Big news in sports the past few days: Daniel Fells, tight end for the New York Giants, is battling a MRSA infection so severe that he has been hospitalized in isolation and had multiple surgeries. Some news stories have speculated doctors may amputate his foot in an attempt to corral the infection.
It’s a tragic situation for the player, and no doubt frightening for the team, which is reported to have sought medical advice and scrubbed down their locker rooms to prevent any additional cases.
What it’s not, unfortunately, is new. MRSA—the acronym for methicillin-resistant Staphylococcus aureus, staph bacteria that are resistant to multiple classes of antibiotics—has been dogging sports teams for more than 20 years. And for at least 10 of those years, we’ve known what to do to prevent it. But it’s not at all clear that teams treat that prevention as a routine thing they should be doing—and because of that, every athlete’s infection seems like a random tragedy, instead of an avoidable mistake.
Among the long litany of MRSA cases in athletes, some have been high-profile: Lawrence Tynes, who is suing the Tampa Bay Buccaneers over a career-ending infection (two of his teammates were infected as well); Brandon Noble of the Washington Redskins, who lost his pro career over a knee infection (six of his teammates developed infections too); Kenny George of the University of North Carolina-Asheville, who had part of his foot amputated.
But the list of those known to have been affected (and this is certainly not complete) is much longer. Some other names: Kellen Winslow (and five teammates) of the Cleveland Browns, Peyton Manning, Drew Gooden, Mike Gansey, Sammy Sosa, Alex Rios, Paul Pierce, Kenyon Martin, Braylon Edwards, and Grant Hill. And, in addition, the St. Louis Rams, the USC Trojans, and dozens of college and high school teams going back to 1993.
MRSA infections seem like they sweep in out of nowhere, especially the apocalyptically bad ones (such as MRSA pneumonia, which can kill a child in days). But in fact, some MRSA cases are very predictable. They are more likely to occur in what the Centers for Disease Control and Prevention call the “5 C’s“: places where there is crowding, skin-to-skin contact, compromised skin from cuts or abrasions, contaminated items and surfaces, and lack of cleanliness.
Add all those together, and you have a pretty good description of a football field, and a locker room after a game.
MRSA is simple to catch: The bacterium lives on the surface of our skin, and in our nostrils and other warm, damp body crevices, and causes an infection when the skin is breached and the bacteria slip into tissue or the bloodstream. In hospitals, where MRSA first became a problem in the 1960s, that breach could come from surgery, or an incision made to allow for a catheter or an IV. But in the everyday world, where MRSA has been a problem since the mid-1990s, the source is more likely to be a cut or a scrape—in the kitchen, in the outdoors, or, in sports, from a razor, training equipment, artificial turf, a wrestling mat, or pads or straps cutting into a shoulder or a shin. (And sometimes, nothing at all. Toxins manufactured by the bacterium can break down the skin, causing the hot pinpoint infections that people often mistake for spider bites.)
Fells is supposed to have been infected at some point in the past few weeks, after a toe and ankle injury and a cortisone shot to the ankle. I don’t have inside intel on his treatment, or on what the Giants do in their locker rooms. But I know what teams that had MRSA problems in the past did to shut their outbreaks down. It wasn’t complicated—but it required commitment and attention, and it took a while.
Between 2002 and 2006, the Trojans, the Rams, and the Redskins were all so spooked by epidemics among their players that they asked the CDC and local health departments for help. (The stories of the outbreaks are told in my last book, Superbug.) They learned that stopping the infections and protecting their players took many steps: requiring everyone to shower post-game. Scouring the hydrotherapy tubs. Disinfecting the training equipment and massage tables. Discouraging body shaving, even though it makes taping up—and untaping—a lot less uncomfortable. Raising the water temperature in the laundry machines. Making sure no one shared bars of soap in the shower or towels on the field.
After Noble’s injury, the Redskins ripped out their entire training facility and installed a new one, spraying germ-killing coatings on the lockers and discarding the shared benches for individual stools. The teams practiced these steps over and over, chastising and sometimes fining players who didn’t bother, and shut their outbreaks down.
MRSA is also a serious problem for school teams; in fact, it was school outbreaks—in a Vermont high school in 1993, a Pennsylvania college in 2000, a Connecticut university in 2003, and throughout Texas high schools for several years in a row—that first alerted researchers that athletes might be at special risk. When I was writing Superbug, I spent a lot of time with trainers and coaches, and it was striking how open they were about the problem. Whether because of affection for their students, responsibility to parents, or fear of lawsuits, athletic programs all over the US were educating kids and staffs about the danger, and teaching them how to protect themselves.
Pro teams, which clamp down on information about players’ injuries as competitive intelligence, mostly don’t talk about their MRSA plans. But it’s not clear they are training and protecting as comprehensively as schools do. A year ago, the Washington Post took a look back at Brandon Noble’s career-ending infection, and reported that MRSA prevention is not uniform across NFL teams. This season, Duke University’s Infection Control Outreach Network Program for Infection Prevention in the NFL, known for short as DICON, began working with the NFL Players Association to distribute a manual on infection prevention to all 32 teams and to train their personnel. That the teams agreed to participate is a big step—but that the program was needed suggests how vulnerable some players still are. Until MRSA prevention becomes routine in locker rooms, other players may end up as ill as Fells now is.