Coronavirus vs. concussions: A college football risk assessment with the season on the brink

There have been five million confirmed cases of Covid-19 in the United States and almost as many opinions, misinterpretations of fact, reversals of policy and instances of ignorance and confusion.

College football leaders have stated from the outset of the pandemic that they planned to follow the science while deciding whether to shutter the season.

That’s great, except the science is everywhere.

Fact: According to the CDC, there have been 225 deaths from Covid-19 in the age range that covers college football players (15-24 years old).

Fact: According to a recent German study, 78 percent of recovered Covid-19 patients had evidence of “ongoing heart involvement.”

So Covid-19 is no big deal for a healthy 20-year-old … unless it’s a very big deal.

Meanwhile, university presidents and athletic directors must consider competing motivations as they ponder whether to forge ahead with training camp and possibly a fall season.

Absolutely, it’s about the money: There are billions of dollars at stake.

But the vast majority of athletes want to play. It’s what they do. It’s their identity. And they voiced that desire loudly on Sunday night.

There are significant mental health and nutritional concerns that must be considered, as well.

Also, the environmental cross currents:

Football might not safe, but it’s safer than most places the players would otherwise be — far safer than the residence halls and the lounges and the parties and the bars.

It’s even safer, for some players, than their own homes, where extended and multi-generation families are living.

An hour not spent participating in football activity is an hour that might be spent at a mask-less indoor gathering with friends.

In other words, it’s complicated.

As NBA commissioner Adam Silver said: “We are left with no choice but to learn to live with this virus. No options are risk-free right now.”

We know — or strongly suspect — what college football will do. The Big Ten and Pac-12 will shut down for the fall, perhaps by the end of this week, and others will likely follow eventually.

But should the Power Five pull the plug?

Should they shut down and pack up now, when there are still seven weeks before the true deadline for season openers.

For clarity on the risk associated with playing football in a pandemic, we sought counsel from someone who studies the risks of playing football at all times:

Chris Nowinski, the founder of the Concussion Legacy Foundation.

No one has done more to communicate the risks over the last decade — and to advocate for safety changes at all levels — than Nowinski.

Covid-19, according to multiple studies, can cause heart damage.

But football, according to mountainous evidence, can cause brain damage.

Changes have been implemented to reduce the chances of players developing Chronic Traumatic Encephalopathy, the degenerative brain disease. But enormous risks remain — and college football hasn’t shut down.

So we asked Nowinski:

Would canceling the season be the equivalent of refusing to jump in shark-infested waters because you’re worried about the piranhas?

Put another way: What does the science say about the relative risks of CTE and Covid-19?

“It’s an interesting framework through which to view this,’’ he said.

Nowinski began his response not with data but with advocacy: What rights do the players have as they contemplate practice and competition amid a pandemic?

Specifically, he pointed to the lack of a union and the need for assurances on frequent testing and scholarship protections for players who opt out of the season.

The NCAA has guaranteed the latter, but the former — the frequency of testing — has been a source of deep concern for Pac-12 players involved in the #WeAreUnited movement and groups across the country.

“The question is, ‘When is it appropriate to ask the players to take on risk,’’’ Nowinski said. “This is a new risk, and it changes the equation. The players should have more choice …

“The CTE discussion started with information the (NFL) players didn’t have, and that’s why there were changes to the game and lawsuits.

“I don’t know how well you can quantify the risk to playing football this fall.”

One component to the equation is known: The odds of of developing brain damage.

“We don’t have absolute risk numbers for brain damage, but we have relative odds,’’ Nowinski said.

“And the odds of developing CTE go up 30 percent every year of playing football.”

According to the Concussion Legacy Foundation’s website:

“A 2019 study on deceased football players led by Boston University researchers and published in the Annals of Neurology medical journal found that the risk and severity of developing CTE among football players is not correlated to number of concussions, but is instead correlated to the number of years playing tackle football.

“The study analyzed 266 deceased football players, 223 of whom had CTE and 43 of whom did not. The researchers found that the risk of CTE increases by 30 percent every year of tackle football, and doubles every 2.6 additional years. (We don’t know the risk of developing CTE after one year of playing tackle football, but it’s likely very low.) This shockingly strong relationship between years of tackle and risk of CTE may be even stronger than the link between years of smoking and risk of lung cancer.

“The link is so profound that a high school football player who starts tackle football at age 5, instead of age 14, has an incredible 10 times the risk of developing the brain disease CTE.”

Playing in any given season — the 2020 season, for instance — carries a “very low” risk for developing CTE. And the odds of a player suffering a fatal brain injury this fall are extraordinarily low.

The likelihood of a player dying from Covid-19 is also very low, but not quite as low.

Nowinski estimated the fatality risk from Covid-19 could be 10 or 20 times higher than the equivalent risk of dying from a brain injury, but the data is insufficient on two fronts:

— The CDC’s age range for Covid-19 fatalities (15-to-24 years old) isn’t narrow enough to isolate college-age players.

— The total number of Covid-19 cases is unknown.

But let’s take our best, unscientific, swing at gaining context on the risk factor, using California data as the guide …

The age cohort tracked by the state that most closely reflects college players is the 18-to-34 range.

According to the state, there have been 196,000 confirmed cases in that range (35 percent of the state’s total).

The CDC estimates the real number of infections is 10 times higher than the confirmed case count across the country.

If we apply that estimate to the confirmed total, then two million Californians in the 18-to-34 range have contracted the disease, either in symptomatic or asymptomatic fashion.

There have been 150 confirmed Covid-19 deaths in that cohort, including those with underlying healthy conditions.

Using those numbers — 150 deaths out of two million cases — there is a .0075 percentage chance of an 18-to-34 year old dying from Covid-19 in California.

Or approximately 13,000-to-1.

There are approximately 6,500 players on Power Five rosters, and about 1,200 in the Pac-12 (if you account for walk-ons).

But again, the age range is too wide to allow for a firm grasp.

And we’re only using one state.

And we aren’t accounting for Body Mass Index, especially with regard to linemen.

So the answer, it seems, is that a Covid-19 related fatality is highly unlikely.

But that’s not the only consideration in the risk assessment.

The unknown longer-term effects of Covid-19 — especially as they relate to the cardiovascular system — are a growing concern among university presidents and athletic directors.

(The German study cited above involved 100 people, with an average age of 49.)

Also, there are the optics:

Amateur athletes participating in a sport largely, but not entirely because of the financial calamity that could strike if the season is canceled.

“There is no perfect answer and a lot of good questions,” Nowinski said. “But the risks are starting to pile up.

“The problem is all the unknowns.”

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