BACK IN THE REAL WORLD

DOCTOR ADRIAN ROTUNNO THE UAE EMIRATES TEAM DOCTOR ON THE COVID CHALLENGES IN SOUTH AFRICA

We’re at our first training camp of 2021 and 27 riders and 32 support staff have just been vaccinated with China’s Sinopharm vaccine. We know vaccinating elite athletes is a sensitive issue but UAE’s programme is ahead of most countries. Frontline workers and vulnerable individuals have had access to the vaccine for over three months.

With the roll-out of vaccines, we’ll hopefully see more races this season and more in their usual dates, though it’s difficult to predict. 2020 was tough for everyone. For me, as a South African, I had to stay in Europe for almost two-and-a-half months because of the compressed season. Travelling and being away in a normal year is difficult but I’m rarely gone for longer than two weeks. With two young children and a wife, it was hard.

At a grand tour, irrespective of covid-19, our mantra is ‘hygiene, hygiene, hygiene’. Over a threeweek race, and due to the continual exercise load, a rider’s immune system can wane, and especially in the last week. That’s when opportunistic viral infections can take hold. With covid-19, we upregulated everything. That meant amplified hygiene practices for staff and riders alike, plus a daily tracking system with a screening health questionnaire that riders and staff had to – and still do – submit. Any red flags in terms of symptoms, we’d pick up. We also undertook internal PCR testing on our entourage going into the Tour bubble.

I balance my team doctor duties with working at the Cape Sports Medicine clinic at the Sports Science Institute of South Africa. We’re trying to establish a centre of excellence, putting sports and exercise medicine at the forefront. In our country, it’s a very private, niche market, and not easily accessible to the public sector where it’s needed. That’s why we run a weekly pro-bono clinic at Cape Town’s biggest public hospital. Ultimately, we’re hoping to receive governmental support and roll this out nationwide.

Many colleagues and patients have had covid and the latest wave has been more devastating than the first. It’s overloaded our system. The first wave, we had several makeshift hospitals, including big marquee tents with up to 800-patient capacity. Due to significant running costs, they were mostly shut down after the first wave. It’s tragic as we need them now.

That’s coupled with unemployment levels that are at a record high. In South Africa, there’s no structured public furlough scheme – some private companies might offer it – meaning a large proportion of the population are in a very difficult position, health and livelihood wise. The government has been paying employers an unemployment insurance fund, and individual monthly grants, but we simply don’t have the resources and this doesn’t go very far.

Covid-19 has not only highlighted our country’s economic situation, but the alcohol problem, too. One of the important restrictions is banning alcohol, the rationale being that it reduces trauma cases, like motor vehicle accidents and those from domestic violence, which reduces pressure on the hospital system and allows greater bed space for those with covid-19. It’s frustrating for many but it’s helped. Recent pictures coming out of South Africa’s biggest hospital showed its trauma unit nearly empty. The same thing happened in the first wave where these units saw an 80 per cent reduction in trauma cases. On the downside, black market alcohol is on the rise, which brings risks of its own.

As a team doctor, and from a cycling medicine perspective, a successful 2021 season would include safety and a clean bill of health for all athletes and staff, from all teams, and to see the races return to relative normality. After what the world has gone through over the last year, that’s enough.