MLS is Back: How the league, players are coping with COVID-19 concerns in Florida

Since arriving at the MLS is Back tournament in Orlando on June 27, 11 FC Dallas players and staff tested positive for COVID-19. By the end of the week, 14 players -- including one from the Columbus Crew -- and two non-players had tested positive.

Even as more teams arrive by the day, several clubs (like Toronto FC and Colorado Rapids) have pushed their arrival dates back, and all of this has come against a backdrop of skyrocketing cases in Central Florida. According to the Florida Department of Health on Saturday, the number of new cases for Florida residents in Orange County -- where the Swan and Dolphin Resort is located, and where the MLS delegation is staying -- was 1,166 and the percentage of positive tests remains in double digits, with Saturday's mark at 15.5%. In neighboring Osceola County, where the ESPN Wide World of Sports Complex is located, the number of new cases was 255, a high over the past two weeks. Saturday's positive test rate was 19.5%.

- Stream MLS Is Back LIVE on ESPN networks, ESPN app (U.S. only)
- Group schedule set for MLS is Back Tournament

The league has maintained all along that some positive tests, while not at all desirable, were expected. Yet the reality of the situation has given plenty of people pause, even as 1,191 people in the MLS delegation have been tested over the past two days, with two positive tests.

As one person in the MLS delegation put it, "I would really like to go home now."

All of this has served to raise, and re-raise, several questions. Should Dallas be removed from the tournament? Should the tournament even go forward? If it does, how safe will it be? MLS is convinced that it is doing everything it can.

"In consultation with infectious disease experts and government health authorities, MLS developed comprehensive health and safety protocols that include pre-travel testing, as well as isolation upon arrival until additional screening tests have been completed," MLS deputy commissioner and president Mark Abbott said. "These protocols have led to the early identification and isolation of infected individuals who likely contracted the virus prior to traveling. Those individuals were promptly identified, and separated from other tournament participants and staff, so that they can receive care and ensure that we minimize the risk of transmission to other participants."

To its credit, MLS has been transparent about its programs and protocols. MLS personnel inside the bubble are tested every other day. If an individual tests positive, they are promptly put in isolation until they are cleared by a medical professional. Contact tracing is then done to see who else might be at risk, with more people put in quarantine.

"As long as you have systems in place for testing and isolating people with cases so that the disease does not spread, then I think you're doing the right thing," said Sandro Galea, an epidemiologist and dean at the Boston University School of Public Health.

There are holes in the Orlando "bubble," although not as much as previously thought. Multiple sources with knowledge of the situation told ESPN that around 90% of the staff at the Swan and Dolphin Hotels (which is run by Marriott) are being tested regularly, although sources didn't disclose how often. The same is true of 100% of the transportation staff. One source added that the 10% who aren't being tested would rarely, if ever, come into contact with member of the MLS delegation.

That differs significantly from what was spelled out in the handbook given to players prior to arrival, in which it said hotel workers and Disney cast members weren't being tested for COVID-19. (Editor's Note: ESPN is owned by the Walt Disney Co.) That change was negotiated before the first teams arrived in Orlando. Those individuals who aren't being tested will be given temperature checks, fill out questionnaires and are required to wear personal protective equipment (PPE).

As promising as that development is, it now looks as though there is a greater potential for asymptomatic individuals from arriving teams to carry the virus into the bubble. The physical nature of soccer exacerbates the possibility of spread.

"Soccer is a sport in which there's close contact between people, heavy exhalation for extended periods of time and close physical contact." said Abraar Karan, a physician at Harvard Medical School and Brigham and Women's Hospital who is working on COVID-19 response in Massachusetts. "That's a setup for transmission. So while soccer is lower-risk than basketball -- which is indoors and there's more close contact -- it's still high-risk in that players do get close to one another."

The situation in Orlando has also highlighted the limits of testing, even as it remains a pillar of the league's plan.

In both the Dallas and Columbus instances, everyone in the traveling party tested negative before leaving for Florida. The issue of false positives has also come up in recent weeks, especially in relation to NWSL side Orlando Pride, which had to pull out of the league's return to play tournament in Utah. Minnesota United also had a false positive test. But Karan says a bigger issue is false negatives, whereby an individual is infected, but for whom the viral load isn't large enough to register a positive result. He cited a recent CDC study of a Louisiana correctional facility in which 36% of the people who initially tested negative ended up testing positive four days later.

"The window by which people transmit to other people, and then those people start to get symptoms or start to get virus growing, it can be staggered," said Karan.

Galea stopped short of calling what Dallas is experiencing an outbreak, referring to it instead as a "cluster" of cases. As to whether Dallas should be removed from the competition or the competition cancelled entirely, Galea said he didn't have enough information to answer, though he expressed confidence in the league's setup.

"As long as [MLS is] on top of it, then presumably they have the data they need to make decisions," he said.

Karan says that he's biased to a degree given that he's seen and treated patients who died from COVID-19. Even those that recover, some have debilitating lingering effects. That explains, in part, why he came down firmly on the side of the argument that the tournament shouldn't go ahead. He viewed the league's stance of not considering a Plan B or canceling the tournament as "reckless" given the number of positive tests Dallas has had, even amid attempts to make training and life inside the bubble as safe as possible.

"If you're heading into a tournament knowing [about Dallas], you're in denial if you're saying that the tournament may somehow magically be safe," he said.

"You're actually moving people in and interacting with even more people. You're basically saying 'we know that this is dangerous. We know our players are testing positive. We know we're putting them in high-risk situations where they're in close contact with one another. And yet we're hoping for a different outcome.' There's no science there. There's no logic there."

Both Galea and Karan agreed that if it's proved that there was a case of community spread of the virus inside the bubble, that would raise whatever concerns they have to a much higher level. No bubble is impregnable, but such a scenario would further erode the sentiment that the bubble is safe enough.

MLS, for its part, insists that canceling the tournament isn't an option. In MLS' view, the protocols are working. There is also no single objective measure -- like a predetermined number of positive cases -- that would force them to cancel the tournament. If there is a case of community spread inside the bubble, the league would consult with its medical advisors on next steps.

"My thought is this: Is the health of the players worth being put on the line while we are still trying to figure out all of the details of this virus and get transmission under control?" Karan said. "In so many states in this country, their epidemics are completely uncontrollable at this point. They're going to have to go to extreme measures to get this under control at all.

"I love sports. I want [them] back as much as anyone. But I can't in good conscience say that it's safe for players knowing that so many people are testing positive and that sports are going to be high-risk for the most part."

MLS has shown flexibility in Dallas' case, by postponing their first game with Vancouver that was originally scheduled for July 9. The league hasn't said what scenario would cause them to pull Dallas out of the tournament, but obviously if FCD struggles to put a team on the field, the league would have to consider it.

The MLS Players Association (MLSPA) has a presence on the ground in the form of executive director Bob Foose, who is monitoring the situation and has been in close consultation with league and player leadership, but has yet to comment publicly on the positive tests. Players have been speaking out, however, in particular those deemed to be at a higher risk of contracting COVID-19. Columbus goalkeeper Matt Lampson, a cancer survivor, took to Twitter to express his concerns.

The coming days ahead of July 8's tournament opener between Orlando City SC and Inter Miami CF (Watch LIVE on ESPN, 8 p.m. ET) could reveal a lot as to the comfort levels around this competition. If the positive tests abate, MLS will be on firmer ground.

Seven teams have yet to arrive in Central Florida; for now, MLS is confident that the news will get better.