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SportsPulse: There's one major reason why a fall without football is a real possibility: lack of robust COVID-19 testing. We dissect why. USA TODAY

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All this week, USA TODAY Sports will examine the possibility of a fall without football, and what that would mean in a country where the sport is king.

The bleakest picture to date of football’s uncertain future amid the coronavirus pandemic was painted by the NCAA, which posted on Twitter last week a graph illustrating the wide gap between two points: one, where the NCAA “thought we’d be” in terms of flattening the national curve of confirmed cases; and two, “where we are,” with cases surging nationwide since the end of June.

“Although testing and contact tracing infrastructure have expanded considerably,” read the accompanying text, “the variations in approach to reopening America for business and recreation have correlated with a considerable spike in cases in recent weeks.”

This spike, along with the politicized pushback against common-sense practices for mask wearing and social distancing, has brought into question the ability to play football as scheduled on all levels of competition. 

High school athletics associations in California, Virginia, Texas and New York have either cancelled the season or pushed competition to the final weeks of September. Smaller college conferences, including the Ivy League and Patriot League, have announced that football won’t be played as scheduled, though there may be an attempt to do so in the spring.

On the highest level of college football, two conferences in the Power Five, the Big Ten and Pac-12, have eliminated non-conference games to create scheduling flexibility, mitigate the risk that comes with travel and streamline testing protocol. Several programs, including national power Ohio State, have seen outbreaks of positive tests and been forced to suspend team activities.

Slowly and begrudgingly, football associations from high school through the upper rung of college athletics are coming to a striking realization: that from a safety perspective, football and the coronavirus are dangerously incompatible.

“I do think that to some degree, any organized athletic event is going to increase the risk of spreading the infection,” said Jason McKnight, a clinical assistant professor at the Texas A&M College of Medicine. “With any large, organized event, whether it’s sporting or otherwise, we’re increasing risk of exposure.”

Barring changes to uniforms and equipment, all team sports violate three of the basic factors behind slowing the transmission of the coronavirus: masks, distance and density. Football is simply the worst transgressor.

It's a sport played in close quarters even on the fringes of the action, with wide receivers and defensive backs jostling for position near the sidelines. The center of the action, meanwhile, exists over the ball — linemen repeatedly come into contact, pause at the whistle, return to the line of scrimmage, wait for the next snap and repeat.

“That’s obviously a part of this game,” said Brian Labus, an assistant professor of health at UNLV. “There’s no way to socially distance as you play. Just being around other people — whether you’re tackling them or not doesn’t matter — just sharing their same airspace with them is where the risk comes from.”

The game isn’t only played in close proximity but with more active players than any other sport, with 22 individuals on the field on a given play. According to the Centers for Disease Control and Prevention, the highest-risk scenarios are large gatherings where it is difficult to maintain social distancing and “attendees travel from outside the local area.”

Without face coverings and without existing in the sort of bubble the NBA hopes will eliminate any chance of an outbreak, football players will breathe and grunt on one another, expel spit through mouthguards and end plays in the same dogpile of bodies. Every interaction during a football game is a potential petri dish for transmission of the coronavirus, which causes the disease COVID-19.

“There is no likely way that you’re going to prevent the virus from getting from one person’s lungs to another person’s lungs if they’re standing around each other, or squatting, depending on what the position, a few feet or a few inches away from each other, tackling each other, and doing it repeatedly over the course of a few hours,” said Rishi Desai, an infectious disease doctor and the chief medical officer for Osmosis, an online health-education platform.

“That’s just not going to happen.”

How much risk is involved?

Sheldon Jacobson, a University of Illinois computer science professor who specializes in data-driven risk assessment, estimates that up to half of players in the Bowl Subdivision would contract the coronavirus during a traditional regular season. Jacobson also projects that up to seven players would die as a result of COVID-19.

In choosing to remove non-conference play from the schedule, the Big Ten and Pac-12 hoped to mitigate some of the risk that could come with travel into current coronavirus hot zones and exposure to teams with different standards for testing. As a broader solution for allowing the football season to proceed as planned, however, playing games only against conference opponents is of a minimal benefit.

“I think you’ve gone from a high risk to still a high risk, maybe slightly, minimally lower,” Desai said. “But still a high risk.”

Playing fewer games doesn’t address the threat posed by the virus inside locker rooms and football facilities. Practicing outdoors does allow for increased spacing and ventilation, but that benefit is negated by the amount of close-contact interactions during the workouts and film study that define the period between games.

“All that other time adds up,” Desai said.

For high schools and colleges, those remaining days of the week would also find players mixing with students, teachers and parents, potentially transmitting the virus from the outside community to teammates and coaches.

“The problem is going to be, you can control that environment, but as soon as they’re out of that environment and they’re on a normal college campus, all bets are off,” said Jon McCullers, the senior associate dean for clinical affairs for the College of Medicine at the University of Tennessee Health Science Center.

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Testing one of many hurdles

Testing is one tool to limit outbreaks of the coronavirus, especially as a way to identify asymptomatic carriers and “more quickly remove the player from team activities,” said Deverick Anderson, a Duke infectious disease doctor who co-runs Infection Control Education for Major Sports, or ICS.

"The main strategy is definitely routine symptom screening and temperature checks," Anderson added. “By doing so, the number of subsequent players potentially exposed would be greatly reduced."

Providing daily testing for teams that can number over 100 players may be unrealistic from a financial perspective, however. Even those teams able to institute routine testing must support that regimen with programs for contact tracing and quarantining. And players must be open to sharing details of symptoms within a culture that values the toughness needed to play through injuries. 

“Guys are going to have to learn that being a great teammate means more now than practicing hard and working hard and being positive. It means trying to take care of your teammates with the virus,” said North Carolina coach Mack Brown.

“You look around the country, there are going to be positives. There are going to be positives everywhere. Unless something changes, there are going to be positives during the season.”

That the virus would creep through football teams on all levels is inevitable — positive cases have already flooded college programs since teams returned to campuses last month. Without a vaccine, competition against other teams in different regions stands to worsen the spread of the virus.

As the sport reaches a breaking point for deciding whether to play this fall, the question of how football can be held may already have been answered: by accepting that eliminating or even noticeably limiting the spread of COVID-19 is impossible. Is football worth the risk?

“To me, things that are quite frankly non-essential by their very definition, such as sports, should not be entertained until essential activities are taking place,” Desai said. “I would just look around. Are we doing all the essential activities? If the answer is no, then football is off the table. There’s just no way.”

Follow Paul Myerberg on Twitter @PaulMyerberg

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