England and Pakistan officials are in discussions about a possible 24-hour delay to the first Test in Pakistan, after 13 to 14 members of the England squad - including half the 16-man playing pool - were struck down by illness on Wednesday.
The issue is thought to be a virus or bug rather than food poisoning, with England taking particular care over what they eat with the help of a chef, Omar Meziane, who has travelled with the team for this tour. However, on Tuesday, some players reported feeling unwell and were told to stay in their rooms to limit the risk of spreading the virus.
Ben Stokes, England captain, and James Anderson are understood to be two of those affected. Jack Leach, who lives with Crohn's disease and takes immunosuppressant medication, which weakens his immune system, is suffering from symptoms but is said to be fine. Joe Root had symptoms on Tuesday but recovered well enough to train on Wednesday. Likewise, Mark Wood, who was already set to miss the first Test through injury, has shown signs of improvement after missing training on Tuesday and being confined to his room.
An ECB spokesperson confirmed that the illnesses were not Covid-19 related, with players experiencing vomiting and diarrhoea. There is a hope the virus passes in 24 hours, though with the first of the three-match series due to begin in Rawalpindi on Thursday, England's chances of getting off to a strong start have been severely hampered.
Root, speaking to the media on Wednesday, acknowledged that discussions were underway about a postponed start to the match, with officials from the two boards - PCB chairman Ramiz Raja, and the ECB's Rob Key and Neil Snowball - meeting to consider all options. A final decision is expected to rest with the England team doctors, who are due to assess the players at 8am local time, two hours before the start of play.
The playing conditions for the World Test Championship require all matches to be staged across a five-day window, therefore ICC dispension will be required if the game is to be rearranged as a four-day Test. However, an ECB spokesperson confirmed that play would not have got underway in the current circumstances.
"It is unfortunate we are in this situation, but we don't think it is food-related," Root said. "I don't think there is any correlation between the two and in fact the chef is ill as well, so I don't think it is the food.
"The thing is we have been trying to bring a chef away with us for a couple of years now. This is the first opportunity we have had to do it. Look at all the other international sporting teams around, even Premier League and Championship teams have their own chef, so we think from a nutrition and performance side of things, we are trying to do everything we can to optimise ourselves and be in the right position to perform."
Apart from Root, only Zak Crawley, Ollie Pope and Harry Brook of the players named in the starting XI, and Keaton Jennings trained at the ground on Wednesday in a session that was anyway optional before the bug spread. The team named by Stokes on Tuesday, with a debut for Liam Livingstone and a return to the fold for opener Ben Duckett, may now have a very different look.
"There's going to have to be Marcus Trescothick, Rob Key and Brendon McCullum as the new top three for tomorrow," Root joked. "As far as I'm aware there are a few guys not feeling 100 percent but - I didn't feel great yesterday but I woke up better today - so hopefully it's just a 24-hour virus and I don't think it's food poisoning or Covid or anything like that.
"I think it's just one of those things that we've unfortunately picked up as a group - we've tried to do absolutely everything, we've prepared really well for this game and sometimes life throws things at you but we'll do everything we can to be right tomorrow and be right and ready to go."
Asked if he believed everyone will be fit for selection come Thursday morning, Root said: "It's hard to say, I've not seen anyone this morning, we've literally got straight on the bus so the guys will do everything we can to be right in that aspect, so time will tell really."
The outbreak has taken place at the Serena Hotel in Islamabad, where both England and Pakistan have been staying along with members of the UK media. England have taken over a wing of the second floor and an executive lounge on the sixth floor, which is operating as their team room. They have not been restricted in their movements around the hotel, beyond being able to leave the heavily-guarded 14-acre complex.
This is not the first time England have been struck down by illness at the start of a tour recently. On the 2019-20 tour of South Africa, another bug coursed through the squad in the lead-up and during their Boxing Day Test in Pretoria, with a number of players having to leave the field of play to use the toilet and take on fluids in separate changing rooms away from the group. They went on to lose the Test. Such was the rate of spread of this particular virus that many England players wondered if they were struck by an early version of Covid-19. But, just as it is now, the symptoms were very different.
"I wouldn't wish it on anyone. It is horrible," Root said. "Running on and off the field all the time. But sometimes it is part and parcel of where you are at as a team. That [Centurion 2019] was very unfortunate because a lot of us got ill during the Test match, not going into the game. But hopefully it is not something we have to contend with, and everyone will turn up well tomorrow and we can enjoy what is an exciting series and have cricket as a talking point."
Root added that he was not aware if any reinforcements were being discussed, with the Lions squad having flown home from Abu Dhabi at the end of last week's warm-up with the Test squad, and said that he was not expecting to stand in as captain if Stokes is not passed fit.
"No, I don't think so," he said. "Ollie Pope did it the other day and he'd do a great job, so we'll see. Hopefully it isn't a conversation we need to have.
"It is frustrating. Today is generally an optional session anyway, so a few of the guys wouldn't have come in anyway. There is not much you can do, other than try to do the right things and hydrate yourself, and do the things away from the game that will serve you well overnight in preparation for tomorrow.
"It is where we are at as a team. Sometimes this happens, and when we're all tight together in the same hotel, then it can spread around. We've done what we can to try and mitigate that, and we'll see how we shape up tomorrow. It is part and parcel of being on tour. Sometimes these things get thrown at you and that is why you have 15 guys here, so in case of injury or illness you are ready to go."