As sports slowly re-emerged from the initial COVID-19 pause in 2020, athletes, organizations, and fans had to adjust to a new reality.

Public health measures such as hand washing and social distancing were widely established, as transmission of the virus became better understood. Mask mandates were variably instituted and sometimes hotly contested and politicized. The COVID-19 vaccine became a lightning rod for political activism, human rights, religious freedoms, conspiracy theories, and ethical conflicts.

The world was hungry for the return of sports, but with COVID-19 still a global threat, the resumption of sporting events required careful planning and strict protocols. Once again, we were reminded that athletes were not just characters in a video game, but human beings who also needed to be mindful of their own health and choices.

At the beginning of the pandemic, Rudy Gobert, the Utah Jazz center, became the first NBA player to test positive. He infamously dismissed concerns about the virus at a press conference, during which he touched every reporter’s microphone on the podium. The messages in response were clear: this virus causes serious disease and death, and changes in behavior are necessary to help combat its spread.

Control the Controllables

Athletes training and competing in the COVID-19 era have dozens of additional elements to incorporate into their routines before they even enter their competition arena: screening, testing, facility protocols, hand/equipment sanitizing, personnel limitations, travel considerations, public health policies, and in some cases “bubbling,” just to name a few.

The overall impact of COVID-19 on daily life, relationships, travel, competitions, and behaviors has been significant. Many athletes have spoken about the impact of COVID-19 on their mental health. Prolonged interruptions in training, isolation, travel restrictions, delays and cancellations of competitions, and perpetual uncertainty have led athletes to struggle with mood and anxiety.

For mental health and performance professionals, “control the controllables” became one of the most frequently spoken phrases since the onset of the pandemic. Common sources of anxiety for athletes include being infected with COVID-19 (including becoming very ill or dying), being unable to train or compete, infecting their teammates or their families, causing their team to forfeit games or tournaments, and having to go into isolation or quarantine.

To minimize the likelihood of any of these events, most athletes have done whatever they could within their control: physical distancing, hand washing, masking, getting vaccinated, and following public health protocols. Beyond that, they rely on others to do their part, to follow protocols and rules. By controlling the controllables, athletes can then focus on their sport.

Beyond the Controllables

High-performance and professional athletes spend most of their lives training and perfecting their skills. When it is time to compete, they bring tens of thousands of hours of preparation, with the goals of competing hard and winning. Concepts of “true sport,” “clean sport,” and “safe sport” have perfused sports culture for several years, for the purpose of making sports a safe place for athletes to “work.”

But what about when other athletes don’t do their part? When they have not followed an event’s rules or protocols? What impact would the presence of a “protocol breacher” have on the other competitors? Their physical health? Mental health? The fairness of competition (when everyone else follows the rules)?

Numerous high-profile athletes made headlines in 2021 for vaccine refusal, rule violations, fraudulent vaccination records, and dishonest reporting of vaccination status. But there’s a crucial message lost in the headlines: every protocol violation places others at risk.

Australian Open 2022

Complying with tournament and travel rules was seamless for most competitors traveling to the 2022 Australian Open. Except for Novak Djokovic. Djokovic, who is currently tied with Roger Federer and Rafael Nadal for the most men’s Grand Slam singles titles of all time (20), has been featured prominently throughout the pandemic as an opponent of vaccines and being somewhat careless about COVID-19 exposures.

He has reportedly been infected on two occasions: June 2020, during an unsanctioned tournament that he hosted, and December 2021. His attendance at the 2022 Australian Open has generated speculation since the tournament’s event chief Craig Tiley announced the vaccine requirement during the Grand Slam’s official launch on Nov. 19, 2021. Speaking to speculation about Djokovic’s participation at the time, Tiley stated, “We would love to see Novak here, but he knows he needs to be vaccinated in order to play.”

Djokovic was one of a handful of athletes granted a medical exemption to compete at the Australian Open without being vaccinated. According to court filings, one of the bases for his exemption request was the claim that he had been infected with COVID-19 in December 2021. News of the medical exemption generated waves of controversy across the tennis world, likely influenced by his overt rejection of the vaccine and dismissive behaviors towards pandemic considerations throughout the last 2 years. In addition, news reports surfaced detailing his behavior in the weeks that followed his recent COVID-19 infection, which showed him unmasked and attending public events, apparently in defiance of the Serbian rules requiring 14 days of isolation.

Despite receiving a medical exemption from two independent panels organized by Tennis Australia, Djokovic’s entry visa was cancelled upon arrival from Dubai because he “failed to provide appropriate evidence for entry.” He was subsequently required to comply with the conditions that all non-citizens who do not hold a valid visa or who have had their visas cancelled have to follow, and was held in a hotel used for immigration detention over the weekend.

This consequence led to a huge outcry from Djokovic’s camp and fan base, as crowds protested in Serbia and outside the quarantine hotel. His family said that he was being held like a prisoner in a dungeon, likening his treatment by the Australian government to being “crucified … like Jesus.”

The saga took another turn on January 10, when the federal government’s decision to cancel Djokovic’s visa was overturned in federal court and he was released from detention. Tensions continued to boil as the potential remained for the Minister of Immigration, Citizenship, Migrant Services and Multicultural Affairs to exercise a personal power of cancellation.

Other key figures in the tennis world have weighed in. Nadal expressed to the media that, while he felt sorry for Djokovic, there were consequences for his decisions. Martina Navratilova opined that the “unbelievable chain of events” could have been avoided if Djokovic had gotten his vaccine, and Laura Robson focused on the plight of refugees and asylum seekers without Djokovic’s resources who remained at the immigration hotel.

There is no doubt that this story is nowhere near complete. The Australian Open will be held from Jan. 17-30, 2022 with or without Djokovic. The “unbelievable chain of events” described by Navratilova, and those preceding Djokovic’s arrival in Australia, can be dissected and analyzed on multiple levels. From questions about favoritism, privilege, bias, human rights, and political targeting, this situation is bigger than tennis, and bigger than a Grand Slam.

But let’s return to the initial questions related to physical and mental health. What is the impact on a competitor when a “protocol breacher” is permitted to compete? Every other athlete had to follow the event rules to enter the tournament. Aspects of fair play certainly come into question and can be a distraction for the competitors. The presence of an individual in the common areas of a competition venue (locker room, lounge, playing area, media room, eating spaces) who is not vaccinated, has reportedly been infected twice, and who has appeared to behave carelessly throughout a global pandemic that has killed millions would almost certainly raise the concern of health risks — physical or mental — to others.

The baseline level of concern for personal health and safety would undoubtedly increase in this situation. If every athlete, staff member, and attendee at this event had the same expectations and followed the same protocols, there could be some element of comfort. Introduction of a “protocol breacher” into that setting creates disruption for all involved. One person can derail an entire system.

The competitors at the Australian Open must still control the controllables to stay on track with their goals. They must trust the event organizers to maintain strict sanitizing protocols and continue to do their part to minimize anxiety, optimize safety, and execute their performance. What fans see on the court will be the tip of the iceberg of everything else an athlete has had to do to stay safe.

Two years into this pandemic, the sports world has adapted and evolved. We can anticipate that COVID-19 will continue to influence our experiences with sports. Regardless of the individual choices made by high-profile athletes, we must make our own decisions based on available scientific evidence and public health policies, and accept the consequences that go along with them.

Carla Edwards, MD, MSc, is a Canadian sports psychiatrist and the high performance mental health advisor for several Olympic programs. She is actively involved in direct care of high-performance athletes and development of policies and programs to address and protect athletes’ mental health. She is the current president of the International Society for Sports Psychiatry.

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