This summer during the 2021 College World Series, the North Carolina State University baseball team had to withdraw from the pinnacle event in college baseball due to an outbreak of COVID-19 inside the team and travel party. This was extremely disappointing to NC State and college baseball fans around the world. With the safety of the players and staff being the number one priority, the question still exists whether the testing protocols deployed by the NCAA could have been further optimized to prevent the outbreak from spreading as large as it did, causing the team’s removal from the College World Series.1
NCAA Testing Protocol Utilized at College World Series: Each player, coach, or travel party member took a SARS-CoV-2 antigen test upon arrival and at pre-determined intervals during the entirety of the College World Series. If a person tested positive on the antigen test, the NCAA would send the person to take a more sensitive molecular test. If the molecular test was positive as well, the individual became subject to what the NCAA dubs “blue protocol,” meaning the individual was not cleared to participate and would immediately go into isolation and contract tracing was initiated.
Timeline of Events for NC State Baseball Team:
- June 20: There were no positive SARS-CoV-2 antigen tests for any members of the NC State baseball team and traveling party.
- June 21: One member of the team was reported to have a “bug” and multiple members requested the need for extra rest. The roommate of the member of the team with the “bug” was removed overnight June 20 from the shared hotel room.
- June 22: The member of the team with the bug tested positive by antigen and then positive again by molecular test and was deemed not clear to participate and was isolated. The roommate of this individual was directed to quarantine. The roommate and the members of the team that requested extra rest on June 21 were all tested by antigen and tested negative.
- June 23 – 25: The roommate of the member of the team that tested positive eventually tested positive by antigen and molecular by June 25. Two additional team members that requested extra rest earlier in the week, too, tested positive for COVID-19, bringing the team’s total to four COVID-19 positive members, deemed “outbreak” status by the NCAA. With this status, the entire team, including all vaccinated and unvaccinated players, were tested with a molecular test.
- June 26: Four additional members of the team tested positive by COVID-19, bringing the team total to eight members with COVID-19 infections. The NC State baseball team was removed from the College World Series, and members with COVID-19 infections followed state and local regulations before traveling home days later.
Could a Different Testing Strategy have made a Difference?2
SARS-CoV-2 antigen testing has been widely used because of the low cost, portability, and ease-of-use. These tests, however, are plagued by poor sensitivity.2 With the high level of infectiousness and transmissibility of SARS-CoV-2, especially with the Delta variant, it may be important to shift to using the more sensitive molecular point-of-care (mPOC) SARS-CoV- 2 tests as front-line tests instead of antigen tests.3 Use of more sensitive mPOC SARS-CoV-2 tests with rapid <30-minute turnaround times in settings like the College World Series, workplaces, and schools can detect infections earlier than antigen tests, allowing individuals positive for COVID-19 and close contacts to be isolated hours to days faster to prevent further spread of disease. Because of the higher sensitivity of mPOC tests, they can also be used with high confidence to understand if close contacts are infected in what is called “test to stay” testing.
With the significant risks posed by COVID-19 to unvaccinated individuals and even some vaccinated individuals, antigen testing is being swapped out in many traditional and non-traditional settings for more sensitive mPOC tests.3 It is unknown whether this change would have made a difference for the NC State baseball team, but given the data available showing the capability of molecular tests to detect the virus earlier, the NCAA may have benefitted from choosing to use mPOC testing as a frontline test versus antigen testing.
- https://www.idsociety.org/practice-guideline/covid-19-guideline-antigen-testing/ Accessed August 4, 2021
- Graphic adapted from https://rapcov.com/covid-19-virus-disease/ Accessed May 13, 2021. All time intervals are estimated based on data from several published reports