Iowa team doctor on testing and Covid-19 issues

With the Big Ten officially postponing fall sports this year, we caught up with Dr. Andy Peterson, Iowa's team physician, on what the Hawkeyes have done as far as testing, the growing concerns for a heart condition with those who have had Covid-19, and if playing in the spring is a realistic option for the Big Ten.

Q: Can you go through the input that you have been able to give to Iowa athletics as far as making this program work?

PETERSON: Yeah, first big picture wise the decision was up to the commissioner and the university presidents. Everything else is really an advisory role. Athletic directors can shut down individual programs, but it really comes down to the presidents and commissioner.

We started preparing in the spring and it took us a while to figure out what we were going to need to do. By May we had a good handle on what we needed to do to bring people back. We brought people back in early June and really focused on the basics as best we could.

We partnered with the lab at the hospital for the most robust testing. We had the best testing in the Big Ten. We had good access to nasal testing with a turnaround time of 6-8 hours from the lab. The people at the hospital have been wildly supportive of these efforts and helping them get this done through the lab. A couple of weeks ago we moved testing itself to through athletics, so we have been collecting them ourselves and then running them to the lab. We are still continuing to test and our testing has been a great success.

What we have found is that our level of positive test rate is right in line with what we have seen in the community. We also have very robust contact tracing. Johnson County public health has been overwhelmed with contact tracing so we trained a bunch of people in contact tracing and have 6-8 of our people go through the Johns Hopkins core contact tracing training. So we do a good job of figure out who they have been exposed to inside and outside of athletics. Then we identify the people who may have been exposed in the days prior to the positive test.

We also do a good job of quarantining as well. We were one of the few schools that created a different type of housing situation for our athletes. We have been using a local hotel for people who tested positive and keep them there. The contacts they have had, we are asking them to quarantine at home.

Then we have been following the American College of Cardiology guidelines for people who are coming back. When some has a positive test, they quarantine and then 14 days after their symptom resolution we have them do cardiac testing and we have very good access to those. One of our doctors, Ian Law, has been a great partner for us on those tests. Then as you have seen in the last couple of weeks there has been some concerns about myocarditis and that might only get detected on MRI’s. We have not been doing that as a screening test. We have been doing that if we see anything abnormal and so far we have had one person who ended up getting a cardiac MRI and it ended up being normal and we have another one that will be getting one soon based on some findings, but no serious issues at this point.

So those are the big pictures things from a medical standpoint. The rest of it is more public health. In our buildings there are a lot of extra cleaning procedures and requirements for people to move a certain way in the building. We are trying to keep our pods as small as possible so we wouldn’t have to quarantine as many people. Universal masking has been very good and probably better than most, I would say. Our players have been very compliant about masking up as have our coaches and some of them have been using a face shield, which is acceptable. Our medical staff has been using masks and shields, as we would if we were in a clinic seeing a patient.

Q: One of the things that we have been told is that while the number of positive cases might not be a problem, the protocols would be a big problem for college athletics. Is that fair to say?

PETERSON: Yeah, I think people are worried about available personnel. It’s entirely possible that you have a positive at a bad time and it knocks out all your quarterbacks or all your running backs or you lose your offensive line. I think that is a real concern. It was real likely that games would have had to be cancelled or moved due to the loss of personnel at some point. I think all of us would have expected it.

Q: When you were tweeting at Tyrone Tracy, the thing that jumped out at me about how you responded to him asking what would be different between now and the spring and you said probably not much, but maybe. Can you dive into that and what needs to change to have football in the spring?

PETERSON: That’s the tricky part, right. All these things are aspirational. It would be nice if we had better testing. Not really for us, but for other places in the Big Ten that are really struggling with testing right now. If there are better quality and more available testing I think that would make people feel more comfortable.

A lot of places are struggling with contact tracing. We are doing a pretty good job here, but other places are struggling, especially as campuses start to open up and people’s social circles expand. I think we would like better contact tracing across the Big Ten rather than have everyone doing it on their own.

We talked about this a little bit, there are still a lot of issue that we don’t understand about the myocarditis. We don’t know if this is a big problem or a small problem. It is a real problem, but we don’t know the scope at this point. The biggest studies that have come out and with around 15-20 people and that’s using cardiac MRI’s. There are other viruses that cause myocarditis, like winter time flu and things like that. Those can cause it, but we don’t routinely get cardiac MRI’s on people with those viruses and we don’t know how frequently a cardiac MRI would show inflammation. We are getting the sense that it’s reasonably common with Covid, but we don’t know the clinical significance and if it’s meaningfully different from some of the other viruses where we kind of ignore it a bit.

The final thing is we hope that there are better treatments or a vaccine by the spring. I think that fairly aspirational, but we hope have better ways to treat people.

Q: Would you have felt comfortable with Iowa football moving forward this fall with practice?

PETERSON: Yeah, that is how I advised Gary Barta when we talked about it at the Big Ten physicians meeting. I felt we were in pretty good shape. While it’s not objectively safe, because we couldn’t say that no one was going to get sick or get hurt or no one would have problems, but I felt we could mitigate the risks and we had all the pieces in place to mitigate those risks effectively. We are not talking about going from high risk to zero risk, but I think we were to the point where we could mitigate the risks well enough that it would have been reasonable to play here. Now that is not the case everywhere in the Big Ten. There are a lot of places that are struggling with the important components of this and I understand why some of them were not ready to move forward.

Q: Is it impossible to build a bubble at the college level?

PETERSON: There are several parts to that. First, they are student-athletes, right? This isn’t their job and they aren’t professionals. The other thing is everyone gets a little uncomfortable when we talk about tracking students or quarantining a bunch of students away from everyone else. That goes against being a student-athletes.

We have explored early on some of the tracking technologies, but we got uncomfortable with tracking a college student. I think that was a privacy issues.

Q: Are you dealing with the basketball players as well and do you think it’s possible that basketball can be played this winter?

PETERSON: Yeah I do think there’s a decent chance we end up playing men’s and women’s basketball this winter. That is the plan for now. The fall sports are off and the winter sports are still on. We are going to keep marching forward with basketball and wrestling.

Q: Do you think it would be January instead of November?

PETERSON: No one knows. I could guess, but it’s not going to be decided yet.

Q: Will it be easier with sports like basketball and wrestling because with football you have like 120 players and support staff and coaches. Basically more bodies equals more risk.

PETERSON: I don’t think it would be easier in part because of the infrastructure we have around football. You could make the argument that football is the easier sport to deal with because they are used to the structure of their day. Every part of their day is structured and this was just another part of that. With basketball and wrestling, that’s different than what they are used to and don’t have the minute to minute structure. They are used to being more flexible in terms of how and when they practice. That will be a challenge when we have to get adequate testing and contact tracing.

Q: Will wrestling be a real challenge because it’s close contact. That the nature of the sport and there’s no barrier.

PETERSON: They aren’t wrestling with masks on, but they are using them when they do other activities, like conditioning. Wrestling is kind of unique because you have a lot of physical contact, but you don’t have contact with a lot of people. It’s easy to keep track of practice partners and training on pods and keep track of who is wrestling who. With football it is more challenging because there are 11 people on each side of the line and they are close to everyone at one point or another. So at football practice, the pod, if you will is 22 people when you are practicing at full speed.

Q: As a doctor, what are your concerns regarding trying to play however many football games in the spring and then turn around a few months later and play a season?

PETERSON: It will be a challenge. The way we practice, as you have seen, normal spring practice is really hard and they work hard. It’s not like playing a full season, but it’s also not like they have nine months off between the seasons. They have training and spring ball and contact. I am not sure how different it would be. I assume that maybe we may have more injuries, but not sure how much more than the baseline.

Q: Are you generally optimistic that Big Ten sports and the Hawkeyes will be back sooner rather than later?

PETERSON: I am optimistic about our program. I feel like we have all the pieces in place and we have done a good job of mitigating the risks. I am less optimistic about some of the rest of the Big Ten. Some of the struggles that they are dealing with seen nearly insurmountable. That’s why things got shut down. It’s not because everyone felt unsafe, it’s because some places just didn’t have the resources or they were in a community that made it untenable.

Q: Do you think they can make up that difference by the end of the year?

PETERSON: I don’t know. I really don’t know. Some of the struggles that places are having with testing are going to be a huge challenge and they are going to have to revamp their testing quite a bit and have a testing protocol that everyone feels comfortable with.

Q: How big of a concern is myocarditis?

PETERSON: It’s the unknown that’s the concern. No one knows if it’s a big deal or a small deal, for real. No one knows.

Q: Is that the scary part for someone in your position, that you don’t know?

PETERSON: Yeah. People look at unknowns in two different ways, either you want proof that it’s a problem before you make decisions on it or you want proof that it’s safe before you let them play on. I think airing on the side of trying to gather more information and having a sense of how dangerous it is makes sense.