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Conference commissioners dabble in epidemiology while navigating NCAA coronavirus testing procedures

Josh Fenton, Jennifer Flowers and Erin Lind are busy figuring out how they'll get back on the ice, court and fields during the ongoing COVID-19 pandemic.

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NCHC commissioner Josh Fenton. File / News Tribune
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Josh Fenton is commissioner of an NCAA Division I men’s hockey league, the National Collegiate Hockey Conference. He has degrees in finance and sport studies, not biology or chemistry, let alone infectious diseases.

Yet here he was on a Wednesday afternoon in August breaking down the pros and cons of polymerase chain reaction (PCR) testing and antigen testing in detecting COVID-19.

Welcome to the life of a college sports administrator in 2020.

“I’m talking about things that I didn’t think I’d maybe ever talk about in my life,” Fenton said. “I stayed at a Holiday Inn Express last night and I became an epidemiologist.”

College administrators are often forced to wear a number of hats, but this offseason, a new and unexpected cap landed on everyone’s head as conference commissioners saw the role of epidemiologist — a person who deals with the incidence, distribution and control of disease in a population — added to their resumes.

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Working alongside athletic trainers, team doctors and other medical personnel throughout the league, as well as local, state and national health officials, the biggest question league leaders are facing during this pandemic is not when they can start playing games, but how?

The NCAA laid out guidelines to play in 2020-21 this month — on top of local, state and federal guidelines — but as WCHA women’s commissioner Jennifer Flowers has seen, there is still a lot that is out of administrators’ control.

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WCHA women's commissioner Jennifer Flowers. File / WCHA photo courtesy of Bryan Singer

“The layers to every decision are incredibly deep and I think people need to be really cognizant and aware that it isn't just, ‘Do we want to play, yes or no?’” Flowers said. “Because the answer is ‘yes,’ everybody wants to play, no doubt about it. The question is, ‘Can we, and can we do it in a safe and healthy way for everyone?’ That’s the challenge right now.”

Meeting a standard

On Aug. 5, the NCAA Sports Science Institute issued a revised “Resocialization of Collegiate Sport: Developing Standards for Practice and Competition” report to provide a framework for how all NCAA schools and conferences would conduct a season in the midst of a pandemic that continues to average over 50,000 new cases each day in the United States .

The report pushes the use of face coverings and social distancing (6 feet) whenever necessary, as well as limiting training to outdoor areas to limit the spread of the coronavirus.

It also includes detailed competition guidelines, testing requirements, isolation procedures and facts and figures concerning those who may be at high risk for suffering complications due to COVID-19 — such as athletes with body mass indexes over 30, like football linemen.

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Erin Lind, commissioner of the multi-sport Division II Northern Sun Intercollegiate Conference, said the NCAA SSI report issued earlier this month provided a lot of clarity for college sports leagues, while also presenting a big hurdle as well.

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NSIC commissioner Erin Lind. NSIC photo

“There's a lot of things in the document that are achievable, that talk about masking both ways, that talk about social distancing and hygiene practices, and all the things I think we're all aware of and that we need our student-athletes to know that this is what needs to happen,” Lind said. “A good majority of the requirements in the SSI document, they can be reached. I think some of the challenges of that will be the testing elements.”

The NCAA’s testing requirements vary depending on the time of the year and by sport. Each NCAA-sponsored sport was lumped into one of three categories — low-, medium- and high-contact risk.

For low-risk sports (which includes golf and tennis) or medium-risk sports (like baseball, softball and cross country), the NCAA requires surveillance testing of 25-50% of student-athletes and all “inner-bubble” personnel such as coaches, medical staff, officials and other essential personnel who are at high risk of exposure during the season. Anyone who is symptomatic or may have been exposed to the virus would also need to be tested.

For high-risk sports such as football, volleyball, soccer, basketball and hockey, the NCAA is requiring weekly testing of all student-athletes and inner-bubble personnel during the season. Testing must be conducted within 72 hours of competition and if it can not be completed within 72 hours, then the competition must be postponed or canceled.

“I would say that in certain places of the country, it's a challenge,” Fenton said of getting results back during the 72-hour window. “Yeah, in other places in the country, they seemingly have been able to turn around those tests fairly quickly. So I think it depends on who you're talking to and where they are and what their experiences are in the country.”

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Solving the testing problem

The NCAA SSI is requiring schools use the PCR test, which is a nasal cavity swab that is considered the “gold standard” when it comes to testing for COVID-19 because it has a very high sensitivity and specificity.

PCR testing is a well-developed technology that has been around for decades to detect bacteria or viruses when someone has an infection, said Dr. Rajesh Prabhu, an infectious disease physician at Essentia Health in Duluth.

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Essentia Health infectious disease specialist Dr. Rajesh Prabhu speaks during a press conference at Duluth City Hall on the COVID-19 pandemic. File / News Tribune

Prabhu said the time necessary to process those results varies, however, depending on a variety of factors such as the vendor and volume of tests needing to be processed at any given time. Nursing homes and hospitals will always receive priority over someone in their 20s with no symptoms, he said.

“It all depends on how many people send tests,” Prabhu said. “If everyone decides that we're going to test every person in school, your turnaround time is going to go from two days to seven days, if not longer.

“There’s some schools — not sports — like, ‘We’re going to test every student before they come onto campus,’ or they’re going to test them with a certain amount of frequency. At this point, we’re just not there with the infrastructure to support that.”

The NCAA SSI report said alternative testing strategies may be considered in the future should PCR testing be compromised or technology evolve.

One of those strategies cited by the NCAA SSI involves the use of antigen testing, which has an extremely quick turnaround. Prabhu said he’s aware of two major vendors that can process test results in 15 minutes.

The downside to antigen testing is reliability when it comes to detecting COVID-19. The NCAA SSI report cited a 70-90% success rate, while Prabhu said he’s seeing antigen testing that can detect anywhere from 80-96% of cases.

The equipment and supplies for antigen testing for COVID-19 are also not as readily available. Prabhu said it’s hard to say the technology will be ready anytime soon for college sports.

“It doesn't seem like it's realistic in the next several months,” Prabhu said. “I mean, they haven't even rolled it out to health care systems for nursing homes — which is the priority group — or doctor's offices.”

University of Minnesota Duluth Athletic Director Josh Berlo said his athletic department believes it has "a strong and sound plan to meet or exceed" NCAA protocols, as well as those of state and national health agencies. However, Berlo added that plan is subject to surges in demand and supply constraints.

Fenton said he is holding out hope that testing methods continue to evolve and improve. A diversity of testing methods beyond just PCR testing would help everyone in college athletics navigate the pandemic.

“People understand that they want to do this in the safest and most responsible manner, and part of that is testing,” Fenton said. “But if the requirement is a PCR test and the PCR test can't be turned around or we don't have the supplies to take the PCR tests, then those tests are essentially useless. It's very much in discussion, not only in our conference, just across the country. What does testing look like now and what will it look like in the future when we're ready to be at that point of needing to do it more regularly?”

Buying time

It was no coincidence that shortly after the revised NCAA SSI report was issued, the 2020 fall sports season came crashing down. The Division II and III fall sports championships were canceled within hours.

The Big Ten became the first “Power 5” conference to cancel its fall sports season and the Pac-12 followed shortly after with a suspension of all athletics until Jan. 1.

Citing the requirements put forth by the NCAA and cancellation of the fall championships, the NSIC has also suspended all athletic competition until Jan. 1 while leaving the door open for fall sports to compete in the spring.

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Malosky Stadium is seen behind fencing on the University of Minnesota Duluth campus Wednesday, July 1, 2020. (Tyler Schank / tschank@duluthnews.com)

Neither the WCHA nor NCHC — technically winter sports, but they are scheduled to drop the puck in late September (women) and early October (men) — have made any decisions on the start of their seasons yet, though Flowers said with no fall sports happening in September and October, it doesn’t seem feasible for hockey to be playing then either.

With a season that spans seven-plus months from the start of practice to the national championship game, a potential delay to 2020-21 won’t hurt their sport as much as others, Flowers said.

“My hope is that if we're able to buy ourselves a little bit of time, that maybe some of those things will continue to advance and we'll find ourselves in a different place,” Flowers said.

Fenton said the NCHC is also discussing whether Oct. 3 is a realistic or feasible start, but in his decision-making processes, he continues to go back to March when, “We ripped away arguably the most important part of a season for a group of student-athletes,” with the cancellation of the NCHC postseason and NCAA tournaments.

Five months later — with spring and fall 2020 championships now wiped out — college administrators once again find themselves addressing the fate of winter sports. Fenton said he doesn’t want to go out there and recklessly play games just to play games, but he also doesn’t want student-athletes to relive their negative experience from March either.

“The experiences of our student-athletes playing college hockey are vitally important to them,” Fenton said. “They're vitally important to us and we want to do everything in our power to ensure they have those experiences. We will not rest until we can provide them as such. If at the end of the day or the time, whatever that is — and I can't tell you when that is — we deem it to be unsafe and not responsible to compete in hockey, then I guess that decision would have to be made. But we're very far from that time because we're keenly focused on trying to provide an experience that can be a safe and responsible one for the student-athletes because I know that's what they want.”

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The ice sheet at Amsoil Arena has been removed for the season as seen on Wednesday, March 18, 2020. (Clint Austin / caustin@duluthnews.com)

Co-host of the Bulldog Insider Podcast and college hockey reporter for the Duluth News Tribune and The Rink Live covering the Minnesota Duluth men's and women's hockey programs.
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