Dr. Anthony Fauci called it “quite creative.” Other epidemiologists call it “extraordinarily comprehensive” and “thoughtful” and “great.” Bill Schaffner, a renowned infectious disease specialist at Vanderbilt for over 50 years, opened the NBA’s 113-page “Health and Safety Protocols” document on Thursday. He scanned it.
And he thought to himself: “It is remarkably thorough, incredibly detailed. … Holy smoke! Wow.”
“I looked through it and I tried to find something that they haven’t thought of,” Schaffner says. “And they kept showing me that they have thought of some things I hadn’t.”
Then, however, comes the caveat: “It’s so comprehensive, you wonder whether it’s workable, or sustainable over time.”
NBA officials are worried. Epidemiologists are concerned. But not by the NBA’s protocols. Rather, by what they can’t address. No sports league, experts point out, can control government competence or “human inclinations.” No U.S. sports league, therefore, can resume comfortably and 100 percent safely amid the coronavirus pandemic.
The NBA’s plan, experts agree, is safer than MLB’s. Far superior to college football’s. Yahoo Sports obtained the NBA’s master document and reviewed it with several epidemiologists. “It’s clearly the most elaborate one I’ve seen,” Schaffner says.
But plans are only as strong as the humans who execute them.
“They’re putting a lot of reasonable protocols in place,” says Kathleen Bachynski, an epidemiologist at Muhlenberg College. “To me, this is probably going to show what can and can’t be done with protocols.”
In other words, the NBA is a “test case.”
And if it can’t finish safely, no U.S. league can.
The strength of the bubble
A sports league’s ability to finish a season in 2020 will depend, broadly, on two things: Its ability to keep the coronavirus out of its workplaces; and its ability to limit spread if the virus gets in.
Or, as the NBA document puts it: The goal is to “reduce exposure to, and transmission of, the coronavirus.”
Part 1, in turn, depends on three things:
Distancing and safety protocols
Human adherence to those protocols
The virus’ presence and spread in surrounding communities
The NBA’s prevention protocols, experts say, could hardly be better. Players and staff members will quarantine in individual hotel rooms for 36-48 hours upon arrival in Orlando, Florida. Disney employees will be entering and leaving the bubble, but will wear masks. And, according to the NBA document, “Disney will implement … physical distancing rules intended to keep Disney cast members [employees] from being in the same room at the same time as a player or team staff member unless required.”
Human adherence, however, is what University of Washington epidemiologist Jared Baeten calls the “big variable.” Asking 1,000-plus people to abide by 40,000-plus words of protocols for up to three months without fail is implausible. Experts worry about players venturing outside the bubble, despite an anonymous hotline to report mischief. They worry about guests. And they worry about hotel staffers, who are outside the NBA’s jurisdiction.
Those Disney staffers will return every day to communities increasingly overwhelmed by COVID-19. The virus’ growing presence in Orlando, Bachynski believes, “is going to be the predominant variable.” Orange County reported a record-high 1,051 cases on Thursday, at a percent positive rate of 17.9. Experts find it unlikely the numbers will return to manageable levels anytime soon.
“The downward slope tends to be a lot gentler than the upward slope. In other words, the exponential growth happens a lot faster, and then it takes a lot longer to get back down,” Bachynski explains. “That’s just the nature of the infectious spread.”
It’s easy to believe in the concept of the bubble. But it’s easy to forget the reason for it. The U.S. has failed to suppress the virus. “If you transported everybody to New Zealand, you could just play the game, and stay at whatever hotel,” Baeten points out. “You’d have no restrictions at all.” But in Florida, “there’s a lot of virus pressure on any sheltered community,” Baeten says. “Whether the sheltered community is your family in your house or [the NBA].”
Mitigating COVID-19 spread
Experts familiar with the NBA’s plan say it’s somewhere between “probable” and “inevitable” that the virus will break in. Even the league admits it’s “possible.”
When it does, Part 2 begins – or, rather, has already begun. Spread mitigation depends on four things:
Testing frequency – the ability to detect cases early (and testing expediency – the turnaround time between administration and result)
Distancing and safety protocols
Human adherence to those protocols
Contact tracing – the ability to identify potential exposure to an infected person, and the protocols
Again, the NBA gets high marks. “The commitment to testing is really important,” Baeten says. The NBA will do it every other day, and sometimes daily. It “will seek to collect samples from players, coaches and referees in the evening with the goal of retrieving [the] result by the following morning,” according to the document. It has outlawed everything from inter-team indoor meals to doubles table tennis, two of many restrictions designed to prevent the virus from spreading before it’s been detected.
Once it has been detected, in everyday life, the CDC recommends that all “close contacts” of an infected individual quarantine for 14 days. The NBA won’t do this. Some experts find the lack of isolation problematic. All agree it increases risk. But neither MLB nor MLS will employ it either. Sports leagues can’t, for obvious reasons. Entire teams would be considered “close contacts.” Games couldn’t be played. The NBA’s alternative, to test contacts daily, is the next-best course of action. The league admits: “Testing is not perfect.” But the plan, experts say, has very few avoidable shortcomings.
And yet it is still at the mercy of human behavior. “How long can so many people adhere to so many strictures and guidelines for a period of time?” Schaffner asks. After a month of deprivation and negative tests, with their bodies, at any given time, likely-but-not-definitely COVID-free, will players still maintain a distance in hotel lounges? Will they still wear their masks? Or will they slip, and fall victim to coronavirus fatigue, like so much of American society has?
Free to make their own life choices over the past months, dozens have contracted the virus. Baeten says “health communication” will be crucial. “It seems very unlikely that any of the players are going to read through the 113-page document,” he says.
The NBA has an answer for that, too. Team reps, the document promises, will conduct mandatory “educational sessions” with players and staff to review protocols.
The document covers everything. The plan is brilliantly conceived. That it’s nonetheless so fragile speaks to the inherent perils of playing sports at the epicenter of a pandemic.
What are realistic scenarios?
Major League Baseball released a 100-plus-page manual of its own on Tuesday. Yahoo Sports obtained that document, too. The plan, in many ways, mirrors the NBA’s, with every-other-day testing, but with one major exception: There’s no singular bubble. This, experts say, makes baseball’s project far less safe.
“It’s much more difficult to control when you have so many moving bubbles all around,” Schaffner says.
“That back-and-forth of the families,” says Ron Waldman, an epidemiologist at George Washington University, “is very iffy.”
And Bachynski: “The more bubbles you’re adding in, and the more connections between those bubbles, the bigger the risk.”
College football’s plans, meanwhile, are woefully insufficient. Universities lack resources to match the NBA. The only other league that can is the NFL. It, too, will eventually release its own extensive protocols. Schaffner says it, too, will “rely very heavily on testing.”
Yet it will presumably lean toward the baseball plan, without a bubble. By allowing players to shuttle between team facilities and households, “you’re instantly multiplying all the potential contacts that can introduce [the virus] into the team community,” Baeten says. The NFL has an extra month to hope for a downward-sloping virus curve. But outbreak potential will be substantial.
This is not to say it’s basketball-or-bust for American team sports in 2020. The NWSL could succeed with an eight-team, month-long, bubbled tournament in Utah. Perhaps MLS could as well. But it, like the NBA, is at Disney, with a seemingly less stringent setup, and with kickoff less than two weeks away.
Basketball’s only real disadvantage is it being indoors, where the virus spreads more prolifically. Roster size can be seen either way. There are fewer opportunities for NBA exposure to the virus. But one or two positive tests, while a blip in baseball or football, could have an outsized effect in hoops.
“There is going to be some random chance involved here too,” Bachynski notes. Rampant community spread does not, for example, guarantee that Disney employees contract COVID. “The transmission of this virus is not uniform,” she says.
And finally, there are the mysterious shutdown thresholds. No league has yet specified one. “It is possible that staff, players, or other participants … may test positive or contract the coronavirus,” the NBA acknowledges. “The occurrence of a small or otherwise expected number of COVID-19 cases will not require a decision to suspend or cancel the resumption of the 2019-20 season.” But what would?
How Adam Silver’s risk tolerance compares to Rob Manfred’s and Roger Goodell’s is the last great unknown.
“I’m pretty sure there will be some leakage,” Waldman says of the NBA’s bubble. There will be elsewhere as well. “And there may be players who are infected. And then they’re going to be faced with some decisions.”
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