SEC Medical Task Force member ‘cautious’ ahead of the football season
GAINESVILLE, Fla. (WCJB) - The college football is hanging on.
After both the Big Ten and Pac 12 announced their respective decisions to punt on the 2020 season, the SEC, the ACC and the Big 12 stood strong. But why?
Florida team physician, Dr. Jay Clugston is one of 14 health professionals on the SEC’s Return to Activity and Medical Guidance Task Force. Clugston sees a path forward for the football season, however, no one is guaranteeing anything.
It will also not be easy considering all the outside variables they must contend with.
One of the reasons the Big Ten decided to push back the season is because a few of its players developed myocarditis after contracting COVID-19, however, the heart condition is not a new phenomenon to team physicians.
Clugston sat down with TV20 to discuss the challenges and decisions that lay ahead.
Here is the full transcript of the conversation (the full video is attached below):
TV20: How do you even start creating a plan when the situation surrounding a pandemic is so unpredictable? When do you go, ‘this is a no go’ or this ‘is a situation we can handle’? What are the challenges there?
We started planning a return to just training for sports back in March and April. Our SEC medical advisory task force began calls in April, and we were once a week, and then we moved up three times a week as we went along. But we started first learning about the virus and learning about its presence within the community and thinking about how we can bring athletes back to our facilities to train, which isn’t the same as playing a sport but it was a step.
I think June 8 is when the SEC allowed activity to resume. We had our athletes come back on campus, a lot of them before then, and the athletes when through the STP program, “screen, test and protect” - so they all had a PCR nasal swab. They had the results from that back before we allowed them inside our facilities and once we had that and it was negative, they were allowed to be in training.
We had to think about what ways to minimize, to mitigate the risks of getting this infection, so we looked at, ‘who do you live with? Who do you train with. What do you need to do to be successful to start training?’ All of our training was broken up in really small groups of athletes – so if you had four roommates, that was the group you were going to train with; you would not go to the normal weight room for football. We moved all the weights to the practice facility, where it has a roof but we open up a garage door to the side of it...So that small group would come get their temperatures checked and get asked about their symptoms everyday. We had a hand washing station out there, the weights racks and benches have all be wiped out before that group came along. And they went straight from training outside, so they can do some running. When they were done, they would leave, get their pre-packaged nutritious snacks for recovery and fluids and go back to wherever they lived to shower there. We had to plan all of this. They had clean clothing, so the next day they had another set of clean clothes for the next workout .They could drop off their dirty clothes when they came for the next work out. So you had to think about all this. How do you enter the building? How do you exit? How do you keep six foot apart with all these activities. So we started with that.
Over the summer we had athletes come back. We had everyone negative coming on, but they are in town, so I think there was some exposure - people were positive, and we had to isolate them and quarantine their close contacts.
We worked through that and by middle of July, we felt like our system seemed to be working. We saw a decrease of infections in our athletes. As we went a long, we were seeing that on other SEC campuses, we had some experience with the virus, and we thought we had things in place that were helping, so we felt like we could keep going. Our next challenge was how do you go about how to actually play the sport. We knew we could lift weights and run, so what would that look like?
We started to talk about that, started to talk about if we screened and tested more, would that give you more of an assurance that you wouldn’t get an outbreak that you didn’t detect in time to shut it down.
So we talked a lot about testing and what that would look like. We wanted to do that in accordance with what the NCAA was saying at the time and the autonomy five conferences had a medical task force, which some of us in the SEC were also on. Eventually we had to make a decision: do we allow training camps to start? And if you recall the SEC pushed it back, and we pushed back the games to Sept. 26. So then we looked at a calendar and said you can start training camp on Aug. 17 – that was pushed back two or even three weeks for some schools from when they were going to start. It gave us a little more time to see how things are going...it allows you to spread your practices. We felt it was important not to add additional practices to the players. So by the NCAA rules in the past, you were allowed 25 practices before the first game. The NCAA said we could change that but we all felt strongly that we didn’t want to add more practices to our players, so we kept it at 25 and now it’s spread over about 40 days. We felt that was important in case you do get an outbreak; you could shift some practices around and not miss as many practices.
I think everybody in our league is very cautious, but felt like we were okay where we are. No on is guaranteeing we are going to make it a season, or play a full season, but until now things are going safe and we are able to keep progressing.
TV20: Now that the players are moving to position group drills and normal fall camp, the groups can no longer be separated by roommates, plus, students started to arrive back on campus. Is this the big challenge that awaits football? How do you handle that, contact tracing and who to quarantine?
Right there is going to be more and more challenges. We are looking at Aug. 31 when classes start at the University of Florida, and we are going to be really cautious. We don’t know whats going to happen. There are no guarantees. We will continue to go through testing at that time, and we have been having more meetings, since we are getting close to play real, live playing of football.
We have moved our small meeting rooms out of the small rooms down around the locker room area and have moved a lot of that and a lot of the coaches’ offices and their functions up into the champions club area.
The contact tracing piece has been a challenge, but we have gotten a lot of help by our local public health official and infectious disease experts and epidemiologists at UF have really helped us a lot.
No one is guaranteeing a positive is not going to quarantine a lot of people on your team - that’s the reality right now. But we want to find the infections as quickly as possible, so we get people quarantined to decrease the chance of spreading to other people.
To actually play of the sport there are still a lot of things to work through. What is going to be considered a contact? There are a lot of things that are done with people outside and spaced apart and then there are also... the fact is it’s a contact sport, you’re engaging with someone. There are different levels of exposure going on out there. What do they all mean, and what they are going to mean for how long you’re out, and who needs to be quarantined. We are still working through that.
Some people are looking at, ‘hey offensive and defensive line, across the ball, they’re out, it’s got to be close contact, and maybe the people to right and left of you and maybe it’s different for receivers and defensive backs. So there are some drafts out there and proposals.. there is going to be a lot of back and forth.
TV20: How much do you confer with the other conferences and were your surprised by the Big Ten and Pac-12 conferences’ decisions?
We talk every week. I am actually on two different evening calls that includes different trainers and doctors from the five different conferences. Although the conferences have gone in different directions, there is good amount of unity there among the medical people. We all know we are in this together. We are playing, some of them are not. We are not saying we are playing the whole season but we’re still playing now. We feel it’s important to keep talking and things we’re learning, things they’re learning is going to help us all.
I think people can look at different situations and come up with different plans. It may be that we saw the virus in our athletes maybe a little bit sooner..it may have helped us develop a little bit of belief that we at least have gone through this, and something we needed to do that may have helped us feel a little bit more comfortable to continue.
We are very aware of possible cardiac complications and other complications from this virus that has only been with us for eight months. There is a lot we know that we don’t know. We are trying to standardize our cardiac evaluations now, so across the SEC any athlete that has a known infection, even if that could have been several months ago, but if we know they had an infection, when they are ready to return to exertion, we need them to go through several tings before we let them proceed.
They all have to have an evaluation with a physician. They have to have a troponin level test, which is a blood test that can indicate damage to heart muscle - that has to be normal. They get an EKG. They all need electrocardiogram… an ultrasound picture of the heart. They all have to be good before they start to exert again. They go through a ramp up period, which is required for the NCAA, to acclimate from being inactive to going through activity. Then they are monitored. We really have to pay close attention to these athletes when they are coming back, and we have to ask them daily and they have to know to come to us with any symptoms they have.
TV20: Myocarditis is something doctors have seen in athletes after viral infections like the flu, however, there are athletes that are sitting out a year to recover after COVID-19. Did you see this with the flu? Is COVID-19 worse?
The chance of developing myocarditis after COVID does seem to be a little higher than some of our other viruses. We are very cautious, but we are familiar with dealing with myocarditis for as along as we had sports medicine. All of us as team physicians, if you look back at your career you can count a few of these that you have dealt with before we had COVID around.
We were cautious about it after influenza and after more common colds. It is something we look for. At Florida, we do an EKG and an echo on every athlete that comes to us, so we have that on record already. So if someone gets COVID, and we repeat this cardiac workup, we are able to compare back to what they were when they came in as a freshman or transfer here. So we have a pretty good idea if there were any changes. There does seem to be more cases or cardiac affects from this virus than maybe we have seen form others, although, we are looking a lot more closely than we have in the past. I think all of us are cautious about it,
I am cautious about it because it’s not just athletes that are getting this. I work on campus and I take care of students..50,000 people and a lot of people are going to get coronavirus.
If there is a risk of myocarditis in athletes, there is a risk of mycardisitis in our students. And our students are active and they want to get back to exercising. I think it’s a big issue and we have to follow closely, so we can give advice to all of our patients on when it is safe to return to exercise after this infection.
TV20: The last week we have had a few testing development including FDA pushing a EUA on the Saliva Direct test - the COVID-19 test funded by the NBA and Yale. Are these the developments you guys were hoping for when you pushed for the delay? Since this is an every changing situaiton.
The latest announcement with saliva is helpful. It’s still a PCR test but that one can be quicker and less costly. Our current plan in the SEC is to test our highest contact risk sports three times a week when you are in competition. We feel like that will allow us to get a good look at what level of infections that are present. It will allow us to pick things up and remove athletes that have been exposed quickly. Testing is part of the process that is going to help us to be as safe as possible.
We are looking at two PCR tests and a rapid diagnostic test. PCR tests could probably be six and three days out from the competition in football for example. The test may be a day before we would be a rapid diagnostic test.
TV20: How hopeful are you for the season?
I don’t want to use hopeful. I don’t want to be negative either but I want to be cautious. We don’t know whats going to happen when we get more students back n Gainesville. We feel like the way we train, and we practice, and the education we have given our athletes and staff has been good and has been working. But there are other variables we are going to encounter here soon. I would say it’s possible that we get through the season.
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