Health Changemaker Leroy Sims, MD, Helped Create the NBA Bubble at the Start of the Pandemic to Bring Back the Game
After the 2019–2020 basketball season came to an abrupt halt on March 11, 2020, along with most other large gatherings, Dr. Sims quickly got to work to see how teams could safely resume play.
Part 1: The March 11 NBA Shutdown
In January of 2020, when news out of Wuhan, China, and beyond was all about the rapid spread of a deadly new virus, Leroy Sims, MD, the senior vice president of medical affairs for the National Basketball Association (NBA), was monitoring the situation while working at the NBA’s Paris office. “We knew there was an outbreak and wanted to know more information,” he said, “[but] none of us knew then that this pandemic was going to happen.”
By January 31, the NBA had sent its first memo to teams and staff about the situation, telling them what they knew about transmission of the virus and recommending public health prevention measures such as hand-washing, regular symptom checks, and physical distancing. Just a little over a month later, on March 11 — the same day the World Health Organization (WHO) declared COVID-19 a pandemic — the NBA suspended its 2019–2020 season as mass closures spread across the country.
For Dr. Sims, who is also an emergency and sports medicine physician at Mills Peninsula Medical Center in Burlingame, California, moving quickly into action and frequently pivoting were nothing new. So when the initial 30-day season suspension turned into a much longer hiatus from the game, Sims continued to plow through research, logistics, and a lot of consultations. By June, he and his colleagues had arrived at a point where they felt it was physically and mentally safe to bring players and staff back together for training, inside the bubble they'd created at the ESPN Wide World of Sports Complex outside Orlando, Florida. With several hundred people in the bubble, the season officially resumed on July 30, almost six months to the day after that initial memo went out.
Sims talked to Patrice Harris, MD, FAPA, a psychiatrist and Everyday Health’s chief health and medical editor, about his journey into medicine, those incredibly intense months between the shutdown and the season restart, how he personally held it all together during this time, how it felt to make it to the end of the season with no COVID-19 cases, and his hopes for the future of healthcare and society.
Patrice Harris:?Dr. Sims, tell us what made you want to go into medicine and why you chose to concentrate in emergency and sports medicine.
Leroy Sims:?I had a fascination with sirens and speeding vehicles and rubbernecking when I was a little kid. From an early age, I wanted to be an EMT or a paramedic. It lined up perfectly with the television show Emergency! that I used to watch. And all the headlines that Dr. Ben Carson was making as a Black physician and neurosurgeon and all the attention the surgery he did separating the craniopagus twins was just fascinating. I originally thought I was going to do neurosurgery, but ultimately decided that I wanted to pursue sports medicine.
I really liked that concept of being able to help anyone anytime or being able to do what you can with limited resources to make a big impact. So I pursued emergency medicine and I practiced my residency at Harbor UCLA. After [that], I did a sports medicine fellowship at Stanford University. In the fall of 2011, I became the team physician and medical director for the Golden State Warriors. I did that for three years and subsequently moved on to being an event medicine consultant for the NBA, prior to rising to this level of working full-time with the NBA.
PH: What a journey. So getting to January and February of 2020, you were in Paris with the NBA, and we were all beginning to hear about what we now know was the pandemic. Based on what you were seeing and hearing, what were some of your earlier thoughts about how this might impact the NBA?
LS: The NBA is a global organization. We're a sports institution, but also entertainment and media. And we have offices around the globe, including in China. So early on, we were getting information about what was happening in Wuhan. The earliest thoughts I had from Paris was preparing those memos and talking points [for teams and staff], reviewing what was being said by the WHO and CDC [Centers for Disease Control and Prevention], and talking to our counterparts at the U.S. embassy and consulate in China to get as much information as we could to alert our staff about the situation. Again, not really knowing where this was going.
PH:?And then just a couple of months later, on March 11, the 2019–2020 NBA season was suspended. I think it made us all stand up and take notice. How quickly did you all begin to think about how you could continue the season?
LS: That suspension was meant to be for 30 days. But as you know, the pandemic really started to unfold, cases started to increase, and that 30-day period was upon us and it was clear that we wouldn't be able to restart right then and there. A lot of collaborative efforts started to go into place. We were talking to other organizations, asking questions, gathering information. We started to seek out experts in epidemiology, infectious diseases, certified industrial hygienists, and statisticians to see what was coming and if we were going to start to plan to resume, how we could do it, where we could do it, and in what manner we could do it the safest.
We knew this virus was continuing to emerge, and newer information was coming out about asymptomatic transmission, the utility of masks, the presence or lack of PPE for healthcare providers, lack of ventilators — all of that we were absorbing and trying to see, does it make sense for us to resume? And if we are going to resume, what's the best way we can do it?
PH: You had to consider literally everything, and you did so with the ultimate concern for safety. I want to give a shout-out to you and the NBA because I think restarting the season was important to us as a society. Everything was shut down, and we did not have the usual distractions — and people were worried. The NBA really helped our country get through at least that early phase of the pandemic. So talk a little bit about the bubble, because a lot of sacrifices were made by the players, staff, coaches, everyone.
LS: We had to consider all aspects of the bubble. First and foremost was the physical and mental health of anyone who would be there and how to make it livable. If we were going to be there for a few months, it not only had to have the essentials in terms of testing and masks, PPE, and all the things that we needed to help make people safe. We couldn't send people out, so we needed to have as much as we could [inside the bubble]. And that included having an on-site medical clinic, imaging resources, and we had to make sure that it was livable so that people had opportunities to exercise, to take walks, and to have fun.
It couldn't be all work. We had to think about the social and the emotional [aspects], too. We had 22 teams and their coaching staff and team staff. We had NBA staff. We had media, we had broadcasters, and all the people who were there to help us operationalize the plan, from transportation to food and beverage to activities and on-campus excursions. If we were transporting people from the hotels to the arenas, we had to think about spacing and ventilation. If people were going to eat, we needed to make sure there was physical distancing and that we could do things in a very responsible manner.
Even when we got there, we had people quarantine for a short period of time. How could we make the quarantine not too onerous on people? And after that, testing every day, getting people to be compliant with the protocols. If someone did test positive, [we needed to ensure] that we were able to follow up with them quickly to abate any transmission. So it was a massive, massive lift, lots of collaboration and lots of meetings. We met constantly to make sure that we didn't drop the bubble. Then what would it look like if we were to allow players to bring their families down, and for kids?
PH: Dr. Sims, you mentioned mental health. The NBA has had relationships with psychiatrists and other mental health professionals and made sure that your players had access to any mental health services that they needed for a long time. Can you double-click on mental health and how you thought about mental health during the bubble and the quarantine?
LS: We thought about it through and through. When I'm a part of the planning for an event or experience with the NBA, one of the things that I always help to put together is an emergency action plan. What do we do [in a] worst-case scenario? What are the resources? We also had a mental health emergency action plan. Not only did we bring physicians to the bubble, we had a clinical and sports psychologist with us in the bubble with office hours [and] on-call hours. And we partnered with local psychiatry and psychology professionals to be on call. Knowing that we had a large number of people there, we didn't want anyone to have to wait for services. We had telehealth [and] in-person options available in the bubble. That was the extent we went to make sure we could take care of the people.
Our teams also have mental health providers. So we made sure that they were ready and on standby for anything, because they have the relationships with the players and the team staff. But for those who didn't have that provider or that access, we made sure we were covered so that if anything came up — whether it was people having difficulties with the quarantine, people struggling being away from family for extended periods of time, anything you can think of — we made sure that we were ready. And if we got to that point of an emergency (and we know that sometimes those happen) we were prepared with an action plan.
We also had lots of activities in the bubble to take the everyday stress out of being there, whether it was people being able to have bicycles to ride around the campus, or fishing. We had lots of people participating in pickleball and slam ball, cornhole. Whatever we could do to take people's minds off just the everyday. And there was about a two-mile loop around the campus where people were out running and walking and hiking. We did have the gyms open, and swimming pools. We sometimes had to limit the numbers, but we always thought through how we can help people get some fun physical activity in there. We did movie nights with a projector and a screen out on a lawn, physically distanced.
PH: As I think about the lessons that we must learn from this pandemic, I think preparedness, and including mental health and public health into how we think about the future of any health infrastructure, will be critical. How did your training as an emergency medicine physician help in all this?
LS: One of the reasons I chose emergency medicine was to be able to respond no matter what. When someone comes in in extremis, we don't jump right in. We think through the situation. Obviously [this] was a COVID outbreak. What do we need to put in place to help us mitigate risk to the greatest extent? What else can potentially happen: illness, injuries? It was a step-by-step measured approach. And I think being an emergency physician where I have received people who are coming into the hospital not breathing, or someone who has suffered a traumatic injury — the approach is the same no matter what. Take a deep breath, relax, rely on what you know. Don't be afraid to ask for help. Don't try to be the hero. Getting by with help from my friends went a long way, and not trying to be the hero and give the impression that I can do it all. It's collaboration.
PH:?Tell us a little bit about what your life was like during March and those early months. And when the [Los Angeles] Lakers hoisted that trophy and that was the end of the bubble, how did that feel?
LS: It felt so great to get to that point, because it took so much time and effort and commitment. And I can't tell you the massive exhale of exhilaration — of “We did it!” It felt like a dream. I remember the night that it came to an end and just being there, just shaking my head, saying I couldn't believe that we had done that, and I was tearful. I felt so responsible for so many lives.
In those early days of March leading up to the bubble, I was still practicing in the emergency room. I was still working with the NBA, thinking through solutions for how we could resume, gathering information, tracking what was happening with the pandemic, and it was exhausting. It was a very challenging time. My hours were very long. Very early, very late, and my sleep did take a hit.
However, I leaned on the things that are most important for keeping me grounded. Exercise being number one. I made sure that I found that time, whether it was going for a run, going for a walk, just getting out. I needed that downtime.
Number two was my family. Whether it was family movie night on Fridays or getting on our bikes and going for a ride, we made sure that we had time together, because the work could be consuming. We made the pivot, remember, to schools going remote. So all of a sudden we were all here and we had to figure out how to live in this space.
Also I relied on my faith, which makes a big, big, big difference for me and my community. Making sure that I kept in touch with my family, my grandma, mom, dad, brothers and sisters, my best friend, and that we didn't drift apart. And so having those breaks — those opportunities were really important.
Our hospital provided free mental health specialists for frontline workers. I made sure to pair with a therapist, and we had an appointment every Tuesday at 4 p.m. Pacific Time. I kept that appointment through the bubble and all the way through December. I started with her in April or May and we met weekly, and that was a time for me to address anything that may have been in my blind spot.
I don't pretend that I am a plumber or that I am a mechanic. When things in my house or my car need attention, I go to a specialist. When I'm dealing with a pandemic and stress, I go to a specialist, and I made sure to let people know — because I know there's that stigma of mental health and having a provider — and I [said], sorry, I can't do that, or I can't cover that game. I have an appointment with my therapist for this hour. And I tried to normalize it, take away some of the stigma, and that helped as well.
PH: As physicians, we always have to be there for everyone else, but we don't always take care of ourselves. But you mentioned that it was a regular appointment. You didn't wait for a crisis. You didn't wait for weeks until maybe your emotional health worsened. That's a critical part of the story as well.
In times of crises, there are always setbacks and challenges. What were some of the biggest challenges? And how do you deal with the setbacks that really just are part of the process?
LS: That's a really good question. Setbacks will happen. Mistakes happen. With the bubble and the pandemic, we really didn't have a playbook, so some of it was being written in real time. Things will happen and you have to be able to roll with it and not let it slow you down. As in the emergency department, [what] happens in room one can't impact what's going to happen in room two, three, four, five, and six. You have to be able to some degree to compartmentalize and move forward, but then take that time to reflect and debrief.
When I'm in a stressful situation, I make sure that I remain attentive to the things that are going to help me function at my best, and I call them the big four: exercise, sleep, eating well, and stress reduction. If I can pay attention to [those things], they keep me grounded. I tell people who know me, “If you want to get a sense of how I'm doing, rather than saying, ‘Leroy, how are you doing?’ ask me, ‘Have you worked out today or do you have a plan to?’” If I can work out, that means I found the time, I've made the time, and that's a good day.
You can ask me, "How much caffeine have you consumed?" Generally, a cup of coffee in the morning — I'm good. If I have to supplement that with an espresso or two, that means I haven't been sleeping much and I'm going, going, going.
Don't ask me how much I've slept. That's not a fair one. But if I'm able to exercise and I'm not loading up on the caffeine, then I'm in a good place, and that's a good barometer for how I'm doing in general.
PH: So fast-forward. We’re in the 2021–22 season. We've had delta and then we've had omicron. But fans are allowed back and the season has gone mostly undisrupted thus far. How's it been? And what are you most concerned about going forward?
LS: It's been thrilling to see the game back to as close as normal as it can be. We always talked about that: Getting back to normal. We knew we wanted to complete our season in 2019–2020. We did that grand experiment of the bubble. But after that, we had to think outside the bubble. What needed to be done? Again, we follow the data. We look at community transmission. We look at the emergence of tools to help us with our decision making. Those tools being vaccines, and now boosters. Or therapeutics, whether it was convalescent plasma in the beginning or now antivirals that are being developed. All those things help us get closer and closer to a better place in this pandemic and hopefully bring it to a close.
For people who aren't in medicine, it can feel like watching a tennis game: “You said this, and now it's this.” For us, those changes reflect evidence and data. As we get more data, we make those updates. So one of the biggest challenges has been the way we have communicated with the public, which to some extent has resulted in some frustration.
Having almost all our players fully vaccinated without a mandate really was a testament to the collaboration of our team physicians, our social responsibility teams, the teams, staffs, and the communication and education that we did.
As we move forward with that in mind, we develop health and safety protocols for the players and for the arenas. What we do in California may look different from what we do in Tennessee because of what the transmission rates are, etc. We are very much in the business of looking out for people holistically and making sure we're not putting people at risk; that we're not being cavalier, we're being thoughtful. Because at the end of the day, we need people to be safe. We don't want to be contributing to the pandemic.
PH: We all know that representation matters. Quite frankly, we need more people who look like you and I in healthcare. What do you think young folks who see people like us in our respective roles think about pursuing a career in medicine or healthcare or sciences or any of the STEM career paths?
LS: I think it is vitally important that people see others who look like them, that we share our stories, that we celebrate the diversity that is within even our own community. I spoke earlier about the inspiration that I had from seeing Dr. Ben Carson in 1987 and 1988. Just seeing someone who looked like me gave me that thought of, "Maybe I can do that." I hope that people see me and get that sense of inspiration.
But also letting people know that I come from the West Side of Chicago. I didn't grow up on third base. I had to grind it out. I had to work hard. I was surrounded by poverty, drugs, and gangs. But I kept my vision straight and I relied on my community. Not everyone shares that story of coming from inner city and whatnot. So then it comes to, well, what did you do to be successful? And sharing that playbook. I sought mentors. I asked for help. I sought scholarship and I pursued excellence vigorously to make sure that I made it. I didn't make excuses.
All those people who allowed me to put my hand in theirs and pulled me forward, they opened the door for me. It's now incumbent upon me to do the same. I have to not only feed into the pipeline, but to be accessible, to be tangible. So one, we have to highlight the fact that, yes, we do need more providers. And when we have opportunities to mentor, that we're there for those providers.
I want to make sure people understand that it's not a one-path-fits-all. You don't have to go to a medical school. You can be a nurse or a physician's assistant or a dentist or a technician. No matter what you do, number one, feel free to change your mind. I carried a burden because I told everyone, once upon a time, I was going to be a neurosurgeon like Dr. Ben Carson. When I was deciding to go in a different direction, I knew people would say, "Hey, what happened?" And it's okay. Own your narrative and say, "I have a different interest. There are other things that I want to pursue, and this is a better fit."
Be curious. Don't lock yourself in. Whatever you do, pursue excellence, find mentors — people who look like you. Ask questions, ask for help. In doing that, I think we can really raise the number of people who are in our professions and who are giving back. You have to look and reach back to give people opportunities. We have to advocate for ourselves, advocate for others, and pursue [opportunities] when we get [them] to the best of our abilities.
I make sure that I'm accessible to our community, whether it's through churches or community health organizations, or through schools, the Boys and Girls Club, you name it. I try to be actively engaged and involved to make sure that I'm feeding into the visibility, but also the growth of people like us in these professions.
PH: Dr. Sims, you have made and been a part of so much change and progress and growth and work already. But you are still a young person. What are your hopes for change in the future?
LS: That's a big question. First and foremost, my hope is that people are open to the diversity that is the human race. We all have a different story to tell. We all have our own lives to live. For people to be open to our differences, to appreciate them, and to not put boxes around people based on their beliefs, their ideas, their pursuits, to really understand each other, and to celebrate each other. That's one. One of tolerance.
Another thing that I hope is that we share in the opportunity. That we provide opportunities for those who are less fortunate, that we commit to the uplifting of others. As scripture says, “To whom much is given, much is expected.” So that is another one, that we don't just build wealth, we share it. I can think about vaccines. That we don't stockpile. That we share and make sure that we roll these out to people and places where it may not be necessarily available.
The other thing that I hope ultimately is that I can be in a position of leaving this world a better place for my kids, for the next generations. And that I can do things that would make my late grandmother proud. The things that were instilled in me, those seeds that were planted, that they germinate in such a way that I have a significant impact on my family, my community, medicine, and sports. This is the world that I live in as an emergency physician, [and in] sports. It's a full circle.
In some instances, my work is treating people acutely at the point of an illness or an injury. But on the other end of the spectrum, the work I do is trying to maximize someone's physical and mental capabilities, or getting someone back after an injury or rehabilitation so that they can do the things they love. I want to take care of people holistically. I want to use the microphone that I have to vocalize the importance of really making sure we pour into people.
This pandemic has highlighted, if not exacerbated, the inequities that exist among us and between us. How can we change that narrative? How can we close the gap and really provide for people and meet them where they are? Asking questions of ourselves and then listening and developing a plan that is tailored toward individuals and communities. So that's my pie in the sky of what I'd like to see. It's tough. It's tough knowing that sometimes people treat you a certain way before you ever open your mouth, just based on the color of your skin or their perception of who they think you are.
So I say, let's be tolerant. Let's give each other a fair chance. Let's open up our minds to new cultures, new ideas, new identities, and ultimately grow a world where all of us can flourish in whatever it is that we do individually — professionally, or personally.