Reggie
Lewis, a 27-year-old Boston Celt-
ics star, collapsed at a practiceend your sports career. Hopefully
not, but there is a sense it’s much
more serious than we are think-
ing, or in particular our young
athletes are thinking.”
Schneider is one of many car-
diovascular experts concerned
about the nascent, growing body
of evidence about how covid- 19
affects the heart. The studies have
not focused on athletes, but their
findings have implications for the
sports world. Research raises the
possibility that athletes who re-
cover from covid-19 may face dire
or lasting heart complications,
and medical experts have urged
cardiac screening for athletes re-
turning to play after contracting
the virus. Two high-level athletes
— including the projected Open-
ing Day starter for the Boston Red
Sox — have reported heart issues
in the wake of recovery from
covid-19.
Many questions remain unan-
swered, and they are coming at a
pivotal time. Scores of NFL and
college football players have opt-
ed out of competing this year,
owing to concerns regarding
covid-19. Thousands of high
school, college and professional
athletes are returning to play, and
inevitably some will contract the
virus. Guarding against the possi-
ble effects the disease has on the
heart will be crucial, and maybe
even lifesaving.
Infectious-disease and cardio-
vascular experts do not have
enough data to make conclusions
about how covid-19 might affect
an athlete’s heart, and even recent
studies of other populations re-
quire further validation. But what
they have seen has alarmed them.
“We have very strong, serious
concerns about the potential for
covid to affect athletes cardiovas-
cularly,” said Michael Emery, co-
director of the sports cardiology
department at the Cleveland Clin-
ic. “When you look at covid in
general, there seems to be a high-
er predilection for involvement
with the heart than about any
other virus we’ve seen.”
Emery said cardiological ex-
perts worldwide have published
five or six significant papers re-
garding covid-19 and athletes. “All
the papers agree that there
should be a heightened level of
concern with this virus and cardi-
ac involvement in athletes,” Em-
ery said. While the specifics and
suggestions of how to manage the
risk differ in those papers, “the
overall level of concern is greatly
there.”
Dean Winslow, an infectious-
disease doctor at Stanford Uni-
versity, said research has shown
as many as 20 percent of people
who recover from covid-19 show
cardiac abnormalities.‘This is very real’
Since the coronavirus started
its spread, the lungs have been at
the center of its effects. The virus
enters the body through the lungs
and can cause severe cases of
pneumonia that demand inten-
sive care and intubation. But doc-
tors have long suspected covid- 19
also affects the heart. Heart mus-
cle cells have ACE-2 receptors,
which the coronavirus uses to
enter cells. The lungs, Schneider
said, are the only place in the bodyVIRUS FROM D1Medical experts offer concerns that athletes should take to heart
DOUGLAS R. CLIFFORD/ASSOCIATED PRESS
Tom Brady talks to Tampa Bay teammates during camp last week. Some in the NFL have opted not to p lay because of coronavirus concerns.