Management of the COVID Journey

I wrapped up the fifty-ninth (59th) testing session for our men’s basketball program at Butler University.  This was our fifth consecutive test day since the student-athletes returned back to campus from a 72 hour break in activities.

I began testing in June with once per week saliva collections to now with daily, sometimes twice per day, PCR nasal swab point of care, rapid result tests. 

Outside of our inner circle of Team Physician and my athletic training colleagues, the entire process is looked upon in a manner of inquisitiveness.  Like a passionate mystery novel reader awaiting their next page, those outside the immediate process are intrigued by the detail, decisions and journey.  So…here we go with some insights on the journey to compete in collegiate basketball.

The Testing Process

The pace of testing and the type of tests process utilized was a collaborative decision of the Big East Conference COVID-19 Task Force.  The Task Force had representation from student-athletes to leading experts in epidemiology.  The strong voice, as it should be, were those of our Team Physicians. They drove the discernment of the NCAA recommendations and best practices to mitigate the spread of the virus while considering logistics and resources per institution.  The Big East landed upon a three day per week, non-consecutive days consisting of at least two (2) PCR and once (1) antigen type test.  Institutions have their own flexibility to exceed those minimum standards.

Butler Athletics was able to gain approval of our application to become a CLIA laboratory for the purpose of doing our own testing.  This was a huge step and did not occur until early November.  Currently myself and our licensed athletic trainers do all of the testing and reporting of student-athlete testing.  This has added an additional four (4) hours to each day over pre-COVID routines.

The Reporting Process

Each test requires a confidential report completed and faxed to the Indiana State Board of Health, negatives and positive results alike. 

The Big East has an Attestation form that is used by both competition institutions to complete and share with each other to validate the student-athletes and personnel who have been tested.

Positive Result Plan of Action

Institutions set their plan of action based upon approved process from their respective University.  The University has to consider the mandates and recommendations of the CDC, respective State Board of Health, the NCAA and the local public health jurisdiction.  Items of variance across the country include:

·       length of quarantine

·       activity during quarantine

·       testing during quarantine

·       location of isolation

·       activity during isolation

There is much discussion on activity during quarantine as well as a common question of activity during isolation.  It has become standard practice recently to allow student-athletes to have a daily opportunity to leave their quarantine room for physical activity and mental health.  Each institution by my anecdotal review has some variance of length and type of physical activity.

Isolated student-athletes have no allowance for physical activity.  The medical stance is that much is unknown about the impact of the virus and to allow physical activity during isolation is not reasonable.

Return to Competition

Each student-athlete with COVID-19 must have a medical consultation prior to return to sport.  This consultation can include a cardiology workup, blood panels and a specific systemic evaluation.

I made a statement to my staff and in print back in early April, 2020 that this virus will demand us to work to our highest level of our credentials and intelligence.  I often think of this statement when making policy on items such as return to competition post-isolation and post-quarantine.  There are two (2) significant pathways converging to challenge the best of minds. 

1.        Determining the physical progression of an 18-22 yo from zero physical activity for ten (10) days of isolation and or quarantine back to a status of mental and physical readiness

2.       Provide a timetable that can be utilized to communicate the availability of the team to be fit for competition.

This has been and continues to be an incredible journey.  The respect I have for the Public Health community is enormous.  The pure joy I have for being part of the daily solution for my employer and student-athletes is real.