Big Ten football is coming back — but how safe will it be for players and fans? A Q&A with medical and health experts.

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CHICAGO — Four FBS conferences postponed fall sports because of COVID-19 concerns last month.

Several football games scheduled in conferences that have been playing were postponed or canceled. Outbreaks have occurred on numerous campuses nationwide.

But games continued in the ACC and Big 12, and a push from many fans, players, coaches, players’ parents and President Donald Trump urged conferences such as the Big Ten to reconsider.

It worked. All 10 FBS conferences will be on the field this fall.

The Big Ten said medical advice guided its Aug. 11 decision to postpone football and all fall sports after an 11-3 vote by university presidents and chancellors. The conference cited medical advice again when it announced about a month later that it would play football after all in a unanimous vote, planning to start an eight- or nine-game schedule Oct. 23-24.

The Pac-12 on Thursday also reversed course and announced it would come back earlier than expected, as did the Mountain West. The Mid-American, the first major football conference to postpone its season because of the pandemic, became the final one to jump back in Friday.

The Big Ten laid out plans for rigorous daily testing and cardiac MRI scans as it gears up for the late October start. Athletes who test positive will sit out 21 days, and teams with a positivity test rate of more than 5% and an individual rate greater than 7.5% must stop games and practices for seven days.

Will it be enough as the nation tops 204,000 deaths and teams in various conferences continue to halt practices after outbreaks?

Medical and health experts answered some of the most prevalent questions. Some responses have been edited for clarity.


— How much has changed medically in the last month?

— Dr. Kathleen Bachynski, assistant professor of public health at Muhlenberg College: We are at a familiar place in terms of knowledge from where we were a month ago. I don’t think we have had a major advance in treatments. You see some of the schools having hundreds of cases, having significant cases among the athletic department and the student body at large, and we have the concern these cases won’t stay on campus. There is not a wall between the campus and local community. We have a lot more evidence of failing to manage the risks than we have evidence of successfully demonstrating this can be done and not creating a significant outbreak risk.

— Dr. Timothy Beaver, sports cardiologist and medical director of adult echocardiography at the University of Kansas Health System: With COVID-19 in general, we are definitely learning on the fly. The longer it’s around and we’re treating it, the more perspective we gain. I don’t think the decision to play was based solely on “we now know it’s safe to play.” There’s a lot of different forces at work and a lot of controversy from the medical community about what to do. There’s a lot of things we have agreed on: symptomatic and asymptomatic, how to get them back on the field. The testing is one thing we haven’t agreed on.


— Will effective daily testing ensure a safe return to competition without a bubble?

— Dr. Kathy Weber, sports medicine doctor with Midwest Orthopedics at Rush University Medical Center: There’s a lot we don’t know. I think the difference is some of the professional teams had the advantage of the bubble. They tried to eliminate external factors that may play into getting the virus. They were in a vacuum testing. … The test is as good as the moment you take it. There are external variables: being with friends, going to hotels, traveling. Those components put them at risk between testing.

— Beaver: From a transmission standpoint it’s helpful. We’ve learned from the NBA and the NHL, the more you can control the better it is. What they wanted to control is the transmission, and then you don’t deal with the consequences of getting COVID. The more frequently you test and the more you can exclude people from the group, you’re able to make more intelligible decisions to keep people doing what they want to do, which is play sports.

— Bachynski: Daily testing is better than no testing or once a week. The concern is the tests aren’t perfect and you can certainly get a false negative. It takes the virus a little while to replicate. The first or second day after you’ve been exposed, it’s possible to miss it. On the other hand, if you’re testing everybody every day, you are certainly improving your chances. Daily testing should be part of a tool kit.


— There has been varying emphasis placed on myocarditis. What is known about how it affects athletes?

— Beaver: There’s not a lot of right answers. COVID is still a virus. We have people who have (it) and contract pericarditis (inflammation of the fibrous sac surrounding the heart) and/or myocarditis every year during viral season. So the difficulty is the translation of a lot of information about COVID in the sick, hospitalized patients that are not completely applicable to a group of 18- to 24-year-olds who are playing college sports.

We have seen it. We know a Red Sox baseball pitcher had it. He was symptomatic. I don’t know there are more athletes diagnosed (with myocarditis) in the last several months than in other viruses. We don’t know the prevalence of myocarditis in athletes with COVID.


— What does the Big Ten’s cardiac MRI scan add as a safety measure?

— Beaver: This is the controversial part. The cardiac MRI is a little more of a specialized test. The ability to do that and do it well enough to get the information they’re talking about is a little more difficult. It’s also a test that’s never been used for screening the heart. We really don’t know what completely to do with the information in an asymptomatic person from a screening standpoint.

If your MRI is completely normal, that’s really easy. If your MRI is abnormal, that’s pretty easy. You probably had myocarditis, and I should restrict you. If you have some of these in-between findings of inflammation we don’t have data on, it’s a little harder to know what to do with, especially with someone who is asymptomatic.

We can do an EKG on most athletes (now after years of study) and have very few false positives. … The MRI just doesn’t have that. It doesn’t have us doing years of testing on normal healthy people to know what they’re like.

Are athletes safe because the death and hospitalization rates for COVID-19 have been relatively low for young people?

— Beaver: As you (age) and acquire medical problems, those people are more affected by this. But I think part of it is being informed going forward. … Are you going to be spreading the virus? It’s the whole community question. There’s also the individual person and ‘What is my risk?’ For most young people, the risk isn’t high. I do see symptomatic athletes post-COVID. To say people 18 to 22 don’t have aftereffects from COVID is not true. Some of them do. (But) if you take any young, healthy age group, it’s going to affect them less.


— Are neurocognitive issues at play?

— Dr. Michael Rippee, neurologist at the University of Kansas Health System: The neurocognitive effects still seem on one hand to be somewhat theoretical. Based on previous pandemics, like the SARS and MERS epidemics, there seems to be a relatively reasonable suspicion for delayed neurocognitive effects. A lot of the literature in the neurology community is “We should be looking for this, rather than we found this.” In previous experiences, it can be delayed for weeks to months. There’s poor attention and confusion.

It sounds very much like a concussion. It gets tricky when they do return to play. Is it due to COVID or did they hit their head playing football? I think it’s probably going to pop up at some point, but I’d be happy to say we have done all this research and nothing comes of it.


— How might the return of football affect public health?

— Bachynski: In terms of the public health message in priorities, it’s hard not to look at this and think the top priority right now shouldn’t be figuring out a way to bring college football back. It should be figuring out a way to address the already existing outbreaks we have that are linked to these campuses and get transmission as low as possible on campus and in local communities.

You increase your options for everything if you focus first on bringing down community transmission. The focus on bringing college football back and the message it sends is this is an opportunity to have off-campus parties to celebrate the return of football and all things associated with the football game. It’s hard for this not to be a mixed message.


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