As expected, the college hoops season is off to a rocky start. Here’s what health experts have to say about the upcoming season
We’re a week into the 2020-21 college basketball season, and the 11-time national champion UConn women’s basketball team has been strangely absent from fans’ TV screens. That’s how it’ll stay until at least mid-December.
Five days prior to what would have been the Huskies’ season opener, a member of the program (not a player or coach) tested positive for COVID-19, resulting in a two-week pause of team activities that wiped out the team’s three early nonconference games. The shutdown arose less than a week after the UConn men returned from a shutdown of their own due to a player testing positive.
With COVID-19 cases surging nationwide, UConn is far from the only school that needed to delay the start of its basketball season or pause things a few days in after someone contracted the virus. In the Big East alone, nine of 11 member schools have publicly disclosed temporary shutdowns for either one of their basketball teams this fall. Six teams have paused activities within the last two weeks.
In interviews with The Courant, public health and medical experts offered best practices as the NCAA moves forward with its season. Here’s what those experts had to say about the risks of playing basketball and how programs can mitigate them moving forward.
Basketball is a challenge
Basketball isn’t the first college sport to return to play, but it is one with unique challenges. It’s played indoors, where the virus is believed to spread more easily. Close contact in games, though relatively transient, is unavoidable. Smaller rosters mean fewer people pose a risk in contracting the virus, but also make the quarantining or isolation of even a handful of players more detrimental.
We’ve seen how basketball can be held safely: The NBA and WNBA had zero COVID-19 cases during their three-month “bubble” seasons, which took place at clean sites in Orlando and Bradenton, Fla., and featured daily testing. For financial, logistical and philosophical reasons, adopting that exact model is infeasible for college sports, though variations are being explored. Mohegan Sun is currently hosting 30+ teams at “Bubbleville,” while the Big East’s contingency plans for after the new year include a bubble or series of mini-bubbles involving shorter stays.
Dr. Karl Minges, chair of health administration and policy at the University of New Haven, said that the long-term effects of COVID-19 remain unclear (there’s not enough data yet, for example, to rule out that the virus can cause cardiac issues like myocarditis), and there’s plenty of evidence that it disproportionately affects Black and Latino people. Per the NCAA, 68 percent of Division I women’s basketball players and 77 percent of men’s players are people of color.
Even with schools and jurisdictions like UConn’s prohibiting fans at games, there’s growing evidence that outbreaks on college campuses have negative impacts on the broader community. A study in La Crosse, Wis. showed that COVID-19 clusters from college campuses were responsible for infections, and deaths, in nursing homes.
Travel is risky
Actual gameplay may not be the riskiest activity associated with college sports, said Dr. David Banach, an epidemiologist at UConn Health who has worked with UConn Athletics. Higher risk of transmission comes from activities surrounding games (such as travel) and from within teams themselves, something that Minges says has been apparent at the high school level.
“It’s become much more clear in the data that transmission of high school spread has been really facilitated by sports — not the game itself, rather the activities surrounding the sport, from the transportation to the practices to perhaps parties,” Minges said. “That’s where the focus needs to be on people exercising caution.”
For months, schools and conferences have developed plans for the season in which teams, like under normal circumstances, travel and host schools from out of town — some more regionally focused than others. But extending one’s geographical reach and network creates a higher risk of being exposed to the virus, says Dr. Sten Vermund, an infectious disease epidemiologist and dean of the Yale School of Public Health. And a travel-based model becomes even riskier with community transmission rates spiking across the country before an already expected jump around the holidays.
“We are not keen to have coronavirus rates surging in the months of October, November as we come into flu season, but that’s precisely what’s happened,” Vermund said. “So it’s not looking favorable.”
Testing and tracing are the priority
According to Vermund, there are five core principles for controlling viral respiratory diseases — masking, physical distancing, hand and surface hygiene, small groups, air quality — and that, realistically, college basketball is managing less than half of them.
The NCAA stipulates extensive mask wearing, but not for players in the midst of competition. Physical distancing may be possible on the sidelines, but it certainly isn’t for gameplay and many practice activities. Though basketball teams are smaller than, say, football teams, the number of players, coaches and support staff constituting “Tier 1” individuals still reaches a fairly high number of at least 20 for each program.
As a result, college sports are banking on a sixth mitigation method: frequent testing and contact tracing. Though NCAA guidelines suggest Tier 1 individuals are tested three times a week on nonconsecutive days during the season, each conference has created its own guidance. The Big East isn’t straying far from NCAA recommendations, requiring Tier 1 individuals to be tested three times a week (a minimum of two times via PCR testing, which is more accurate than antigen testing), and any nonconference opponents must adopt those testing standards seven days out from a game against a Big East school.
“In situations where you can’t use the other measures as well, like masking and distancing in sports, testing may be an opportunity to help mitigate the risk for transmission — particularly more frequent testing of asymptomatic individuals can be really important in reducing the risk,” Banach said, as it allows programs to identify an infected individual and hopefully isolate them — and, through contact tracing, anyone who has been in close contact with them — before they can transmit the virus to others.
“None of these strategies is perfect,” Banach added, “and I think everyone needs to be mindful of that.”
Experts support stricter measures
There are also other stricter, or more innovative, mitigation efforts that can be taken, the experts said: Teams could be stratified into smaller groups that practice, live and travel only with each other, a transmission mitigation method and a way to prevent an entire team from having to quarantining after a positive test.
Masking may not seem practical for game play, but Minges and Vermund were fervent that it should still be mandated. Given the amount of shouting and spitting players produce on the court, it’s easy for basketball players to exchange respiratory droplets and aerosols that could carry the virus. A mask helps filter these particles.
“What’s the point of not doing it, that’s my question,” Minges said. “Because it’s uncomfortable? That’s not a legitimate argument to me.”
Teams could also decline to play opponents from localities experiencing significant outbreaks or with more lenient public health guidelines, Minges added. Depending on how December goes, conferences may be more inclined to switch formats and adopt a bubble model. Minges and Vermund added that to encourage compliance, anyone who exhibits reckless behavior should be disciplined.
But to Vermund, such steps may not be enough for him to safely endorse going about the season given the pandemic’s currently trajectory. As part of the Ivy League, his institution, Yale, opted out of the 2020-21 basketball season due to COVID-19 concerns.
“If one of my sons were playing basketball, I might think that this was a good season to try to build their skillset and forego the actual games,” Vermund said. “I understand that I can say whatever I want as a public health expert, and it will fall on deaf ears. There are very high stakes involved here, and people are likely to take risks even if I were to recommend that they don’t. But I do think that these risks could be substantially mitigated.”
Alexa Philippou can be reached at aphilippou@courant.com
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