Anatomy of California Response to Pandemic

When Victor Espinoza rolled through the gates of Los Alamitos racecourse on the afternoon of Saturday, July 4, he did so anticipating a quick in-and-out with few disruptions. The Triple Crown-winning jockey had two mounts, in the eighth and ninth races, neither of them hot fancies.

Approaching the jocks’ room, however, Espinoza paused.

“There wasn’t enough room for all of us,” said Espinoza of the room’s quarters, which had been split between Quarter Horse and Thoroughbred riders. “We were stacked in there like sardines.”

Events from that afternoon have played out like a serialized medical drama, with one jockey after another testing positive for COVID-19, first Martin Garcia, then Luis Saez–both of them riders from out of state.

Espinoza’s two rides yielded no wins that day and he returned home as usual. Two days later, “it hit me pretty bad,” he said of symptoms including headaches and body pain.

Aware of Garcia’s positive diagnosis, Espinoza sought his own test–positive–after which he alerted Del Mar management.

A weekend of live racing later, Del Mar tested all of the track’s jockeys and jock’s room personnel, with 15 riders proving positive for COVID-19, all reportedly asymptomatic.

Many in the industry have been quick to point the finger of blame at Los Alamitos–something Dr. Ed Allred, who owns and operates Los Alamitos, takes umbrage with.

“Our track doctor [Michael Morris] assures me he was careful,” said Allred, who added that, while hindsight would suggest prior jockey testing and better social distancing in the jock’s room might have been wise, the vagaries of the virus–which includes an incubation period of between 2-14 days–mean that it’s hard to pinpoint exactly when and where the infections occurred.

“The idea that this has started at Los Alamitos is poppycock,” he said.

Los Alamitos had suffered only one positive test–a backstretch worker in early May–prior to the track’s short two-week Thoroughbred meet, said Allred. Last week, Los Alamitos conducted tests on 49 riders and various track employees–mandatory for the former, voluntary for the latter–which yielded nine positives, all of them jockeys, he added.

But now that racing in California has entered into a second temporary suspension of live racing, coupled with the recent patchwork of subsequent positives, tough questions are being asked over the industry’s response so far, and its plan of action into the future.

Certainly, there have made missteps–lost tests, misguided protocols, slow lines of communication.

At the same time, industry figures are quick to highlight the unprecedented nature of this public health crisis, including the slippery complications of shifting guidelines from a variety of local, state and federal agencies, along with limited and sometimes inaccurate testing availability and equipment.

Still, lessons can be learned, experts say. As the pandemic in the U.S. shows no sign of abating, and as medical resources continue to run thin, these lessons will need to be adopted quickly, especially as the industry in California remains under a public microscope unlike any other jurisdiction in the country.

“Racing is not an essential service,” warned Dr. Ghazala Sharieff, corporate vice president and chief medical officer at San Diego’s Scripps Health, who has provided Del Mar with medical guidance. Individual responsibility, she added, is paramount.

“If people can’t follow the guidelines, and we have all these outbreaks, the better part might be to unfortunately say, ‘No more racing.'”

“It’s frustrating”

When the pandemic closed Santa Anita’s doors at the end of March, the impetus was to resume live racing as quickly and safely as possible, said Aidan Butler, acting executive director of California racing for The Stronach Group (TSG).

“We made a statement when we were shut down, and it was a true statement,” said Butler, pointing to the industry’s fragile economic ecosystem. “‘You’ve got to get us going or we’re going to have a humanitarian and animal welfare issue.'”

By and large, the protocols that Santa Anita built into the race-day furniture, including the mandatory testing of jockeys before each weekend of live racing and the efforts to separate the front side community from the backstretch, were warmly received. Terry Meyocks, CEO of the Jockey’s Guild, held them up as a possible gold standard other tracks should seek to emulate where possible.

The porous nature of the backstretch, however–with veterinarians, trainers, exercise riders and farriers coming and going daily–is an Achilles heel of every track. According to the Los Angeles County Department of Public Health, there were 38 confirmed infections at Santa Anita, with 10 symptomatic cases awaiting confirmation. Testing problems suggest this could be an undercount.

According to trainer Ben Cecil, when his foreman tested positive for COVID-19 near the end of May, he sent his team of eight employees to be tested by Santa Anita’s own medical personnel.

However, when Cecil checked on the results some 10 days later, he was told the samples had been lost, he said.

“By the time I found that out, there wasn’t much point in testing everybody again,” he said.

None of the untested employees became sick, he added.

“I think personally, our guys on the ground might have been slightly overwhelmed with the level of pressure and stress they were under,” admitted Butler, about the lost samples. “But I think as we moved forward, we became far better at it.”

Arguably the greatest obstacle to backstretch testing appears to be limited testing capacity within LA County as a whole–a problem since the start of the pandemic.

When one of trainer Jim Cassidy’s exercise riders returned from a weekend trip to Las Vegas carrying the virus, Cassidy sent his other employees to the nearby Methodist Hospital in Arcadia, opposite the racetrack–what had hitherto been a popular testing destination for the backstretch community–only for the workers to be turned away.

“They were told that there were too many race-trackers coming over to get tested,” said Cassidy. “They never did get tested.”

TDN reached out to Methodist Hospital for comment, but did not receive a response before deadline.

According to Cliff Goodrich, executive director of the California Thoroughbred Horsemen’s Foundation (CTHF), which is responsible for backstretch healthcare, Methodist Hospital adopted a policy of testing only those who are symptomatic.

“It’s frustrating when you’re doing what the health department calls for to test anybody who came in close contact with an individual who tested positive, and then have a hospital say, ‘We’re only testing those showing symptoms,'” said Goodrich.

“There’s always room for improvement”

Besides the daily traffic in and out of the backstretch, live racing has maintained open channels between tracks, none more so than between Santa Anita and Los Alamitos, which maintained live racing throughout the pandemic. Los Alamitos carded additional Thoroughbred races during the evenings–races that proved popular with several Santa Anita-based trainers.

As the latest Santa Anita meet drew to a close, Santa Anita convened a “Working Group” consisting of key representatives from Del Mar, Los Alamitos, California Thoroughbred Trainers and the CTHF to share information.

According to Josh Rubinstein, Del Mar Thoroughbred Club president, Santa Anita provided overall testing numbers and individual results in a timely way.

“Santa Anita management was also great about sharing what they felt were best practices from their experience,” he wrote in an email.

Since the Del Mar stable area opened its doors June 26, five backstretch employees have tested positive, confirmed Rubinstein.

Some industry figures, however, argue that vital information could and should have been shared much sooner among all necessary stakeholders. The first working group call occurred on June 20, with closing day at Santa Anita just one day later.

According to Jack Liebau, vice president of the Los Alamitos Racing Association, he was unaware of the “extent” of the infection within Santa Anita’s backstretch until “Yahoo News” alerted him to an LA Times report July 12.

When asked whether Los Alamitos had similarly shared with other associations information concerning the backstretch employee who had tested positive, Liebau responded that the individual “was not known” to go to either Santa Anita or Del Mar. “Los Al backside is pretty much a self contained one,” he wrote in an email.

Privacy restrictions through the Health Insurance Privacy and Portability Act (HIPPA) pose barriers to the free flow of information, explained various officials, despite these laws having been relaxed in response to the pandemic.

“The original intent was to build something of a database that specific associations would have access to,” said Butler. “Unfortunately, the lawyers put the fear of God into everybody, including ourselves.”

Still, “there’s always room for improvement,” said Goodrich, about the way information has been shared among necessary stakeholders, adding that patient permission would also help to open those lines of communication further. “It would become easier to share information among a key group.”

“Why do we need to move from place to place?”

As the fallout from the July 4 weekend unfolded, several of Del Mar’s jockey COVID protocols proved a lightning-rod for criticism, none more so than the decision not to conduct mandatory testing of jockeys before opening day.

“If I was a reckless person, then I could have just gone and ridden opening day,” said Espinoza, adding how by that time, his symptoms had disappeared. “Nobody would have known I was infected, even myself.”

According to Sharieff, the reasons behind the decision not to mandate uniform jockey testing were largely two-fold. One concerns the possible deceptive nature of negative test results.

“Just because you get a negative test one day, does not mean even the same day or the next day you can’t start having symptoms,” Sharieff said. “There’s that period in-between testing where you can infect a ton of people and think you’re safe.”

The other surrounds restricted testing capability in San Diego County.

“As we get even tighter on tests now–we just got notified about a shortage, we’re down to less than a month of supplies–we’re going to tell you, ‘If you have symptoms, you need to stay home and self-quarantine,'” she said. “Even the governor now says not to do asymptomatic testing.”

Santa Anita contracted out the weekly testing of jockeys to a private company. When asked how limited capacity in the county might impact Del Mar’s intended weekly jockey testing, Rubinstein wrote that, “We are confident that we’ll be able to source testing resources as needed.”

“I get it, people are social”

As the track gears up towards a resumption of live racing next weekend, what specific lessons can be gleaned from the industry’s response thus far?

The TDN asked the California Horse Racing Board (CHRB) about what guidance the agency has provided during the pandemic.

CHRB spokesperson Mike Marten responded, “We issued an advisory Mar. 26 stating that local health authorities have jurisdiction in these matters, but that we would assist them on request. We have had communications with local health authorities and assisted when requested to do so, but the principal contact is between the track and health authority. The CHRB has taken direct action at racetracks to protect CHRB employees, including the closure of licensing offices when warranted.”

The CHRB failed to respond to multiple follow-up questions, including further agency guidance.

According to Liebau, effective action boils down to “more and more testing, and more transparency in the results of that testing.”

Liebau also posited an idea to limit the movement of people: isolate live racing to one facility.

“If we don’t have spectators, why do we need to move from place to place?” he said.

Butler said that regulations at Santa Anita will continue to be tweaked. He highlighted an intended additional precaution at Golden Gate Fields, whereby those who don’t live on the backstretch will be required to wear face shields along with their masks.

At the end of the day, said Sharieff, the more we practice individual responsibility–wearing masks, rigorous hand hygiene and social distancing–the greater the likelihood of stemming further spread of the virus.

“I get it, people are social,” said Sharieff. “It’s across the board, people feeling like, ‘The county’s opening up, we’re safe.’ But that’s actually the wrong message, and now we’re closing back down again for the same reason–people aren’t being careful. And if [individuals] wants to keep racing, they’re going to have to do better.”

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Montanez Fundraiser Surpasses Goal

The GoFundMe account set up to support jockey Rosario Montanez, injured in a spill at Laurel, surpassed its goal of $20,000 less than 24 hours after it was created. Montanez, 28, suffered multiple fractures to his back in a first-race spill at the Maryland track July 17, and underwent successful surgery the following morning at R Adams Cowley Shock Trauma Center in Baltimore. Agent Joe Rocco, Sr. said Montanez also injured his neck in the accident.

Laurel trainer Brittany Russell launched the fundraiser the same day to help with medical and general living expenses for Montanez and his fiance, Chloe LaBarre, who works in Russell’s barn and is the sister of apprentice rider Rebecca LaBarre.

“It’s incredible, right? It’s so cool. The racing community, everybody is amazing,” Russell said. “You know when these guys get hurt, between the medical bills and just the living expenses, they’re going to be out for a while and something like that can help.”

A career winner of 609 races and more than $18.8 million in purse earnings since 2010, Montanez missed 20 months after suffering a concussion, fractured rib and pelvis, and head lacerations that required a plate to be surgically inserted in his face after a July 2014 spill at Saratoga, returning to the irons in March 2016. He was hurt again last August and didn’t ride back until getting single mounts Mar. 14 and 15 at Laurel.

“It’s so sad. He’s taken some hard hits. You’re just gutted for him,” Russell said. “He was ready to come back and then the coronavirus hit. He was out there working every day, trying to hustle, and we [weren’t] even racing. We get back to racing and then this happens. It’s brutal.”

The day before Montanez was hurt, Russell’s husband Sheldon, a multiple meet champion in Maryland who was leading Laurel’s current summer stand in wins and purse earnings, broke his wrist in a starting gate mishap at Delaware Park and is expected to be out four to six weeks.

“It’s been a rough couple days,” Russell said. “Sheldon’s OK. It sucks and it’s never a good time to get hurt, but looking at what happened to Rosario, it’s a risk that’s always there. Sheldon has a great attitude. It’s racing. Things happen. It’s dangerous.”

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Promising Developments In Quest To Prevent Catastrophic Racehorse Injuries

Catastrophic injuries in Thoroughbred racehorses is a top-of-mind concern for the racing industry and for its fans. That sentiment is shared by researchers at the University of Kentucky, who are working to learn more about the changes happening at a cellular level that might indicate an injury is present before it becomes career or life ending.

Might it be possible to identify an early marker or signal for horses at risk of catastrophic injury, allowing for intervention before those injuries happen? And, if yes, might this type of detection system be one that could be implemented cost effectively on a large scale?

According to Allen Page, DVM, PhD, staff scientist and veterinarian at UK's Gluck Equine Research Center, the short answer to both questions is that it looks promising.

For the past three years, Page, along with UK colleagues, has been analyzing blood samples from more than 1,000 Thoroughbred racehorses. The samples, collected by participating racing jurisdictions from across the country, have come from both catastrophically injured and non-injured horses in a quest to better understand changes that might be happening at the cellular level during racing and if there are any molecular red flags which consistently differentiate horses that suffer a catastrophic injury.

An abstract of this research will be presented at the American Association of Equine Practitioners' annual meeting in December and more information about the study's findings will be shared this fall.

“We are definitely encouraged by our findings,” Page said. “The ultimate hope is, of course, to develop a screening tool that can be used pre-race to identify horses at increased risk for injury. The results of this study suggest that analysis of messenger RNA expression could be an economical, effective and non-invasive way to identify individual racehorses at risk for catastrophic injury.”

This study, as well as a follow up study beginning this month, has been entirely funded by the Kentucky Horse Racing Commission's Equine Drug Research Council.

“It is hard to overstate how much we appreciate the continued support of the KHRC and the Equine Drug Research Council. Their willingness to fund these projects is really a testament to their interest in supporting innovative ideas geared towards improving the safety and wellbeing of horses and riders,” Page said.

David Horohov,  PhD, chair of the Department of Veterinary Science, director of the Gluck Center and  Jes E. and Clementine M. Schlaikjer Endowed Chair, echoed those sentiments, “I am pleased that the EDRC is able to continue to provide support for this important study and that Dr. Page is able to continue his work on finding ways to protect our equine athletes.”

Joining Page in the research from UK's Gluck Center are Emma Adam, DVM, PhD, DACVIM, DACVS, assistant professor, research and industry liaison, Horohov, James MacLeod, VMD, PhD, John S. and Elizabeth A. Knight chair, director of UK Ag Equine Programs and professor of veterinary science and Ted Kalbfleisch, PhD, associate professor.

Previous research has shown that many catastrophic injuries occur in limbs with underlying and pre-existing damage, leading to the theory that these injuries occur when damage accumulation exceeds the healing capacity of the affected bones over time. Since many of these injuries have underlying damage, it is likely that there are molecular markers of this that can be detected prior to an injury.

The identification of protein biomarkers for these types of injuries had been explored in previous research, albeit with limited success. The focus of this project, measuring messenger RNA, had not yet been explored, however. The overall objective was to determine if horses that had suffered a catastrophic injury during racing would show increased inflammatory mRNA expression at the time of their injury when compared to similar horses who were not injured. It turns out that this theory might be on to something.

Messenger RNA (mRNA) is a single-stranded RNA molecule that is generated from DNA through the process of transcription. This mRNA carries the genetic information specifying a particular amino acid sequence, which can then be used to create a protein through the process of translation. While work looking at inflammation often involves measuring proteins, Page and his collaborators opted to focus on mRNA due to the limited availability of reagents available to measure horse proteins and concerns about how limited the scope of that research focus would be.  Focusing on mRNA expression, however, is not without issues.

According to Page, mRNA can be extremely difficult to work with. “A normal blood sample from a horse requires a collection tube that every veterinarian has with them. Unfortunately, we can't use those tubes because mRNA is rapidly broken down once cells in tubes begin to die. Luckily, there are commercially-available blood tubes that are designed solely for the collection of mRNA,” he said.

“One of the early concerns people had about this project when we talked with them was whether we were going to try to link catastrophic injuries to the presence or absence of certain genes and familial lines. Not only was that not a goal of the study, the samples we obtain make that impossible” Page said. “Likewise for testing study samples for drugs. The tubes do an excellent job of stabilizing mRNA at the expense of everything else in the blood sample.”

Horses eligible for inclusion in this study were Thoroughbreds entered into any race in one of five participating jurisdictions from September 2017 to June 2020. To look at the mRNA, these jurisdictions collected specific blood samples either pre-race or post-race from a selection of non-injured horses or immediately from a horse after a catastrophic injury. Once collected, samples were sent in batches to the Gluck Center where they were analyzed using quantitative PCR (qPCR). The names and category (injured, pre-race or post-race) of sampled horses were kept from the researchers by participating jurisdictions until the samples had been fully analyzed.

Once the names and dates of samples were revealed, public records were used to learn more about each horse. Information examined included the horse's sex, age, race type and whether non-injured horses raced again within three months of the sampled race. For horses who had been injured, more information about the race itself was gathered to determine if there were other factors related to the injury.  Additionally, necropsy results, when available, were used to categorize the type of musculoskeletal injury that occurred.

“As of right now, there are four mRNA markers, out of the 23 we have measured with qPCR, that show some significant promise as markers for identifying horses at risk of a catastrophic injury. Obviously, there has been an impact of COVID-19 on our research, so there are still a few more samples to process and add to our data analysis. Once we do that, we plan to submit the findings for publication. Currently, we're targeting the end of the year to be able to share exactly what we have found so far” Page said.

Read more here.

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Saez Expected to Return Friday

Luis Saez will be cleared to ride at Saratoga Friday pending the completion of a 14-day quarantine period, a negative COVID-19 test and clearance from a physician noting that he can no longer transmit the virus, the New York Racing Association announced Sunday.

Saez tested positive for COVID-19 July 10 while riding at Keeneland Race Course. He has remained asymptomatic throughout the period of quarantine, which will total 14-days July 24.

Current Centers for Disease Control (C.D.C.) guidance recommends a 10-day quarantine period for individuals who have tested positive for COVID-19, but remained asymptomatic prior to and throughout the duration of quarantine. Saez made the determination to extend his quarantine to 14-days in the interest of protecting his fellow riders.

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