NCAA advisers: For football, first stop spread of COVID-19

UGA's Sanford Stadium is empty, waiting and hoping for football season. Curtis Compton ccompton@ajc.com
UGA's Sanford Stadium is empty, waiting and hoping for football season. Curtis Compton ccompton@ajc.com

Credit: Curtis Compton

Credit: Curtis Compton

The Big Ten, Pac-12 and several lower-level conferences aren’t playing football this fall. The SEC, ACC and Big 12 are giving it a go. I figured if anyone could provide reassurance that those leagues can make it work, it’s the members of the NCAA’s COVID-19 advisory panel. That was my expectation when I joined the Thursday video conference arranged by the NCAA and Infectious Diseases Society of America.

Instead, the experts provided a harsh dose of reality. They said individual schools can follow best practices for safety, but playing fall sports depends mostly on controlling the spread of the novel coronavirus. That’s not going well, and if it doesn’t change, all of college football is on a collision course for cancellation.

“I feel like the Titanic,” said Dr. Carlos del Rio, professor of infectious diseases at Emory University School of Medicine. “We have hit the iceberg, and we are trying to make decisions on what time should we have the band play. We need to focus on what’s important. What’s important right now is we need to control the virus.

“Not having fall sports this year and controlling this virus, to me, would be the No.1 priority. My advice is if you cannot do it safely, you shouldn’t do it.”

For del Rio, it’s safe to play sports in a community with less than 10 new COVID-19 cases per 100,000 people or, ideally, less than five. The positive test rate should be no greater than 10 percent or, ideally, five. As of Thursday the SEC and ACC states weren’t close to making those cutoffs according to covidexitstrategy.org. The site uses 14-day rolling averages that are based on data the White House relies on for its reopening guidelines.

Only three of 16 states with ACC and SEC schools meet both of del Rio’s minimum standards: Massachusetts, New York and Pennsylvania. None of the SEC states had less than 10 new COVID-19 infections per 100,000 population. Only one SEC state, Kentucky, had a positivity rate of less than 10 percent. Georgia had about 30 new cases per 100,000 people and a positivity rate of 10.9 percent.

“Obviously, we are far away from where need to be,” del Rio said.

He said areas with high spread could see a large downward trend in 4-8 weeks with “significant interventions” that include mask mandates for the public, closing bars and limiting other indoor activities. Del Rio said those states could get the virus spread under what considers safe levels within 8-12 weeks.

“If we bring the number of community (spread) down to a low-enough level, we would be able to do all the things we talk about: opening schools, having sports, etc.,” del Rio said.

Big Ten commissioner Kevin Warren said there’s too much “uncertainty” with medical risks for athletes. Pac-12 counterpart Larry Scott said COVID-19 spread is too prevalent in many campus communities. (Cynically, I wonder how much of a role the labor organizing efforts by players in those leagues played in punting on the season more than a month before it was scheduled to begin.)

Leaders of the SEC, ACC and Big 12 say their medical advisers tell them it’s safe to proceed. Those officials have offered few specifics about how they arrived at those conclusions. How can different medical experts look at the same data on the pandemic and come to different conclusions?

“There are a number of ways to approach complicated issues,” said Dr. Colleen Kraft, associate professor infectious diseases at Emory School of Medicine. “One of them is to dip your toe in and see what happens. I think that’s what we are seeing a little bit from the conferences that are continuing to try to play.

“I think they will be able to see the experience that many others have had, where there will be transmissions. ... It’s incredibly difficult to (gather) college-aged individuals and not have any transmission.”

Kraft said one of her major concerns with athletes and COVID-19 risk is myocarditis, an inflammation of the heart muscle that’s usually caused by a virus. According to the Mayo Clinic, severe cases of myocarditis can cause permanent damage to the heart.

“As a frontline physician, I don’t see the statistics as numbers, I see them as individual patients,” Kraft said. “I am currently this week taking care of people that have very sad stories that could have been prevented. ... I think we are playing with fire. I think one case of myocarditis is too many.

“That is sort of my perspective. And I know it’s difficult when people when they don’t want things told to them; they want to try things, they want to do things. When you say one percent, 10 percent, people don’t see that as individual faces.”

Dr. Brian Hainline, the NCAA’s chief medical officer, said he knows of 12 cases of myocarditis among college athletes. He said the NCAA screens for the condition and, based on the advice of leading cardiologists, the organization updated its rules to prohibit players who have been infected with COVID-19 from training.

The NCAA has adopted mandatory COVID-19 protocols, but they are short on accountability. There’s a “concern hotline” that players or others can use. If tips are received, then the NCAA will notify conference and athletics officials, who are “expected to review and address concerns.”

As usual, the NCAA’s oversight for player safety is weak. Thankfully, some of the organization’s mandates for pausing or stopping sports under adverse conditions include the assessments of government officials. Five considerations are listed in the NCAA standards:

  • Lack of ability to isolate new positive cases or quarantine high-risk contact cases.
  • Inability to perform testing at the required level.
  • Campus or community test rates that are “considered unsafe by public health officials.”
  • Inability to perform contract tracing that meets government requirements or recommendations.
  • Local public-health officials declaring that hospitals can’t accommodate a surge of COVID-19 cases.

Hainline said those criteria leave a “very narrow path to get fall sports right.”

“I think you are seeing different conferences looking at that document and saying, ‘We really can’t envision this happening through January, so let’s make this stop now,’” Hainline said. “And other conferences are saying, ‘If things continue to get better under this especially narrow path, we can perhaps pull this off.’”

The members of the SEC, ACC and Big 12 are trying to thread that needle. The problem for them is that a lot depends on factors outside of their control.

Said del Rio: “We can do all the planning we want to be safe in sports, but what happens outside of sports is really where the problem is.”

Kraft, del Rio and Hainline emphasized the responsibility of individuals, including college athletes, in helping to control the virus. That means wearing masks in public, washing hands and avoiding crowds. Everyone should do those things. Freedom without personal responsibility is a bad combination during a pandemic that requires a collective response.

But individuals can only do so much. Government officials — especially President Trump and his coronavirus task force -- have failed to provide the resources and leadership for an effective response. In the early stages of the pandemic in the U.S., people sheltered in place waiting for a coherent national plan that never arrived.

Hainline said he wasn’t expecting that in May, when he was cautiously optimistic about a football season.

“We fully expected ... to be farther along,” he said. “That there would be a national surveillance system, national testing and national contract testing that would allow us to really navigate this pandemic into re-socializing both in sports and the rest of society. That hasn’t happened, and it has made it very challenging to make decisions as we approach fall sports.”

If we want college football, first we must control the coronavirus. It’s still possible. The SEC, ACC and Big 12 still plan to try. But even some of the NCAA’s COVID-19 advisers acknowledge that the odds aren’t looking good.

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