Breaking Down the Big Ten's New CoVID-19 Antigen Testing Protocols

Brendan Gulick

The Big Ten is glad to have football back, for sure. And while they could thank the players/coaches/schools for publicly supporting the idea to play, or the state and local government officials that applied some pressure to the situation, or the fans for vehemently voicing their opinions, the real heroes are those in the medical field that made it all possible.

Across the conference, presidents and chancellors understood the financial ramifications of not playing a season. But they were never willing to put their students in harm's way if it wasn't safe to compete. Thanks to the chance to conduct daily, rapid antigen tests, the league has done a complete 180 and football is back.

“The new medical protocols and standards put into place by the Big Ten Return To Competition Task Force were pivotal in the decision to move forward with sports in the conference,” said Dr. Morton Schapiro, Northwestern’s president who’s also the chair of the Big Ten Council of Presidents/Chancellors.

Ohio State team physician Dr. Jim Borchers is the co-chair of the medical subcommittee on the Big Ten's Return to Play task force. Borchers said today that their ability to pause and take a step back over the last month to look at the data and implement a solution gave them comfort the league could safely move forward.

“We’ve ended up in a place where we feel comfortable that we have a path forward that’s going to emphasize that health and safety,” Borchers said.

So what does this all look like?

Well for starters, all 14 Big Ten schools must report daily testing results to the league through an appointed Chief Infection Officer (but they are not obligated to share that information publicly). As teams collect data each day, they will use two metrics to decide if it's safe to continue practicing and playing.

The first is "Team Positivity Rate" and the second is "Population Positivity Rate." The team rate is defined as the number of players/coaches/staff members that test positive divided by total number of tests administered on any given day. The population positivity rate incorporates the overall number of active positive cases divided by the overall population of team players and personnel who are deemed at risk because they are affiliated with the programs. The rates will be based on a 7-day rolling average.

The league has assigned green, orange and red colors to separate zones, based on the positive case rates. Here's how they break down:

  • Team positivity rate:
    • Green 0-2%
    • Orange 2-5%
    • Red >5%
  • Population positivity rate:
    • Green 0-3.5%
    • Orange 3.5-7.5%
    • Red >7.5%

Decisions to alter or halt practice and competition schedules will be based on the following scenarios:

  • Green/Green and Green/Orange combinations: Team continues with normal practice and competition.
  • Orange/Orange and Orange/Red combinations: Team must proceed with caution and enhance its COVID-19 prevention plan (alter practice and meeting schedule, consider viability of continuing with scheduled competition, etc.).
  • Red/Red combination: Team must stop regular practice and competition for a minimum of seven days and reassess its metrics until they are improved.

Using this strategy, Dr. Borchers believes schools can reduce infection rates by "near 100 percent."

If an individual tests positive through the rapid antigen test, they will take a polymerase chain reaction (PCR) test to confirm the result. Any player who tests positive will miss at least 21 days. While on the surface that may seem like a long time, Borchers indicated that it follows the general Center for Disease Control guidelines (14 days), with additional time to allow that athlete to transition back to competition.

Testing will be provided by the conference and Ohio State athletic director Gene Smith said the league will announce who's producing the tests at some point in the future. The Council of Presidents and Chancellors were presented with at least four different options.

All individuals who test positive will be subject to thorough cardiac testing upon recovery and must be cleared by a cardiologist before they can return to the field. That testing includes ECG, labs and biomarkers, echocardiograms and a cardiac MRI. The league is also creating a cardiac registry to examine the effects that CoVID-19 has on athletes that have recovered.

Dr. Borchers also noted that daily, rapid antigen testing essentially eliminates the need for contact tracing because as soon as someone tests positive, they can be isolated. One test on the market claims to be able to diagnose a positive case below the threshold of contagiousness, which would theoretically make contact tracing obsolete. But the system does rely on accountability that each school adheres to the guidelines.

“Our progress will be measured by their efforts,” he said.

While the focus on Wednesday was primarily on football, the league will announce a plan to return to practice and competition for all sponsored fall sports and for the winter sports that begin in the fall semester. Every athlete in every sport will have to go through the daily rapid testing.

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