Why coronavirus testing might be the key to the return of college football

The hurdles to bringing student-athletes back to campus (1:01)

Andrea Adelson lays out the roadblocks college administrators are facing when trying to coordinate the logistics of having students on campus during the pandemic. (1:01)

Every day is roughly the same for McKenzie Milton. The UCF quarterback drives from his off-campus apartment to the team's football complex, where he has received permission to use the facility to continue his rehabilitation following a gruesome injury to his right leg nearly 18 months ago.

Before entering the building, he gets a forehead scan for a quick temperature check -- part of new health and safety protocols implemented in the wake of the coronavirus pandemic. Then he washes his hands. Masks are required, and equipment must be wiped down after each use. He also must stay 6 feet apart from other players who are there. It's a protocol many schools across the country have administered for athletes rehabbing long-term injuries.

But then, about a week ago, his throat started to hurt. He stayed home. When he developed a slight fever, he started to panic. Milton drove himself to a COVID-19 drive-through testing center located in a parking garage on the UCF campus, where medical personnel administered a diagnostic test by pushing a long swab up his nose.

His eyes watered. "It was terrible," he says, "but better safe than sorry."

He got the results the following day: He tested negative. Within a few days, the fever was gone and he felt like himself again. Milton missed two days of physical therapy, but while he awaited the test results, he could not help but think about all the people he had interacted with on a daily basis after he decided to stay in Orlando and continue with his daily rehab instead of returning home to Hawaii.

"I would have felt bad if I was around people and was sick and the possibility of our physical therapy having to get quarantined because of me," Milton said.

What happened to Milton gets to the heart of the question of how and when to resume sports safely after the coronavirus pandemic forced the entire sports world to shut down in March. College athletic departments are grappling with the same dilemma as the rest of the country -- desperate to reopen because of dire financial challenges while trying to prioritize the health of unpaid student-athletes. Collegiate leaders are acknowledging the realization that once workouts, practices and games resume, the spread of COVID-19 will be inevitable.

While searching for preventative measures, officials are struggling with if and how to incorporate testing, but one question seemingly always leads to more. There are simply no concrete answers or definitive, uniform plans right now. The logistics of implementing a testing regimen at one athletic department -- let alone hundreds across the country -- is an overwhelming concept, raising issues including cost, feasibility, and the ramifications of positive test results.

"I think it's unrealistic to think that we won't have positive tests on campus and positive tests in locker rooms," Big 12 commissioner Bob Bowlsby told ESPN. "Somebody somewhere is going to have that occur, and they'll have to deal with it."

How schools across the country handle testing protocols, and what to do when someone tests positive, will help determine not only whether any sports can be played, but also whether they can be played for the entire length of their seasons. The 10 FBS commissioners and Notre Dame athletic director Jack Swarbrick are in constant communication about best practices and plans with the hopes of making uniform decisions knowing that might not be possible.

"This is not simple," American Athletic Conference commissioner Mike Aresco said. "It's easy to say we're going to test everybody, but what does that mean and how is it going to be done? That's going to be the key to everything we're doing. We have to get it right."

This week, the SEC is in the midst of meetings to determine what would be the first publicized considerations for allowing athletes to return voluntarily. SEC athletic directors are expected to meet with health experts on Thursday and then give a recommendation to university presidents and chancellors about whether they should extend the current May 31 lockdown deadline or determine a date to begin phased reopening. The presidents and chancellors are expected to make a decision when they meet Friday, multiple sources told ESPN.

While there is no formal timetable for college sports to resume, and NCAA president Mark Emmert has made it clear his office won't mandate any uniform start date, there is a growing acceptance among college athletics leaders that in order for the student-athletes to return to a safe environment, some form of coronavirus testing will have to be part of the equation.

"What we do know is we have to work very hard with federal, state and local health officials to try and get in place testing at every level we can," Emmert said. "As we heard from the federal guidelines and all of the public health officials, it's a necessary step before you can move back toward anything like normalcy. In my opinion, it's the critical linchpin to making this all work."

What has changed since sports went on lockdown in mid-March?

About two months ago, Utah Jazz center Rudy Gobert tested positive for the coronavirus, and the NBA suspended operations immediately. The next day, Syracuse was scheduled to play Louisville in the ACC men's basketball tournament.

But just before tipoff, conference tournaments across the country were canceled, the first domino in what was to come for the NCAA men's and women's basketball tournaments and spring sports over a wild 48 hours. Syracuse athletic director John Wildhack said at the time that the first positive test in the NBA "changed the entire dynamic for all of sports."

A chain reaction of difficult decisions by the most powerful people in sports followed, but before canceling the basketball tournaments and spring championships, NCAA officials considered playing a shortened version of the Final Four -- in one secluded place. Two members of the NCAA's coronavirus advisory panel are based at Emory University, which is adjacent to the Centers for Disease Control and Prevention.

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"We were saying, 'Hey, let's do it in Atlanta, we have all of the geniuses in the world,'" said Dr. Brian Hainline, the NCAA's chief medical officer.

The turnaround time for a diagnostic coronavirus test at the time was at least 72 hours -- and that was with Emory's on-site lab, which was highly prioritized for the critically ill. Based on that information and the advice of its medical experts, the NCAA saw no ethical justification for attempting to continue with the tournaments.

So, what exactly has changed since then to give anyone the confidence to believe that one positive test won't again shut down sports?

"That's a hypothetical, so I can't predict in terms of the fall, but we know a lot more today than we did two months ago," Wildhack said. "We'll know a lot more two months from now than we know today. Anything that we do is going to be done in concert with the overall university, local, state, the CDC. I think everyone's looking at some of the pro leagues and the models that they're looking at to resume competition, most notably the NBA, NHL and Major League Baseball. There will be some learning for everyone."

Hainline points to better testing capabilities as one key difference; as they continue to advance, so does the hope for the eventual return of college sports. Not even the doctors, though, can predict how much the testing might advance between now and Aug. 29, when the college football season is tentatively scheduled to start.

"Now we're at a point in time when the diagnostic tests are becoming much more widely available," Hainline said. "We're moving away from the prioritized schedule, and if we get to the point-of-care testing that we can get a result in 15 minutes, then you go to a completely different scenario and you create these bubbles. The inner bubble would be if you're talking about a football team, that you have all of the players on the team and those that are going to be in close contact with the players and you can't start a game until you've tested everyone that day."

Testing everyone who will take part in any game is radically different than mid-March, when it was difficult to not only secure tests but exhibit severe enough symptoms to qualify for one. There is more knowledge about how the virus spreads, and contact tracing -- which is a method of tracking every individual an infected person has come in contact with -- is another practice every administrator is looking at as they develop testing guidelines.

"I don't know whether the NBA would take the position they took in the spring now if you have sophisticated testing," Aresco said. "It's hard to say what they would do. I can't speak for another league, but if somebody tests positive, does that mean the season is suspended? I have no idea. That would be an extreme position. We'll all talk about acceptable risk, and that's a decision we're all going to have to make collaboratively in our conference.

"You look for the best practices, you glean something from the conversations you have with everyone, but it's something that's going to have to be addressed," he added. "Aside from the testing, that's going to be the key, because when it happens -- and it could be a player, it could be a coach, a staff member, an event person, an official -- what do you do?"

What measures are being implemented to ensure safety?

Major programs across the country have begun to draft detailed plans, the first real tangible steps on paper that will constitute a new normal for when athletics programs can resume. This includes anything from deep-cleaning chemical procedures to prescreening athletes and staff to appointments for training rooms.

Testing will be the first step at Nebraska.

"First when they get here, they're quarantined for 48 hours, and then tested," Nebraska athletic director Bill Moos said. "If there's a positive, there's a dorm provided to quarantine them -- and then all the precautions in regards to where they are training, what they are doing, how they are doing, how they get access to our food and our nutrition. All very well thought out. All superbly managed with the safety and well-being of those young people uppermost in our thinking."

One team doctor at a Power 5 school, who spoke on the condition of anonymity, suggested that, for a Saturday game, testing should happen on a Thursday so results are available on a Friday. Anybody with a positive test would not participate.

"You don't have to list who is playing and don't have to say why, just like a kid with a knee injury," the doctor said. "That way, there's some degree of uniformity across the board. But those decisions don't need to be made now. It's not even June yet. But at least you could have the players and staff tested on Thursday and know where those people are at before you get on the plane Friday to go play the game."

Conferences across the country have formed medical advisory councils that are helping administrators come up with a set guideline for testing protocols.

"I think there will be a great deal of comfort if you know the people you are competing against are following the same or very similar protocols in terms of maintaining the health and safety issues on a daily basis as well as on a game day," ACC commissioner John Swofford said. "So that would be the goal if we could get to that point."

Even if conferences can agree on a testing protocol, how schools plan to enforce social distancing policies for young adults once they leave the confines of the athletic facilities remains in flux.

"I understand that some coaches feel like it may be a more controlled atmosphere on campus in weight rooms and the football facility for players than where they are now if they're going to Gold's Gym or their old high schools," the same Power 5 head team physician said. "And some people are thinking that once you get them back on campus, there's a better chance of going forward with momentum. But just because you test them on Monday here and they're negative doesn't mean they won't test positive the next Monday if they run to see their girlfriend over the weekend in another city."

One 32-page draft of an SEC plan obtained by ESPN details three phases of reopening, each phase a part of a gradual progression that allows for more access to different parts of the athletics facilities. It shows tentative return dates of June 15 for Phase II and July 1 for Phase III -- targeted dates that are in line with what other schools throughout the country are hoping for but certainly not guaranteed.

The plan shows that anyone entering a training or weight room will go through a screening process that includes a temperature check. Anyone with a temperature at or above 100.4 and/or any symptoms will not be allowed in and "will be arranged in an isolated area."

Other proposed protocols: All dumbbells and barbells are wiped after each use; social distancing guidelines, designated by signage and floor markings, will be enforced at all times; and a mask or face covering must be worn at all times in training and weight rooms. The guide also includes maps of the athletic facilities, with green arrows indicating entry routes and red arrows showing exit routes.

Noticeably absent from the plan, though, is a testing procedure -- and that might become the trend. Dr. Dev Anderson, who works with the program called Infection Control Education (ICS) for Major Sports, questioned whether routine testing will be economically feasible for athletic programs. The group, based out of Duke University Hospital, has long focused on infection prevention for the NFL, and it was recently hired by the Big 12.

"It is clearly going to be a part of the way professional athletes deal with this, and professional leagues," Anderson said. "I think it's going to be more of a struggle for colleges. ... My suspicion is testing will be a part, there will probably be various screens from time to time, but I will be surprised if routine testing is a part of college. The logistic cost and numbers don't add up very well."

Hainline estimated the current cost of a diagnostic coronavirus test to be between $100 and $150, and he said it would be up to the conferences and schools, not the NCAA, to get the tests and pay for them.

"The conferences are getting together and saying, 'OK, how can we have a unified approach to testing?' And then they use their power as a conference if they're working with private industry or if they're working with one of the schools that has a research lab or a large hospital lab," Hainline said. "I think increasingly we're going to see this worked out at the conference level. That doesn't mean that the individual school doesn't pay for it, but there's sort of a power in bringing down costs when several schools are coming together."

Developing those relationships with local labs is already happening. Syracuse chancellor Kent Syverud said, "We have been working extraordinarily closely with our county health department and with the state on all issues involving the virus. We have employees embedded in the response network. We talk every day, and testing and access to testing labs is part of that daily conversation."

Other universities are working on developing their own tests. Rutgers, for example, has a salivary test it is currently piloting. But there also are disagreements among medical professionals about which testing should be used and how often.

"You start talking around testing and you start talking around monitoring," said Dr. Vicente Gracias, senior vice chancellor for clinical affairs at Rutgers. "Right now, the data is just starting to come in terms of how confident we can be in the particular type of testing, whether it is point-of-care testing, rapid testing as we call it, or PCR [polymerise chain reaction]-based testing. Until you have that, we're not going to be able to have very good sound advice on how to do this safely."

There also is concern that widespread testing among college athletes who are not showing symptoms, just to ensure their safety to play a game, might take away tests from those who are in need.

"It does feel a little inappropriate to me to be testing people for entertainment when we can't adequately test people, for example, in the nursing home," said Dr. Preeti Malani, the chief health officer at University of Michigan. "That's a place where we're doing more asymptomatic testing because people can't visit their family members. You have a population of people who are aging and dying and can't be with their family, but we're testing athletes."

That leads to one of the biggest unanswered questions: How often do you test athletes and coaches, and when do those tests happen? Is it better to test on a Thursday, as the team doctor suggested earlier? Or is it better to test as close to game day as possible? Is only one test a week enough?

"That's the kind of thing that keeps you up at night," Aresco said. "We all want to have state-of-the-art testing, and part of this is what kind of quarantine, what kind of isolation do you have for the team? You may have to put in stricter procedures than you normally would, because then if they're mixing with students across the board, there's a better chance something can happen.

"I don't know that you want to be too draconian here, but one test a week isn't going to do it. Do you test Saturday morning before the game? Do you test Thursday before they get on the plane or the bus? We don't know yet, but we will have answers to these questions."

Hainline agreed with Anderson that it's not possible to test 50,000 people on one campus daily, but he said he is encouraged by how testing is improving.

"I think it's very possible even within a month that we may be going away from the current tests, the PCR tests, to an antigen-type test," he said. "If we can pull that off, it will be easier to administer. The serology tests are really rapidly evolving. They don't just tell us about immunity -- they can tell us if you have recently been infected, and your body is already developing an acute immune response; and I think that's going to guide us in a whole different way."

What happens if an athlete tests positive?

TCU athletic director Jeremiah Donati has already initiated a very difficult conversation with his head football coach, Gary Patterson: What happens if, and when, you get sick?

"And who's taking over?" Donati said. "What if the whole defensive staff gets sick? Do you promote your GAs? Do you forfeit the game? Do you roll with offensive coaches trying to coach defense? That's a realistic possibility. We've started the conversation, and the looks I got back from the other side of the table were like that emoji where the two eyes burst off their head or the one where the guy's brain is exploding. It's like, are we really having this conversation?

"Yeah, of course we are, because everything we're doing right now is everyone who shows symptoms needs to self-isolate, and anyone who's sick is quarantined for 14 days. There's no exceptions to that rule last time I checked."

Coaches are having these conversations with their players too. In the days before Florida's Miami-Dade County started Phase I of its reopen, Miami coach Manny Diaz specifically addressed the way one positive test could have ramifications across an entire locker room.

"We want our players to understand that every one of them has a responsibility to protect the team," Diaz said. "If they say we should be socially distant, we have to be socially distant. If they say we have to wear a mask when you go into a pharmacy, you've got to wear a mask. What if it's uncomfortable? It doesn't matter.

"It's not about your comfort. It's about protecting the team, because if you bring something in our team, if you're a corner and you're carrying it asymptomatic and you play bump-and-run on our wideouts and four of our wideouts get it, then we have a hard time fielding an offense. Our messaging to our guys was it's not about you. Protect the team."

In order to "protect the team," does everyone have to be quarantined if one person tests positive? Every player and coach in that position meeting room? Every tutor? Nutritionist?

Dr. Doug Aukerman, senior associate athletic director for sports medicine at Oregon State and member of the Pac-12 COVID-19 medical advisory committee, said working with local health departments and within their guidelines is a must, especially when an athlete tests positive.

"I don't think we can necessarily manage student-athletes in any less of a way than the general population. I think depending on how well we're able to do contact tracing and mitigation efforts depends on how widespread that shutdown needs to be," Aukerman said. "Is it just that person's individual contacts? If it's a single case, if it's multiple cases, it could very well be the whole team and has to be quarantined."

These are the questions athletic administrators and university presidents are weighing as they all try to open their doors.

"I'm not one of the individuals who's waiting for the vaccine," Hainline said, "because we could possibly not restart society, and that would be a much greater public health tragedy overall."

UCF quarterback Milton, for one, welcomes whatever testing is necessary in order to try to get sports started up again.

"We definitely want it to be a safe environment for everybody. And whatever our ADs, our conference commissioners, the NCAA feels is the best-case scenario to get us back out there, we'll roll with that," Milton said. "Whatever precautions we need to take while being at school, whether it's having smaller workout groups, whether it's having noncontact practices, we'll see.

"It's going to be a different world we live in. And it's not just for football; it's for everybody. This is bigger than football, whether we have a season or not. Obviously, I'd love to have a football season. It's something the country can use right now."

ESPN reporters Adam Rittenberg, Chris Low, Tom VanHaaren and Kyle Bonagura contributed to this article.