With at least three major collegiate athletic conferences -- the Big Ten, Pac-12 and Big East -- forgoing fall athletics, including football, those choosing to play games during the COVID-19 pandemic may find the path quite difficult.
"We're moving into very troubled waters," Dr. Brian Hainline, senior vice president and chief medical officer for the NCAA, said on Thursday. "It's a very narrow path to get fall sports right."
Hainline explained that expectations from earlier this year of containing the novel coronavirus in the U.S., allowing for sports through the end of 2020, simply have not been met.
"In April, we were envisioning that there would be a continued downward trajectory of COVID-19 new infections and deaths, that there would be a national surveillance system national testing and national contact tracing that would allow us to really navigate this pandemic into re-socializing both in sport and then the rest of society," Hainline said. "That hasn't happened, and it's made it very challenging to make decisions as we approach fall sports."
Two infectious disease experts from the Emory University School of Medicine, who also are members of the NCAA's COVID-19 advisory panel, warned that restarting sports could lead to negative outcomes both for the athletes involved and their communities.
"My advice to organizations that I've talked to is: If you cannot do it safely, you shouldn't do it," said Dr. Carlos del Rio, a professor of medicine and global health at Emory University.
As of Thursday afternoon, at least 5.2 million people in the U.S. had contracted COVID-19, and nearly 167,000 had died. Globally, those figures have surpassed 20.7 million and 752,000, respectively.
The U.S. has "a quarter of the world's total number of cases. We have a serious problem," del Rio said. "I feel like the Titanic, and we have hit the iceberg, and we're trying to make decisions of what time we should have the band play."
Time spent discussing whether to bring back sports, del Rio continued, would be better spent "focused on getting control of the pandemic. If we control the pandemic, we would be able to do all the things we're talking about: opening schools and having sports."
Professional sports leagues have seen mixed results. Major League Baseball has had interruptions of play as some teams recorded significant outbreaks -- 13 St. Louis Cardinals players and staffers tested positive in early August, while the Miami Marlins had 18 players and two coaches become ill -- while the NBA, confining players to a "bubble" in Orlando, Florida, hasn't seen a major outbreak.
Among the college ranks, whether or not to host games may have been an even tougher decision.
"The decision to not hold fall sports competition was not made lightly," said Peter M. Donohue, chair of the Big East Board of Directors and President of Villanova University. "Athletics play an integral role in the student, alumni and fan experience at each of our institutions, and we were all hoping to allow the fall seasons to move forward. However, this decision, while disappointing, was made with the health and safety of our student-athletes and staff in mind. The well-being of our community members are, and will continue to be, our priority and focus."
Although much is still unknown about COVID-19, and while the majority of those killed by it have been older or had underlying health conditions, younger people haven't been immune. And some of those so far infected may develop longterm health issues.
"When we think about types of side effects and long-term consequences from viral illnesses specifically from COVID-19, we think about myocarditis, we think about neurologic complications. I'm very concerned about myocarditis," said Dr. Colleen Kraft, an associate professor in the Department of Pathology and Laboratory Medicine and director of the Clinical Virology Research Laboratory at Emory University.
Myocarditis, or inflammation of the heart muscle, is a rare heart condition that could be linked with the novel coronavirus. According to Hainline, the NCAA is aware of 12 cases of myocarditis in athletes, and between 1% and 2% of athletes are currently testing positive for COVID-19.
"I think we're playing with fire -- one case of myocarditis in an athlete is too many," added Kraft.
For athletes to return to their respective sports safely, del Rio advised that within a community there should be fewer than 10 new cases per 100,000 in population, with a positivity rate of less than 10% -- ideally closer to 5%.
Additionally, hospital resources already stretched thin may not be able to handle additional large-scale community outbreaks.
"If you were to have an outbreak bigger than what we have -- if you have some sports event or college events -- you would be in a very serious situation," according to del Rio. "And I don't want to be there, so my advice is that we hold off and we control this virus."
The NCAA left it up to schools and conferences to decide whether to move forward with fall athletic competitions as "they determine how to safely begin the academic year and the return to sports," NCAA President Mark Emmert said in a statement. However, on Thursday, Emmert announced that there would be no fall NCAA championships because there are not enough schools participating in competition.
There are no clear paths for schools that choose to go forward with sports, even those best adhering to NCAA recommendations.
"All of us are just learning about this disease, in the last seven months, and there is no black-and-white answer," Hainline said.
Students who do play need to understand the risks and how to best prevent contracting the virus, both on and off the field, del Rio added.
"There's so much transmission in the community," del Rio said. "Using that social distancing, you know, avoiding those parties -- that's where we need to really focus our education on the students."
The Big 12, unlike several peers, announced on Wednesday it intended to continue with fall sports, with revised conference schedules.
"In the end, I think we all have to do what is best for our individual conferences," said Big 12 commissioner Bob Bowlsby, adding that should an outbreak occur "we're very well prepared to deal with those things."
Bowlsby acknowledged that things could change later in the fall.
"If we get to the place where our doctors and scientists say, 'You guys got two wheels off the tracks, and you're headed for a train wreck,' we will pivot that day," he added. "If it's during camp, it's during camp. If it's during October, it's during October. If it's the week before our championship game, that's when it is."
Count the president among those rooting for fall sports to be played.
"The student-athletes have been working too hard for their season to be cancelled," President Donald Trump tweeted.
However excited for college football many may be, doctors and experts agree that games cannot come at the expense of the athletes' health and safety.
"The NCAA is not only about sports," Kraft said. "It's really about the safety of athletes."