The sight of fans decked out in scarlet and gray and spread throughout Ohio Stadium this fall would mark one of the clearest signs of a return to normalcy in Columbus.


At a press briefing last week, Ohio Gov. Mike DeWine considered the possibility of 100,000 people packed inside the stadium for a college football game.


His forecast was hazy.


"I don’t think anybody knows," DeWine said.


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Even as the spread of the coronavirus slows, it is likely to be later than sooner for sports to resume business as usual.


"Large gatherings of people are going to be the last thing that you check off the box," DeWine said, "and you say, 'We should be doing that.' "


To better grasp the challenges of the return of sports, The Dispatch spoke with Dr. Mark Cameron, an infectious diseases researcher and associate professor at the Case Western Reserve University School of Medicine. Below is a transcript of the conversation with Cameron, who also studied the SARS outbreak in Toronto 17 years ago. It has been lightly edited for clarity and brevity.


What is the unique risk of a sporting event?


When you talk about the measures that were successively put in place in Ohio, where we are looking at the peak of new cases, the removal of public health measures to get us this far have to come off as carefully and come off in the reverse order of where they were put on. Things like mass gatherings, things like travel restrictions, will be the last ones to be removed. We went from not congregating in large audiences to not congregating in groups of people above 25 and then even meetings between five to 10 people were taken off the table. What does that say in terms of any sporting event? Whether it’s teams playing on the field that have traveled to see each other or the audience in the stands watching them, right now the ability to spread the infection and the number of people they can affect can be as high as two or three people in their immediate vicinity. It's a recipe for disaster. It's a recipe for causing a second wave until we're at the point where we're certain we can avoid that.


So because sports were among the first things to go, they'll be among the last to return?


Unfortunately, that's absolutely correct. Even if we learn that we can go to work in small-business places, we can go back to relative normalcy in walking around our communities and shopping, there might be things like we should continue to wear a mask, we should continue to wash our hands, we should continue to put space amongst us. If we can get out of the stay-at-home phase of this outbreak, that's one thing. But to congregate en masse with thousands of spectators at a sporting event, it's hard to imagine that happening right away. They would have to be certain they've broken the chains of transmission enough and there are enough people protected in the population already by either having had it or more importantly a vaccine out there to make sure if you get together as 1,000 or 100,000 fans that it's not a risk event of suddenly causing a new outbreak simply for watching a sports event. Those final limitations coming off are going to take the longest time.


How would you tier the risk of types of sporting events? You have 100,000 fans at an outdoor football stadium versus 20,000 fans inside a hockey arena or golf. They’ve rescheduled to have the Memorial Tournament in July.


I don't know if you can rank different activities in terms of sporting events of whether they are more or less risky. I would say that some time on the back side of this curve, there's going to be a lessening of the restrictions that are currently in place. And if certain sporting events can adhere to those guidelines, then they might come back sooner. A golfing tournament is certainly different than having dozens of people on the field and on the bench and the spectators. So a golf tournament versus a hockey or football game, just maybe certain activities could come back a little sooner if they adhere to the public health guidelines at the time. But that is a really difficult part of the conversation that is going to have to occur. Because even if it's OK to start gathering in work places or among five or 10 people, and maybe certain sports could adhere to those type of guidelines, you're still bringing together people beyond that and how do you manage those variables.


Dr. Anthony Fauci, the nation's top infectious-disease expert, recently said you could have no fans in attendance and sequester players in a hotel to decrease the risk of transmission. How feasible is something like that?


If we come to a point where we have the tests necessary to make sure we have a team or a set of teams that are not infected, or the tests necessary to know if a certain number of players on those teams are already immune, or the vaccine to know if they're protected, then with enough control of the situation, it is conceivable that two teams could play or a league could play. The fact that it would be televised and not have spectators would relieve one of the variables of getting people together that haven't had the tests, that haven't been vetted. Bottom line is if there's a process to vet the players and to isolate them from infection risk, it is conceivable that that idea could work.


Is testing the primary obstacle to this?


Testing right now is the obstacle in front of us for controlling the entire pandemic. There's not enough testing being done. There's not enough of an idea of how many people are carrying the virus without knowing it. Even if every single person who got sick could get tested and confirmed as having COVID-19, there's still people walking around who have no idea. So that means testing everybody. Or in the Dr. Fauci example, that means testing everybody in that bubble.


Assume everybody gets tested and cleared inside the bubble. That seems fairly straightforward. But could something go wrong?


There are a lot of things that could go wrong. I'll give you an example. The public, in general right now, feels like there is a light at the end of the tunnel with this pandemic. That is true. We are rounding the peak. Now, do you become more complacent by knowing there's good news out there? Do you continue to take that same measure of carefulness, the same adherence to the guidelines, knowing that the end of the tunnel is nearing? If you can operate in this bubble of risk protection for a sporting event, how long or how do you enforce that adherence?


If you have players and participants in a bubble and one person tests positive, then has everyone been exposed? Say you have a bunch of teams in the same city, one player tests positive and their team played three teams that week.


The scenario you just mentioned could be the seed of a brand new series of infections, and the seed of a second wave, whether local or statewide because people travel so much and so easily. That one infection can become dozens, and then hundreds, the way this virus spreads. That bubble of people, that are not COVID-19 positive, in the event of one of them contracting it, you all of a sudden have a group of people that the virus can spread in. That alone can be the impetus of a second wave of infections. That's what is going to make it so difficult.


Before sports return to normal, is a vaccine required?


There are vaccine candidates in clinical study right now. So, the optimism about having a vaccine out to the general public is pretty high. But we are still looking at another year. We are still looking at COVID-19 vaccination into the 2021 cold and flu season, the fall of 2021. When the vaccine is out there, that will be the golden ring of going back to complete normal if we continue to see waves of COVID-19 coming back. If it comes back in the fall or next winter as a circulating virus, that would be bad news. However, every time it comes back, you already have a certain segment of the population that is immune to it by having it before. That helps break the chain. But nothing is as perfect as a vaccine in stopping a virus like this dead in its track. The sure way back to absolute normal in all of this is a vaccine to protect us in advance of it coming back.


jkaufman@dispatch.com


@joeyrkaufman