First published in the Daily Maverick 168 weekly newspaper.

As the 2021 Rugby Championship reached its conclusion, debates about performances and results will start giving way to concerns over the wellbeing of athletes.

The Springboks are the most prominent examples of a team that has been taken to the extreme by the Covid-19 pandemic. They have been in an almost unbroken bio-secure environment (BSE), or bio-bubble lockdown, since 2 July. They will have a two-week break before entering another bubble for at least six weeks for their November tour to Ireland and Britain.

Typical of the team’s culture, the Boks have refused to use this unnatural existence as an excuse for their mediocre performances on the away leg of the Rugby Championship, which was hosted in Queensland.

But two players – prop Thomas du Toit and lock Nicolaas Janse van Rensburg – have left the squad citing “personal reasons”. Many others have not even enjoyed the highlight of playing in a Test, as coach Jacques Nienaber was forced to take a bloated 43-man playing squad on tour because of Covid-19 protocols.

Opponents Argentina had six players suspended for taking an unauthorised day trip out of Queensland into New South Wales. Although the circumstances were unclear, months of being in BSE must have been a factor in that situation.

With each passing sports tour and tournament, medical practitioners are gathering more data about the impact of bio-bubbles on the physical, but more importantly, the mental wellbeing of athletes and the knock-on effects on their performances.

Against the Wallabies in Brisbane, the Boks’ second match on tour that ended in a 30-17 defeat, the Springboks delivered a particularly lethargic performance that was not in keeping with their recent high standards.

Their other two matches (at the time of writing) were narrow defeats to the All Blacks and Wallabies again. In both those Tests, the Boks were below their best. Although they played some good rugby, overall they appeared to lack the crackle that took them to World Cup triumph in 2019.

“There’s an excitement that the bubble is almost at an end, but the challenge for us is to ensure we have two feet in Australia,” Nienaber said from the Gold Coast this week.

“It’s critical to be in ‘the now’, and it takes a while getting used to the bubble. It took one back to the levels of hard lockdown that we had in South Africa. It’s not an excuse, but, sometimes, one forgets how it was sitting in your house and that’s how things were for 14 to 15 weeks.”

A recent study of cricketers in India, undertaken by the Government Institute of Medical Sciences and Research, Srinagar, Uttarakhand noted: “The players have to spend a long period of time away from their families. Moreover, during the pre-competition quarantine phase, players are restricted to their hotel rooms only. 

“This can have an adverse effect on the health of the players as they have to spend a lot of alone time, which can lead to introspection and rumination consisting of constant negative feelings.

“The players are susceptible to various mental health issues, including mental fatigue, depression, anxiety or insomnia. 

“In most of the cases, there will be no signs in the athlete on general physical examination and diagnosis needs to be made on the basis of the presence of various symptoms including feeling low, sleep disturbances, anxiety, change in eating habits and a lack of motivation,” the report said. 

“Mental health issues need prompt identification and treatment as not only can it affect the performance of the player on the field, but it can also have an adverse impact on his physical health and personal life.” 

Big business vs mental health

Professional sport, though, is big business and the cancellation of events comes at massive financial cost. As a result, bio-bubbles have become the only way to stage events safely during the pandemic.

The excitement and desperation for professional sport to return initially superseded other considerations, but gradually the cost is being counted and players and coaches are the victims.

In January this year, former Proteas assistant coach and renowned mental coach Paddy Upton urged the International Cricket Council (ICC) to seriously consider studies into “bubble fatigue”.

“Because we haven’t done enough research to get feedback from different players – what were their unique challenges – we have all these medical people saying we can’t approve this drug and that drug until we do the trials, but have we gathered the research?” Upton told the Press Trust of India.

“There have been a lot of bio-bubbles around the world, but I haven’t seen large-scale interventions where we do an extensive study to get feedback from players to understand the dynamics.

“I don’t think we have seen the fallout yet. There is a potential [that] we will see more fallouts with more mental problems and illness because of extended bio-bubbles. I think some of them are preventable, but we are not doing all we can to prevent them. We have to wait until that happens, which is unfortunate for the athletes.

“If players are left alone, your mind goes all over the shore.” Players, he said, had to have the discipline to “find a good distraction” or they would “get caught up in anxiety and emptiness”. Extroverts, especially, were struggling in a bio-bubble “because they need people. Introverts are happy in their own space.” 

Mitigation

The Boks and Proteas’ cricket squads have been the two most prominent teams affected by living in bio-secure environments, and both SA Rugby and Cricket South Africa (CSA) have done their best to mitigate negative mental impacts.

“I spent 60 days in a bubble with the team in the West Indies and Ireland and it’s hugely challenging,” CSA’s chief medical officer Dr Shuaib Manjra told DM168.

“So, the big question is, how do we mitigate the mental strain as best we can? Firstly, it needs to be remembered that everyone has a choice to play international sport and if an athlete does decide to, then it comes with certain demands in the current environment.

“Most obviously professional sport is going to happen in a bio-safe environment. In a normal community setting, there are certain risks that can be taken. If you get Covid, you deal with it. But in a team environment, if an athlete gets Covid, many more might be ruled out of a match because they are close contacts.

“So there are ways we try to mitigate the impact. Firstly, we try to protect the BSE as best we can and that means people coming into it have to be vaccinated plus 10 days and a series of negative tests. And when they are in that environment, we test regularly.

“Then we soften the psychological impact on players. We try to get comfortable hotel spaces that allow for mental breaks, such as being on a golf course or on a beach.

“With that, the next aspect is creating ‘safe activities’, which means establishing certain times for going to the beach, going out to sea or playing golf, which allows them out of the space but not at the risk of contaminating the BSE. They are controlled group activities with a series of protocols.

“The third thing is allowing families into the BSE because of a major psychological need. On home tours, that is a little easier to achieve but, even so, wives and partners can’t always take leave and kids need to go to school.

“They can’t come and go, so they either come into the bubble completely, or not at all. And on top of this, we provide psychological support both in person or via online counselling set up by the South African Cricketers’ Association [Saca].”

My Players, rugby’s equivalent to Saca, offers the same for the players. 

Although all these steps are essential, the reality facing professional sportspeople is daunting for the foreseeable future.

And the longer the BSE, the greater the mental impact. 

It’s worth remembering when the Boks meet the All Blacks that one team has been in a BSE for 12 weeks and the other for a mere four. DM168

This story first appeared in our weekly Daily Maverick 168 newspaper which is available for R25 at Pick n Pay, Exclusive Books and airport bookstores. For your nearest stockist, please click here.