Steven Goodman, an associate dean and professor of epidemiology at Stanford, knows medicine. He’s studied at some of the most renowned universities in America—Johns Hopkins, Washington University, Harvard and NYU. He’s won a multitude of awards for his research and teaching contributions to the field of epidemiology. In fact, he’s a lifetime fellow of the American College of Epidemiology.
His sports knowledge isn’t as deep. He’s a basketball and tennis junkie, his days as a child on Long Island spent rooting for the New York Knicks and attending US Open championships. He says his Sunday TV football watching is typically a break from epidemiology (concussion concerns aside), but the two sides came together during a recent interview about the Power 5 conference’s in-season COVID-19 management plan, a draft of which was obtained last week by Sports Illustrated. The plan requires a mandatory 14-day quarantine for those who have been found to have had “high-risk” contact with a person who tested positive for the virus. According to the document, “high-risk” contact includes collisions in practice.
Goodman chuckles when hearing this, the medical and sports areas of his brain colliding. “You could be talking about knocking out a whole team,” he says. “It bumps into reality. If you’re going to be that cautious—and I’m not saying you shouldn’t be—does that make football possible? I think there are good reasons to doubt it.”
The Power 5’s in-season virus plan, along with the NCAA’s own in-season guidelines it released last week, is drawing concerns from both college athletic leaders and physicians alike. At issue is that mandatory 14-day quarantine as part of the contact tracing section of the plan. Some around college football believe the quarantine time to be so long and the definition of a “high-risk” contact to be so cautious that completing a season may be virtually impossible.
“Are you telling me a contact is you and I lining up against each other and you block or tackle me and two days later I come down with the virus and you’re out?” asks a college athletic director. “Then you’re not going to finish a season.”
One SEC assistant coach described the contact-tracing portion of the guidelines as “overwhelming.” A Pac-12 team doctor calls the issue a “massive challenge,” and West Virginia athletic director Shane Lyons, even while on an NCAA video news conference, posed a chilling question last week to the audience listening. “How can we play the game of football and, with contact tracing, not lose the entire team?”
According to both the Power 5 and NCAA guidelines, those who test positive for COVID-19 must isolate for at least 10 days from their onset of symptoms/positive test and until they’ve gone at least three days without symptoms. However, those found to have contact with the infected must miss even more time—two full weeks—even if they test negative for the virus.
COVID-19 is known to produce delayed infection. Most people get sick five to seven days from the time of contraction, but research has also found some who don’t show signs until Day 14, says Amesh Adalja, a senior scholar at John Hopkins University and an infectious disease physician who sits on the NCAA COVID-19 advisory panel. The 14-day quarantine, while consistent with CDC guidelines, is “a conservative approach,” Adalja acknowledges.
The 14 days is a safe interval for the virus to potentially work its way completely through the body, Goodman says. He believes, however, that it’s reasonable for a player to leave quarantine if, within the 14-day window, they produce consecutive negative tests, “but it’s not a guarantee,” he says. This is referred to as “testing out” of quarantine. The NCAA’s COVID-19 guidelines are a time-based model. Many professional leagues, including the NBA, are using more of a test-based model for quarantine, allowing a person to “test out.” That comes at a price, quite literally. One test can cost about $100-$150.
In college sports, a test-based model may be a non-starter. College leaders are concerned about the cost, availability and turnaround time for tests for dozens of schools, many of them small programs that lose money on football to begin with. “I don’t think we can test our way out of it,” says Jon Drezner, a team physician for the Washington Huskies who sits on the Pac-12 COVID-19 advisory committee. “Maybe after five to seven days with two negative tests, they may not be infected.”
The key word there: may. There are liability concerns. College athletes are not paid like their professional counterparts. “This could shut down a team for 14 days and then you need time to re-acclimate,” Drezner says. “If you have a normal college football practice and someone turns out to be positive, you are quarantining a large portion of the team.”
That’s why there will be no normal practices this fall. To potentially avoid masses of ineligible players through contact tracing, coaches plan to split a team into small groups, holding as many as four practices in a day this fall, says Todd Berry, executive director of the American Football Coaches Association. That’s not necessarily doable during the school year, but could work in August. “Many are looking at walkie talkies and bullhorns to have their players remain separate,” Berry says. “That idea in practice of somebody making a big play and everybody hugging and stuff. That’s probably not going to happen. They’ll have to control emotions. It’s going to be a different year.” In fact, on a Zoom call with reporters Tuesday, North Carolina coach Mack Brown says coaches will use a six-foot stick at practice to distance people.
Lyons recommends coaches creating “pods” for practices, where 10–20 players are in their own practice bubble. He says some teams plan to avoid typical first-string vs. second-string scrimmages, fearing one outbreak could cost the entire starting group. The starters might scrimmage against the third-string and the second-string might meet the fourth-string. Position drills could look different, too. Imagine a starting offensive line—supposed to be the most cohesive unit on a team—not practicing alongside one another to avoid one positive test among them bringing down the entire group.
A Big 12 assistant coach says his staff is already organizing roommates based, not on position or grade, but by depth chart. The days of having all three of quarterbacks or half of a starting receiving corps sharing an apartment are, for now, over. “That could be a disaster,” the assistant says.
However all of these mitigating factors are void if they hang out together too much. In both the Power 5 and NCAA plan, a “high-risk” contact is defined as those who are within six feet of an infected person for at least 15 minutes while one or both parties is not wearing a mask. The Power 5 plan also includes a “high-risk” contact as “anyone participating in face-to-face or contact drills against each other.” The NCAA’s guidelines aren’t as specific to the latter, citing a high-risk contact as “an individual who had direct physical contact with the person (touched, hugged, or kissed them).”
“The 15-minute, six-feet rule, that’s based on normal life,” says Adalja, who helped craft the NCAA guidelines. “An exposure may be different if you’re a collegiate wrestler or football player. You have to take that into account. You can imagine, saliva exposure during wrestling or close contact that may not be 15 minutes but is enough for the virus to have a chance to spread.”
Identifying high-risk contacts isn’t necessarily easy. In fact, the NBA relies upon tracking devices for its contact tracing. Not every college environment has such a luxury. Many athletic department staff members are learning to trace contacts instead of having a third-party or local health department workers intervene.
Identifying high-risk contacts takes honesty. Did you collide with Infected Player A at practice at all? Were you around Infected Player B for 20 minutes without a mask? It’s a massive undertaking. For some, the worry is that coaches and players alike will impede contact-tracing protocols to protect a star player or players from what would amount to a two-week suspension. “They are influenced by the pressure to win,” Drezner says. “It’s possible people won’t be forthcoming. It would be sad.”
Back at Stanford, Goodman’s medical and sports interests are colliding again. Like many in America, he wants college sports to return. He’s just not sure how it can happen. The deck is stacked against college football. From testing issues to the impossibility of an on-campus protective bubble, from in-season interruptions to the latest quandary—contact tracing and that pesky 14-day quarantine. “It’s very very hard to imagine how this can work,” he says. “It’s cautious, so in that sense it’s good, but in terms of actually envisioning a workable system, it seems unlikely.”