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In an attempt to return to play amid a global pandemic, professional sports leagues have built their safety protocols on a common basis: testing.

Major League Baseball and Major League Soccer are testing all their key players and staff members for COVID-19 several times a week. The NBA bubble near Orlando, Florida has daily tests. The NFL has yet to finalize its protocol for the fall, but if it continues with the 2020 season, frequent testing will certainly be a priority.

A month ago, it was thought that the sporting use of those COVID-19 tests – and the laboratory skills needed to process them – were accidental. But now, the United States is seeing more than 50,000 new cases of COVID-19 per day. Major commercial labs are struggling to keep up with high demand, causing delays in response times. And experts wonder if the return of sport could weigh on an increasingly fragile test infrastructure.

“This has been a major concern for me since I have seen several leagues and their plans for reopening,” said Celine Gounder, an infectious disease specialist and epidemiologist at New York University and Bellevue Hospital.

NBA, MLB and MLS are conducting around 19,000 tests per week as the leagues try to keep players, coaches and staff members safe from coronavirus and able to play. (Photo: CHRISTOF STACHE, AFP via Getty Images)

“We are testing a lot (in New York), but other parts of the country don’t have the same ability. And if all the players on a team want to be tested, even if it’s once a week or twice a week – it’s just a big one voltage for the system “.

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In addition to the tens of thousands of tests per week that will likely be needed for the safe return of sports, there is the laboratory capacity needed to process them.

As large commercial labs face slowdowns, leagues could be forced to wait several days for test results as members of the public – making the results essentially useless while athletes continue to compete – or get results back earlier, with the perception that they are cutting online.

The championships claim to have taken steps to ensure that their operations do not affect laboratory testing and infrastructure, both regionally and nationally. And some experts have said they believe the tests used by the NBA, MLB and MLS – which the USA TODAY Sports estimated at 19,000 per week – equate to little more than a drop in the metaphorical bucket for a nation that has recently processed nearly 640,000 tests. per day.

Others said it was difficult to know exactly what kind of burden sport could have on test infrastructure, a complex network of public and private labs and supply chains that often overlap. They argue that even a slight strain on the system could prove to be consequential and that the notion of sports leagues that consume scarce resources shifts to ethical and optical issues.

“You don’t want to be in the mansion on the hill, while all the farmers over there are starving,” said Zachary Binney, an epidemiologist and professor arriving at Oxford College at Emory University. “The peasant situation isn’t your fault, but you still don’t want to be sitting in that house on that hill when you could help.”

“Not against each other”

Several professional sports leagues have already returned to play or are scheduled to return this month, including MLB, MLS, NASCAR, WNBA, PGA Tour and National Women’s Soccer League.

But perhaps no league has been at the heart of the country’s COVID-19 response like the NBA.

It was the first professional league to stop the game, stopping a game on March 11 when Utah Jazz center Rudy Gobert turned out to be positive for COVID-19. So, he had to face brief backlashes because his teams had access to the tests while some in the general population struggled to take the tests.

Two months later, the pandemic had not completely subsided but there were promising signs. Cases, hospitalizations and deaths related to COVID-19 had increased or tended to fall. Once scarce tests had become abundant. Hot spots like New York City were largely under control. Then the NBA began developing a plan to resume play in the Disney Florida sports complex.

But when states began to relax household orders, those promising trends changed.

Now, with the start of the games scheduled for July 30, the timing and location could not be much worse: almost half of Florida’s ICU units are at least 90% full and the state has reported 215 deaths from COVID-19 Thursday and Friday, the highest total of two days since the start of the pandemic.

“It only took two or three weeks to get back to this bad situation,” said Jill Roberts, an infectious disease expert and associate professor at the University of South Florida.

The spike in cases – first in a handful of southern states and now in much of the United States – has led to a sharp increase in demand for tests. And many of the nation’s large commercial labs are facing arrears.

Quest Diagnostics, which facilitated some of the NBA’s tests, said this week that everyone who is not part of his high priority group – i.e. hospital patients and symptomatic healthcare professionals – should now wait 4 to 6 days for their results. LabCorp, another major commercial laboratory, said Wednesday that it is experiencing similar problems.

BioReference Laboratories, which has partnered with MLS and NBA to develop tests for their bubble sites in Florida, said Friday that it is processing tests within 72 hours with an estimated capacity of 70,000 tests per day.

“We have enough capacity right now to test the people with whom we made our commitments,” Jon Cohen, executive president of the company, told TODAY Sports in the USA today. “If you have a relationship with BioReference and we have made a commitment with you, we will keep that commitment.”

Cohen said that this commitment extends to delivery times. However, he also acknowledged that there have been days when his labs have not been able to process all the tests they have received due to a myriad of factors, including excessive demand, supply chain problems and equipment malfunctions. . And this leads to a situation where some test batches are processed faster than others.

“I have hospitals that need some turnaround time because they want to do some elective procedures,” he explained. “I know we have urgent care where people suffer, who need certain delivery times. I have sports franchises that need certain things in order to work in their leagues … … It’s not the one against the other. It is not as if you need to do these before those and all the rest. We commit ourselves and honor our commitments “.

Cohen said the NBA and MLS tests will be processed locally in Florida. When asked in an email to clarify whether those athletes would receive their test results faster than members of other groups, BioReference spokesman Hillary Titus stressed the company’s efforts to increase its testing capacity. in Florida, but did not answer the question directly.

The NBA has indicated in its health and safety protocols that it will try to collect test samples every evening, with the aim of recovering the results by the following morning. The response times would be faster than those currently available to the public in the main commercial laboratories.

The league said it requested its laboratory partners, including BioReference, to certify that its testing efforts will have no impact on the availability of tests for healthcare professionals and other high priority groups in each team’s community. He said he also took steps to conserve resources in the Orlando area, including laboratory capacity.

“BioReference has brought new testing capabilities to its laboratory in central Florida to simultaneously manage NBA and local testing needs and ensure that Florida tests to support hospitals and patients are not diverted from the community,” said the spokesman for the NBA Mike Bass.

MLS, which also operates on a so-called bubble site near Orlando, has not answered a series of questions from the U.S. TODAY Sports on what steps it has taken to preserve or expand test resources for the public.

No certainty of not being a burden

Unlike NBA and MLS, MLB plans to play its shortened season of 60 games in the home stadiums of its teams, spread across 28 cities.

The league said it relied on saliva-based tests for asymptomatic players in an effort to preserve materials such as nasal swabs for “essential tests”. It is also processing the vast majority of its COVID-19 tests in a Utah laboratory that usually manages drug tests.

“By taking this step, the program will be additive to public tests,” MLB said in response to a series of questions from the US TODAY Sports.

The league also said that its laboratory in Utah is subcontracting with an unspecified second laboratory “to ensure the continuity of reporting results.” Several MLB teams had to stop training this month due to delays in test results.

Roberts, the South Florida infectious disease expert, said that the primary use of a private laboratory by the MLB that will not delay processing public tests is a significant gesture, but it is almost impossible to completely mitigate the impact. of the alloy mass tests.

“They are not taking (significant) laboratory staff out of the public bucket,” he said. “The problem is that they are taking supplies, and that’s how we encountered our (test) problems in March.”

The availability of test materials has improved since the early stages of the pandemic, according to Eric Blank, program director of the Association of Public Health Laboratories. But now even more people are looking for tests.

As manufacturers have increased production of materials such as swabs, reagents and pipettes, “they are still unable to keep up with demand,” said Blank – and it seems unlikely that it will change soon.

“I think we will have to deal with these supply chain problems as long as this response continues,” he said. “Because it’s so big. I think it goes beyond what anyone imagined.”

Blank said he did not believe that the tests used by the sports championships will have an impact on its member labs. Even with frequent tests, he said, the leagues are using fewer tests than in small cities.

Other experts are less certain, citing the ever-changing nature of the virus and the lack of a centralized test authority, which could monitor test usage and distribute materials where they are needed most. They say there is simply no way of knowing what impact the return of sports could have on the wider testing infrastructure, particularly when taking into account the tests used by college sports and potentially the NFL in the fall.

“A larger picture, it’s hard to imagine that you would have a really large organization that plans to perform mass tests – several times a week – and be certain that it will in no way put a burden on the system,” said Ryan Demmer, associate professor of epidemiology and community health at the School of Public Health of the University of Minnesota.

Does sport hurt more than good?

To counteract their potential burdens, NBA, MLB and MLS have committed to providing COVID-19 tests or antibody tests for the public.

The NBA has outlined multiple initiatives that will expand testing options in central Florida by providing “a mobile test site and a drive-through test event, which will be open to the public and together provide thousands of tests to the community,” said Bass. .

The NBA is also supporting the search for tests through partnerships with the Yale School of Public Health and the Mayo Clinic, among others. MLB said it offered free COVID-19 tests and antibody tests to healthcare professionals and first responders in their cities of origin. And BioReference said in a press release that it is working with MLS to provide antibody tests for the Orlando public.

Despite those bona fide efforts, sports risk losing the battle of perception as long as athletes are receiving multiple tests in a virtual bubble, while citizens in hard-hit areas wait in their cars or long lines for hours, often in vain, to same test.

“I think sport in general will be an easy target to say, why are we doing it?” said Roberts. “But you could say it in a hundred things. You don’t need to do your nails. You don’t need your tacos. But those are obviously part of the economy.”

The stakes for the sport could intensify in the fall, however, if the NFL and college football proceeded as planned.

There are more teams in the Football Bowl division (130) than the NBA, NWSL, MLB, MLS and WNBA put together. And while the roster active in those other sports range from 12 to 30 players, the football roster are typically two to three times larger. With daily tests and roster of 70 men, for example, the NFL would use and process more than 15,000 tests a week just for its players.

Binney, the professor arriving at Emory, said that the championships must ultimately ask themselves a simple question: are they doing more harm or better returning?

The answer, of course, is complicated. And constantly changing.

“I think professional sports, with the right configuration and the right logistics, can come back again without having a negative effect on the community around them,” said Binney. “But it’s getting more difficult.”

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