Same data. Same research. But different conclusions on safety of college football

Josh Peter

Dr. Michael Ackerman, a genetic cardiologist from the Mayo Clinic, knows what launched him from the sidelines into helping to decide whether major college football is played this fall.

A tweet – one that also illustrates the current confusion over whether it's safe to play football and other fall sports.

On Aug. 9, citing a Washington Post article on health experts’ fear that coronavirus could cause lasting heart complications for athletes, Ackerman tweeted, “I have heard some using this article 2 call 4 the cancellation of all university #sports this academic year. NONSENSE! The data cited can not compel that.’’

Nonsense was not the word being used during the meetings of the Big Ten Task Force of Emerging Infectious Diseases, according to Robert Parker, director of McKinley Health Center at the University of Illinois at Urbana-Champaign and a member of the committee.

“There’s no question that in recent weeks the attention increasingly focused on the cardiac effects of a COVID infection and really there’s just a lot of uncertainty there,’’ Parker told USA TODAY Sports. “So given the fact that sports are discretionary and you don’t want to put athletes in harm’s way, I think depending on what conference you’re in and what conversations have been had, I think people are increasing saying, ‘Yeah, we ought to learn more about this before we put people basically into competition.’ “

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On Aug. 11, the Big Ten and the Pac-12 announced its presidents and chancellors voted to cancel fall sports and said the cardiac risks were a factor. On that same day,  Ackerman participated in a Big 12 Conference video conference and a day later joined in a Conference USA meeting and explained why he thinks fears over cardiac risks related to COVID-19 are being overblown.

"From a practical standpoint, I would take the heart out of the equation or at least demote it to ingredient number 10,'' said Ackerman, director of Mayo Clinic’s Windland Smith Rice Sudden Death Genomics Laboratory. "Certainly not one of the top three ingredients that they are stirring around."

The Big 12, SEC and ACC continue to move forward with plans to play football as scheduled.

Dr. Chris Hostler, an infectious disease specialist at Duke, was one of eight medical experts who spoke to USA TODAY Sports about advising the conferences. The fundamental question: How are doctors reviewing the same COVID-19 data and research, and yet coming to different conclusions?

“The old saying for infectious disease doctors is, you can have 10 different infectious disease doctors looking at the same patient and reach 13 different conclusions,’’ said Hostler, co-owner of Infection Control Education for Major Sports, LLC.. “There’s a lot of nuance to what’s going on.’’

'See what they want to see'

Confirmation bias could be at work, said Dr. Jonathan Drezner, Director of University of Washington Medicine Center for Sports Cardiology. COVID-19 has been linked to myocarditis – inflammation of the heart that is potentially fatal to athletes at exertion – and Drezner said there are "well over a dozen cases" of myocarditis in college athletes from the Power Five conferences

“Confirmation bias is a tendency to interpret new evidence as confirmation of one’s existing beliefs,’’ Drezner told USA TODAY Sports via email. “So in this case, if you tend to believe that COVID myocarditis is a big concern, you may err on the side of interpreting limited data as a reason to be cautious.

“On the contrary, if you don’t believe that the risk of COVID myocarditis is high or proven, then you are less likely to interpret limited evidence as a risk. Bottom line, people see what they want to see."

Ackerman said he thinks his tweet downplaying cardiac risks related to COVID-19  “caught the attention of the conferences that had not yet made their decision."

Kyle Bowlsby, who is the son of Big 12 commissioner Bob Bowlsby and operates a sports advisory business, took to Twitter two days after the Big 12 video conference to react to “some claiming these specialists are handpicked to get the answers they want.’’

Big 12 spokesman Bob Burda addressed the issue in an email to USA TODAY Sports.

“As the science around the virus continues to evolve, so does our outreach to medical experts to provide advice and guidance from both campus and independent practitioners,’’ he said. “This includes Dr. Ackerman who was asked, along with many other doctors, to participate in our most recent board of directors video conference.

“Opinions vary regarding the best path forward, as we’ve seen throughout higher education and our society overall. Our board has taken in the data and the expert opinions to formulate our return-to-play protocols and will be engaging with doctors and specialists on an ongoing basis to ensure we have the latest information to help inform our decisions going forward.’’

Another medical expert drawing attention is Cameron Wolfe, an infectious disease doctor at Duke.

Wolfe, who chairs the ACC medical advisory team and also serves as a member of an advisory committee for the Power Five Conferences, told the Sports Business Journal Daily Aug. 11 he thinks college football can be played safely this fall.

“We believe we can mitigate it down to a level that makes everyone safe,” Wolfe said. “Can we safely have two teams meet on the field? I would say yes. Will it be tough? Yes. Will it be expensive and hard and lots of work? For sure. But I do believe you can sufficiently mitigate the risk of bringing COVID onto the football field or into the training room at a level that’s no different than living as a student on campus.”

Wolfe did not reply to interview requests made by email and through one of his colleagues. He has provided no specifics about the ACC’s plan, and among those wondering how the conference will keep its players safe is Robert A. Kloner, professor of medicine at the University of Southern California.

“There’s a lot of unknowns, and because of that, you’re going to have a lot of physicians, smart people, with different opinions,’’ said Kloner, chief science officer of Huntington Medical Research Institute in Pasadena, California. “I think we have to respect everyone’s opinion.

“But we’re still very much on a learning curve with this, and I would tend to the err on the side of safety. I don’t want to see dead football players.’’

Risk assessment

The fear of college football players dying of COVID-19 is rooted in emerging research but so far there are no examples. The coronavirus is responsible for more than 170,000 deaths in America, and the risk of death is slightly higher where Power Five schools are located, according to data analysis conducted by Pooja Naik, a master of public health candidate at Emory University’s Rollins School of Public Health.

In Power Five school counties, the COVID death rate is 12% higher and the number of confirmed COVID-19 cases per capita is 19% higher than the rest of the country, according to the data analysis.

Such numbers are only part of the decision-making process, said Gary Langsdale, who was assistant vice president and university risk officer at Penn State before retiring in 2019.

“There are quantitative numbers that go into it, such as the number of positive tests and the percentage of positivity,’’ said Langsdale, who said he was speaking as a representative of the University Risk Management & Insurance Association and not on behalf of Penn State. “But ultimately it is a qualitative decision about whether you are willing to take a qualitative risk to have something on a large scale as a football game, whether or not there are fans in the stands.

“Risk management looks for people to make informed decisions based on the information they have available because you can’t go into analysis paralysis. You have to make a decision at some point.’’

The final decisions could be coming soon, with the ACC season set to begin the season Sept. 10, the Big 12 scheduled to open Sept. 12 and the SEC to start Sept. 26.

“I think what it really boils down to is what risk are you willing to take?’’ said Boris Lushniak, dean of University of Maryland's School of Public Health and a member of the Big Ten’s Task Force on Emerging Infectious Diseases. “And that’s why we have this divergent approach to it.

“The Big Ten says one thing, other conferences are saying other things. It’s all about risk. It’s all about the idea of taking the facts, not necessarily interpreting them differently, because the facts are the facts.’’

But with the novel coronavirus having been identified for only eight months, the facts are changing, said Lushniak, a former deputy and acting U.S. surgeon general who spent 13 years at the Centers for Disease Control and Prevention.

“There’s new things going on all the time,’’ he said. “But part of it is are you willing to take the risk based on the unknowns.’’

Or as Carlos del Rio, the executive associate dean at Emory University’s medical school who has been part of the NCAA’s coronavirus advisory panel, put it, “Just think about the headline in your local newspaper saying, ‘Football coach in ICU, or football coach or athlete or student dies because of COVID outbreak.’ Look at that headline and if you can spin that, if you think that’s OK, then you probably can (play).’’

Political football?

Ackerman is among those who said he noticed decisions being made by the Power Five conferences about playing college football appear to run along political lines.

The Big Ten and Pac-12, comprised predominantly of schools in blue states that typically vote for Democrats, have canceled fall sports. The ACC, Big 12, SEC, comprised largely schools in red states that typically vote for Republicans, are attempting to play this fall.

“Is it coincidence that it’s lining up in the layout?’’ he said.

James Carville, the political strategist and ardent fan of LSU, noted the SEC, ACC and Big 12 are “trying everything they can’’ to play this fall.

“And it’s true, I guess, that college football tends to be more popular in red states,’’ Carville said.

Later, he added, "In the SEC, I’m not sure how much of a role politics is playing in this. I’m pretty sure that most people who play football are Democrats. Given my career in politics and living in Louisiana, I suspect the players and the parents are pretty much Democrats. All of our friends, all of my Democratic friends, everybody hopes they play.’’

It also turns out that Carville, 75, has performed his own football-related risk management calculations. Although he is a regular at LSU home football games, don't count on seeing him at Tiger Stadium this year.

“Honestly,’’ Carville said, “even if they play, given my age and everything, I’d probably watch on TV.”

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