Is it time for Notre Dame football to revise its COVID-19 testing strategy?

Eric Hansen
South Bend Tribune

SOUTH BEND — The wiggle room for a second COVID-19 surprise for the Notre Dame football program essentially got swallowed up by the first one.

Stuck on pause Thursday for the third day in a row for all football-related activities beyond Zoom meetings and now idle on Saturdays until their Oct. 10 primetime matchup with Florida State, the seventh-ranked Irish (2-0, 1-0 ACC) have one open scheduling window left through the balance of the 2020 season.

And on that particular Saturday — Nov. 21 — 12 of the other 14 ACC teams already have games. The other two, Syracuse and Louisville, play each other on Friday night of that week.

Which makes ND’s next steps off the field even more critical than the next ones on it, once practice resumes.

As of Monday Notre Dame had 13 players in isolation and 10 in quarantine, with the results of Wednesday’s testing still not available for public consumption. This after only one notable previous hiccup of positives since Irish players returned to campus in mid-June to begin conditioning for the 2020 season.

The greatest ally toward an uninterrupted finish for Notre Dame — and the rest of college football, for that matter — remains scientific advancements and the school’s willingness and ability to adapt its COVID-19 protocols and strategy to reflect those. So far it has.

Twenty-one cancellations/postponements of games since Aug. 26 — including Saturday’s ND-Wake Forest game being recast to Dec. 12 — suggests the 76 FBS teams that plunged into fall football first could use a refreshed template.

And that may just be provided by two of the FBS leagues that initially rejected the concept of playing fall football in a pandemic, the Big Ten and Pac-12. In fact, there are those in the medical and sports fields who see it as a silver bullet of sorts.

If the theory pitched to the Pac-12 presidents, that ultimately coaxed them to reverse field on their original punt to spring, morphs into reality, the daily, rapid-response COVID-19 antigen testing would essentially eliminate any risk of transmission of the virus during a practice or a game. As in 100 percent reduction in that risk.

That’s not to say a player couldn’t become infected in class, at home, getting groceries, etc. But the spread would be reduced, as would the need to quarantine players in close contact that have necessitated so much of the schedule chaos to date.

Notre Dame tests its entire roster at least three times a week, a mix of rapid antigen tests and the slower PCR tests. It would have administered a fourth round — a rapid antigen test — before the team boarded the plane Friday to Winston-Salem, N.C.

Irish head coach Brian Kelly said last week that the team’s high-contact position groups, offensive and defensive linemen, already get tested every day.

Even with mostly success up until the past week and a campus with a staggering command of its infection rate in recent weeks, Notre Dame is at a pivotal crossroads heading into its virus-induced double bye.

St. Joseph County deputy health officer Dr. Mark Fox has been a consultant to Notre Dame and its football program throughout the pandemic. The following is a Q-and-A with Dr. Fox on the COVID-related issues facing ND and the possible solutions.

Q Just curious and moving way into the future, are we going to be having these kinds of conversations in the 2021 football season? Or will science have made these questions and conversations irrelevant?

Dr. Mark Fox: “That’s a really interesting question. I totally expect there to be an October surprise announcement about a COVID vaccine sometime between now and election day. But I don’t expect there will be a safe/effective vaccine widely available for distribution to kind of the general public and college students and everything until probably close to summer time next year.

“So I say all that because as we look at college football season next year, there probably will be some lingering effects. Hopefully, not as dramatic or pronounced as what we have this year. But I don’t think that come next summer and the beginning of next academic year things will be back yet to ‘2019’ normal.”

Q The Pac-12 is announcing it’s jumping back into the fall football game. And that league’s schools are pinning their hopes of a smooth season on their partnership with Quidel Corp., which has the point-of-care, rapid testing. They have a contract with them. They plan to test every day. They say they can get results within 15 minutes. Do you feel like this kind of testing could change the game in terms of all universities if they’re able to access this kind of test in large scale at some point this year?

Fox: “I think at some level it does increase the safety of all sorts of interactions. The safest thing to do is do what the NBA has done, and create a bubble and really reduce the risk of any exposures.

“Of note, Notre Dame uses that same Quidel testing for their testing site on campus for students who are ill, students who are symptomatic. So I don’t want to get too geeky on this. But for people who don’t have symptoms, there is some risk of false positives. And you may end up with more people in isolation than there should be. The benefits seem to outweigh that risk.

“The benefit of testing every day is to get people out of circulation and reduce the number of people that they’re exposing to the virus.”

Q Presymptomatic people with the virus may not have enough viral load in the first few days of the incubation period to trip a positive test. But Quidel argues that those people wouldn’t have enough viral load at that point to be contagious, either. So they wouldn’t be a transmission threat in practices or games. Is that sound science?

Fox: “The thinking is the rapid test may miss some of the low levels of virus, but that they’re such low levels that they aren’t contagious. That’s a reasonable approach. That is an accurate statement and certainly one that has emerged over the last 6-8 weeks as kind of a more prominent way of thinking, especially in congregate living environments on college campuses and such.

“That means we should be focusing on who’s contagious, and that requires a higher viral load. And the rapid antigen tests are more likely to reflect that.”

Q Would you expect at some point this season Notre Dame specifically, and maybe the ACC as a whole, to shift to the daily testing model? Or is there not enough availability of these tests to be able to do that in the near future?.

Fox: “It’s funny, because I asked (team physician) Matt Leiszler and (athletic director) Jack Swarbrick kind of the same thing and whether they expected pressure from the ACC to adopt this daily testing strategy in light of the Big Ten and the Pac-12 doing so.

“And they kind of hemmed and hawed. I kind of got the sense that they’re not getting that kind of pressure now. We’ve had discussions with Notre Dame about whether their testing protocols should change in light of the current cases.

“And, in fact, we talked about whether we should do rapid antigen testing on everyone daily here for a while and decided that at least for now — with practices and games on pause — that it really doesn’t offer a particular benefit.

“If Notre Dame was contemplating going back to practice or to games, there may be a role for that. But given that they’re kind of on pause, at least for the time being, I don’t feel like it adds anything. And I’m not overly worried about in-game transmission.

“I still think Notre Dame has a sound testing strategy. But they’re still working through contact tracing on the current infection, trying to identify how it started, where it came from. They did really well through the summer and something has changed in the last 10 days to two weeks.

“They are looking at every aspect of players’ lives to see what has changed.”

Q But given that ND has such little margin for error in its scheduling now, wouldn’t daily testing make sense as a safeguard?

Fox: “I think if we’re not able to find a likely source of exposure in this current cluster of cases, then that may make it more reasonable to be more aggressive in testing. If we find the likely common exposure, then I still think kind of adapting the current behaviors and the strategies is reasonable.

“I feel like the fundamental testing strategy is fine if we identify the likely source of exposure. We just may not be able to.”

Q When you look at what might have changed from the summer routine, how closely do you look at the fact family and friends of the players are now coming into town, often on flights, and then mixing with the players after the home games, on Saturdays and Sundays?

Fox: “Certainly family and friends visiting is a change. The team having meals together — Friday dinner together, Saturday breakfast together — those are things that they hadn’t been doing and now are. What I tried to point out to the ND folks is that from around the time of the Duke game (Sept. 12) and moving forward, something has changed.

“So gathering at the hotel, having team meals inside together has been a change. I don’t know what kind of social gatherings there have been with families — or parties — may have happened after a win against Duke or whatnot. They’re really trying to dissect all of those aspects to try to figure out what the source of exposure is.

“When you look at the stadium, the only people from outside of Northern Indiana are the visiting team, who we know have all been tested, the visiting team’s guests and the guests of Notre Dame’s coaches and players. It’s my understanding that the contract tracing efforts have asked all the players if any of their family members have been sick or developed symptoms or have been tested. So they’re really trying to turn over every stone to figure this out.

“So they are really asking a bazillion questions trying to figure out all the different variables that may have changed over time.”

Q Does Notre Dame have to get to the bottom of the contact tracing before the Irish resume practicing?

Fox: “Not necessarily. It certainly would be kind of reassuring if they could say, ‘Oh, so-and-so’s family member tested positive two days after the Duke game and he rooms with this person and they’re in team meetings with these people.’ It would be nice to parse that out.

“But no, I think it will be more about what subsequent rounds of testing show. If increasing numbers of players continue to test positive, that will be more of a determining factor about a likely return to practice than necessarily having an answer to the contact tracing questions.

“I would be surprised if they commit to any practice schedule until they have a handle on the Wednesday testing numbers and can assess what that means.”

A COVID-19 outbreak has Notre Dame’s 2020 football season at a standstill.
St. Joseph County deputy health officer Mark Fox has been a consultant for Notre Dame and its football program regarding COVID-19 decisions throughout the pandemic.