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How worried should the Red Sox be about Chris Sale's 0-3 start?

BOSTON -- Opening Day at Fenway Park began with the good vibes of the World Series ring ceremony, a final celebration of perhaps the greatest team in Boston Red Sox history.

Past Red Sox heroes such as David Ortiz, Manny Ramirez, Curt Schilling and Mike Lowell brought out the team's four World Series trophies from 2004 onward Tuesday to the sounds of the Boston Pops orchestra playing "We are the Champions." Giant banners honoring the 2004, 2007, 2013 and 2018 World Series winners were unfurled one at a time over the Green Monster. The players were given their World Series rings featuring 185 total stones -- the sum of 162 regular-season games, 14 postseason games and Boston's ninth title -- that included 14 princess-cut diamonds, 21 custom-cut rubies, 22 blue sapphires and 15 total carats of gems. The championship flag was raised in center field and two dozen members of the Super Bowl champion New England Patriots walked in from left field carrying all their trophies, and Stephon Gilmore, Julian Edelman and Rob Gronkowski threw out the first pitches.

Then Chris Sale took the mound and 76 pitches later, Red Sox fans were reminded that all those 2018 memories are now stored in the medial temporal lobes of their brains and that it's a new season and everyone's anxiety level about Sale's effectiveness increased a little bit more.

Sale pitched four innings against the Blue Jays in a 7-5 loss, giving up five runs and seven hits while recording three strikeouts -- which at least was an improvement over the one strikeout the left-hander had in six innings in his previous start at Oakland (although he allowed just three hits and one run that game).

Fresh off his recent five-year, $145 million contract extension, Sale is now 0-3 with a 9.00 ERA through three starts. He says he feels fine and blamed this loss on his performance.

"We gotta win that game," the 30-year-old said. "It's very easy to just throw it on top of the pile and say we're not playing good, but this wasn't about us not playing good. Today was a day we were going to turn it around, we're back home, the ceremony, in front of our home fans, playing our first home game."

While there were apparently extenuating circumstances in the Oakland start, when his fastball averaged just 89.1 mph -- Red Sox manager Alex Cora revealed before Tuesday's game that Sale had been pretty sick that outing and "spent a lot of time in the bathroom" -- there was hope a better Sale would show up at Fenway.

Instead, he lasted just those four innings.

His average fastball velocity was back up to 91.8 mph -- still not quite what it was in his first start -- with a peak of 94.7 mph. More troubling than just the velocity is that it took 83 fastballs this season before a batter finally swung and missed one, when Toronto's Billy McKinney waved at a 94 mph heater in the fourth inning. Compare the effectiveness of his fastball in 2018 and 2019:

2018: Swing rate of 52.8 percent, swing-and-miss rate of 28.7 percent
2019: Swing rate of 33.0 percent, swing-and-miss rate of 6.9 percent

Batters aren't swinging as much on the fastball because Sale isn't throwing it in the zone -- down from 53 percent to 38 percent. Of course, all this comes with the caveats that it's just three outings, one in which he was sick and this one in which he had just recently been sick. He also didn't throw many innings in spring training, and it's worth reminding that Sale also started last season with a lower velocity before cranking it up in June and July, when he was routinely hitting the upper 90s (he averaged 98.0 mph in one June start against the Mariners).

Still, Sale was visibly frustrated after the game.

"I don't know if I've ever pitched like this in my life," he said. "It's a tough spot to be in. I have guys in here fighting and I have to keep fighting. No giving up. If something's not working, you have to go to something else, and if that's not working you have to go to something else.

At the same time, it's not as though the Blue Jays were ripping him with line drives like the Mariners did in his first start. Look at the seven Blue Jays hits (and their exit velocities):

Alen Hanson: ground ball single, 89.3 mph
• McKinney: ground ball single, 80.0 mph
Freddy Galvis: ground ball single, 99.2 mph
Randal Grichuk: ground ball single, 93.8 mph
Danny Jansen: ground ball single, 97.8 mph
Lourdes Gurriel Jr., line-drive single, 89. 2 mph
• McKinney: fly ball single, 68.7 mph

It's easy to chalk this up as just one of those days, with five ground ball singles and one soft looper. (In comparison, Sale gave up more than three ground ball singles in a game just once in 2018, and that was just four.) Still, as Cora said after the game, "He wasn't able to put batters away. He didn't have too many swing-and-misses and he paid the price."

Sale had just 10 swing-and-misses in this game, a low total for him -- against a Blue Jays team that has the fourth-highest swing-and-miss rate in the majors. He had just six swing-and-misses against the A's his previous time out.

"I feel fine, I'll never make excuses," Sale said. "I'm a starting pitcher. I should wake up on Christmas and be able to throw strikes."

Unfortunately, while the pregame ceremony felt like Christmas, it's April 9 and the Red Sox are 3-9 -- already six games behind the Tampa Bay Rays in the American League East. The rotation ERA is now 8.78, worst in the majors. As Cora said after the game, the Red Sox are built around the rotation and it hasn't done the job.

It's a stark contrast to last year, when the Red Sox stormed out of the gate to a 17-2 record. Sale was on his way to a dominant season until shoulder inflammation sidelined him in August and September.

He did leave us with this, however, something Red Sox fans can hold onto: "I'm still searching. I'll find it. I know who I am."