Why health experts are skeptical NBA can begin next season with fans in arenas
After crafting a comprehensive game plan that required extensive preparation and intense discipline, the NBA appears on the verge of celebrating something more important than its league championship.
In about a week, the NBA will finish its resumed season at a quarantined campus during a pandemic that yielded zero announced infections among players, coaches and staff members. But commissioner Adam Silver faces another challenging goal in the coming weeks as the league determines what next season looks like while the nation continues to see a surge in positive cases.
“I know that Adam is hoping we’re going to have fans,” said Tarek O. Souryal, the medical director at Texas Sports Medicine who previously worked as an NBA physician. “But right now, I think it’s too early to tell.”
Despite the uncertainty, Silver outlined his hopes last week that the NBA will begin next season in January and its 30 teams will play in team arenas with fans in the stands. Though Souryal expressed optimism, he conceded the idea “is not going to be fool proof.” Other health experts had serious concerns about the league's initial hopes.
“It is possible to execute in-arena home games,” said David Swedler, who works at the Pacific Institute for Research and Evaluation as an epidemiologist and statistician. “But I think it is ludicrous to allow fans to attend those in-arena home games.”
Dr. Armand Dorian, chief medical officer of University of Southern California Verdugo Hills Hospital, considered the NBA’s fluid start date in January “a little premature for having fans in the stands.”
Not when there have been more than 7.4 million confirmed cases of COVID-19 in the U.S. and more than 210,000 deaths and scientists say that number will hold steady through next year. Not when Silver and health experts predict there won’t be a safe and widely available vaccine by January. Not with the complicated logistics required to pull off such an operation.
“We had a victory in the NBA – it created a bubble and was able to have a season,” Dorian said. “The next step after that has to be a very small and scientifically measured step, and not a big leap.”
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Rapid testing is key
The NBA wants to take that big leap for obvious reasons. It has lost money off of ticket sales and concessions since suspending the season on March 11. Though television ratings do not directly affect the league’s bottom line, the NBA salvaged some earnings during the resumed season because of its contract with ESPN/ABC and Turner that lasts through the 2025 season. By hosting games next season before fans, however, the NBA can make some progress with earning back some of its gate revenue. ESPN reported the league has spent more than $150 million to operate the bubble in Orlando.
“We’re learning that it can be done, that you can strike a balance between public health and economic necessity,” Silver said. “They’re all valid, and it’s not just whatever the scientists say, and it’s not just whatever the politicians say. Ultimately, the people in government have to make these decisions. But all of these are public health issues, not just COVID-19.”
From now until January, the NBA also plans to monitor how other professional leagues have fared with hosting fans. The NFL and most college football conferences have had fans in attendance in a limited capacity and teams have traveled for games. But health experts see the early returns as warning signs the NBA should avoid.
The NFL postponed Sunday's Pittsburgh Steelers-Tennessee Titans game, while the Titans closed their practice facility after 10 players and 10 staff members tested positive for COVID-19. The league then postponed the New England Patriots-Kansas City Chiefs game after a player from each team tested positive. Major college football teams have either postponed or canceled 24 games since Aug. 16 because of positive tests.
It is not entirely clear to what extent fans have contracted the virus after attending games. The potential for spread is a concern. In February a Champions League match with more than 40,000 fans in attendance in Milan, Italy, became a super spreader event for the virus.
“You can keep the fans separate from the players. But what’s the obligation of the teams with keeping their fans safe?” Swedler said. “The pro teams in the Big 4 leagues will financially survive the pandemic. They might not make as much money if they don’t have fans present. But they have huge TV contracts. That’s going to pay the majority of the bills. I really think it’s unconscionable to give the fans an opportunity to get sick in a super-spreader event by gathering them at one place, especially the NBA with having indoor only games.”
The CDC says indoor spaces with poor ventilation are more risky for spreading the virus than being outside. NBA arenas can hold between 18,000 to 20,000 people, much lower than the capacities for outdoor stadiums (between 50,000 to 100,000). Therefore, Silver has proposed hosting games at limited occupancy with rapid testing available while enforcing mask-wearing, social distancing and sanitary rules. He has emphasized the rapid testing part of the plan, saying it "could make a big difference" in terms of allowing fans.
“Anybody who goes to a game and thinks they’re going to be totally risk-free are full of themselves. So the question is – how can you integrate a testing regimen going into the game?” said Georges Benjamin, executive director of the American Public Health Association. “If we have positive rates at less than 5% around the country, then we’re much more likely able to do that. You still have to recognize people will get infected and will get sick if they go to games. But we’ll be able to get our hands around the contact tracing, so that you can do disease containment much more easily.”
The overall national COVID-19 "positivity rate" in the U.S. has hovered around 5% since the middle of September, according to John Hopkins University. At the beginning of August, it was 8%.
Health experts believe there are enough technological advances to implement rapid testing. While they suspect the NBA will front these costs for participants, they wonder how it will be handled for fans.
“If it adds $20 to a ticket, there will be people who can afford it and won’t care. Then there are other people that won’t be able to afford it and won’t do it,” Benjamin said. “My biggest concern is the black market of false negative tests. The biggest issue is people trying to trick the system and someone buying a false test. If they do it for tickets, why wouldn’t they do it for that?”
William Schaffner, an infectious disease specialist at Vanderbilt University, considered the idea “an acceptable level of low risk” if venues are filled only to 20 percent capacity. In the NBA’s case, that would be between 3,500 to 5,000 fans. Still, he expressed concern about the varying local and state policies on the virus.
“They will have to regulate and control the entire fan experience from the moment they park to the moment they sit,” Schaffner said of the NBA and local government officials. “They are going to control the experience in the parking lot with spreading everybody out. They’ll have decide about eliminating any tailgating and letting people only that pass temperature assessments and wear masks. They will be instructed to go directly to their seats and all spread out."
Fans will need to have restricted access to restrooms and food service with no long lines, Schaffner said. During the game, fans must be required to wear masks and after it's over, the exits will need to be controlled so there's no crowd.
"The entire experience will change in many, many ways. You will be there really to see the game, and not do much else," Schaffner said.
Moving forward outside a bubble
Those concerns explain why the NBA resumed the season at a quarantined site without fans. Though Silver conceded that “nothing has really changed with this virus,” the NBA and the players union have leaned against hosting another bubble amid concerns about extended time away from family.
“I'm hoping ideally we would not return to a bubble environment,” Silver said, “but it's something we're going to have to continue looking at.”
Though Dorian proposed multi-bubble sites with frequent breaks to ease concerns about extended time away from family, health experts that spoke to USA TODAY Sports believe the NBA can have teams travel to home arenas – but without fans.
First, health experts pointed to current protocols that include daily testing and enforcement of mask-wearing and social distancing. For home teams, they advised all players, coaches and essential staff to stay at home between practices and games with the exception for essential services, such as trips to the grocery store, hospital or school. Their family would be subject to the same rules.
For road teams, experts suggested the league should subject all pilots, bus drivers and hotel workers to the same protocols. Meanwhile, all participants would be limited to staying in the team hotel between practices and games, a setup health experts believe might be more realistic since they believe it would be safe enough for family members to attend under the same protocols.
“The chance of somebody messing up is very little unless you practice unsafe behavior,” Dorian said. “If they are going out to the club that’s a different story. But if you are with your family and your family is testing daily, the chances of introducing the virus is very low.”
How the NBA formulates these policies remains to be seen. After the Finals, Silver and the players union will negotiate how much time teams will have to rest and train before next season, salary cap implications and other issues.
Silver and experts outside the league concede the state of the world can change dramatically in four months.
“The pandemic is not going away in the next three or four months, and we have to plan as if it’s still around,” said Souryal, who had served as a Dallas Mavericks team physician for 20 years and an NBA physician for two.
“We can hope and keep our fingers crossed. But we are still trying to hold an NBA season in the middle of a global pandemic. It will not be normal by any stretch.”