The Pac-12 Conference voted this week to shutter fall sports for the remainder of 2020 because of the coronavirus pandemic.
Robert C. Robbins, president of the University of Arizona, was part of the CEO Group that made that call. In some ways, he felt conflicted. Robbins is a rabid sports fan who grew up in Mississippi, where college football is king. In other ways, the decision was as clear as the Southern Arizona sky.
It was “one of the toughest things I’ve ever had to do in terms of my emotion as a sports fan,” Robbins said. “But as someone who has the safety of young athletes and students as my No. 1, overriding priority, it was actually pretty easy.”
The sentiment among the conference leaders was unanimous – especially in light of emerging information linking COVID-19 to myocarditis, an inflammation of the heart. Several Big Ten student-athletes have been diagnosed with the condition, according to reports. The Big Ten preceded the Pac-12 in postponing fall sports.
Robbins is a cardiac surgeon who has devoted much of his professional life to studying and researching cardiac disease and treatment. Even though he considers the chance of a “major, adverse event” happening to an otherwise healthy young athlete to be “infinitesimally small,” just one such incident would constitute a worst-case scenario.
“It's just not worth it,” Robbins said.
Robbins elaborated on the Pac-12’s decision, explained how viruses can lead to heart problems and offered advice for the UA’s sidelined student-athletes in an interview with the Star. The conversation has been lightly edited for context and clarity.
On July 31, the Pac-12 release a revised football schedule, and there was at least a degree of optimism at that time. Then the league announced Tuesday that it was postponing all fall sports. What changed during that span?
A: “When we announced the schedule, we were hopeful – but there were some lingering doubts. (A) major factor is that the L.A. schools, USC and UCLA, and then Stanford and Cal, they were challenged because of the local conditions; they couldn’t return students to campus.
“In Arizona, (over) the last month to six weeks, which I'm very thankful for, the number of cases has gone down. … But there's still too many cases and too high a (rate of) transmissibility in California for those schools to participate. So from the start, we were going to be down a third of the teams in our conference. That proved problematic.
“Our medical experts briefed us about the ability to do rapid testing. Us and Arizona State, we had no issue with that. But some of the schools, for whatever reason, didn't have the cadence well enough worked out to be able to get timely testing.
“The final thing was learning about some of these other effects in asymptomatic individuals, especially the reports that we started seeing (about) certain effects that COVID-19 is having – the cardiac issues that we started to see.
“So when we started to put it all together, we just thought it was the better part of valor – the prudent, cautious route to just say, ‘Let’s suspend. Let's take a pause. We'll revisit this over the coming months, because we'll have more data then.”
A pause sounds like a couple of weeks. Why didn’t you just go that route?
A: “The idea that in just a couple of weeks the situation in California was going to be dramatically different, we didn't have a lot of confidence in (that). The other thing is, we thought we needed more time to observe these health issues and to get our testing protocols more frequent.
“The collective wisdom was, ‘Let's just take a break. Let's learn as much as we can through observation.’
“When you test positive, you're quarantined and isolated for two weeks. And then you have to get (a) troponin (blood test), an EKG, monitors to look for arrhythmias, a stress echo and a cardiac MRI before you’re even allowed to return to practice, much less competition.
“All of that sounded like a bridge too far in this period of uncertainty.”
You used to be neighbors with Big 12 commissioner Bob Bowlsby at Stanford. Are you surprised that his conference, the ACC and the SEC are moving forward with football at this point?
A: “No. They're listening to their medical experts.
“I don't know this individual, but the chair of the medical advisory committee for the ACC is a prominent infectious disease physician from Duke (Dr. Cameron Wolfe). Everybody said, ‘Well, maybe the ACC will play, but Duke certainly won't do it.’ But this individual said he's looked at all the data, and in his opinion and in their medical advisory committee’s opinion, (it’s possible to play safely). We just didn't see a path forward.”
How do viruses cause heart issues?
A: “There are two major causes for having to do a heart transplant. One would be an ischemic cardiomyopathy – not enough blood flow to the heart. You have a heart attack. Your coronary arteries get blocked, and your heart muscle, there’s just not enough of it left. So you have heart failure.
“The other one is called idiopathic cardiomyopathy. Idiopathic simply means we don’t know what causes it. But for decades, one of the culprits has been the Coxsackie B virus. It affects the heart muscle in still unknown ways.
“We know that even with regular influenza, every year we see individuals that have inflammation in their heart.
“But there (also) can be a direct attack of the virus on the heart muscle. That’s what myocarditis is.”
That development clearly raised red flags among Pac-12 leadership. How much more time and data are needed to get a handle on that?
A: “I've spoken to my friends who are in leadership at the National Heart, Lung and Blood Institute about it. We just don't have enough data.
“We’ve got data from the JAMA article (Journal of the American Medical Association) that was published about individuals that are (mostly) in their 40s and 50s. There was a high incidence of myocardial inflammation or myocarditis. (The study revealed cardiac involvement in 78% of patients and ongoing myocardial inflammation in 60%.)
“We just don't know in asymptomatic, elite athletes what the prevalence or incidence is.”
How feasible is it for all the other schools to be on the same level as you and ASU in terms of testing?
A: “We were way ahead of this game, so we've got this down. ASU’s got their robotically analyzed saliva test. The problem for our testing is, it does require that you have a supply chain of tests kits. We're just lucky that we've got that, because we were in early.
“We’ve been at this since March. We've refined the protocols – how we collect, how we test, how we get the results back. You need to have it in a timely fashion, especially if you're testing, say, the day of the game.
“I think we can run a test every three minutes. So within 10 minutes, you can know if an individual is positive or negative. Not everybody has that capability. Trying to scale that in the next couple of weeks would have been really tough.”
School starts Aug. 24. What do you expect campus to look like?
A: “I still don't know the answer to that, even though we're inside two weeks. My sense is, we’re going to have a lot of students who want to continue their education in some form, whether it be synchronous online, in person or asynchronous online.
“So the number of students that actually return to Tucson, I don't know exactly how many that's going to be. But … out of the 45,000 students we would normally have this time of year … we think we’re going to have between 35,000 and 40,000. I just don't know how many of those individuals will actually be here on campus or living near campus. But I wouldn't be surprised if it's between 20,000 and 30,000.”
Are they all going to be tested?
A: “The only mandatory testing we have is for the students who are going to live in our dormitories, which is less than 6,000; it’s probably 5,200, 5,500. They will need to have a negative test before they're allowed to move into the dorm.
“All other students, we’re strongly encouraging them to get tested. We've opened it up to them, and our faculty and staff, and we've had a big response. And then … we've got an incidence testing algorithm, where we'll be testing frequently over the course of the semester.”
If you could address the football players this week, what would you say?
A: “What I would tell them is, ‘I am heartbroken for all of you and all the other athletes.’ Remember, it's not just football. It’s volleyball, it’s soccer.
“The message would be one of, ‘Hang in there. I'm really disappointed for you. I know how hard you've worked.’
“ ‘This just a pause. It's a long pause. But keep the hope up that we can learn more about this devastating disease and that we potentially can start competition back up in January.’
“ ‘Stay active, stay in shape. We'll learn a lot more about this virus in the coming weeks and months.’
“ ‘My biggest concern for all of you is your safety. I can never allow that responsibility to not be taken seriously.’
“ ‘We'll get through this. There's no question we'll get through this. We'll come out on the other side smarter, with better understanding.’
“My hope, of course, in the intervening few months, is there's going to be a vaccine or some therapeutic that will be a game-changer.
“They've all been through adversities in their lives. This is another one of those curveballs. So I would encourage them to remain vigilant.
“When the time is right, we're gonna eagerly cheer them on the field, in the pool and whatever venue they’re going to compete in.”
