Christian Romero left the field in tears with 20 minutes remaining at Sunderland. The sight of new Tottenham Hotspur head coach Roberto de Zerbi watching in anguish as captain Cristian Romero walked past him in tears may yet become the lasting image of a season slowly sliding towards the Championship.

De Zerbi's hopes of a fast start after succeeding Igor Tudor, the madcap experiment of the Croatian's appointment lasting only 44 days, ended brutally as Spurs failed to show any significant response to the Italian's arrival. Amid another flatlining display, the tearful departure of De Zerbi's leader on the field with Spurs 1-0 down with 25 minutes left and on the way to deserved defeat at Sunderland was yet another harrowing chapter in this sorry tale of the fall of a giant club.

The question of whether Spurs are too good to go down was consigned to the dustbin long ago. A team without a win in 14 Premier League games stretching back to 28 December at Crystal Palace answers that. A more pertinent question now is - are Spurs too bad to stay up? On the grim evidence that unfolded in the Wearside sunshine, it looks like they are.

De Zerbi's Spurs reign starts with defeat at Sunderland. De Zerbi's reputation has been forged as a visionary coach at Brighton and Marseille, but he now needs to act as a psychologist as much as a training ground strategist to coax something from this subsiding Spurs team. "My job now is not to coach a style, with or without the ball, but try to give the players what they need in terms of mentality," he said. "My style is to trust the confidence of the players. During the week, they play better because they are clean in their heads, but in the game it is different. My work must be to get them to show what they are doing during the week in a game."

De Zerbi agreed the stress and fear of relegation could be the factor consuming the Spurs squad – but he has no time to lose getting his message across. In football terms, this is now a critical emergency for Spurs. He must also wait to see how long he is without Romero, whose downcast departure wiping away tears was yet another twist in this harrowing season.

Romero appeared to have a knee injury, although De Zerbi said "we have to see in the next few days," adding: "I hope that it is not too important a problem. He's a crucial player for us. He's a good guy and a good player with a big personality. We need him to finish the season." Whatever the prognosis, former England goalkeeper Ben Foster questioned whether Romero's downcast manner as he left the pitch sent the right message to a Spurs team already a goal down after Nordi Mukiele's shot deflected past keeper Antonin Kinsky off Micky van de Ven on the hour. It was a moment of misfortune, the sort that is often the fate of a team, and indeed a club, in crisis.

"Romero's probably the one player who has got a bit of character in that team, a bit of grit and determination," said Foster, a pundit on Sunday's Match of the Day. "If I was one of his team-mates there, I want him to be walking off the pitch grabbing everybody, getting everybody firing. They've still got 25 minutes there until full-time. But the tears, I feel, send the wrong message. As a captain you shouldn't be doing that."

In Romero's defense, his injury was caused by a reckless intervention from Sunderland striker Brian Brobbey, who pushed him into keeper Kinsky, who sustained a head wound but was able to carry on. Troubles are already piling up around De Zerbi's feet like rubble and he has barely got his feet under the desk. And he will know it. Spurs are a very poor team, shorn of confidence and self-belief, looking on course for the Championship.

De Zerbi only has six more games to turn this predicament around. Such is the extent of the rot that has set in at Spurs, this may not be enough. The Europa League win under Ange Postecoglou – even his presence seems an age ago now - provided glory and long-awaited silverware for the first time since 2008, but it has been exposed as a flimsy fig leaf disguising fundamental deep-seated problems running through the club on and off the pitch.

No wonder television cameras panned in on concerned expressions on the faces of Spurs chief executive officer Vinai Venkatesham and sporting director Johan Lange as they looked on from The Stadium Of Light's directors' box. Venkatesham and Lange will struggle to survive if Spurs suffer the humiliation of relegation, especially as they must take responsibility for the left-field appointment of Tudor.

De Zerbi played three strikers with Dominic Solanke through the centre, Richarlison on the left and Randal Kolo Muani on the right. Solanke had Spurs' best chance right on half time, only to be blocked by Sunderland keeper Robin Roefs. And for a coach known for pressing intensity and purist passing style at pace, De Zerbi's new team were not afraid to go long in search of results. Richarlison also had a couple of opportunities, but Spurs got exactly what they deserved from this game. Nothing.

He clearly encouraged full-backs Pedro Porro and Destiny Udogie to venture forward, often inverted, but Spurs barely created an anxious moment for Sunderland. De Zerbi said he wanted to revive memories of how Spurs played under the ultra-positive Postecoglou. If they did, they were bad ones.

If Spurs players are struggling to cope with the threat of relegation, the two-point gap to West Ham United with only six games left may suddenly feel like a chasm. The lack of response after Sunderland went ahead was alarming, Regis Le Bris's side, inspired by the experience and quality of Granit Xhaka, closed out the win with minimum anxiety. De Zerbi must get the response he needs before Spurs' next game at home to former club Brighton – because if he does not, he will be starting his rebuild in the Championship.