TUSCALOOSA, Ala. — About a month ago, some 600 miles west of here, a Texas A&M soccer player registered positive for COVID-19 during a routine PCR test conducted by the SEC.
Convinced she did nothing to put herself at risk, the player sought her own test from the student health center on the College Station campus. The result returned negative. Over the next few days, the school tested the player three more times, producing all negative results.
The soccer player was cleared by the SEC office and then, days later on Oct. 3, the conference’s COVID task force drafted a new item to its 34-page medical guidance policy to address false positive tests. The new 151-word policy, titled “Considerations for Handling Asymptomatic PCR Positive Tests,” would allow an asymptomatic person who tested positive to return to activity if they test negative in three consecutive tests administered at least 24 hours apart from one another. The policy was approved through the league’s task force and was sent to the conference’s executive board.
Then, last Thursday, completely under the radar and without any fanfare or an announcement, league presidents and chancellors unanimously voted to implement the change.
Little did they know just how consequential it would be.
Nine days later, the game’s most successful active college head football coach, Alabama’s Nick Saban, has been cleared to stalk the sideline at what is thus far the sport’s biggest game, when the No. 2 Crimson Tide host No. 3 Georgia.
He’s got the Aggies to thank for it.
“It’s interesting sitting here and watching it unfold,” Texas A&M athletic director Ross Bjork says in an interview with SI on Saturday. “The genesis was here at Texas A&M. If it benefits Coach Saban or another player, that’s why it was put in place.”
Without the soccer incident, without the hurried change to the policy and without a rushed test to a Mobile-based lab on Saturday morning, Saban wouldn’t be in such a position. He’d instead be quarantined for another several days over an initial positive test that, physicians say, was likely due to either a lab error, faulty equipment or, maybe most likely, incremental traces of viral matter that were at first detected but then had dissipated during subsequent testing.
“We will no doubt be discussing the Saban situation going forward,” says Jeff Dugas, Troy’s team doctor and an orthopedic surgeon in Birmingham who chairs the Sun Belt’s COVID-19 advisory panel. “Is this opening Pandora’s box a little bit so that anybody who tests positive, we’re going to retest and retest and retest?”
Saban’s positive test, taken Tuesday and announced Wednesday, sent waves through the college football pond, exacerbated by the timing—four days before one of the most anticipated games in the most powerful conference in the most bizarre season college football has seen in decades.
But the door for Saban’s return was always left ajar, rooted in that little-known, brand spanking new policy. In appearances he made both Wednesday and Thursday nights, he subtly hinted about a potential return.
There were other clues that something was abnormal with this case. A strict follower of COVID guidelines, always wearing a mask and keeping his distance, Saban’s test result stunned those close to him. His initial positive test was conducted not by the SEC’s laboratory but with a lab that Alabama contracted with for its own more enhanced testing protocol, even more stringent than the league’s three-times-a-week model.
He was then administered PCR tests on Thursday, Friday and Saturday mornings, this time each sent to one of the league’s own laboratories in Mobile. They all returned negative. The last one was flown to the lab around 7 a.m. Saturday—a quick but possible timeframe, doctors say. The result returned to Alabama officials in time for them to release a statement at 11:20 a.m.
And with that, Saban will coach Saturday night, using a policy that did not exist until last Thursday, five days before he tested positive.
It all goes back to College Station, Texas.
Without revealing the player’s name, Bjork explained that one of his soccer players tested positive on Sept. 20. Seven other players and staff members were deemed to have been close contacts, triggering a 14-day quarantine. The Aggies had to even postpone their next game against Auburn.
After the player registered four consecutive negative tests, Bjork and his staff brought the case to the league, whose medical task force had already been considering the option, spearheaded by Florida team physician Jay Clugston.
“There was no policy at that time to clear her unless there was a true lab error,” Bjork says. “We worked through the SEC to get it cleared as a lab error, and then we made a recommendation to the task force to review the policy and verify positive tests.
“Our deal was let’s use common sense and make sure we are accurate. If you’re testing this much, there’s bound to be falsities. If we had to be the case example to get it going, so be it,” he says. “As soon as the news happened Friday [about Saban] that it could have been a false positive, I texted our medical folks, ‘Hey, the policy could work!’”
In an interview earlier Saturday morning on SEC Network, commissioner Greg Sankey addressed how the league had seen a similar false positive last month.
“It’s happened in other sports before it’s actually happened in football,” Sankey said. “This just so happens to be one of the more prominent conferences and one of our more prominent programs at the center of the story.”
But still, more questions linger. What exactly is a false positive? How did Saban’s initial test, of the PCR variety, the gold standard in the industry, register positive?
Barring a lab error or faulty equipment, the most sensible explanation is that the test was actually accurate and that very small traces of viral matter were detected within Saban’s nasal cavity, says Geoffrey Baird, the interim chair of the department of laboratory medicine and pathology at the University of Washington who is an expert in COVID testing.
Saban’s viral load could have been so low that subsequent testing found no traces or not enough traces to register another positive.
“It could be he had a very mild case and was only detectable for a brief time,” Baird says. “He could have had a brief interaction with it, but he didn’t become symptomatic or problematic.”
However, there are many variables at play here. Testing is not all created equal. Laboratories process tests differently, and Saban’s initial positive was processed at a different lab than the other three. Methods of administering the test are different, too (was his initial testing method administered in the same way as his other three?). Different equipment is used, some more valued and respected than others. But, in this particular case, the most important variable is the viral threshold: How much virus does it take to trigger a positive?
“Say you’re looking for viral particles and there are one million in a sample,” Dugas says. “You put a drop of the sample on the swab and you’ve got the swab in the [reagent] liquid and then it goes to the slide and into the machine.
“Maybe the machine picks up 20,000 of the viral particles because that’s what happens to be in that little portion of the sample. That might trigger a positive. But what if that 20,000 was 1,000?”
Laboratories have different thresholds on what registers a positive and what doesn’t. In fact, Baird says, a person with a small amount of viral matter can register a negative result.
As for false positives with PCR tests, they are rare without a lab error. Baird’s lab has conducted 900,000 tests and though he doesn’t have a specific number, he’s seen a false positive “only a few times.”
“At most, it’s 1-2%, but it’s probably quite a bit less,” he says. “It’s incredibly unlikely.”
The numbers, though, don’t necessarily take into account retesting every positive. “Very few people can afford or have the ability to get three subsequent tests,” he says.
In fact, many other college football conferences do not include such a policy as the SEC implemented last month—the one triggered by the A&M soccer player. Now in the spotlight, the policy may get scrutiny from some and praise from others.
But everyone agrees that “the Saban situation,” as Dugas says, will send more ripples through the college football landscape.
“It’s a weird time,” says Bjork. “It’s another example of the fluidity of all of this.”