While much remains uncertain about the novel coronavirus that causes covid-19, five infectious-disease experts interviewed by The Post agreed that frequent testing of all players, regardless of whether they show symptoms, is the linchpin of any effective outbreak prevention policy. Ideally, all athletes should be tested before returning to campus, those experts said, and once full-contact practice begins — scheduled for early August — all players should be tested weekly.
“This is a highly transmissible virus … and we do know that with just a single case that’s not necessarily symptomatic, in high-risk settings, it can spread explosively,” said Albert Ko, an infectious-disease epidemiologist and professor at the Yale School of Public Health. “There’s actually a question and debate of whether you should test twice per week.”
Across college football, however, what Ko believes is a consensus is not yet agreed upon. Over the past week, The Post surveyed all 65 schools in the five major college football conferences and discussed best safety practices with the infectious-disease experts — including Ko, who consulted with the NBA, which plans to test its players every day when it attempts to resume play this summer.
In interviews, emails and news releases, officials in the Power Five conferences described policies that vary widely from school to school — most of them subject to change — ranging from weekly tests for all players, regardless of symptoms, to no tests for players unless they display symptoms or are discovered to have been near an infected person.
The array of policies among conferences and schools reflects the parochial nature of the sport, which is one reason college football could face more difficulties attempting to play during the pandemic than professional leagues.
“This is the big problem with college sports. It’s just a lot more feasible for professional sports because they have the resources to implement a lot of these procedures and protocols, which will give the best chance of lowering the risk of outbreaks,” said Jill Weatherhead, assistant professor of infectious-disease and tropical medicine at Baylor College of Medicine.
In response to questions for this story, NCAA spokeswoman Stacey Osburn highlighted educational materials the organization has published that advise schools that football is a high-risk sport for outbreaks that may require more regular testing, without specifying testing frequency recommendations.
Of the five major conferences, which control the lucrative College Football Playoff and thus set the tone for the sport, the Pac-12 appears to be the most aggressive, with Commissioner Larry Scott declaring in a recent interview that all schools would be required to test all football players weekly.
“The idea of checking symptoms, it’s too late,” Scott said. “If you’ve got a symptom, you’ve probably been infectious.”
In an email exchange this week, however, a Pac-12 spokesman said the conference’s medical advisory committee is still discussing testing protocols.
“We are in the process of finalizing testing parameters, which will include the frequency of testing,” Pac-12 spokesman Andrew Walker said. That frequency will be based on sport, level of contact and other factors, Walker said.
Officials at the Big Ten, Big 12, SEC and ACC, in emails, said that they are offering guidance and discussing best practices but that individual schools are ultimately in charge of setting testing policies.
“We are of the belief that our member institutions are best-equipped to determine the particular protocols followed on each campus,” Big Ten spokesman Adam Augustine said.
To one athletic administrator at a major program — who spoke on the condition of anonymity because he wasn’t authorized to speak publicly — the lack of uniformity across college football presents perhaps an insurmountable challenge to the upcoming season.
“The big problem here is we can put together the best policy in the world, but if they’re doing something different over in Texas or Florida, can we really travel there and play a game?” he said.
The importance of testing, the experts said, has been shown over the past two weeks. At least 10 Division I schools have reported coronavirus infections among returning athletes (not all schools specify by sport) or staff members who were immediately quarantined. At Texas, 15 athletes have been presumed positive, the school said, and an outbreak of six cases at Houston forced a suspension of football workouts.
Range of plans
Officials at five schools said they plan to test all players weekly when full-contact practice begins: Oklahoma, Notre Dame, Washington State, Oregon State and Arizona.
“In the perfect world, if everyone has the means, I think [testing] would be weekly as well as a test prior to competition,” said Stephen Paul, director of athletic medical services and reentry planning at Arizona, where all players are taking three types of coronavirus tests weekly as part of research to evaluate the accuracy and efficiency of each test.
Costs per test range from about $40 to $240, Paul and officials at other schools said, meaning weekly testing for an 85-player football team as well as coaches and staff easily could exceed $500,000 over the course of the season. No school officials said costs would deter them from regular testing, however.
On the opposite end of the spectrum from Arizona are LSU, Kentucky and Arkansas, which are not requiring coronavirus tests for any players as they return to campus unless they develop symptoms or are found to have been in contact with someone infected.
Instead, these schools are requiring players to take antibody tests, which may indicate if players already have had the virus and might be immune from getting infected again.
Many schools are mandating players take both antibody and coronavirus tests upon returning to campus. Antibody results also serve as warning notices to monitor players for potential cardiovascular or pulmonary complications, which some evidence suggests are risks for covid-19 survivors.
LSU, Kentucky and Arkansas, however, are the only three schools whose officials said they’re only requiring antibody tests.
“That doesn’t really make sense to me,” said Zachary Binney, an epidemiologist and assistant professor at Oxford College of Emory University. Binney and other experts pointed out there are still significant unknowns about antibody tests — most importantly, whether people with antibodies are truly immune and for how long — while it’s established that coronavirus tests can identify infected people spreading the virus before they have developed symptoms.
Shelly Mullenix, LSU’s senior associate athletic director of health and wellness, said the school’s medical team felt tests for active infections were too unreliable and advised the best overall policy to prevent outbreaks was to screen players daily for symptoms, then test any symptomatic players and potentially those in contact with symptomatic players.
“We think that’s the best plan, for now,” said Mullenix, who, like many officials, noted all policies are in flux and could change.
“That’s complete nonsense,” Binney said. Coronavirus tests are far from perfect, Binney acknowledged — sometimes missing up to 30 percent of active infections — but they’re better than nothing.
“It’s not foolproof … but we know that you will miss a lot of cases if you wait for symptoms to develop,” Binney said. “We’re seeing example after example where waiting for symptoms to develop leads to widespread outbreaks.”
Officials at LSU, Kentucky and Arkansas said, in defending their testing protocols, that they were based in part on guidance from the SEC.
SEC spokesman Herb Vincent, in an email, said the conference’s task force set minimum standards — including daily screening of athletes for symptoms — but didn’t prohibit schools from enacting more aggressive testing procedures.
“Each school is developing their own protocols and policies,” Vincent said.
Three schools — Duke, Boston College and Wake Forest — declined to comment or did not respond to requests to comment and have not publicly disclosed testing policies, although it’s unclear whether any players are back on campus at those schools yet.
Purdue, where players have begun returning to campus, has a testing plan but declined to disclose it publicly.
“We have developed an extensive protocol based on the guidance of the NCAA, Big Ten, Purdue University and our medical advisers,” wrote Purdue athletics spokeswoman Kassidie Blackstock, who did not reply to a response email seeking to review this policy.
Officials at Michigan State and North Carolina also are concerned about the accuracy of coronavirus tests, but unlike their peers at other schools who do not require tests at all, they have decided to require players take at least two tests when they return to campus, about a week apart, to reduce the risk of a false negative, when a test misses an infected person.
Auburn is testing all athletes before they return to campus and also is doing frequent testing of groups of randomly selected players, an official said. Michigan also will randomly test groups of players weekly, and Mississippi officials said they are considering a similar policy. Players at Maryland, Illinois, Oklahoma State, Colorado and Georgia Tech will receive at least two tests this summer, officials at those schools said, and probably more frequent testing when contact practice begins, but specifics are still under discussion.
Officials at the more than 40 other schools — including Alabama, Clemson and Texas — said that they are requiring testing as players return to campus and that discussions of subsequent testing protocols are underway but hypothetical.
A distance early warning
Even if schools mandate weekly testing, the experts noted, college football faces a looming challenge as more students return to campus: social distancing.
In addition to daily testing, the NBA plans to attempt to resume play under a “bubble” scenario at the ESPN Wide World of Sports Complex near Orlando. NBA players and coaches will effectively live in quarantine, barred from leaving and risking infection.
In an interview with CNN this week, Anthony S. Fauci, the federal government’s top infectious-disease expert, said he felt an NFL season would need a similar bubble environment.
“Unless players are essentially in a bubble, insulated from the community, and they are tested nearly every day, it would be very hard to see how football is able to be played this fall,” said Fauci, who was not asked about college football.
While many schools are putting football players in reduced-capacity dormitories and advising social distancing, two athletic directors Thursday expressed doubt bubbling college athletes would be feasible.
“That would be very, very difficult on a college campus, just by the very nature of what a campus is,” Maryland Athletic Director Damon Evans said in a phone interview.
Michigan Athletic Director Warde Manuel, in a Zoom conference call, expressed unequivocal opposition to any bubble plan.
“I did see Dr. Fauci’s comments … but I will tell you we’re not going to be isolating our student-athletes,” Manuel said.
“They’re not professionals. We won’t get into a situation where we are placing them into a hotel continuously to isolate them from their fellow students and whomever else. … If that is the only way that we have to proceed, then we will have to make other decisions.”