Is Wayne Rooney more susceptible to covid-19 than other people?

Wayne Rooney is an English professional soccer player who is considered as one of the best players of his generation. A record goalscorer for Manchester United and the England national team, he played for D.C. United during 2018-19 and he is currently the captain of Derby County FC which plays in the EFL Championship (English 2nd tier).

Leaving aside Rooney’s headlines in the media for various controversies, one of the characteristics that soccer fans have noticed about him during the years he has been a prominent player is his receding hairline. Obviously, we do not mention this to criticize him about his looks. After all, this is something he did not choose and everyone should stand against unjust and prejudicial treatment of other people. Instead, it is our way to draw your attention to a medical study between covid-19 and male-pattern hair loss (MPHL).

Although the female-pattern hair loss (FPHL) is not well understood, more details are known for the MPHL which is believed to be the result of a combination of genetics and the male hormone dihydrotestosterone.

In a letter to the editor (i.e. a quick article) published on April 7, 2020 in the Journal of Cosmetic Dermatology, doctors in Spain reported a possible association in the severeness of covid-19 symptoms and MPHL.

In order to explain the differential effect between men, women and children, the Spanish doctors hypothesized that this outcome is due to the different amounts of androgens in the three populations (i.e. hormones that regulate the development and maintenance of male characteristics). To test their hypothesis, they looked at the male patients hospitalized for covid-19 between March 23 and April 6 at two Spanish tertiary hospitals and tested them for MPHL using the Hamilton-Norwood scale, a scale that assigns a number from 1 to 7 for the stages of MPHL. The result was that only 29% did not have MPHL; 71% had significant MPHL. In fact, 39% had severe MPHL.

Two months have elapsed since the previous study and the link between androgens and covid-19 appears to gain more momentum. Some researchers believe that this relation is so tight that it should be used as an indicator and they have proposed to call it the Gabrin sign, after Dr Frank Gabrin who was the first American doctor to die of covid-19.

Part of the supporting evidence comes from prostate cancer research. The Spanish study links TMPRSS2, a membrane bound enzyme, as a facilitator for covid-19. A study by a team of researchers in Italian and Swiss institutions published online in the Annals of Oncology on May 6, 2020 established that cancer patients have an increased risk to develop covid-19 compared to non-cancer patients. In particular, TMPRSS2 plays an important role for prostate cancer. Hence, many prostate cancer patients receive androgen-deprivation therapies. The study found that such patients are partially protected from the infection hence demonstrating the relation between covid-19 and androgens.

There are many additional studies pointing in the same direction. Obviously, such accumulated evidence can help point the way for possible treatments. However, one open question at the moment is if androgens control TMPRSS2 in the lung as they do in the prostate since lung infection is a key manifestation in covid-19.

We can now answer the question asked with the post’s title: Unfortunately, evidence says that Rooney is at higher risk than many other players. Perhaps, he should think twice before English soccer matches restart on June 17. And you, my dear reader, if you are an avid soccer player who has MPHL, please be careful!

Read the Spanish study: A preliminary observation: Male pattern hair loss among hospitalized COVID-19 patients in Spain — A potential clue to the role of androgens in COVID-19 severity by A. Goren et al.

Read the Italian-Swiss study: Androgen-deprivation therapies for prostate cancer and risk of infection by SARS-CoV-2: a population-based study (N = 4532) by M. Montopoli et al.

Spread of covid-19 during soccer matches

Photo by Stanley Morales on Pexels.com

Any person who is involved in a contact sport is currently in a state of uncertainty as data about the behavior of covid-19 are still unavailable. The scientific community is feverishly working to produce such data.

If you have asked “what are the chances to get infected by playing soccer?”, you are not alone. This question is in the minds of every player (pro or otherwise) and every organization (again, pro or otherwise). A paper providing some data towards the answer of this question has appeared in the preprint server for health sciences.

The paper’s authors used data from 14 matches of the Danish Superliga. They assumed a single infected player and they defined the Danger Zone (DZ) as a circular area of radius 1.5 meters. Then, they used data from GPS trackers and calculated the time each of the remaining players spent inside the DZ. In addition, they had to add some reasonable assumptions about the effect on a healthy player passing through an area previously occupied by the infected player. They quantified the final result for each player with an exposure score which can be converted to an exposure time.

The conclusion of the paper is that the average exposure time for each player is 1 minute and 28 seconds. However, there is a big variation to actual exposure time from zero to as much as 15 minutes depending on position and tasks performed in the pitch. In general, strikers are at risk the most and goalkeepers the least.

Given the present understanding of the virus, it is not clear what exactly the previous statements imply. We only know that the longer the exposure, the greater the chances to get infected and the higher the severity of the illness. But what is long and short exposure, as well as intensity of exposure is still unknown.

The study has also certain inherent limitations. First of all, the assumptions introduced for the calculation are based on educated guesses and not accepted medical standards. The latter will be the outcome of the current research activity and will become available only in the future. Then, the study takes into account only one infected player. However, more may exist. The authors state that for more players the effect is linear (i.e. just multiply by the number of players). However, this statement needs a thorough checking.

Finally, the study limits itself only to the `risk through proximity’ and ignores transmission through other mechanisms, for example through physical contact of the players or transmission through contact with a third object. Perhaps the virus can pass to the clothes of a healthy player even during a brief exposure and later he/she can get infected after touching his/her clothes. Or a healthy player may get infected through long distance after the virus transfers to the ball and from there to the player.

As a final remark, players in youth leagues do not have the same mobility as pro players. Their games also last slightly less time. Therefore, the exposure will be less, whatever that means.

Read the actual paper: Spread of virus during soccer matches by N.S. Knudsen, M.M.D. Thomasen, T.B. Andersen.

Spring 2020 Science & Futbol Lecture Series

Photo by Samuel Pereira on Unsplash

Episkyros is a soccer education provider. We educate kids how to play better soccer in the pitches but we also teach them about the relation of soccer with all science disciplines and mathematics. We create round student-athletes.

In collaboration with the University of Central Florida (UCF), we offer a completely free series of four lectures on soccer and science for kids 10-15 years old.

On March 22, 2020, at 10 am – 12 pm.: The first lecture, entitled “Where is the talent?”, will investigate if soccer players are born or made. The talk will describe (in plain language) results from scientific research on cognitive psychology about the creation of elite soccer players.

On March 29, 2020, at 10 am – 12 pm.: The second lecture, entitled “Soccer ball design”, will explore the designs of the soccer balls and, in particular, the designs of the modern Adidas balls and highlight the connections with the mathematical polyhedra.

On April 5, 2020, at 10 am – 12 pm.: The third lecture, entitled “Social contagion”, discusses the relation between the spreading of infectious diseases and the behavior of soccer spectators.

On April 12, 2020, at 10 am – 12 pm.: The fourth lecture, entitled “mind games”, investigates the response of the brain in elite soccer players and explains why intense pressure to perform well often results in the opposite outcome.

The talks will take place in one of the most technologically advanced rooms of UCF, designed to advance student engagement and satisfaction. The exact location is: Mathematical Sciences Building, Room 350, UCF, Orlando, FL 32816.

RSVP is required on UCF’s site to reserve your seat: http://bit.ly/2V3Z8yx

Parents/guardians/chaperones are required to accompany the kids.

Science & Futbol Lecture Mini-Series

Photo by Luis Quintero on Pexels.com

Episkyros is a soccer education provider. We educate kids how to play better soccer in the pitches but we also teach them about the relation of soccer with all science disciplines and mathematics. We create round student-athletes.

In collaboration with the University of Central Florida (UCF), we offer a completely free mini-series of two lectures on soccer and science for kids 10-14 years old.

On November 16, 2019, at 10 am – 12 pm.: The first lecture, entitled “Get In Formation”, will use elementary graph theory (an area of mathematics) explained in plain language to evaluate team formations and decide on the most effective way to place the 11 players on the field.

On November 23, 2019, at 10 am – 12 pm.: The second lecture, entitled “Banana Kicks and Knuckleballs”, will present a short summary of the quest to understand the aerodynamics principles of the flying soccer ball and then explain how elite soccer players take advantage of these principles to beat the opponent’s walls and goalkeeper.

The talks will take place in one of the most technologically advanced rooms of UCF, designed to advance student engagement and satisfaction. The exact location is: Mathematical Sciences Building, Room 350, UCF, Orlando, FL 32816.

RSVP is required on UCF’s site to reserve your seat: http://bit.ly/2PSiT9J

Parents/guardians/chaperones are required to accompany the kids.

Soccer is becoming boring!

An important element for soccer’s vast popularity is its unpredictability. Since the goal is so rare, surprises due to many different factors can happen. Ajax’s successful run in the last Champions League to reach the semifinals was a welcome change from the previous years. Only the top clubs from the top four European leagues usually reach the quarter finals with Portugal to be the only country from the other leagues to have one of its teams reach the later stages. Before Ajax, there had not been a Dutch representative at quarter finals since 2007.

In a paper that was posted on the Cornell archives on August 23, 2019,  Victor Martins Maimone of Oxford University and Taha Yaserri of the Alan Turing Institute in London looked at the predictability of the football during the last 26 years. In particular, they looked at the matches of 11 major European leagues (Belgium, England, France, Germany, Greece, Italy, Netherlands, Portugal, Scotland, Spain, Turkey) which had a winner and they checked if one could establish the winner using the  teams’ performances of the previous games.  To avoid  the obvious limitation arising from the fact that the set of previous teams is different for each team, the two researchers established  a directed network of matches and created a fair weighting system to establish the probability of winning the next match. Using their rules, they established that the predictability has increased over the years in seven leagues (England, France, Germany, Netherlands, Portugal, Scotland and Spain) and has remained almost stable in two leagues (Belgium and Italy). In the remaining two leagues (Greece and Turkey), the predictability was high in the past, then dropped and in recent years there is an increasing trend.  [Looking at the data, my personal view is that the curve of the Italian league follows the same pattern as that of the Greek league.]

The data also demonstrated that, although the home advantage still exists, it decreases over time for all leagues.

Finally, the trends of predictability are increasing very fast for the richer leagues (England, Germany, Spain).  [Why the Italian league (which completes the top four leagues)  does not follow the same pattern is a curiosity that deserves to be studied.]  This is something we all know through our experience: Richer clubs win games with greater frequency and we are not surprised when they do. To establish this correlation between predictability and influx of money, the researchers used the so-called Gini coefficient which is a way economists use to measure wealth inequality. The result is as expected. To say it in the words of the researchers: “There is a high correlation between predictability in a football league and inequality amongst teams playing in that league, uncovering evidence in favour of the `gentrification of football’ argument.”

Read the full paper “Football is becoming boring; Network analysis of 88 thousands matches in 11 major leagues” at https://arxiv.org/abs/1908.08991

Water breaks to attenuate heat stress

Photo by Pixabay on Pexels.com

The 2022 FIFA World Cup will be held in Qatar. Leaving aside all scandals that have plagued it, it is the first World Cup not to be held in May, June, or July. Instead, it is scheduled from November 21 until December 18. The reason for the change of dates is the excessive heat the players will face. (The reduced timeframe is probably due to the fact that the new dates interfere with all national soccer leagues and the longer the duration, the more problems will be created.) Even with the change of dates, Qatar, in its bid, promised to improve and deliver cooling technology during the tournament.

Soccer is a highly demanding game and soccer players under extreme heat conditions are susceptible to heat illness. In professional soccer, extreme heat cannot be avoided since scheduling is based on commercial needs; in earlier levels it cannot be avoided since soccer fields are in continuous use and game scheduling has no flexibility. Hence, players of all levels are in danger of heat illness.

Photo by Samad Deldar on Pexels.com

In order to reduce the risk of the players playing in extreme heat conditions, FIFA has introduced heat breaks after 30 minutes of game play. The 30-minute mark was chosen based on research showing that player core temperature reaches its peak around that moment.

Studies investigating best strategies to reduce heat stress for soccer players continue with the latest one published this month. (See https://doi.org/10.1016/j.jsams.2019.04.009)

In this study, participants completed four simulated football matches at an ambient temperature of 35° C (95° F) , relative humidity of 55% and wet bulb globe temperature of 30° C (86° F). Each game had different cooling breaks: (a) Normal rules (i.e. no cooling breaks and a half time break of 15 minutes). (b) An extended half time break of 20 minutes total but no additional cooling breaks. (c) A 3-minute cooling break in each half where participants consumed chilled water. (d) A 3-minute cooling break in each half where they consumed chilled water and also applied an ice towel around the neck.

The study concluded that all three cooling strategies reduced the core temperature of the athletes and, hence, reduced the risk of heat illness. However, it was not able to establish that one of the three cooling strategies had a higher efficacy.

Unfortunately, the study has some serious limitations: The sample of the participants was too small (just twelve participants) and the games were simulated in a laboratory. Hence, overall, the study was able only to reinforce the known fact that cooling strategies help to keep players safe by reducing their core temperature.

What Sunscreen are you using?

sky sunny clouds cloudy
Photo by Skitterphoto on Pexels.com

Soccer is an outdoor sport. Therefore, soccer players are subject to all environmental conditions. Most importantly, soccer players have to put up with the sun. The sun’s ultraviolet (UV) radiation is very beneficial for kids and adults. However, excessive amounts of UV radiation can have harmful effects. For this reason protection from the UV radation is strongly recommended. For soccer players who cannot be under shade and cannot adjust their clothing (which is subject to strict requirements),  the protection comes from the application of sunscreens.

Sunscreens come in two kinds: physical (which are based on natural minerals) and chemical (which are based on the advances of nanoscience). The former works as a `mirror’ which reflects the UV radiation; the latter as an absorber converting it to non-harmful radiation (heat).

Infographic about sunscreens by the American Academy of Dermatology
Infographic about sunscreens by the American Academy of Dermatology.

During the past decades the use of sunscreens has skyrocketed. In particular, the vast majority of people are using chemical sunscreens since physical sunscreens create a white layer on the skin surface which many find unattractive. FDA classifies the physical sunscreens as safe.  However, it has expressed a concern for chemical sunscreens. Simply said, there is not enough research on the effects of the chemical ingredients on the human body.  Even more, current data point out that people should use chemical sunscreens with caution and suspicion. In the following, we report some of these data.

It is known that oxybenzone (which is in two-thirds of all chemical sunscreens) is the most common cause of contact allergies. A 10-year study (from 2001 to 2010) found that 70% of people had a positive patch test when exposed to it (see https://www.ncbi.nlm.nih.gov/pubmed/23857015).

In 2008, the US Centers for Disease Control and Prevention analyzed urine samples collected by a government study and found oxybenzone in 97% of the samples. Another analysis of breast milk samples found oxybenzone or other sunscreen chemicals in 85% of the samples (see https://doi.org/10.2533/chimia.2008.345).

Other studies have indicated:  a possible connection between oxybenzone and lower testosterone levels in adolescent boys (see https://ehp.niehs.nih.gov/doi/10.1289/ehp150); hormone changes in men (see https://www.ncbi.nlm.nih.gov/pubmed/15191542);  shorter pregnancies and disrupted birth weights in babies (see https://doi.org/10.1016/j.reprotox.2017.08.015); disruptions of endocrine systems (see https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4997468/).

A recently released study (see https://jamanetwork.com/journals/jama/article-abstract/2733085) on the most common chemical incredients of avobenzone, oxybenzone, octocrylene, and ecamsule found that it takes only a day of use for the ingredients to enter the bloondstream at levels which are high enough. It also found that their concentration increased as the use increased and, finally, the chemicals remained in the body one day after the sunscreen use had stopped.

In addition to possible human physiological effects, oxybenzone and octinoxate  cause coral bleaching and are dangerous to marine ecosystems.  Hawaii and Key West, FL  recently banned sunscreens containing them.

As a result of the elevated concern, in February, the FDA called manufacturers to do safety investigations of 12 commonly used sunscreen chemicals.

Episkyros, LLC  has a deep commitment to natural and organic practices as a way to protect the youth. Hence, given the current state of knowledge, we side with The Environment Working Group which recommends choosing a mineral sunscreen containing titanium dioxide and zinc oxide when possible.