Can the NBA win its rematch with COVID-19?

As the pandemic wreaks havoc on the NCAA and NFL, the 2020-21 NBA season offers new hopes and fears

The 2020-21 NBA season features several intriguing storylines: whether one ball will be enough for Kyrie Irving and Kevin Durant, LeBron James’ attempt to repeat, the emergence of Luka Doncic among the league’s elite and the mystery of James Harden’s present and future.

But all those stories pale compared to the rematch between the NBA and COVID-19.

From early on in the pandemic, the NBA played a central role in how society thought about COVID-19. It was one of the first major organizations to suspend activity as cases started to rise during the early spring of 2020. And of course, the bubble experiment for resuming play in Orlando, Florida, was one of the most peculiar and successful ventures in the history of modern epidemiology. The NBA bubble was so elaborate that it was even used for original medical research on how virus populations grow in the blood following acute infections, and for the development of a Food and Drug Administration-approved test called SalivaDirect.

The bubble served as an example of how to make a dent in a problem that has looked impenetrable, even as other sports struggled to replicate the bubble’s success. MLB had mixed results with COVID-19, ending its season with a player having to be removed from the deciding game of the World Series because of a positive test. But it is the NFL and NCAA football and basketball where the message from the NBA bubble seems to have translated poorly.

For example, as of mid-December, only a single NFL team — the Seattle Seahawks — can report no positive COVID-19 tests among its players and staff. And several teams reported outbreaks where transmission occurred in members of the organization. This all happened despite a rigorous set of protocols that govern testing, education, travel and game-day activity. (For example, during the last full week of November, the NFL used more than 40,000 tests for players and personnel.) None of these measures prevented outbreaks that have forced the league to make sometimes puzzling, even embarrassing alterations to the schedule. Teams aren’t sure what to fear more: having to play against the Kansas City Chiefs and Patrick Mahomes at Arrowhead Stadium, or the prospect of an outbreak that burns through all of their quarterbacks.

Blake Griffin (center) of the Detroit Pistons drives to the basket against the New York Knicks during a preseason game on Dec. 13 at Little Caesars Arena.

Chris Schwegler/NBAE via Getty Images

The NFL’s public response to the outbreaks has been as much about disciplining coaches and players as acknowledging potential flaws in its COVID-19 plan. In this regard, its approach resembles the way higher education responded to outbreaks early in the fall, after several campuses decided to open their doors to students: When problems arise, treat them as a compliance issue — the product of irresponsible individuals, and not systematic or procedural issues. Naturally, higher education’s blame deflection has trickled down into college athletics, whose COVID-19 situation might be the worst of all popular televised sports.

COVID-19 has highlighted many absurdities and fragilities that have long existed in college sports: the fact that their “amateur” athletes have no true decision-making power, the trouble with different divisions and conferences setting their own rules, how state and national politics can undermine public health messaging, and just how little regard some college coaches have for player safety. For example, Florida State canceled its November game against Clemson after someone on the Clemson roster tested positive. Clemson head football coach Dabo Swinney famously responded with the wild claim that the COVID-19 explanation was an excuse to hide the real issue: that Florida State was afraid to play Clemson.

Not only have almost 19% of all NCAA football games been canceled or postponed this season, teams are opting out of bowl games, and some teams have played so few games that controversy looms about how to pick the BCS finalists. It is fair to say that college football is nearly in complete disarray.

Nita Bharti, an assistant professor of biology in the Center for Infectious Disease Dynamics at Penn State University, says that “the truth is that much of what happens with college sports has less to do with what’s actually happening out in the field and more about what’s happening on the campus is driving community-level transmission. In addition, none of the college sports have the resources that the NBA had with regards to testing and regards to putting student-athletes in bubbles and such.”

Gregg Popovich (center) of the San Antonio Spurs coaches from the bench during a preseason game against the Oklahoma City Thunder on Dec. 12 at the AT&T Center.

Logan Riely/NBAE via Getty Images

So far, NCAA basketball is looking more like its college classmate (NCAA football) than its professional counterpart, the NBA. One of the earliest reported positive cases was on the UConn women’s basketball team, which forced them to delay the start of their season. And on the first major day of men’s college basketball, Nov. 25, approximately 20% of games were canceled, many due to COVID-19. The first few weeks of the season give us little reason for optimism: positive tests turn up regularly everywhere, games are routinely canceled and rescheduled, and hope diminishes that we’ll experience a recognizable version of March Madness.

What are the fundamental differences between the NBA bubble of 2020 and the protocols that have been less effective in the NFL and NCAA? And do these differences explain the discrepancy in their experience with COVID-19?

In general, the problem with the non-bubble solutions is that they assume organizations can test and isolate their way out of a COVID-19 outbreak. The protocol in the NFL says that if a player has a positive result without symptoms, the player needs to wait 10 days to return to football activities or have two negative tests at least 24 hours apart. But these methods don’t account for possible transmission events between the time one becomes infected and the time that the athlete undergoes a test — one might be able to spread SARS-CoV-2 even before current testing methods detect infection (this is an active area of research). In addition, the system isn’t equipped to address the 12- to 24-hour window between when a test is administered and receiving results. In both of these scenarios, a player might unknowingly infect others.

“Testing is certainly an integral part of a multipronged response, but testing on its own is not sufficient. And quarantine and the isolation on their own are not sufficient,” Bharti said. “We need all these things working in concert. As we start to add more to the toolbox – and hopefully pharmaceutical interventions will become part of that toolbox – all those things will work together to help us get ahead of this.”

The NBA beyond the Bubble

Now that the NBA is abandoning the bubble, how should it adjust to the failings in other sports? For the 2020-21 season, the NBA is loosening its belt with a new set of policies that govern everything from how teams handle a positive test to the size of a team’s travel party (45 people max). The new rules include a shortened season and altered schedule structure, while including elements that look something close to normal with travel, and fans allowed into arenas (albeit a limited number, and under certain conditions).

But the key novelty is that basketball will be played without the defining feature of the bubble — a firewall that separates NBA players from the rest of society. And the timing could not be worse, with deaths and infections in the United States surpassing the peaks from the spring. And this disregard for the current situation manifests in several notable gaps that could spell trouble ahead.

1. Like the NFL, the NBA’s policy seems to be driven by testing.

The problem is that frequent testing is a reactive, and not a truly preventative means of stymieing an outbreak. A forgotten fact about the 2020 NBA bubble is that there were dozens of positive tests from staff, workers and other individuals involved with running the bubble. But the bubble was successful in preventing these cases from spilling over into the pool of players because of the hard barrier between the players and the rest of the bubble (and surrounding world).

Bharti noted that “when you have something like the NBA’s bubble system, it’s defined by layers of increasing porosity around the tightly protected players [e.g., buffers between the players and the hotel staff, who move in and out of the bubble]. But once you’re in the inner bubble, the mixing and the contact rates inside of it are very high and the contacts are frequent. So if you take that configuration of frequency of contacts and intensity of contacts, and you try and do it without the peripheral buffers, you would very quickly end up in trouble because you wouldn’t have firebreaks between teams.”

Kevin Durant (center) of the Brooklyn Nets lays the ball up during a preseason game against the Washington Wizards on Dec. 13 at the Barclays Center.

Nathaniel S. Butler/NBAE via Getty Images

Given the way the bubble was structured, and what we know about how viruses such as SARS-CoV-2 spread, it is quite possible that a single infectious player could have created a rapid and explosive outbreak that would have ended the season. For the 2020-21 season, the act of preventing infections among players or coaches appears daunting, perhaps even unrealistic.

2. The NBA schedule means more travel and frequent contact between teams.

For all of the NBA’s problems with COVID-19, the structure of the NFL schedule facilitates more control over interactions between teams. That is, over 80% of teams usually play on a single day (Sunday, with most of the other matchups being single games on Thursday and Monday). And this schedule means that it is easier to control contacts through the rescheduling of games. For the 2020-21 season, the NBA has gone to lengths to change the schedule to prevent frequent travel and contacts (e.g., instituting a “series” structure as in the MLB, where teams play each other multiple times consecutively, all in one city).

However, these still contain more contacts between teams than the NFL. For example, let’s look at the defending champion Los Angeles Lakers’ schedule during the first week of 2021: on the road against the San Antonio Spurs on New Year’s Day, two in a row at the Memphis Grizzlies on Jan. 3 and Jan. 5, and then the Chicago Bulls in Los Angeles on Jan. 8. That is, from one Friday to the next, the Lakers will have interacted with three different teams in five games. While this represents a reduced-travel schedule designed to minimize exchanges between teams, the mathematics of NBA scheduling means that there will be far more contacts between players on different teams per unit time than in the NFL.

3. The NBA may not have the personnel to withstand player losses that will come with team outbreaks.

One of the largest threats to the NBA’s well-being resides in one of its strengths. That is, the league has risen to prominence so rapidly in part because it is a player- and personality-driven sport. And it is that way because teams are not composed of large armies of faceless individuals who can easily be replaced. Rather, basketball is a great sport specifically because singular performers have such a large influence. And part of this is reflected in the size of NBA rosters. The league recently allowed teams to expand their active rosters on game days from 13 to 15 for 2020-2021 season. But even with this change, an outbreak among three players on a given team would be much more challenging to compensate for than in the NFL, with its larger roster (53 players) and practice squad reservoirs. Given the interconnectedness of the schedules and frequency of travel, an outbreak on one team could have ripple effects throughout the league, complicating the schedules of other teams.

The three items described above aren’t quite the stuff of impending doom, but they are worth consideration when thinking about the upcoming season. One can think of them as part of a “scouting report” that describes why COVID-19 has a chance in this upcoming rematch.

The interaction between sports and epidemics is revealing because professional athletes are among the strongest, healthiest, most fit people in the world. The idea that they might be susceptible to the same illnesses as everyone else is tough to imagine. But the gap between what we think is possible and what is really happening has defined the COVID-19 pandemic. As of mid-December, 300,000 Americans have lost their lives.

And here lives the greatest lesson from the experience of COVID-19 and sports as we enter 2021: It is time for the relationship between sports and COVID-19 to move on from the experimental phase. The stories of the NFL and NCAA have taught us that sports with frequent contact between athletes are amplifiers for infection. Because of this, the NBA’s migration away from the bubble structure is cause for alarm. Nonetheless, we will watch closely, cheering in unison for the NBA as it begins the second battle against this scourge.

C. Brandon Ogbunu, a New York City native, is a computational biologist at Yale University. His popular writing takes place at the intersection between sports, data science, and culture.