Vital Signs: COVID infections and the mental health of elite athletes

CATHY WURZER: This is Minnesota Now. I'm Cathy Wurzer. Time for our segment Vital Signs. Each month, we talk about topics that are important to your health and take a deep dive into medical news or what's top of mind at the doctor's office. Joining us is Dr. Jon Hallberg, a family medicine physician at Mill City Clinic in Minneapolis and a professor at the University of Minnesota Medical School. Hey, welcome back.

JON HALLBERG: Thank you, Cathy. It's great to be back.

CATHY WURZER: Well, my friend, a lot of people don't want to talk about this, but let's talk about COVID.

JON HALLBERG: Ugh.

CATHY WURZER: I know. Our APM Research Lab found a 46% increase in COVID-19 in wastewater samples statewide between the first and second week of July. Still going up, evidently. And APM is thinking that could be because of 4th of July festivities, right? So I'm curious, what are you seeing in the office?

JON HALLBERG: Oh, we're seeing exactly that.

CATHY WURZER: Ugh.

JON HALLBERG: I mean, it's amazing. Interestingly, most of the people who are coming down with it are calling in. They're not really coming in to see us. I mean, that's been a little bit of a shift. It's like we're testing at home. It's positive. Then they reach out. And then we have a protocol in place where we can get people on Paxlovid if that's what they need to do.

And I have been noticing, too, if people are flying overseas-- oh, my gosh. Not that that's an automatic invitation to COVID, but I'm guessing it's just these packed airports, or you're in tight quarters. And I think it's worth mentioning that we think, well, cold, flu, COVID season, it's fall and winter, right? It's something to do with the temperature. And it's really not that.

It's about proximity to people, you know? And when you're amongst each other, and we now know, of course, that this is a respiratory spread illness, and so if you're in proximity, breathing one another's air, it's somewhat inevitable that we're going to see a spike in this.

CATHY WURZER: Is anyone masking up to stop the spread or isolating? I mean, what's the guidance, actually?

JON HALLBERG: Well, it's interesting. So, the health systems have been very clear about this in the past. And we've had spikes that, OK, guys, it's time to mask up again in clinic or in the hospital. And we have an optional policy. I would say it's probably about a third of my colleagues in the clinic wear a mask. A third don't.

Some patients are wishing that we all would mask, we have a universal masking policy. There are people out there that-- a lucky few who've never had COVID, and they're really not wanting to get it. And they're hearing about long COVID. And no, I just don't want to touch it.

CATHY WURZER: Or they're with someone, a loved one, who is medically compromised.

JON HALLBERG: Oh, absolutely, or they themselves have a chronic disease like emphysema or diabetes, things that we know can put people at higher risk for this. There are some people-- I mean, I've got some patients, too, where they're just really, really worried about getting it, and they're wearing N95 masks wherever they go. I've seen people-- bikers that are wearing masks as they're biking or people walking outside. So it's interesting. We've never seen anything quite like this, certainly not in modern times.

CATHY WURZER: So I was looking at the booster shot rates, and they're really low. They are low.

JON HALLBERG: Like single-digit low in some cases, especially over 65. And I have to say, I mean, my own clinic, I think it's much higher than that. But people are asking me. It's probably one of the most common questions I get now when seniors are coming in for their annual wellness visits, is, hey, I didn't get it in the spring. Here it is, end of July. Should I be getting it now?

But it's tricky because the new ones going to come out maybe late next month or in September. So we'll have a conversation about, are you traveling? Are you going overseas? Can we just wait and get the next one that's coming out? So conversation for people to have.

CATHY WURZER: And maybe as you're waiting, to just kind of be aware of your surroundings, perhaps?

JON HALLBERG: Yeah, I mean, especially if you're older and you have any other kind of chronic illnesses, buyer beware. Be careful. And maybe it is time to mask. And I have been advising some people, like, hey, you're going to be going to a really busy airport. And maybe at least when you're going through passport control and you're packed in there for an hour, going back and forth through those lines, maybe not a bad idea to put a mask on while you're doing that.

CATHY WURZER: So speaking of COVID, I see that there are some athletes testing positive at the Summer Olympics already in Paris. So we're going to keep an eye on that, obviously, although I want to focus this next question on elite athletes and mental health. Folks like Michael Phelps, Simone Biles, obviously, have kind of changed the conversation since Tokyo. And I know you've worked with athletes in your career. So I'm wondering about the unique stressors that they face that we don't even think about as we watch them perform.

JON HALLBERG: Well, these athletes are-- how else to say it? I mean, they're kind of superhuman, right? I mean, to rise to this level of competition, there's a huge self-selection that goes on. They're blessed genetically. They found the right sport. And they've devoted countless hours to perfecting their sport.

And that's like the physical side of things, but there's a huge mental side of things, too, to get yourself in the pool at 5:00 in the morning before school starts and the hours that they spend doing these things. And yet, they're human beings. And I think that what we're finally acknowledging, is that there is perhaps a psychological mental health toll to that kind of excellence and perfection and expectation that's also just out of this world. It's really hard for many of us to even imagine.

And of course, they're going to suffer from mental health issues. They said that-- what is it-- something like half of the athletes in the last two Olympics have been flagged as having some degree of issues with anxiety, depression, sleep disorders, substance use, substance abuse. I mean--

CATHY WURZER: Really?

JON HALLBERG: Yeah, I mean, like half, which, again, that's probably not that different than the population as a whole on some level. I mean, most people will suffer from some version of one of those things at some point. So I think it just goes to show, like, they're not that different.

And but the difference is that we're now talking about it, and then they're being wiser about it. Like, look, I am scared about doing these, frankly, really dangerous moves in my gymnastics routine. And I just need to back out of competition. And Simone Biles did. And I mean, maybe that saved serious injury, if not, at the very least, embarrassment or not performing at the level that she was expected to perform at.

CATHY WURZER: Do we think that athletes, Olympic athletes, have always had these issues and just wasn't talked about? I wonder.

JON HALLBERG: Well, I mean, I think that that's the idea. I mean, I think there's no question. And I think that people who are teachers and they're working with kids at the secondary education level now, there is so much anxiety. There is so much depression--

CATHY WURZER: Now.

JON HALLBERG: Now. And again, it's a really important question-- has this always been there, or is it sort of new, the amount of ADHD, for example? So I think it's, A, yes. I mean, I look back to going to school in the '70s and '80s, and I know that there were kids. We just didn't call it anything. But they were suffering silently, but-- I don't know-- maybe not to the same degree that we're seeing now.

And people are quick to point out that social media is the reason for this. And we are a more interconnected world. We're more hypervigilant. We're keeping track of things in ways we never used to. I mean, right? You don't have to write a note and pass it to somebody anymore. You can tweet it. You can put it on X, you know? So, yeah, there's a lot of factors at play.

CATHY WURZER: I want to go back to the mental health of superior athletes, elite athletes, and I'm thinking about Suni Lee from St. Paul. And I think Sports Illustrated did that article about Suni.

And she talked about the post-Olympic depression that she went through, and actually, post-gold depression, really, if you think about it. Because I mean, can you imagine winning a gold medal? I mean, that's like the highest of the high, right? And there's gotta be a downer after that because you just can't be that high all the time. You gotta fall to Earth. And that's really hard.

JON HALLBERG: Yeah, I mean, so you've-- and in her case, too, she wasn't even expecting to win gold. I mean, at the best, she was thinking that, well, maybe I'll get silver. And then you've always got this place to go up afterward. But once you've attained perfection, let's say, or the highest award, well, now what? Either you repeat, which is really hard to do, if not statistically almost impossible, or you just have to be content with, like, well, that was then, and this is now.

And in that same article, one of the athletes talked about this incredible dopamine surge, this sort of pleasure chemical surge when you're winning a gold. You're the best of the best. And then this-- you can't maintain that. And so there's this crash after that.

And I think that there's-- this is not the same analogy, but when women get postpartum blues, not depression, but postpartum blues, I mean, it's like, yeah, everything led up to a certain point. Then this thing happens, and then it's kind of like, now what? Right? Now, I've been expecting--

CATHY WURZER: I've got a screaming baby right now.

JON HALLBERG: Right, right. I mean, and so there's this-- I think there's a lot of events in life like that, like a wedding or big, big events. It's like, now it's a letdown. Now it's like, oh, I'm back to being Joe citizen, you know? Or I'm going back to Auburn to be an NCAA gymnast. And it's not the same thing as being on the Olympic stage. I mean, there's a lot of things that are at play.

CATHY WURZER: And I know, again, you've had some professional experience with this when it comes to professional athletes. So I appreciate you giving us some background. Thanks for coming again.

JON HALLBERG: Oh, my gosh. Thank you, Cathy. It's a pleasure to be here.

CATHY WURZER: Dr. Jon Hallberg is a family medicine physician at Mills City Clinic and a professor at the University of Minnesota Medical School.