Return of pro sports could strain the system
Frequent testing of leagues’ athletes and staff for COVID-19 could be a burden on nation’s increasingly fragile infrastructure.
In their quest to return to play amid a global pandemic, professional sports leagues have built their safety protocols upon a common foundation: testing.
MLB and MLS are testing all of their players and key staff members for COVID-19 multiple times a week. The NBA’s bubble near Orlando, Florida, features daily tests. The NFL has yet to finalize its protocol for the fall – but if it goes ahead with the 2020 season, frequent testing will surely be a priority.
One month ago, sports’ use of those COVID-19 tests – and the lab capacity needed to process them – was thought to be incidental. But now, the United States is seeing more than 50,000 new cases of COVID-19 a day. Major commercial labs are struggling to keep up with the high demand, causing delays in turnaround times. And experts wonder if the return of sports could burden an increasingly fragile testing infrastructure.
“That’s been a big concern for me, as I’ve been seeing different leagues and their plans for reopening,” said Celine Gounder, an infectious disease specialist and epidemiologist at New York University and Bellevue Hospital.
“We’re testing a lot (in New York), but other parts of the country don’t have that same capacity. And if you have every single player on a team wanting to be tested – even if it’s once a week or twice a week – that’s just a huge strain on the system.”
In addition to tens of thousands of tests a week that will likely be needed for the safe return of sports, there’s the lab capacity needed to process them.
As large commercial labs deal with slowdowns, leagues could be forced to either wait several days for test results like members of the public – rendering the results essentially useless as athletes continue to compete – or get results back earlier, with a perception that they are cutting in line.
Leagues say they have taken steps to ensure their
“That’s been a big concern for me, as I’ve been seeing different leagues and their plans for reopening. We’re testing a lot (in New York), but other parts of the country don’t have that same capacity. And if you have every single player on a team wanting to be tested – even if it’s once a week or twice a week – that’s just a huge strain on the system.” Celine Gounder An infectious disease specialist and epidemiologist at New York University and Bellevue Hospital
operations don’t impact testing and lab infrastructure, both regionally and nationwide. And some experts said they believe the tests being used by the NBA, MLB
and MLS – which USA TODAY Sports estimated at 19,000 a week – amount to little more than a drop in the metaphorical bucket for a nation that has most recently been processing nearly 640,000 tests a day.
Others said it’s hard to know exactly what kind of burden sports might have on the testing infrastructure, a complicated web of public and private labs and supply chains that often overlap. They argue that even a slight strain on the system could prove consequential and that the notion of sports leagues using up scarce resources veers into matters of ethics and optics.
“You don’t want to be in the mansion on the hill, while all the peasants down there are starving,” said Zachary Binney, an epidemiologist and incoming professor at Oxford College of Emory University. “The peasants’ situation isn’t your fault, (but) you still don’t want to be sitting in that house on that hill when you could help.”
‘Not one versus the other’
Several professional sports leagues have already returned to play or are scheduled to return this month, including MLB, MLS, NASCAR, the WNBA, the PGA Tour and the National Women’s Soccer League.
But perhaps no league has found itself at the center of the country’s COVID-19 response like the NBA.
It was the first pro league to suspend play, halting a game on March 11 when Utah Jazz center Rudy Gobert tested positive for COVID-19. Then it faced brief backlash because its teams had access to testing while some in the general population struggled to get tested.
Two months later, the pandemic had not completely subsided but there were promising signs. Cases, hospitalizations and deaths related to COVID-19 had plateaued or trended downward. Once-scarce tests had become plentiful. Hot spots such as New York City were largely under control. So the NBA began developing a plan to resume play at the Disney sports complex in Florida.
But as states began relaxing stay-athome orders, those promising trends flipped.
Now, with games scheduled to begin July 30, the timing and location couldn’t be much worse: Nearly half of Florida’s intensive-care units are at least 90% full and the state reported 215 COVID-19 related deaths on Thursday and Friday, the highest two-day total since the pandemic began.
“It only took us two or three weeks to get back into this bad situation,” said Jill Roberts, an infectious disease expert and associate professor at the University of South Florida.
The spike in cases – first in a handful of Southern states, and now across much of the U.S. – has led to a sharp increase in the demand for testing. And several of the nation’s large commercial labs are now facing backlogs.
Quest Diagnostics, which has facilitated some of the NBA’s testing, said last week that everyone outside of its highpriority group – namely hospital patients and symptomatic health care workers – would now have to wait four to six days for their results. LabCorp, another major commercial lab, said Wednesday that it is experiencing similar issues.
BioReference Laboratories, which has partnered with MLS and NBA to process tests for their bubble sites in
Florida, said in a statement Friday that it is processing tests within 72 hours with an estimated capacity of 70,000 tests a day.
“We have enough capacity right now to test the people we’ve made our commitments to,” Jon Cohen, the company’s executive chairman, told USA TODAY Sports on Friday. “If you have a relationship with BioReference, and we have made a commitment to you, we’re going to deliver on that commitment.”
Cohen said this commitment extends to turnaround times. However, he also acknowledged that there have been days in which his labs have not been able to process all the tests they received due to myriad factors, including excessive demand, supply chain issues and equipment malfunctions. And that leads to a situation in which some batches of tests are processed more quickly than others.
“I have hospitals that need a certain turnaround time because they want to do some elective procedures,” he explained. “I know we have urgent cares where people are suffering, that need certain turnaround times. I have sports franchises that need certain things to be able to function in their leagues . ... It’s not one versus the other. It’s not like you need to do these before those, and everything else. We make the commitment, and then honor our commitments.”
Cohen said tests from the NBA and MLS will be processed in Florida. When asked in an email to clarify whether those athletes would receive their test results more rapidly than members of other groups, BioReference spokesperson Hillary Titus pointed to the company’s efforts to increase its testing capacity in Florida but did not directly answer the question.
The NBA has indicated in its health and safety protocols that it will seek to collect testing samples each evening, with the goal of retrieving the results by the following morning. That turnaround time would be faster than what is currently available to the public at major commercial labs.
The league said it has required its lab partners – including BioReference – to certify that its testing efforts will not impact the availability of tests for health care workers and other high-priority groups in each team’s community. It said it has also taken steps to preserve resources in the Orlando area, including lab capacity.
“BioReference has brought new testing
capacity to its laboratory in Central Florida in order to manage NBA and local testing needs simultaneously, and ensure that tests in Florida supporting hospitals and patients are not diverted from the community,” NBA spokesperson Mike Bass said in a statement.
MLS, which is also operating out of a so-called bubble site near Orlando, did not respond to a series of questions from USA TODAY Sports about what steps, if any, it has taken to preserve or expand testing resources for the public.
No certainty of not being a burden
Unlike the NBA and MLS, MLB plans to play its 60-game shortened season in its teams’ home stadiums, scattered across 28 cities.
The league said it is relying on salivabased testing for asymptomatic players, in an effort to preserve materials such as nasal swabs for “essential testing.” It is also processing the vast majority of its COVID-19 tests at a Utah lab that usually handles drug tests.
“By taking this step, the program will be additive to public testing,” MLB said in response to a series of questions from USA TODAY Sports.
The league also said its Utah lab is subcontracting with a second unspecified lab “to ensure continuity of results reporting.” Several MLB teams had to pause their workouts this month due to delays in test results.
Roberts, the South Florida infectious disease expert, said MLB’s primary use of a private lab that won’t delay processing of public tests is a significant gesture but it’s nearly impossible to entirely mitigate the impact of the league’s mass testing.
“They’re not taking (significant) lab personnel out of the public bucket,” she said. “The problem is, they’re taking supplies, and that’s how we ran into our (testing) problems in March.”
The availability of testing supplies has improved relative to the early stages of the pandemic, according to Eric Blank, chief program officer at the Association of Public Health Laboratories. But more people are seeking tests now, too.
While manufacturers have ramped up production of materials such as swabs, reagents and pipettes, “they’re still not able to keep up” with demand, Blank said – and that appears unlikely to change anytime soon.
“I think we’re going to be dealing with these supply chain issues as long as this response is going,” he said, “because it’s so large. I think it goes beyond what anybody imagined.”
Blank said he doesn’t think the tests that are being used by sports leagues will impact his member laboratories. Even with frequent testing, he said, the leagues are using fewer tests than small cities.
Other experts are less certain, citing the ever-changing nature of the virus and lack of a centralized testing authority, which could monitor test usage and distribute materials where they are most needed. They say there’s simply no way to know what impact the return of sports could have on the broader testing infrastructure – particularly when you factor in the tests being used by college sports, and potentially the NFL this fall.
“Bigger picture, it’s hard to imagine that you’d have a really large organization that plans to do massive testing – multiple times per week – and be certain that it won’t somehow put a burden on the system,” said Ryan Demmer, an associate professor of epidemiology and community health at the University of Minnesota’s School of Public Health.
Sports doing more harm than good?
To counteract their potential burdens, the NBA, MLB and MLS have pledged to help provide COVID-19 tests or antibody tests for the public.
The NBA has outlined multiple initiatives that will expand testing options in Central Florida providing “a mobile testing site and a drive-through testing event, which will be open to the public and will together provide thousands of tests to the community,” Bass said.
The NBA is also supporting testing research through partnerships with the Yale School of Public Health and the Mayo Clinic, among others.
MLB said it is offering free COVID-19 tests and antibody tests to health care workers and first responders in its home cities.
And BioReference said in a news release it is working with MLS to provide antibody tests for the public in Orlando.
Despite those good-faith efforts, sports risk losing the battle of perception as long as athletes are receiving multiple tests in a virtual bubble while citizens in hard-hit areas wait in their cars or long lines for hours, often in vain, for the same test.
“I think sports in general will be an easy target to say, why are we doing this?” Roberts said. “But you could say that about a hundred things. You don’t need your nails done. You don’t need your tacos. But those are obviously part of the economy.”
The stakes for sports could intensify in the fall, however, if the NFL and college football go ahead as planned.
There are more teams in the Football Bowl Subdivision (130) than the NBA, NWSL, MLB, MLS and WNBA combined. And while active rosters in those other sports range from 12 players to 30, football rosters are usually two or three times as large. With daily testing and 70-man rosters, for example, the NFL would use and process more than 15,000 tests a week for its players alone.
Binney, the incoming professor at Emory, said leagues must ultimately ask themselves a simple question: Are they doing more harm or good by returning?
The answer, of course, is complicated. And changing all the time.
“I think that pro sports, with the right setup and the right logistics, can come back still without having a negative effect on the community around them,” Binney said. “But it’s getting harder.”