When it comes to testing for COVID-19, let's just say the NCAA tried. In its eagerly awaited release of minimum testing guidelines, it suggested that football players be tested once a week at least 72 hours before a game.
Good effort, NCAA.
Try to count the ways a football player -- or any athlete -- can party, date, mingle, socialize and otherwise associate with other humans over a three-day period before a Saturday game. In other words, particularly in college, there's an endless number of ways to spread or be infected with COVID-19.
"Testing once a week with up to a 72-hour turnaround definitely leaves a big gap through which a case can sneak," said Zachary Binney, an epidemiologist at Emory University in Atlanta. "That makes me very nervous, particularly in areas with a lot of cases in the community."
Lately, there are a lot of those – particularly in the South, which continues to be an epicenter of a surge in both coronavirus cases and hospitalizations. Cases have hit an all-time high within the last two weeks in 31 states.
The 2020 college football season continues to hang in the balance. The Ivy League and several other FCS conferences already have pushed their seasons to at least spring 2021 if they are played at all. The Big Ten and Pac-12 have moved to conference-only schedules for 2020.
The SEC, ACC and Big 12 are deciding what they're going to do schedule-wise with a decision expected by the end of July.
With cases nationwide spiking, once-weekly testing with a 72-hour window until kickoff hardly seems like the answer, even if it is just the NCAA's guidelines.
We are nearing a tipping point for college football. What is the game's risk tolerance?
"Where is the panic button?" asked Dr. Michael Saag, an infectious disease expert at the UAB School of Medicine. "Where is the number of positive tests that makes the administration say, 'OK we've got to cancel this week's game?'"
This is not to mock the NCAA's minimum standards. They are well intentioned but certainly not enforceable. For some smaller schools, once-a-week testing may not even be affordable.
Experts agree that testing at least twice a week would be ideal. Even better, testing Friday night or Saturday morning (before a Saturday game) with the ability to have a quick turnaround in results.
In their return to play, professional leagues are testing more frequently … because they can.
The NFL, for example, is set to enact daily testing until positive cases hit below a 5% threshold; it will then move to testing every other day.
Testing procedures for the NFL, NBA, MLB, NHL and other leagues are also vetted through player unions.
College athletes are being told what the testing procedures are going to be.
"Twenty-four hours [before a game] is the ideal, and every campus should strive for that," Saag said. "In that case, it means that every campus has to have access to testing with quick turnaround. That probably isn't true for every campus."
Why did all of this take so long, anyway? Most teams begin fall camp the first week of August.
The NCAA's protocols, Binney said, could have been issued before June 1 when players began returning to campus.
"Better late than never," he said, "but if you knew you were going to put together a document like this, why didn't you put it together before you had students coming back to practice and you had all these outbreaks?"
The grind toward a season seems interminable. Teams trickled back to those voluntary workouts on June 1. There were spikes of positive outbreaks. At least eight programs have paused workouts.
All of this highlights the truest conclusion of the summer: Nothing happens until the risk of the coronavirus is mitigated.
"Sadly, the data points in the wrong direction," NCAA president Mark Emmert said last week. "If there is to be college sports in the fall, we need to get a much better handle on the pandemic."
The NCAA standards state that anyone who tests positive for COVID-19 with symptoms must wait 72 hours after recovery to participate again.
Those who have a high-risk exposure -- defined as being within 6 feet of a someone testing positive for the virus for at least 15 minutes -- must quarantine for 14 days whether they test positive or not.
Asymptomatic individuals -- those who test positive but have no symptoms -- must isolate for 10 days.
"Where we're seeing the most push back is from our players who are positive but have no symptoms," said one Power Five athletic director. "They don't get it. They don't understand it. They're young. They're immature. They're saying, 'I'm not sick. What do you mean I have to stay in my room?'"
As mentioned, the guidelines don't account for schools in the lower divisions, which don't have the money to test. Stetson University is a typical example. The private FCS university located in DeLand, Florida, had players be responsible for their own testing by the time they returned to campus.
As far as in-season testing, a booster has told coach Roger Hughes that he will fund it.
"These freshmen that are coming in did not have a prom, did not have a graduation," Hughes said. "I'm really concerned, once they have freedom, they're going to want to exercise that freedom."
The desperation of the situation is beginning to show. The NCAA has made it clear why it believes we are in this situation: a lack of leadership.
"The federal government has not yet published uniform federal guidance related to certain practices like diagnostic testing protocols …" the release read.
The biggest barrier to getting back to what we all once considered normal is the lack of testing and how we have handled COVID-19 as a nation.
"The biggest obstacle far and away is our poor response to the virus. It's completely out of control in many of the areas that want to come back and play college football," Binney said. "That is going to make it very difficult to prevent outbreaks from happening on college campuses."
A lot of college football's future will be reflected in optics. It will be hard to play in hot spots such as Florida, Texas and California if hospitals are being overloaded.
Hope is not an effective strategy, but that seems to be the chief policy around college football. Coaches, athletic directors and commissioners can't predict outbreaks among their teams, much less the country.
There is a ray of hope … if the public embraces mask wearing and social distancing guidelines.
"We might see a downturn in new cases by the time late August rolls around, Saag said, "and I think we can all feel a lot more confident that the season will progress somewhat unabated."
If not, next year has always been there as a last resort. One that is such a longshot there is debate within the game that college football's stakeholders may just punt and go directly to the fall of 2021.
For now, multiple sources mentioned concern about dwindling test supplies in impacted areas.
"The big issue is going to be the allocation of supplies and the political nature," one Power Five health professional said. "If we're using a bunch of supplies because we're trying to keep football going and people who are sick can't get tests, politically, that's a terrible thing. As a medical provider, I'm telling you that's a terrible thing."
Then there's the obvious: 22 sweaty players in close proximity for 140 plays (or so). Hitting one another literally is one of the most effective ways of spreading the coronavirus. That's not to mention the exposure of standing on top of teammates, coaches, trainers and others on the sidelines.
The Polymerase Chain Reaction (PCR) test recommended by the NCAA is the gold standard. That involves the intrusive nasal swab you've probably seen on TV.
The turnaround for a result varies from a few hours (for a professional sports team) to a week-plus (for the general public). The access to that processing varies for colleges.
Binney advises schools to invest in rapid testing machines from Quidel and Abbott.
"If college football wants to try to play this fall, I would definitely advise them to consider looking into whether they can buy one of the rapid testing machines," Binney said. "You can test everyone on your team and everyone on the other team [shortly before a game]."
Layers of tests would help since no current test is 100% reliable. Schools could combine the PCR tests with easily-affordable paper strips, similar to a pregnancy test. While paper strips have not been approved by the FDA, their efficacy has been noted. They were the subject of a recent New York Times op-ed, "A Cheap Simple Way To Control The Coronavirus."
But merely administering 120 PCR tests to a football team can cost upwards of $100,000. That begs the question: If cost is a factor, then what are you doing playing college football anyway?
"Exactly," Binney said. "I've been saying this for months now. Don't mix up the best you can do with what we need to do."
Some schools will do more. Those in the lower divisions are likely to do less.
For now, that possible 72-hour gap in testing looks like a tunnel with no light at the end of it.
There is at least one more huge hurdle before the game returns.
Experts agree on an almost-certain spike in cases when students return to campuses -- on some by the tens of thousands.
Binney sees more logic in pushing the season to early 2021. By that point, we might be past an inevitable flu season.
"Say, 'We may try to play in the spring,'" Binney said. "I'm not going to criticize you for that. As long as you do what everybody needs to do, and that is stay flexible.
"Recognize your plans are temporary and they rely on the virus and our response to the virus."
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