The difficulties of creating and maintaining a bubble became apparent during South Africa-England series, when the ODI component of the tour was called off in the wake of a string of positive tests. ©Getty
In any other year, Dr Shuaib Manjra's time would be divided between his role as Cricket South Africa's chief medical officer and his own private practice. Dr Manjra specialises in sports medicine and occupational medicine, an appropriate skill base from which to treat cricket injuries and figure out how to manage player workloads. There were times over the past decade when cases arose that were around the edges of that speciality - when a bail in the eye ended Mark Boucher's career in 2012, Dr Manjra found himself escorting the wicketkeeper between ophthalmology experts - but most of the work for CSA has revolved around more regular injuries. Until this year, that is.
"It's been pretty much full time for CSA over the past few months," Dr Manjra says. "Fortunately I have partners in my private practice who are able to share the burden, and clients who have been understanding of my availability - or non-availability, to be more precise - particularly during my times in the bio-bubble."
Medical officers such as Dr Manjra faced a new set of questions about how to keep their players fit and healthy as Covid-19 spread this year, the pre-eminent concern being what might happen to Covid-positive athletes exerting themselves to the maximum. "We didn't know what the impact would be on the heart, on the lungs, on the muscles. It could potentially have endangered the lives of players," he says. Yet the biggest task would come in establishing bio-safe environments (BSEs), the undoubted phenomenon of the year as far as cricket was concerned. The game could not go on without them, but creating a bubble required meticulous planning, huge financial investment, and ultimately some luck. It also involved making sense of a virus that nobody fully understood.
"We knew so little about Covid and yet we had to try and manage it and make serious decisions around it. We just have to do enormous amounts of reading," Dr Manjra reflects. It wasn't as simple as just doing the reading either. "If you look at normal academic journals, it would usually take them four or five months to publish an article. But during Covid, because of the challenges and because information needed to get out there quickly, things were being fast-tracked and journals were publishing things in a week or two weeks. So some things were peer-reviewed and some were not, and you had to read all of that stuff and then sift out the relevant information and figure out what's true and what's not true.
"There's lots of fake news out there. Everyone is reading all kinds of stuff and dealing with information and misinformation, trying to sift through it as stuff comes out on a daily basis. And some of the findings are changing - there will be something that comes out now, and then in a couple of weeks something else comes out about it that is completely different. It's been an enormous learning experience, picking through it and then putting it into practice, and it's not always easy to put it into practice."
The difficulties of creating and maintaining a bubble became apparent during England's tour to South Africa, when the ODI component of the tour was called off in the wake of a string of positive tests. Two Proteas players sat out the three T20s after testing positive soon after their entry into the bubble, but it was a third positive test among the hosts between the T20 and ODI series that caused real challenges. Two hotel workers and two England players subsequently tested positive. Neither of the hotel workers had left the hotel premises in weeks, they hadn't been in contact with each other or with any of the Proteas players that had tested positive, and none of the people they had been working with tested positive. Further testing suggested that they had come into the hotel with Covid, but had tested negative in their original PCR test. The English cricketers, meanwhile, proved to be 'false positives'. All of which highlights how unreliable the PCR test - on which so much of the world's Covid narrative is based - can be, and also how a simple cricket tour can turn into an expensive detective exercise.
"I didn't go into the bubble expecting zero positives, I went in expecting positives and saying how do we manage them," Dr Manjra says. "That's what our protocols are based around: how do you manage positives? I look back and see we had positive cases and try to think what we could have done differently, but I actually don't know. Maybe a little bit more testing, more stringent lockdowns of the players, but I don't know if it would have changed the outcome."
Over the course of its summer, the England Cricket Board carried out 10,000 tests on men and women players - and that was just for its internationals. In a similar vein, players at the IPL were tested every three days. "That's probably your best guarantee," Dr Manjra says, while pointing out that these measures come at significant cost. Because PCR tests alone are not enough, medical teams in charge of the bubbles follow an exhaustive process to try and build a fuller story.
"Is the Covid (PCR) test positive or negative? What is the Cycle Threshold (CT) score? And then we look at antibody levels. This is all to try and figure out whether it's a true positive or a false positive and where the person is sitting in the cycle of the disease," explains Dr Manjra. "For example, you have a positive and so you do a CT score; 48 hours later you do a repeat of the PCR test with a CT score to figure out whether the bio-load is increasing or decreasing. That's how we try to filter false positives and false negatives, and try to extrapolate backwards to try and figure out where they might have contracted the disease - whether it was inside the bio-safe environment or outside. And having long conversations with virologists to try and understand some of the complexities around it. Even with all of these modalities we still sometimes don't have a final answer."
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All of which offers insight into the mechanical process of the bubble. But what about the humans inside it? "This whole thing has cast a spell over peoples' minds and taken a huge toll on their mental state," notes Dr Manjra. The anxiety among the players was what ultimately led CSA and the ECB to postpone the ODI series. Many of the English players had spent the better part of six months in bubbles, cut off from loved ones and often from each other. Around the time of the South Africa tour, Tom Curran and Tom Banton announced that they were pulling out of the Big Bash due to bubble fatigue - a decision that Jofra Archer had already taken back in September.
But the effects of bubbles are not just being felt by English players; they were the forerunners after being exposed to bubble life first, and others are now following -
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