Article from The Athletic:
A member of the medical task force charged with advising the SEC on the safety of a 2020 fall football season is unaware of any conference football players who have developed myocarditis as a result of COVID-19, and she believes the conference’s team doctors are prepared to handle the heart condition if it arises.
“We always look for it after viral infections,” Dr. Catherine O’Neal told The Athletic on Friday afternoon. “We are always attuned to the fact that that can happen so this is not surprising to us. We’re ready. We’re prepared to look for myocarditis and feel comfortable in the knowledge of what happens to somebody who does get it and what we need to do. There is some really good evidence in sports medicine behind how to recover from myocarditis as an athlete. Our plans reflect that.”
O’Neal, an infectious diseases expert and assistant professor at LSU’s Health Sciences Center, is one of 14 doctors and healthcare professionals on what is officially called the SEC’s “Return to Activity and Medical Guidance Task Force.”
This week saw the Big Ten and Pac-12 cancel their fall seasons while the SEC, ACC and Big 12 have decided to forge ahead, leading to questions over what medical advice each conference is receiving. O’Neal believes that the difference in approaches at the moment may have to do with how long different regions of the country have had to deal with the virus.
“I would say we have seen enough to develop a safe plan. They have not,” she said. “Our plan was earlier. Our plan was based on an experience that they had not had yet. And we implemented that plan faster than they did for that reason, so we could prepare for this. So we feel confident in our plan. I think our football teams can absolutely get through this, I think our athletic departments can absolutely get through this. I worry about our community and outside forces that we can’t control.”
SEC teams are scheduled to start fall practice next week. Conference officials have stressed the league has not made a final decision on playing, but O’Neal also made it clear that the SEC sees a potential path from here to Sept. 26, when the conference is set to begin the season.
O’Neal discussed all that in detail, along with issues surrounding mental health, triggers that could stop the season and what will stop the potential domino effect of contact tracing — it’s not masks, by the way — and more below:
Will it take a trigger to start the season or will it take a trigger to stop the season?
The first thing is, I’m not comfortable with a pandemic. There is nothing that makes me feel comfortable about what we have ahead us for the next couple of years, but when I think about this pandemic, I do think about it over the next couple of years, and when you put it in that kind of perspective, I think that you have to start to think about the things we do in life and what makes them safe and what things cannot be safe and how to proceed. That’s been the charge that the commissioner has given all of us about playing football. Can we proceed? And, if we can, how do we do it as safely as possible? I think there are triggers to stop and start and those are triggers that have been laid out by the CDC and are laid out in our plan. Those are some of the first things we put down on paper. How do you define what is just a no-go? When is it unsafe? And what is safe? How do you distance people? How do you mask appropriately? How do you teach them safe tactics just to get through life. And football, in so many respects, is no different than our day-to-day activities as we came out of our stay-at-home orders and starting going back to our normal environments. We have to teach our athletes and our student body how to be safe. That’s how we start. We start safely. When do we stop? We stop when we realize that people can’t do it. That they can’t follow safe instructions, that either there is something we didn’t prepare for or something that happens such as rules that become unmanageable, such as masks fall apart and then we know that we can’t continue. Our stops and starts are based on CDC guidance.
Have you seen the data the Big Ten and Pac-12 used in their decision-making process beyond what has been released publicly by those leagues?
No, I haven’t seen any data from their conferences. I don’t know if they have coalesced data or not. We were able to share our experiences and our plans along the way to the different conferences. It has really been a very open forum through the summer with them but how they came to this decision and how we came to ours, we have been at very different time points than them because we saw cases earlier than them in our region. Our group started meeting earlier than their group started meeting so when we did come together, there was definitely a discrepancy in preparation and most of that not because they weren’t prepared but because this disease has occurred later in their conferences than it did in ours. We had an earlier jump on the cases so that necessitated an earlier plan for us.
Are you surprised that conferences at the moment have landed on two very different decisions or does that seem natural because of the nature of a novel virus?
I am not surprised. You could take the same thing between parts of Louisiana and make the same comparisons. When you are in an area that has not seen a lot of activity, you have a very different perspective on what is ahead the next couple of months than when you are in an area that has seen your hospitals overwhelmed and your population really be gripped by this. Lessons learned come a lot faster during difficult times. Our regions now have banked a ton of lessons learned. Our athletes and their families have banked a ton of lessons learned. That is not the case for people who have not seen the virus so they are beginning that process now, and that’s nobody’s fault. That’s a pandemic.
How big a concern is myocarditis? How many cases has the league had that you know of?
I don’t know of any cases. The league has not put out anything, and I am not aware of a case of myocarditis that has occurred in the SEC. How big of a concern is it? We all agree as a task force that myocarditis is a concern with every viral illness. We have seen myocarditis (prior to the pandemic). We are very familiar with it. It occurs in young people after viral infections. It’s rare but the more kids you see, and our doctors are very experienced, the more likely you are going to see a case of myocarditis in a young person. We always look for it after viral infections. We are always attuned to the fact that that can happen so this is not surprising to us. We’re ready. We’re prepared to look for myocarditis and feel comfortable in the knowledge of what happens to somebody who does get it and what we need to do. There is some really good evidence in sports medicine behind how to recover from myocarditis as an athlete. Our plans reflect that.
Was the task force looking at myocarditis for a long time?
Our task force has a critical care physician on it (Dr. Stevan Whitt, University of Missouri) and also myself as a hospital-based representative, so when we first met we had already seen quite a few very severe hospitalized cases of COVID-19 and knew that it affected multiple organs. At that point, we didn’t know what it would look like in the younger population, but we knew that it was a virus that is above and beyond your worst flu, and we have so much experience with flu affecting things beyond the lungs. We knew we would see neurologic issues and cardiac issues the same way we do with other severe viruses.
Is it fair to say at this point in time that the task force believes that whatever myocarditis associated with COVID-19 is manageable safely?
I think that the myocarditis that will occur in COVID-19 cases is something that the medical field is ready to manage. I don’t think that anybody is prepared to manage outbreaks and large numbers of cases in any population, so our focus is on how to prevent that. If someone does get COVID-19 through any activity and they go on to develop what is a rare but unfortunate complication of a virus, which is myocarditis, yes medicine is prepared to handle those types of complications.
Are there other potential long-range impacts that you are looking for?
No, not long term. Our biggest concern is making sure we don’t push people back to recovery too quickly. And again we see that with severe flu and so our trainers have great plans already. There are some things that make this virus difficult. How to make a good plan to return an athlete safely back from an illness was not a difficult thing for the task force. There are some good plans in place to do that. It’s just making sure that you are watching their cardiopulmonary function really, really closely and that you don’t push them too hard coming back and you’re aware of triggers for further evaluation. I think we have that nailed and as long as we do that we are going to proceed safely.
Is the positive test rate across the conference encouraging or discouraging?
The positive test rate in the community across the conference, we all know they’re very discouraging, and they have been for six months. We have a lot of community activity in the South, and so that makes me concerned about proceeding about opening up campuses and opening up the rest of our economy here. So that’s why we’ve been so cautious with our athletes, and we’ve invested so much in education for them, to protect themselves. We have some really large numbers of case rates in our communities.
How do the numbers across your teams look, and do those numbers make you feel any differently?
We don’t report our numbers as a conference, so I have no concept what the conference rate is. We report numbers according to geographic location and that’s the best way to report numbers, and most of our conference numbers are going down, at most of our schools are going down. Which makes me feel good about starting in the next couple of weeks. But we have to watch it real closely.
South Carolina said it is getting same-day test results. Is the same true of other league schools and how important is the timing of that?
The timing is really important no matter where you are. It helps with contact tracing, it helps with appropriate quarantine. And I think if you had asked me that question again in April we would have had a lot of concerns, about the lag in timing. Our campuses have made really, really great strides in getting quick tests back so our entire campus can come back, and that includes the athletes. So I feel better about that today. I think anything that is a 24-to-48 hour turnaround is exceptional in a pandemic. You start to worry when you get five-to-seven days out, and we haven’t heard those kinds of numbers in awhile now.
Rapid-response testing: Can everyone get same-day results on Friday and, if need be, on Saturday (gameday)? Can you get a test pretty quick and feel good about that test?
In Baton Rouge, we can absolutely. And I feel like (based) on our task force calls, I feel like that is the case on all of our campuses now.
Face coverings: What I’ve been told is that an approved face covering, whether it be a gaiter, a mask, even a face shield on a helmet, would stop the contact tracing domino effect, so to speak. Even if those were players who had contact in a game. Is that accurate? Is that how you all are proceeding right now?
No, we use the CDC’s definition for contact tracing, which is within six feet for greater than 15 minutes. And that’s the definition of a close contact. It doesn’t matter if you have a mask or a shield on.
OK, so the real trigger there is the time, which is 15 uninterrupted minutes.
That is how the CDC reads when you read the definition.
So, if you’ve got guys who are practicing and playing and offensive and defensive linemen who are banging heads for 30 seconds or however long a play lasts, and they go their separate ways between the play, that breaks that contact tracing time?
It does. It’s not 15 minutes of having a close conversation within six feet. That’s right.
Is that the same rule off the field? So if you were in a meeting room, even if you had a mask, if you were within six feet for 15 minutes you still fall under the mandatory quarantine if you came in touch with a positive person?
If you were in a meeting room, and you were within six feet for greater than 15 minutes, you were a close contact.
Obviously the numbers, with some exceptions, have gone down within these quasi-bubbles. With the return of students, how closely can you track the numbers and make sure that you’re continuing to have success?
I think we track the numbers really closely. We have a surveillance plan for our student body, as well as for our athletes. We have developed just a really great system of quick-to-test. So any symptoms, any mild symptom, even if you had a surveillance test and you tested negative, if it’s three days later and you don’t feel well, let’s test you again. So I think everybody’s very aware of how to find new cases quickly. And that’s so important to the health of the rest of the team. We’ve spent a lot of time through this summer in teaching that we want to be as safe as possible, and how not to blow off mild symptoms. So I think we keep track of the numbers really, really well, and I think we stay on top of them with our plan.
What is your level of optimism that this will work?
I’m not a very optimistic person. (Laughs). I don’t think they make infectious disease experts that are very optimistic during pandemics. I think the only word that I can use to describe is that I’m cautious. Every day with whatever question that I get asked, including about football, I don’t think optimism has a role. I think caution does. And that’s how you proceed.
Mental health: How much has that been discussed, and is there any data or evidence from the spring shutdown to point to?
Mental health was discussed a great deal. Everything we do in this pandemic is a balance, with being very, very safe and cautious, and also really educating so that we understand the ‘why.’ Having the knowledge is the power to success, and so that is why we spent so much time educating on the why, so that when things happen, when you get pulled away from your team to get quarantined, after you’ve moved to a new place and you were expecting a different type of situation. … I think that was uppermost in most of our minds, that we had this group of elite athletes who came together for a goal, and then because of time spent in which you may have to isolate and quarantine you get taken away from the team. So how do you not take away from that team feeling so you don’t feel mentally isolated. We’ve focused a lot on that and I think that’s been very important to the task force.
Is there a biggest concern for you? Something looming out there in the next six weeks that you particularly want to see or don’t want to see, or is it just the whole picture?
My biggest concern, what I think about when I go to bed and when I wake up in the morning, is the health of our community, as we bring a lot of students back to our towns from other communities. That is what we know in pandemics can light the next wave. And so I’m very concerned about what our communities will look like in about four weeks, as we see that spread, if any occurs, with colleges starting back. I’m not worried about our athletes. They are the leaders now. They’ve learned the lessons. They can tell you how to take off a mask. They can tell you what six feet looks like with a glance. They’re perfect at this. I’m worried about our communities, and our athletes can’t proceed with the safe plan we’ve made for them unless our communities proceed ahead of them. They have got to make this work or else football is a non-issue. Community health will be the only issue if we can’t be successful on our campuses. So that’s my main concern.
Just to be blunt, the thing you will hear, that everyone will hear, is that if the Big Ten and Pac-12 have seen enough to shut down, and others have as well, then why aren’t you guys, why aren’t the other conferences. What is the simplest answer in your mind, as a public health expert, to that?
I would say we have seen enough to develop a safe plan. They have not. Our plan was earlier. Our plan was based on an experience that they had not had yet. And we implemented that plan faster than they did for that reason, so we could prepare for this. So we feel confident in our plan. I think our teams can absolutely get through this, I think our athletic departments can absolutely get through this. I worry about our community and outside forces that we can’t control. But I think that’s the difference between us and the conferences (that shut down), is we were prepared earlier.
A member of the medical task force charged with advising the SEC on the safety of a 2020 fall football season is unaware of any conference football players who have developed myocarditis as a result of COVID-19, and she believes the conference’s team doctors are prepared to handle the heart condition if it arises.
“We always look for it after viral infections,” Dr. Catherine O’Neal told The Athletic on Friday afternoon. “We are always attuned to the fact that that can happen so this is not surprising to us. We’re ready. We’re prepared to look for myocarditis and feel comfortable in the knowledge of what happens to somebody who does get it and what we need to do. There is some really good evidence in sports medicine behind how to recover from myocarditis as an athlete. Our plans reflect that.”
O’Neal, an infectious diseases expert and assistant professor at LSU’s Health Sciences Center, is one of 14 doctors and healthcare professionals on what is officially called the SEC’s “Return to Activity and Medical Guidance Task Force.”
This week saw the Big Ten and Pac-12 cancel their fall seasons while the SEC, ACC and Big 12 have decided to forge ahead, leading to questions over what medical advice each conference is receiving. O’Neal believes that the difference in approaches at the moment may have to do with how long different regions of the country have had to deal with the virus.
“I would say we have seen enough to develop a safe plan. They have not,” she said. “Our plan was earlier. Our plan was based on an experience that they had not had yet. And we implemented that plan faster than they did for that reason, so we could prepare for this. So we feel confident in our plan. I think our football teams can absolutely get through this, I think our athletic departments can absolutely get through this. I worry about our community and outside forces that we can’t control.”
SEC teams are scheduled to start fall practice next week. Conference officials have stressed the league has not made a final decision on playing, but O’Neal also made it clear that the SEC sees a potential path from here to Sept. 26, when the conference is set to begin the season.
O’Neal discussed all that in detail, along with issues surrounding mental health, triggers that could stop the season and what will stop the potential domino effect of contact tracing — it’s not masks, by the way — and more below:
Will it take a trigger to start the season or will it take a trigger to stop the season?
The first thing is, I’m not comfortable with a pandemic. There is nothing that makes me feel comfortable about what we have ahead us for the next couple of years, but when I think about this pandemic, I do think about it over the next couple of years, and when you put it in that kind of perspective, I think that you have to start to think about the things we do in life and what makes them safe and what things cannot be safe and how to proceed. That’s been the charge that the commissioner has given all of us about playing football. Can we proceed? And, if we can, how do we do it as safely as possible? I think there are triggers to stop and start and those are triggers that have been laid out by the CDC and are laid out in our plan. Those are some of the first things we put down on paper. How do you define what is just a no-go? When is it unsafe? And what is safe? How do you distance people? How do you mask appropriately? How do you teach them safe tactics just to get through life. And football, in so many respects, is no different than our day-to-day activities as we came out of our stay-at-home orders and starting going back to our normal environments. We have to teach our athletes and our student body how to be safe. That’s how we start. We start safely. When do we stop? We stop when we realize that people can’t do it. That they can’t follow safe instructions, that either there is something we didn’t prepare for or something that happens such as rules that become unmanageable, such as masks fall apart and then we know that we can’t continue. Our stops and starts are based on CDC guidance.
Have you seen the data the Big Ten and Pac-12 used in their decision-making process beyond what has been released publicly by those leagues?
No, I haven’t seen any data from their conferences. I don’t know if they have coalesced data or not. We were able to share our experiences and our plans along the way to the different conferences. It has really been a very open forum through the summer with them but how they came to this decision and how we came to ours, we have been at very different time points than them because we saw cases earlier than them in our region. Our group started meeting earlier than their group started meeting so when we did come together, there was definitely a discrepancy in preparation and most of that not because they weren’t prepared but because this disease has occurred later in their conferences than it did in ours. We had an earlier jump on the cases so that necessitated an earlier plan for us.
Are you surprised that conferences at the moment have landed on two very different decisions or does that seem natural because of the nature of a novel virus?
I am not surprised. You could take the same thing between parts of Louisiana and make the same comparisons. When you are in an area that has not seen a lot of activity, you have a very different perspective on what is ahead the next couple of months than when you are in an area that has seen your hospitals overwhelmed and your population really be gripped by this. Lessons learned come a lot faster during difficult times. Our regions now have banked a ton of lessons learned. Our athletes and their families have banked a ton of lessons learned. That is not the case for people who have not seen the virus so they are beginning that process now, and that’s nobody’s fault. That’s a pandemic.
How big a concern is myocarditis? How many cases has the league had that you know of?
I don’t know of any cases. The league has not put out anything, and I am not aware of a case of myocarditis that has occurred in the SEC. How big of a concern is it? We all agree as a task force that myocarditis is a concern with every viral illness. We have seen myocarditis (prior to the pandemic). We are very familiar with it. It occurs in young people after viral infections. It’s rare but the more kids you see, and our doctors are very experienced, the more likely you are going to see a case of myocarditis in a young person. We always look for it after viral infections. We are always attuned to the fact that that can happen so this is not surprising to us. We’re ready. We’re prepared to look for myocarditis and feel comfortable in the knowledge of what happens to somebody who does get it and what we need to do. There is some really good evidence in sports medicine behind how to recover from myocarditis as an athlete. Our plans reflect that.
Was the task force looking at myocarditis for a long time?
Our task force has a critical care physician on it (Dr. Stevan Whitt, University of Missouri) and also myself as a hospital-based representative, so when we first met we had already seen quite a few very severe hospitalized cases of COVID-19 and knew that it affected multiple organs. At that point, we didn’t know what it would look like in the younger population, but we knew that it was a virus that is above and beyond your worst flu, and we have so much experience with flu affecting things beyond the lungs. We knew we would see neurologic issues and cardiac issues the same way we do with other severe viruses.
Is it fair to say at this point in time that the task force believes that whatever myocarditis associated with COVID-19 is manageable safely?
I think that the myocarditis that will occur in COVID-19 cases is something that the medical field is ready to manage. I don’t think that anybody is prepared to manage outbreaks and large numbers of cases in any population, so our focus is on how to prevent that. If someone does get COVID-19 through any activity and they go on to develop what is a rare but unfortunate complication of a virus, which is myocarditis, yes medicine is prepared to handle those types of complications.
Are there other potential long-range impacts that you are looking for?
No, not long term. Our biggest concern is making sure we don’t push people back to recovery too quickly. And again we see that with severe flu and so our trainers have great plans already. There are some things that make this virus difficult. How to make a good plan to return an athlete safely back from an illness was not a difficult thing for the task force. There are some good plans in place to do that. It’s just making sure that you are watching their cardiopulmonary function really, really closely and that you don’t push them too hard coming back and you’re aware of triggers for further evaluation. I think we have that nailed and as long as we do that we are going to proceed safely.
Is the positive test rate across the conference encouraging or discouraging?
The positive test rate in the community across the conference, we all know they’re very discouraging, and they have been for six months. We have a lot of community activity in the South, and so that makes me concerned about proceeding about opening up campuses and opening up the rest of our economy here. So that’s why we’ve been so cautious with our athletes, and we’ve invested so much in education for them, to protect themselves. We have some really large numbers of case rates in our communities.
How do the numbers across your teams look, and do those numbers make you feel any differently?
We don’t report our numbers as a conference, so I have no concept what the conference rate is. We report numbers according to geographic location and that’s the best way to report numbers, and most of our conference numbers are going down, at most of our schools are going down. Which makes me feel good about starting in the next couple of weeks. But we have to watch it real closely.
South Carolina said it is getting same-day test results. Is the same true of other league schools and how important is the timing of that?
The timing is really important no matter where you are. It helps with contact tracing, it helps with appropriate quarantine. And I think if you had asked me that question again in April we would have had a lot of concerns, about the lag in timing. Our campuses have made really, really great strides in getting quick tests back so our entire campus can come back, and that includes the athletes. So I feel better about that today. I think anything that is a 24-to-48 hour turnaround is exceptional in a pandemic. You start to worry when you get five-to-seven days out, and we haven’t heard those kinds of numbers in awhile now.
Rapid-response testing: Can everyone get same-day results on Friday and, if need be, on Saturday (gameday)? Can you get a test pretty quick and feel good about that test?
In Baton Rouge, we can absolutely. And I feel like (based) on our task force calls, I feel like that is the case on all of our campuses now.
Face coverings: What I’ve been told is that an approved face covering, whether it be a gaiter, a mask, even a face shield on a helmet, would stop the contact tracing domino effect, so to speak. Even if those were players who had contact in a game. Is that accurate? Is that how you all are proceeding right now?
No, we use the CDC’s definition for contact tracing, which is within six feet for greater than 15 minutes. And that’s the definition of a close contact. It doesn’t matter if you have a mask or a shield on.
OK, so the real trigger there is the time, which is 15 uninterrupted minutes.
That is how the CDC reads when you read the definition.
So, if you’ve got guys who are practicing and playing and offensive and defensive linemen who are banging heads for 30 seconds or however long a play lasts, and they go their separate ways between the play, that breaks that contact tracing time?
It does. It’s not 15 minutes of having a close conversation within six feet. That’s right.
Is that the same rule off the field? So if you were in a meeting room, even if you had a mask, if you were within six feet for 15 minutes you still fall under the mandatory quarantine if you came in touch with a positive person?
If you were in a meeting room, and you were within six feet for greater than 15 minutes, you were a close contact.
Obviously the numbers, with some exceptions, have gone down within these quasi-bubbles. With the return of students, how closely can you track the numbers and make sure that you’re continuing to have success?
I think we track the numbers really closely. We have a surveillance plan for our student body, as well as for our athletes. We have developed just a really great system of quick-to-test. So any symptoms, any mild symptom, even if you had a surveillance test and you tested negative, if it’s three days later and you don’t feel well, let’s test you again. So I think everybody’s very aware of how to find new cases quickly. And that’s so important to the health of the rest of the team. We’ve spent a lot of time through this summer in teaching that we want to be as safe as possible, and how not to blow off mild symptoms. So I think we keep track of the numbers really, really well, and I think we stay on top of them with our plan.
What is your level of optimism that this will work?
I’m not a very optimistic person. (Laughs). I don’t think they make infectious disease experts that are very optimistic during pandemics. I think the only word that I can use to describe is that I’m cautious. Every day with whatever question that I get asked, including about football, I don’t think optimism has a role. I think caution does. And that’s how you proceed.
Mental health: How much has that been discussed, and is there any data or evidence from the spring shutdown to point to?
Mental health was discussed a great deal. Everything we do in this pandemic is a balance, with being very, very safe and cautious, and also really educating so that we understand the ‘why.’ Having the knowledge is the power to success, and so that is why we spent so much time educating on the why, so that when things happen, when you get pulled away from your team to get quarantined, after you’ve moved to a new place and you were expecting a different type of situation. … I think that was uppermost in most of our minds, that we had this group of elite athletes who came together for a goal, and then because of time spent in which you may have to isolate and quarantine you get taken away from the team. So how do you not take away from that team feeling so you don’t feel mentally isolated. We’ve focused a lot on that and I think that’s been very important to the task force.
Is there a biggest concern for you? Something looming out there in the next six weeks that you particularly want to see or don’t want to see, or is it just the whole picture?
My biggest concern, what I think about when I go to bed and when I wake up in the morning, is the health of our community, as we bring a lot of students back to our towns from other communities. That is what we know in pandemics can light the next wave. And so I’m very concerned about what our communities will look like in about four weeks, as we see that spread, if any occurs, with colleges starting back. I’m not worried about our athletes. They are the leaders now. They’ve learned the lessons. They can tell you how to take off a mask. They can tell you what six feet looks like with a glance. They’re perfect at this. I’m worried about our communities, and our athletes can’t proceed with the safe plan we’ve made for them unless our communities proceed ahead of them. They have got to make this work or else football is a non-issue. Community health will be the only issue if we can’t be successful on our campuses. So that’s my main concern.
Just to be blunt, the thing you will hear, that everyone will hear, is that if the Big Ten and Pac-12 have seen enough to shut down, and others have as well, then why aren’t you guys, why aren’t the other conferences. What is the simplest answer in your mind, as a public health expert, to that?
I would say we have seen enough to develop a safe plan. They have not. Our plan was earlier. Our plan was based on an experience that they had not had yet. And we implemented that plan faster than they did for that reason, so we could prepare for this. So we feel confident in our plan. I think our teams can absolutely get through this, I think our athletic departments can absolutely get through this. I worry about our community and outside forces that we can’t control. But I think that’s the difference between us and the conferences (that shut down), is we were prepared earlier.
