SalivaDirect is not the answer.
So says UW football team physician Kim Harmon, despite the fact that the saliva COVID-19 test — which was developed by the Yale School of Public Health and recently approved by the Food and Drug Administration — was hailed as a testing breakthrough (and potential college football savior) in social media circles last weekend.
“It’s not a big deal. It’s overhyped,” said Harmon, who has worked with UW football since 1999, in a phone interview Wednesday.
“I reached out to our lab director at UW and he basically said, ‘This is less sensitive. It’s a central lab test. We won’t run it here, because it’s not good enough. We have a saliva test that’s better, and it’s not going to change the cost or the run time.’ The Pac-12 sent out a survey to our medical board, basically saying, ‘Can you check with your institutions and see if they can run it? How long would it take to get approved at their institution? How much would it cost? What’s the run time?’ The answers were pretty much the same as my lab. ‘We’re not going to run it, and it wouldn’t change much if we did.’”
Harmon added that, while UW has access to saliva COVID-19 tests, the anterior nasal swab tests used with Husky athletes is a more sensitive and thus a superior alternative.
Below is a conversation with Harmon on a wide range of topics related to the postponement, and possible return, of Pac-12 sports.
As of the last public update on Aug. 12, 280 UW athletes had returned to campus and been tested more than 1,000 times, producing 12 positive cases. Just three of those cases were active. When you look at UW’s plan to return athletes to campus safely, how would you evaluate the results thus far?
“I think it’s actually gone really well. People have come back. We’ve been in small groups. We’ve been physical distancing, and the vast majority of the cases that we’ve identified have come from the community. So (it came from) somebody’s parent or they were with a friend who had it or whatever. It hasn’t come from spread within the athletic footprint. So far we’ve done a good job of being able to keep it out of the athletic department and keeping spread from happening within the athletic department.
“The difference is, though, that we were getting to the point where we’re asking people to abandon a lot of the things we’ve been talking about, in terms of social distancing. When you’re trying to line up and do football practice or play basketball that’s a much different thing than lifting weights outside six feet away from somebody. In Washington we’re actually doing pretty good compared to the rest of the Pac-12 (in terms of COVID-19 community prevalence). But you have to keep it out of your athletic department, so it doesn’t spread when you’re in situations that are potentially more spreadable — where the virus is going to spread easier.
“That cardiac thing (link between COVID-19 and heart condition myocarditis) just takes it up another notch. So we used to think, ‘We want to keep it out because we don’t want to have big outbreaks. But kids aren’t going to have a lot of problems with this.’ Now we’re like, ‘Oh gosh, we don’t know if they will or not.’”
For schools that are returning students to campus and also attempting to compete in athletics this fall, how big of a challenge will it be to stop COVID-19 from spreading within athletic departments and teams?
“We’re going to see at some of these places. When you look at some of these places that are getting 40,000, 25,000 students back on campus … the stakes just go up. … When you bring a bunch of students back, I think you’re going to see — and this is sort of what’s panning out in places where they’re bringing their student bodies back — we’re asking a group of people to do things that college students are not very good at doing, like socially isolating. That leads to big outbreaks on campuses. That’s why it becomes even more important to up the frequency of testing in your athletic department, so it doesn’t get in.”
There have been conversations about attempting to play football and other fall sports in the winter or spring. Given the improvements that need to be made with COVID-19 prevalence and testing, how possible do you think that will be?
“I think it’s totally possible. There are point-of-care tests that are in the regulatory pathway that can be scaled rapidly and available. When those point-of-care tests come and we can test every day and it’s cheap, you can come in and you get tested and we know you’re not infectious. You can get tested again tomorrow, and we can do it before games. You know that the other team is not infecting my team. It’s really going to be those rapid point-of-care tests that will be a game-changer, and we’ve got them now. They’re just not OK’d (by the Food and Drug Administration), or they’re in short supply.”
There are other questions about the viability of playing two football seasons in one calendar year and the physical tax that would put on athletes’ bodies. Do you think it would be viable to do that, even if the spring season is less than 12 games?
“Yeah. I think you have to be thoughtful about how you do it. We have a pretty intense spring season that’s not games, but — in terms of injury rates — our spring football practices are typically higher than fall camp or even in season. The spring practices, that’s a tough time to be a football player, and we do that every year. (A spring football season would be) more than that. But if you spread that out a little bit and be thoughtful about the timing of that, I definitely think it can be done.
“I think doing something like that is much less risky than plowing ahead right now and saying, ‘We’re sorry that 10 or 20 or 50 players got it.’ It’s not ideal, but it’s all about risk tolerance and what types of risk. The problem is that the risk is unknown.
“So say I have a jar and it’s filled with white balls and red balls, and if you get a red ball something really bad happens, and if you get a white ball something really good happens. You get a million dollars if you get a white ball and if you get a red ball maybe you get super sick. Maybe you have long-term problems. So if I could tell you that there’s one red ball in that jar you could kind of say, ‘OK, does it make sense to take a ball?’ Or if I could tell you there’s 10 red balls in that jar. But I can’t tell any of the players how many red balls are in that jar. It could be 99. You just don’t know. It’s this uncertain risk that really makes these tough questions.”
I think what’s frustrating for readers and football fans is that there seems to be different opinions even in the medical community about whether football can and should be played this fall. Some doctors say it’s too risky to play, while others continue to support it. Why do you think that disparity of opinion exists?
“So I will tell you that doctors from all conferences are talking, and we all have similar concerns. From a team-physician standpoint, we all have similar concerns. But as physicians, in most places we’re not the decision-makers and we’re like, ‘OK, given the fact that we’re plowing forward, we’re going to do the best we can to keep our athletes safe. We’ll just keep going and try to protect our athletes as best we can while this is going on.’ So there is widespread concern.
“There’s a lot of things that go (into the decision) besides medical concern. There’s a lot of difference of risk tolerance. It’s unfortunate that sometimes this gets turned political, because the spread of this very much looks like a political map if you look at the conferences that have canceled (fall seasons) versus those that haven’t. Mike Akerman’s tweet didn’t help at all. He was the (Mayo Clinic) cardiologist who’s a good friend of mine (who tweeted that football seasons should not be postponed because of myocarditis concerns).
“The good thing is that it has spurred significant collaboration. There are people moving forward as we speak to try to get the answers to some of these questions. We’re putting together a national registry for cardiac issues — How many people are asymptomatic? How many people have it? — so we can better understand this. We’ll understand it a lot better in a month or two.”