Sports are coming back in the United States, and as they do, professional leagues are creating conditions that researchers say are tailor-made to study COVID-19. They offer sizable groups of people who are regularly monitored by doctors. When leagues enter a pandemic isolation zone, like the National Basketball Association plans to at Disney World, the controlled environment offers even more opportunities to understand the virus.
Whether sports should come back is still debatable — the pandemic is surging, and many experts are concerned that it’s not possible to create a safe environment for the athletes and staff — but leagues are forging ahead with plans for reopening. And as they do, they’re pushing medical and technical research along with it. The sports “bubbles” are also home to experimental new tech and trials of new ways of testing for COVID-19. They might also tell us more about how the virus spreads.
“There’s a lot of interest in sports coming back, and they could also be a plan for how we bring back universities, colleges and school safely. It’s the same concept, with a lot of people in close proximity to each other,” says Priya Sampathkumar, an epidemiologist at the Mayo Clinic who’s working on an NBA antibody study. “It’s trying it out — if we can’t keep them safe, maybe it’s not safe to open up.”
Major League Baseball participated in the first nationwide coronavirus antibody study in April. At the time, there hadn’t been any effort to check what percentage of the US population had been infected with the coronavirus. The league has teams spread around the country, so testing players, support staff, and their families would give a snapshot of how widely the virus had spread.
“The authors of the study realized they had a ready-made national network of medical providers — sports medicine physicians and orthopedists — who were scattered in a really broad number of markets and would be able to help conduct these tests. It was really, really clever,” says Zach Binney, an epidemiologist at Emory University. And the data the study collected was incredibly valuable: it found that less than 1 percent of MLB employees had antibodies to the coronavirus. “That was the moment for me to shut down pretty much any argument that there are just a ridiculous number of undiagnosed cases,” Binney says.
Sampathkumar is doing a similar antibody study with the NBA. The league had a few high-profile positive cases back in March and April, so researchers knew the virus was introduced into the league. Because the players are in close contact, the virus probably had some amount of spread within the group, and some may not have shown symptoms. “It would be a way to assess the true spread of the infection within a sort of closed population,” she says.
The closed-off NBA bubble is dedicated to basketball, but it’s also a makeshift COVID-19 research laboratory. The league is helping trial a saliva-based COVID-19 test, and any players who opt in will help the Yale School of Public Health validate their testing method.
Players in Orlando will be tested almost every day using the typical method: having a swab shoved deep inside their nose. Players who enroll in the Yale study, though, will also give a saliva sample along with each test. The team will compare the two types of tests and check if the saliva test is as accurate as the nose and throat swab.
The most important things the NBA offered were logistical, says Anne Wyllie, a Yale research scientist leading the project. Gathering a group of people to study is usually a huge challenge. “What just made this really possible was that they already had staff out there collecting samples,” she says. “This really enabled us to do something that it’s hard to say if we would have been able to do otherwise.” If saliva proves to work just as well as a swab, and gets authorization from the Food and Drug Administration, the NBA might adopt it as their standard testing method. The research team expects they’ll have results by the end of July.
A saliva-based test would be valuable for similar environments where testing has to happen regularly, Sampathkumar, who is not involved in that study, says. “It can potentially be scaled up and done for schools and colleges, because it’s relatively non-invasive.”
The NBA is also giving players the option of wearing a smart ring, made by Oura Health, that tracks things like heart rate and body temperature. Researchers working with Oura think that it can flag subtle changes that could indicate someone is sick before they feel symptoms. Scientists at the University of Michigan will evaluate the data from athletes wearing the ring and flag anyone they think the data shows might have early signs of an illness.
The caveat: there’s still no published evidence showing that the ring can catch early signs of COVID-19. Like the saliva test, the system is an experiment. Many researchers are skeptical that it would actually provide useful information, and scientists are still testing the idea at the University of California, San Francisco and West Virginia University. Athletes will be tested almost daily for COVID-19, so the league is not in any way relying on the ring to guide baseline testing — but the data might be used to flag players for additional tests, Oura Health CEO Harpreet Rai told The Verge.
Benjamin Smarr, a University of California, San Diego data scientist working with Oura on the studies, says that the information is still valuable, even if it’s not a proven way to detect illness. Because they’re being tested anyway, he says, players can get a sense of how the data they see from the ring matches the way they feel and how that relates to their test results.
NBA athletes are also able to opt in to the University of California, San Francisco study on the Oura ring. They’re being encouraged to do so, Rai says. It’s unclear, though, how many players might decide to participate in the study or how many will choose to use the ring at all. Their data will be protected: the league’s policies make it clear that the teams won’t have access to player’s physiological data, and it won’t be able to be used in contract negotiations. But some NBA athletes said on social media that they had some concerns about the device.
The NBA and the National Basketball Players Association did not respond to interview requests.
Easier detective work
The goal, of course, is to keep the coronavirus shut out entirely of the sports “bubbles” in Orlando (where the Women’s National Basketball Association, NBA and Major League Soccer will play) and Utah (where the National Women’s Soccer League Challenge Cup is underway). It’s a challenge, particularly when athletes are traveling in from areas where the virus is widespread: players have already tested positive after arriving in the MLS isolation zone.
If the virus starts to spread within the isolation zones, though, it should be relatively easy to trace the path it traveled. In the outside world, it’s hard for people to remember where they go and who they interact with, says Angela Rasmussen, a research scientist at the Center for Infection and Immunity at the Columbia University Mailman School of Public Health. If you’re on a tight schedule and living in a central location, like athletes in these environments are, that information is easy to access. “You can work out, not only the number of contacts you’ve had, but the types of interactions you have with those people.”
That will make it easier than usual for doctors to track down anyone who may have been exposed to the virus, which is important for the safety of the people inside the bubbles. But hypothetically, it could also help scientists learn more about the coronavirus. It might make it easier to learn how long it takes for people exposed to the virus to show up as positive on a test, for example. NBA players are being tested close to every single day, so it’d be easier to pinpoint the moment they started to test positive.
Tracking people over a long period of time is one of the best ways to understand how the coronavirus spreads, but those types of studies are resource-intensive. “We’ve seen a study of 30 people here, a few people there, that have helped us understand a little bit more about, for example, asymptomatic transmission,” Binney says. “The most interesting thing will be having data points regularly, from the same person.”
At least one league, the NBA, is reportedly thinking about those issues. The league is putting together a group of experts to think through research approaches to the bubble, Sampathkumar says. “They’re willing to share the data that they come up with, and are asking for input on the type of data they should collect,” she says.
The information is important for the league itself because it helps it manage the health and safety of its employees. But learning more about the virus and how it spreads is useful for everyone, not just professional athletes holed up at Disney World. “That could be really valuable information,” Rasmussen says. “And that could be extrapolated to the larger population.”