They’re 67 or so Americans strewn from coast to coast with their CVs voluminous and their expertise various. Life has led them to another turn of the unforeseeable – to little squares on videoconference screens, week upon week through five long months, grappling with one lousy decision that gobbled up more time than they imagined. Amid a pandemic, five medical task forces for five major college football conferences have had to weigh this: Is America’s most deeply felt sport viable for autumn 2020?
Then last week, they took their vanguard knowledge and reused a shopworn saying. In interview after interview, they agreed that the split – the Big Ten and Pac-12 canceling football, with the SEC, ACC and Big 12 somewhere between wait-and-see and stay-the-course – felt analogous to some old, old words:
Get a second opinion.
“There’s no throwing of stones,” said John Swartzberg, an emeritus clinical professor of infectious diseases and vaccinology at the University of California and one of 12 panelists advising the Pac-12. “It’s just two people who see the same data differently. And (the old ‘second opinion’) is just the perfect analogy there. Absolutely perfect.”
“I think it lines up (with ‘second opinion’) in the sense that I think very reasonable people can look at the same information and reach a different conclusion with neither being incorrect,” said Leslie Beitsch, chair of the Behavioral Sciences and Social Medicine department at Florida State, one of the 15 panelists (plus one alternate) advising the ACC, and a former commissioner of health for the state of Oklahoma. “We thought we could do things in a relatively safer way than other conferences felt they could do these things.”
“There’s no right or wrong here,” said Bonnie Maldonado, a Pac-12 panelist who is also senior associate dean and professor of pediatrics (infectious diseases) and of health research and policy at Stanford, and who has done extensive research on COVID-19, including epidemiological modeling. “There’s degrees of certainty and there’s degrees of risk perception and there’s degrees of resources. Unless you are like the NBA and, knock on wood, they are in a real bubble, and I know they’re spending a lot of money on that …”
Such humility can come even from 67 souls who include an infectious-disease-research giant who has studied HIV pretty much since HIV began its menace (Maldonado); a pediatric-infection expert who has represented humanity in the wars in Guinea against Ebola, in Brazil against Zika, in Uganda against Rift Valley fever and in Wisconsin against Seoul virus (Annabelle De St. Maurice at UCLA of the Pac-12); a retired rear admiral and former acting surgeon general of the United States (Boris Lushniak at Maryland of the Big Ten); a researcher who once uncovered a disturbing rate of cervical cancer in the Little Haiti neighborhood in Miami (Erin Kobetz at Miami of the ACC); and multiple sports-medicine docs who work with universities trying to sustain community happiness by trying to sustain the health of college football players.
Even in an SEC still hoping to play on, its fans peerlessly tethered to its normal rhythms, assessment continues. “By far, playing is not a foregone conclusion,” said Catherine O’Neal, an assistant professor of medicine, infectious diseases, at LSU who has helped advise the SEC. “We focus on today and the next couple of days, not what’s going to happen in the next couple of months. We don’t know what’s going to happen.”
The Washington Post contacted about 30 of the medical panelists. The Big 12, reprising its role as the sport’s eccentric, did not divulge its experts’ names but said it had 10 (plus one outside agency as further guidance). Some referred all commentary to a conference office. Those who declined to comment included Cameron Wolfe, the Duke-based, Australia-educated chair of the ACC committee and a specialist in infectious diseases, who early last week told Michael Smith of Sports Business Journal: “We believe we can mitigate it down to a level that makes everyone safe. Can we safely have two teams on the field? I would say yes. Will it be tough? Yes. Will it be expensive and hard and lots of work? For sure.
“But I do believe you can sufficiently mitigate the risk of bringing COVID onto the football field or into the training room at a level that’s no different than living as a student on campus.”
In that same vein, O’Neal of LSU and the SEC said: “The playing of the game is not the risk we worry about day to day. We worry about all the risks leading up to it (from the other places of life). … If they (manage those risks), the game itself is really the lesser of the concerns. All of the things we keep talking about, the amount of infectious droplets in the air, is so much less of a concern if I bring a safe team to the game.”
In a sense, the hinging of a college football season upon five panels reinforces the disjointed nature long present in an eccentric sport without a sole governing body or commissioner. The NCAA, which governs some aspects of the sport but not others, held a news conference last week during which Carlos del Rio, a Distinguished Professor of Medicine at Emory University and a member of the NCAA’s advisory panel (which is separate from conference advisory panels), said: “We have a serious problem. I feel like the Titanic. We have hit the iceberg, and we’re trying to make decisions of when the band should play.”
From conference panelist to conference panelist, there’s an oft-stated respect, both within panels and far-reaching, across the cancel-or-wait aisle.
“The closest parallel” to the disjointedness, said Beitsch of Florida State, “is how the (elementary, middle and high) schools are reopening” – some, in some regions, less painfully than others, in other regions. A public-health expert with a medical degree from Georgetown and a law degree from Harvard, Beitsch said: “We’ll see how these things unfold. More information will come out in the next weeks that may change our minds, may change their minds.”
Regarding some of his fellow panelists with athletic department affiliations, Swartzberg wound up thinking: “Wow, these people, this is their job. This is what they get paid for. They knew they were voting themselves out of a job. These people were the ultimate professionals, in my opinion.”
Regarding other and divergent (for now) leagues, he said: “I’m not privy to what went on with the ACC or the SEC or the Big 12, or even the Big Ten. All I can say is it was unanimous in our community.” When he hears people say, “ ‘It must be because the ACC, the SEC, the Big 12, all they care about is money,’ ” he said, “I don’t believe that.” He just knows the Pac-12 panel conveyed its unanimity to Doug Aukerman, the chair of the Pac-12 Student-Athlete Health and Well Being Initiative, who then conveyed it to a meeting of Pac-12 presidents and chancellors last week.
He cautioned against “hubris” in judging a pandemic just eight months going.
O’Neal displayed none in her tone, even as she feels “a different perspective from some other conferences who didn’t see cases early on, so in this pandemic are a little bit behind us in what has been learned from activity in the area.” The path of the virus does not sustain that view – some of the earliest outbreaks hit New Jersey, home of Rutgers of the Big Ten, and Seattle, home of Washington of the Pac-12 – but O’Neal did speak from one of the first major epicenters, Louisiana.
“Every day when I go see patients, I learn the most from them,” she said. “ ‘What have you been doing? Who have you been with? How much time do you spend with them?’ … And they are almost always the same story. It is a baby shower, a wedding, a family dinner, a card game. One of the most devastating things in this pandemic has been watching families being admitted (to the hospital) together, but we also learned so much from it.”
As the learning began, Swartzberg wondered what to expect when he agreed to join the Pac-12 panel in mid-March. He brought “a different view of the situation because I’m from the outside.” He’s a 75-year-old Berkeley native who sold football programs at the stadium as a kid, owns a T-shirt diagraming Cal’s famous five-lateral, kickoff-return touchdown of 1982 and said, “I didn’t have a dog in the fight, other than that I love sports and love football.”
A surprise awaited. “Little did I know how much work it was going to be,” he said. “We met, on average, three or four hours a week, with Pac-12 groups, every week. As things ramped up, there were often evening meetings and, ‘Let’s meet for three hours.’ ”
They read “a lot of documents,” said De St. Maurice, an assistant professor of pediatrics in the division of infectious diseases at UCLA.
“I think none of us was expecting to be where we are now when we started meeting in March,” she said. “I think we all thought the pandemic would be in a different place.”
That preceded the national failure in controlling and managing it, which threw down the obstacles.
“The first stumbling block never completely resolved,” Swartzberg said. “ ‘What do we do when they put pads on and stop social distancing and don’t wear a mask?’ We couldn’t completely figure out how to do that and have a great deal of confidence when they had pads on.
“The second difficulty was we were aiming at a moving target. By that I mean COVID was changing, or at least our understanding of it was changing, in terms of how it was transmitted, how the virus manifests itself in human beings.”
“Basic logistics even in a static situation would have been difficult, but this was (not a static situation),” Maldonado said.
A flash point came around mid-April, when understanding of the virus morphed from an idea of a flu from which one recovers without enduring effects to an illness which, even when asymptomatic, can leave behind trouble.
“That created considerable disquiet, particularly with the fact we had very little knowledge of it,” Swartzberg said. “It was hard to feel absolutely secure or even modestly secure on much of anything.”
Beitsch of Florida State looked back to something he has studied intricately, the 1918-19 flu pandemic, and said: “What’s unprecedented during this pandemic is the explosion of information in real time. And I don’t know that anybody can keep up with everything that’s going on. The sheer volume is astronomical, but we’re also seeing things before they’ve been rigorously peer-reviewed.”
“Those stumbling blocks became insurmountable when data started coming out about cardiac complications,” Swartzberg said – including a German study released in mid-July and individual testimonies from football players at Indiana and Houston.
Still another disincentive hovered: the nation’s abject failure in producing helpful testing. The Pac-12 panel considered the steep costs of testing, of course, but: “More than cost, the turnaround for testing is horrible,” Swartzberg said. “That means testing’s worthless. … We had no way to commit to teams or to your teammates that nobody on the field is infected.”
Three days after he spoke, news broke of FDA approval for the kind of at-home, inexpensive, rapid-result saliva test, a consideration panelists lacked as they deliberated.
Developed at Yale with help from the NBA, the test seems “likely to be an important advance both because of ease of obtaining the sample and simple technology/cost,” Swartzberg said by text Sunday. “It’s probably cutting it too close to salvage a season. We will need some real-life experience with it to see if it meets our expectations.”
Analyzing the infection rates in the Pac-12’s six states, from Oregon’s “very low” to Arizona’s “terrible,” Swartzberg said, the panel concluded that if going by the desired metric of fewer than 10 positive cases per 100,000, the only Pac-12 game which could occur would be Oregon vs. Oregon State.
“We were quite stuck,” Swartzberg said.
“I’m sure they’re disappointed,” Maldonado said of athletes and fans, “but in the end those facts were just staring us in the face.”
“I think it’s good to explain to sports fans,” De St. Maurice said, “that this isn’t something we came to without much deliberation and thought.”
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