A Global Health Researcher Is Not Impressed With the NBA’s Reported COVID Plans for This Season

The bubble is gone. (Some) fans are in!

Giannis Antetokounmpo falls into the crowd during a game in January in Sacramento.
A worrying sight come winter. Ezra Shaw/Getty Images

The NBA isn’t going to have much of an offseason. The league is preparing to start the 2020–21 season on Dec. 22, just two months after the Los Angeles Lakers left the Orlando bubble as champions. (The typical offseason is about twice as long.) But the bubble is no more. Teams will be playing games in their normal arenas, and the NBA sent a memo to its 30 organizations with an outline of protocols for hosting reduced-capacity crowds.

Some teams, like the Lakers, have already committed to having no fans at games throughout the season. But for those “eligible markets,” reduced-capacity games are a way for franchises to recoup financial losses brought on by the COVID-19 pandemic.

To learn about the viability of these reported plans, I called global health researcher Abraar Karan, who is a physician at Brigham and Women’s Hospital and Harvard Medical School. Our interview has been condensed and edited for clarity.

Nick Greene: What did you think of the NBA’s plan last season—the “bubble” in Orlando?

Abraar Karan: I talked to Zach Lowe about this for a piece he was doing for ESPN when this was first happening. I said it was a pretty foolproof plan. The only problem would be if you had any false negatives and people ended up playing when they were actually infectious. That didn’t happen, and people stuck pretty close to the bubble. It effectively took complete isolation of a large social circle to prevent the virus from coming in. I think that really hits on the idea that it’s socializing, which is a key part of sports and going to games, that unfortunately is how this virus spreads. It’s one of the main ways.

According to reports, the NBA is preparing for “eligible markets” to host some fans at arenas during the upcoming season, which is slated to start in December. Does this strike you as realistic, given the trajectory the country is on with the virus?

They’re starting in December?

Yes, the plan is to start in late December.

That’s crazy. It feels like the finals just ended. I’m happy to see basketball again, but that’s crazy. In the NBA’s plan, are they requiring fans to be tested?

The report says fans above the age of 2 are required to wear masks, be socially distanced, and undergo symptom surveys. Fans within 30 feet of the floor have to submit a negative PCR test two days before the game or a negative “NBA-approved” rapid test on the day of game.

But if you’re not within 30 feet of the court you do not have to do that?

It appears as if testing is only required for those within 30 feet of the court.

OK, that’s crazy. We have an uncontrolled epidemic right now. We have community transmission all over the country. They’re saying that you can go into the game and you don’t need a test unless you are within 30 feet of the court, which seems to me to be related to how close you are to the players and the safety of the players. What’s the distancing?

Not specified, but the report refers to fans wearing masks and staying in a “physically distant manner,” and those who are part of the same ticket group can sit together. When I hear that, based on widely discussed public health guidelines, I think about it being 6 feet apart.

That’s not going to work. You’re going to have aerosol-based spread. Aerosols don’t respect 6 feet. They spread most effectively indoors and in crowds. So that’s the exact situation you don’t want. What is it that’s driving COVID-19 in this country? It’s clustering. That is literally driving the epidemic. So when you have people crowding together, I don’t care what your percent positivity is [in your city]. Even if it’s low, you can still have clustering and superspreading. A place where you’re cheering and yelling and drinking—the virus does not respect 6 feet.

What would the ideal distance in an arena be?

There is no ideal distance in the sense that aerosols linger in the air. The further apart you are, the lower your risk is going to be, but that risk doesn’t get eliminated. We’ve seen studies showing aerosols hanging around in rooms for hours and hours. That’s why the indoors are more of a problem in general. For these types of events, we need to wait for a vaccine.

Going back to testing, for fans within 30 feet of the court, the NBA reportedly wants a negative test two days before the game, or a negative rapid test at the venue. Isn’t that the same strategy the White House used before it experienced its own outbreak?

With the White House outbreak, I’m not sure whether everyone got tested that day. But let’s say they did. Even then, yes, you will have some false negatives, but they will be few and far between. People who are most infectious and peaking their viral load—the rapid antigen test is pretty good at detecting that. For the PCR test two days before, it takes one or two days to get your results back in this country, in most places. That means [if] I’m testing four days before, I get a result two days before, and in the interim I certainly could have developed an infection or been exposed. And then I show up. Those gaps are really going to hurt us.

There was news today that the Golden State Warriors have a plan, dubbed “Operation DubNation,” where they want to use rapid PCR tests to help them fill their stadium to 50 percent capacity by testing everyone who comes in. What does the research say about rapid PCR tests? How accurate are they?

The rapid PCR tests are quite good. The rapid antigen tests are also quite good, but it kind of depends what you are looking for with your testing. If you’re doing asymptomatic screening, you are going to have false negatives and false positives with both tests, but [there will be] more with rapid antigen tests.

What percentage accurate are these rapid PCR tests?

It’s not really a percentage accuracy rate. You’re probably talking about sensitivity and specificity. Both of those are quite high for PCR tests; they’re both in the high 90s.

The Chase Center in San Francisco holds about 18,000 fans, meaning they’d be testing 9,000 people at a time if they did half-capacity. That’s a huge amount of rapid tests, even if they are highly accurate.

Yeah. You’re going to have false positives and false negatives. Obviously here, your false negatives are what are going to concern you. Even if the false negative rate is a couple percent, with 9,000 people that comes out to what, 180 people? Getting 9,000 people together indoors in a month—without any reservation I would say that’s an absolutely terrible idea. You run into issues with a lot of things. The actual swabbing itself. The kits, the reagents. Everything has to work perfectly, and even then you miss some.

So, in other words, you wouldn’t feel safe going to a game in December.

No. Absolutely not. That’s a bad idea. I wouldn’t do it.

Would you recommend the NBA go back to the bubble?

I would recommend that if the NBA does not go back to the bubble that they at least don’t have fans indoors in December, because we are in a heavy third wave of COVID right now.

The optional plexiglass shield behind the bench isn’t going to cut it?

That’s right.

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