Virus Outbreak Surgeon General

Microbiologist Xiugen Zhang runs a Polymerase Chain Reaction (PCR) test at the Connecticut State Public Health Laboratory, Monday, March 2, 2020, in Rocky Hill, Conn. The Connecticut Department of Public Health has received federal approval from the Centers for Disease Control and Prevention and the Food and Drug Administration to run diagnostic testing for the coronavirus at the department's lab in Rocky Hill. (AP Photo/Jessica Hill) ORG XMIT: CTJH107

Greg Burke has been monitoring the speed of his athletic department's coronavirus tests. The Northwestern State athletic director knows that, as of now, a sample can make the one-mile trip from campus to the Natchitoches Regional Medical Center and produce a result in one-to-two days max.

He's been keeping an eye on the costs, too. The department hasn't paid for any tests. For now, the hospital has willingly absorbed whatever isn't covered by an athlete's insurance.

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Burke knows both scenarios aren't sustainable. If coronavirus cases continue to surge, return times will slow. Once fall sports begin, Northwestern State athletes must test weekly to safely compete, and it's unlikely insurance companies and hospitals will be as generous with the additional costs.

Louisiana's athletic directors join Burke in answering perhaps the two most important logistical questions for playing fall sports in the face of the coronavirus pandemic: Can I get test results back in time to meet weekly testing requirements? and Can I afford them?

These are the driving factors within safety guidelines the NCAA released last week — especially in Louisiana, where there are recent shortages in coronavirus test supplies and 11 Division I athletic programs that are already experiencing substantial revenue losses because of COVID-19.

The Southwestern Athletic Conference announced Monday it was postponing all of its sports until the spring, and commissioner Charles McClelland said testing cost was a major reason within the decision.

"There were some (members) that were clearly going to have to come up with additional resources for testing," McClelland said. "It was going to be a strain on their overall budget. I do think we had institutions that had major concerns about the cost of testing."

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Polymerase chain reaction (PCR) tests, the NCAA's preferred test, costs on average $100 to $110. Take a football team like Northwestern State's: It would cost almost $8,000 a week to test the 71 players on its 2020 roster.

"Multiply that by 16 weeks," Burke said. "I mean, that's a chunk of money for somebody like us. And I think it is for a lot of schools at the FCS level, to be honest."

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Then the other fall sports are added to the equation: cross country, soccer, volleyball. Their players. Their coaches. Their staff members.

The most wealthy schools, like LSU, will be able to absorb the testing costs. But athletic directors across the state agree that it can still be impractical for fall sports to proceed if coronavirus cases continue at peak numbers.

The NCAA advised schools to test players and receive results within 72 hours of competition — a guideline all football conferences are expected to adopt. Burke has heard of tests in Natchitoches taking as long as four days, and if a player doesn't receive their test in time, they would be ineligible to play.

Louisiana Tech athletic director Tommy McClelland said tests were returning quickly when players first returned to campus on June 8; but, after a post-Fourth of July surge in Lincoln Parish's coronavirus cases, test results were taking as long as five-to-eight days to complete.

Imagine a scenario in which a football team's starting quarterback hasn't received his test results by kickoff. Or the defensive line. Or the kicker.

"That's something I know is on all of our minds," UL athletic director Bryan Maggard said, "and we're working very hard, even as of now, to line that up so we meet that requirement."

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McClelland said his department is "hedging our bets" with multiple options to avoid a logjam of testing. Louisiana Tech can send tests to three places for processing: the Louisiana Medical Center; the Green Clinic, a general practitioner in Ruston; and a private testing company that's run by an alumnus.

Shelly Mullenix, LSU's director of wellness and a senior associate athletic director, said the Tigers athletic department has done the same. The team's PCR tests are being sent to Our Lady of the Lake's labs and have recently been returned in 48-72 hours. In the case of surges, LSU can send tests through drive-thru labs in the region.

Mullenix, who has led the department in its COVID-19 protocols, said the SEC is considering using a company that will process the league's tests in a more unified approach.

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Even if schools can find alternative routes, surges have the capability of shutting down athletics. The NCAA guidelines also say that if local public health officials say that there is an inability for the hospital infrastructure to accommodate a surge in hospitalizations related to COVID-19, schools should consider pausing or discontinuing athletic activities.

Our Lady of the Lake was down to a single available intensive care bed last week, and, on Saturday, a military strike team was deploying to Baton Rouge to assist the region as Louisiana surpassed 100,000 virus infections.

The Louisiana Department of Health reported Friday there were only 26 ICU beds available in Region 4, where UL is located. The Sun Belt Conference announced Thursday it will delay competition until Sept. 3 — a move that mirrors the Southeastern Conference's decision to suspend play through August.

It's likely delays will continue if public health trends do not improve. 

"That's a scenario that can happen," UL's Maggard said. "It could be something like that, that either prevents a season from happening or curtails it during the season. I think that's a reality everybody has to be prepared for."

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And even if coronavirus cases are moderately high, Burke said at some point there's a moral issue: Asymptomatic athletes getting routine tests are adding to the total, and labs have to choose which patients get their test results back first.

"So you're going to test a 20-year-old, asymptomatic player to make sure he can play," Burke said. "In the meantime, here's a 70-year-old who really needs to have a test, because they're high risk. What's more important? When you get right down to basic human rights, what's more important? Finding out if that 20-year-old can run out on the field, or finding out if that 70-year-old, if there's anything about that test that would maybe necessitate additional treatment that they need to get sooner than later?

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Two weeks ago, LDH issued prioritization guidelines to health providers on who to test first when testing capacity is limited. Top priority patients include: symptomatic, hospitalized patients; symptomatic patients who have underlying chronic health conditions; symptomatic patients over the age of 65; and symptomatic patients who are immunosuppressed.

The guidelines aren't mandates, and there are no LDH prioritization guidelines on which tests should be processed first once the samples reach the lab. So, an athletic program can still attempt to quickly receive test results by accessing its variety of health care options.

"I don't think it's an issue of prioritization," Maggard said. "It's an issue of accommodation. We're just trying to accommodate requirements that are placed upon us to compete."

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The NCAA appears to be attempting to mitigate this potential issue. The governing body, according to Stadium, is advising schools that after a player tests positive for the virus, they won't have to test again for the next three months unless they show symptoms.

The reported advisement has received criticism. It is still medically uncertain whether people can contract coronavirus twice, but the NCAA's guidance does not account for an asymptomatic recurrence.

As smaller athletic departments scrape up the cash to pay for the weekly testing of its athletes, there are still concerns that asymptomatic cases will slip through the cracks. Teams are attempting to contain their players through stringent safety restrictions, but no team can prevent a player from somehow being exposed in the public.

The Centers for Disease Control and Prevention advises those with high-risk exposure to people who have tested positive to spend 14 days in quarantine. It's possible that a player unknowingly contracts the virus, which lies dormant until after the player is tested before their competition.

"Nobody can guarantee 100% that over the next 72 hours, somehow, someway, that a student-athlete doesn't become exposed," Burke said. "Now they're running out on the field on Saturday, and you think they're negative."

Yet, Maggard said, these are the safety measures that have been set in place to proceed as safely as possible. UL has made provisions to pay for all of its tests, Maggard said, because "the alternative would be much more costly."

"Everything is about mitigating risk," Maggard said. "But I don't know if you'll ever mitigate 100% of the risk."

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Email Brooks Kubena at bkubena@theadvocate.com.