Infectious disease experts warn of fall sports pitfalls

Dr. Carlos del Rio, the executive associate dean at Emory University’s medical school who has been part of the NCAA’s coronavirus advisory panel, said Thursday it feels like “we have hit the iceberg and we are trying to make decisions of when the band should play” regarding plans for a fall college football season.

In a sobering webinar hosted by the Infectious Diseases Society of America, multiple infectious disease experts and NCAA chief medical officer Dr. Brian Hainline took a cautious tone on hopes for the Southeastern Conference, Atlantic Coast and Big 12 to continue toward a fall season. Earlier this week, the Pac-12 and Big Ten announced they would postpone their sports for the fall semester and hope to play in the spring.

Hainline said the NCAA went into the summer expecting that a national COVID-19 testing and contact tracing plan would be in place that would not only help mitigate the pandemic in the United States but establish a framework that would make it easier for college sports to be played.

“That hasn’t happened, and it’s made it very challenging to make decisions as we approach fall sports,” Hainline said. “We fully expected we wouldn’t be where we are in this country today.”

Hainline said that the NCAA’s data indicate that between 1 to 2 percent of athletes have tested positive for COVID-19 and that he was aware of “about 12” cases of myocarditis, heart inflammation that emerging studies have shown could be a lingering complication of the coronavirus.

While other viruses can cause myocarditis, some studies are showing a higher rate of incidence with COVID-19, which was cited by the Pac-12 and Big Ten as a reason to be cautious. In deciding to continue toward a season, the Big 12 announced Wednesday that athletes who test positive would undergo a battery of cardiac tests after recovery, including an MRI.

Dr. Colleen Kraft, also an infectious disease expert and professor at Emory, characterized the myocarditis issue as “playing with fire.”

“One case of myocarditis in an athlete is too many,” she said. “People don’t see (statistics like) 1% as individual faces. I don’t want to see stories of athletes who can no longer play and had promising careers but simply because somebody else didn’t protect themselves. It’s not a punitive thing. It’s a pandemic situation.

“I understand we’re all tired and ready to move through this but if we don’t start ratcheting up our public health policies, we’re going to be doing this for a long time and the numbers aren’t going to just be numbers. More and more people are going to experience this tragedy, this infection, if we continue as we’re going now.”

Hainline said the ultimate decision on whether fall sports would move forward could come down to the numbers of infections in the local areas of campus as students begin to return to school and the health care infrastructure in place to deal with a surge in cases.

Del Rio said the target for safely playing sports in a state or local area should be between 5 to 10 cases per 100,000 people.

“If the local infrastructure of a particular school is really imploding and can’t accept any new cases, you can’t go forward with fall sports,” Hainline said. “When you say you’re a go and you’re ready to move completely forward, that has to be a check box that the infrastructure can support that.”

Hainline also indicated that campuses building de facto bubbles for athletes has entered the behind-the-scenes conversation. That model would potentially work for sports starting after Thanksgiving, as many schools have said that students will not come back to campus after Thanksgiving break until at least the spring semester.

That would give colleges an opportunity to more closely control the number of positive cases before a season got started. There’s also hope that quick turnaround tests with high accuracy will be widely available in the coming months, which would more easily allow a football season to be played in the spring semester as the Big Ten and Pac-12 are attempting to do.

“Spring football carries other considerations,” Hainline said. “Can you recover enough from a neurological or musculoskeletal point of view to proceed with a fall season? Those active discussions are happening.”