Feature image from Purdue Sports.

What happened?

Our beloved Jeff Brohm has tested positive for COVID-19 infection this past weekend, unfortunately presenting with real symptoms. He is the first publicly-known member of Purdue’s football staff and players to test positive with the SARS-CoV-2 virus, and the first Big Ten head coach to test positive.

Getting the less important stuff out of the way – Brohm will have to isolate from the team for 10 days, seemingly leaving him away from the sidelines for Purdue’s opener vs Iowa, when Co-OC Brian Brohm will assume head coaching duties.

How did this happen, and what does it mean?

Brohm said during his Monday press conference he wasn’t sure where he contracted the virus, but a family member was tested positive, and immediately isolated but recognized symptoms on Saturday. This is why distancing, masks, and contact tracing (pre-emptively isolating and testing if you came in contact with a known case) is so vitally important to get this pandemic under control.

While Brohm appears to be the model of a person at minimal risk – a former professional athlete, in seemingly still good shape and health, under 50 years old, an undeniable tough guy, a millionaire with the full might of Purdue’s testing and healthcare resources behind him – the reality is that he was still susceptible to COVID-19 infection and symptoms.

We should be wary to assume that a person appearing healthy to our outside eye is entirely without risk. What we’ve learned is that common conditions – high blood pressure, obesity, diabetes, smoking, and a family history of coronary artery disease or lung disease – results in a higher likelihood of severe COVID-19 infection. Many of these conditions aren’t easily identifiable by those of us who aren’t Brohm’s doctors, and even that list is only a partially-known list of why some people experience short-term infection symptoms and others don’t, and why some people spread the disease more than others.

In short, it’s unwise to assume that this virus, entirely new to the human body, couldn’t cause very real harm to people that seemingly fit a perfect bill of health, without “pre-existing conditions”.

There is also the potential long-term risk of COVID-19 on Brohm’s health. Immediately, there are a significant number of “long-haulers” who experience the symptoms Brohm is experiencing for months at a time – tremors, fever, fatigue, extending to “brain fog” and short-term memory loss. That is in addition to potential long-term impacts on the lungs, heart and cardiovascular system, and neurological system. We know these long-term effects are real but only appear in a smaller percentage of patients, and might not be related to the severity of short-term symptoms.

These kinds of viruses aren’t limited to one system of the body – usually, they infect the whole body, and thus takes the entire body to react and fight off infection.

(For those interested in keeping up with the science, without actually reading dense scientific journal articles, follow The Atlantic’s Ed Yong. He writes about complicated health science topics in a very compelling and accessible way, without diluting the science at all.)

Acknowledging these facts is not “fear-mongering”, it’s about informing ourselves about the most up-to-date information about this new virus. This is not about “eliminating” risk, this is about directly addressing a known risk that has rightfully ground the entire world to a halt.

Why is this worrisome now?

Brohm’s test is unfortunately part of a larger national uptick in cases, looking to make up a “third wave” of the pandemic in the United States:

This uptick seems to be concentrated in the middle of the country – unfortunately, in communities exactly where most Big Ten institutions must travel to play football.

We’re on the eve of the 2020 Big Ten college football season, where hundreds of students, coaches, employees, staff, and media will travel from city to city and (in some situations) congregate indoors.

With many of those communities experiencing local outbreaks, there is a real risk that this travel will further spread the virus, and force us to deal with this awful pandemic for even more time.

Is testing really that accurate?

The last week has been a little bit of a whirlwind for those of us who are both Purdue fans and Colts fans:

Very simply, there are two levels of testing:

Level 1: “Rapid Antigen Testing” – Minimally invasive, inexpensive, very quick, but less accurate.
These are the tests that Purdue, the Colts, the NBA, and other sports leagues have used on a daily basis, typically using a swab just inside your nose or saliva as samples. They also are designed to identify when you are most infectious.

Unfortunately, they are not 100% accurate, they are merely ~85-95% accurate. This might seem good enough, but when you’re testing 1,000 people, it means between 50 to 150 tests could return an incorrect result. That’s why the tests are designed to produce more false positives than false negatives. That way, more people are filtered to the next level of testing, and fewer COVID-19 infections slip through the cracks.

Level 2: “PCR Testing” – statistically 100% accurate, require hours of work by trained personnel, expensive.
This is where the “Level 1 positive” tests get filtered to for verification. This takes time, money, personnel, and usually requires that deep nasal/throat swab (though saliva PCR tests are being developed).

(It’s also worth noting that Brohm experienced symptoms and isolated before testing positive on his rapid antigen test. This is because rapid antigen tests still have a time gap between COVID-19 incubation period and a positive test. This is why frequent testing is necessary.)

TL;DR – Any time you see “false positive”, they likely mean “Antigen test positive, PCR test negative”. This is how we balance mass testing with time and cost, and isn’t a reason to doubt tests or infection numbers.

Frequent (daily) testing is the whole ballgame – it should be the United States’ top priority for not just athletes and coaches, but teachers, nurses, EMTs, media, grocery store and delivery workers, and anyone who regularly leaves the house during this pandemic.

The longer we delay in making testing our top priority as a society, the longer we’ll be dealing with this pandemic.

(And, much less importantly but for the purposes of Purdue football fans, the fewer games we’ll likely have with both Rondale Moore and David Bell on the field.)

What is the Big Ten policy if an athlete tests positive for COVID-19?

Any PCR-confirmed test of an athlete requires self-isolation for 21 days. This is different than the 10-day rule for coaching staff.

So, days before the Big Ten season kicks off…should we be playing?

This is the question I’m sure will be argued endlessly on Twitter and message boards and hot take shows. I’m sure we’ll even get people angry that I wrote this, framing it as negative rather than what it is – a public health reality.

In short…I don’t feel great about it. I’ll be watching as long as it happens, because I am a Purdue football nerd, but I can’t say it’s the most-sound decision given America’s current circumstances.

8 football games in 8 weeks, without bye weeks to recover from normal football fatigue. Hundreds of people travelling via bus or plane across the middle of the country, the epicenter of this third wave of COVID-19 cases. The first month of the season includes trips to Champagne and Madison, which are both entirely surrounded by COVID-19 hotspot counties.

There are real economic consequences to not playing – from beloved athletic department staff members, to small businesses in each of these communities, to those of us who love football and just need a break from [/gestures broadly].

That’s not even approaching the fact that every Purdue fan was waiting for this year – Brohm’s fourth season, if he stayed at Purdue, was when the revamped culture and talent overhaul was supposed to finally produce results. Moore and Bell leading a dozen explosive offensive weapons, Karlaftis and Barnes leading the defense, playing what turns out to be a cakewalk schedule…

It’s really easy to ignore everything else and want to see a Purdue football season.

But…while I know I play the part of a 24/7 Purdue fanatic on Twitter, my day job is in health science research and public health. COVID-19 has also taken a member of my family. This won’t be a distant memory in a few months – we, as a society, will be dealing with the health and economic and psychological ramifications of the SARS-CoV-2 virus for years to come.

Community transmission, not just positive tests among each team/school, should be a key factor in travel restrictions. It’s worth questioning, as the entire country is entering a third peak of COVID-19 cases, whether we should be doing this whole football-like-normal thing at all.

My only hope is that we don’t needlessly put people we care about at risk, just for our entertainment.