The National Basketball Association resumes its season Thursday night in Orlando, the end result of months of planning, myriad safety precautions and tens of thousands of coronavirus tests.
It’s the largest attempt so far at sports in a bubble, a mass-group quarantine designed to keep everyone healthy while staging games on TV. Testing is a critical piece of that endeavor, and it’s become increasingly polarizing.
Inside the bubble, NBA players, coaches, referees and guests are tested daily, a massive operation of more more than 1,300 tests per day. Meanwhile, in other parts of Florida, infections are rising, and many people are waiting at least seven days for results, a delay that renders the tests themselves almost useless. The stark contrast has many contemplating the role that wealthy, private companies like the NBA may have on the market as a whole.
On one side, testing companies with unused capacity contend that big employers are adding to America’s long-term testing ability by adding an incentive to invest in more capacity—machines, staff and kits. On the other side, some doctors say that demand is dire right now for high-risk cases alone, and there aren’t enough testing kits to go around. “It’s simply untrue that a test being used for one company couldn’t be helpful elsewhere for public health purposes,” one university pathologist told Sportico. “Virtually no one in our field can get the number of tests that they want.”
By numbers alone, the pro sports testing isn’t enough to disrupt the marketplace. The U.S. is doing about 800,000 tests per day, which puts the rough daily output from the MLS (600), MLB (1,500) and NBA (1,300) at just around 0.4 percent of the overall. (The NHL’s 3,000 tests per day are now being done in Canada).
That said, these tests are nearly all happening on asymptomatic people. Professional athletes are being tested whether they’re sick or not, a luxury that has some experts worried, should the practice become more broadly adopted across the business world.
“What concerns me is not that the NBA will use many tests, but more that they will be the pilot case study that gets copied by thousands of firms across the country, and that will lead to shortages,” said Dr. Bob Kocher, a partner at Venrock and former co-chair of California’s Testing Task Force. “If we start making thousands of NBA-like bubbles where we’re testing people on a really frequent pace, that will actually be really damaging to our ability to get tests to people with a higher clinical priority.”
Those at testing companies say that scenario is ideal—and not just because it serves their business. Sports leagues are among the first large private entities to pay for wide-scale testing for employees. More of that from companies means more testing for people.
“If you’re a Walmart or an Amazon, or frankly a state government, you have tens of thousands if not millions of people working for you across all pay grades,” Jason Feldman, CEO of Vault Health. “Many of them are hourly workers who keep the fulfillment centers, distribution centers and stores alive in this country, which is the backbone of our economy. If they’re willing to pay for that testing and take an organized approach to making sure that people have the results they need to safely come to work and stay at work, then God Bless them. Please do it, because guess what? Nobody else is.”
So how do we reconcile those two ideas? How one views the situation likely depends on one’s position within the healthcare industry. But it also may hinge on the time-frame of your thinking. In the immediacy, it’s true that all asymptomatic, preventative testing is using infrastructure—reagents, pipettes, machines and lab staff—that could be better used in virus hotspots. But testing programs like the NBA’s benefit the country longer term, according to Sean Murray, President of lab testing company Eurofins.
“If tomorrow you said we need to free up 5,000 tests for emergencies, and you required all sports leagues to stop testing, then yes, you could maybe create some instant capacity,” Murray said. “But if that became a broad policy, anyone who’s trying to do proactive testing would stop investing, and stop building capacity. Long term it would be detrimental.”
Then there’s the disjointed nature of the U.S. healthcare system as a whole. Both Vault and Eurofins, which work with sports leagues, said they had unused daily testing capacity, staffing and equipment, but struggled to pair their excess supply with the people and institutions experiencing delayed results.
Diagnostic testing is built largely on relationships between providers and labs, a space dominated by a few big companies like Quest, LabCorp and BioReference (the NBA and MLS partner). In a time of emergency, there’s no larger entity, government or otherwise, that is coordinating the testing.
“It’s not like they can immediately say, ‘Oh, let’s switch our volume to Eurofins,'” Murray said. “They’ve got to find us and learn that we have capacity, which we do. Then there’s a negotiation with the healthcare provider to get the terms correct. Then we’ve got to get our people in place, set up logistics. The entire market isn’t bottlenecked, but it might be Lab X in State Y.”
Dr. Anthony Fauci, the country’s leading infectious disease specialists, told the Wall Street Journal this week that sports leagues likely weren’t having a huge impact on the market. “I don’t see the dots between sports getting their results back quickly and other groups not as being necessarily connected,” he said. “They have a system, which is the rapid tests that get it quickly. We should be doing more for surveillance that way.”
The leagues themselves say they’ve been thoughtful with their approach. That comes after some early public hiccups. Shortly after the NBA suspended games in March, commissioner Adam Silver said that eight full teams had been tested for the virus. That came as access to testing was virtually non-existent, even for the most critically ill patients. The scandal drew harsh criticism from New York City Mayor Bill DiBlasio, who said tests should be for the sick not the wealthy. Even President Donald Trump weighed in to lament the issue.
Dr. Winne Meeuwisse, the NHL’s Chief Medical Officer, said the league made sure its testing plan for its Canadian restart wouldn’t strain public resources. NBA spokesman Mike Bass said the same.
“By bringing new testing capacity to Central Florida, launching a mobile testing site open to the public, and bringing in point of care testing to support not only the NBA but members of the community in the Orlando area, our program will actually be additive to public testing,” Bass said. The NBA on Wednesday announced that it will work with several private labs to offer more free testing in communities of need across the country.
It’s unclear if that’s enough to sway the league’s critics. Sportico spoke with a handful of doctors who voiced frustration that sports leagues were indeed taking resources away from those who need it more. One said his university-affiliated lab had stopped doing testing for sports teams because there were more pressing public health needs.
“The NBA’s ability to set up a bubble and establish a utopia where they can have a normal life, play basketball every day, test themselves and feel safe, it’s at some level hard to feel like that’s fair when the rest of us are sheltering in place,” Kocher said. “Is it ethical? It’s difficult for me to say. Is it fair? No, and that’s representative of how healthcare is organized in America.”