The long-time face of the National Hockey League looked awfully puffy on Friday morning, as the Pittsburgh Penguins prepared to play the visiting Calgary Flames. Even as Sidney Crosby insisted he was fine to play, the team held him out of weekend action for precautionary reasons, and on Sunday, the diagnosis was confirmed.
Mr. Crosby became the 13th NHL player officially diagnosed with the mumps this season, although there is a possibility that others, including players from the St. Louis Blues who were battling bacterial infections back in October, may have also come down with the disease. The outbreak continued later Sunday when New York Ranger centre Derick Brassard was diagnosed.
Just why and how a disease connected with childhood illness and mostly eradicated by a vaccination program in the 1960s has spread through the NHL with such abandon this season is a matter of some conjecture.
The problem, according to the Atlanta-based Centers for Disease Control and Prevention, stems in part from the disease's long incubation period, which can last anywhere from two to four weeks, and means players can unknowingly infect one another before their own symptoms become visible or pronounced.
And while the vaccine against mumps – when administered in a two-dose regimen – is effective 80 to 90 per cent of the time, it is not entirely foolproof. Instead, the remaining 10 to 20 per cent of the population remain susceptible to the disease, even after immunization. The net effect, according to the CDC, is that occasional mumps outbreaks still occur, especially in population settings where people have a high number of close contacts with others, such as school and college settings.
Both the league and the players' association have forwarded recommendations to the teams and players about mumps prevention, but the directives haven't completely eradicated the problem.
"It's an unfortunate situation, but not one we have much control over," said NHL deputy commissioner Bill Daly, in an e-mailed message. "We have been in touch with the clubs with best practices and precautions they should be taking to minimize the outbreak and all are taking those necessary steps."
Other NHL players previously diagnosed with the mumps include a quartet of Anaheim Ducks – Corey Perry, François Beauchemin, Clayton Stoner and Emerson Etem – plus five members of the Minnesota Wild: Ryan Suter, Keith Ballard, Marco Scandella, Jonas Brodin and Christian Folin.
Speaking to reporters in Pittsburgh Sunday morning, Penguins team doctor Dharmesh Vyas revealed that Mr. Crosby had twice been tested for mumps in the aftermath of a salivary-gland injury suffered playing against the Carolina Hurricanes in late November and, both times, the tests came back negative.
Mr. Crosby had received all of his vaccinations as a child and, as recently as a year ago, had a further booster shot in advance of playing for Canada at the 2014 Winter Olympics in Sochi, Russia.
Tests run on all of the Penguin players in early December showed Mr. Crosby had among the highest resistance levels for the mumps and yet, somehow, he contracted the illness anyway – a diagnosis confirmed by the CDC on the weekend after they'd received a DNA sample from the team.
How could such a thing happen?
"That's why it came as a bit of a surprise to us – because every indication was he was well-protected from the disease," Dr. Vyas said. "We had made sure the whole team was checked. We immunized all the players and staff … approximately two weeks ago, just because of the outbreak of mumps in the NHL. We're trying to stay ahead of it."
Mr. Crosby is currently in isolation, but could be ready to return to the Penguin lineup later this week.
"That's the presumption, yes," said Dr. Vyas. "The CDC recommends five days of isolation before the virus infection is completed, so we'll follow those recommendations. However, we'll continue to evaluate him daily and follow him closely to see how he's doing clinically."
Last month, the NHL circulated a memo to its member teams, directing them to the CDC's website for further information about the mumps and advising them about immunization options. A number of teams subsequently offered to immunize its players, although vaccinations cannot be made mandatory, under terms of the collective bargaining agreement.
Winnipeg Jets' coach Paul Maurice spoke about "best practices" in advance of Saturday's game against the Ducks, noting: "The league will learn from this and there may be different ways the water bottles get washed and that will change the protocol going forward and we'll make those adjustments.
"We offer our players everything we possibly can to give them the chance to be healthy."
That may be a good thing because as long as new cases of the mumps continue to be diagnosed, the problem could linger – league-wide – for some time yet. The Penguins have sterilized their dressing room multiple times since the mumps outbreak occurred, and did so again Saturday night.
"Trying to avoid transmission is probably the best way of getting this controlled," said Dr. Vyas. "There's no pharmacological medical treatment for it. It's just trying to curb the transmission from person to person."
It was the noticeable swelling on Mr. Crosby's face Friday that set off alarm bells within the team, according to Dr. Vyas, who indicated that Mr. Crosby didn't have the "classic presentation of mumps" because the swelling was only apparent on one side of his face.
"It was rapidly evolving and his condition worsened from the day before," said Dr. Vyas. "As soon as we noted that, we sent off additional samples.