The first steps toward having a 2020 football season were taken this week, but the biggest question remains unanswered and maybe, for now, unanswerable.


The NCAA announced this week that it would lift its moratorium on on-campus athletic activities in all sports, allowing for voluntary workouts starting June 1.


In a sports world that has been mostly shuttered since mid-March because of the coronavirus, that initial step was heralded by some as a sign that football will return in the fall.


But that can only happen if the sport is deemed safe enough to play, and that remains very much in question. It’s established that because the coronavirus is spread through respiratory droplets, medical experts urge people to maintain at least 6 feet of distance from each other.


That is impossible, of course, in football. The only sport that would seem to be as risky for the spread of COVID-19 as football might be wrestling. But wrestling matches last only seven minutes and it’s a one-on-one sport. If both wrestlers are free of the virus, it would be safe.


There are 22 football players on the field at one time and the game includes collisions on every play. Factor in the multiple substitutions that are part of the sport and all the other personnel on the sideline — other players, coaches, medical staff, etc. — and the risk is obvious.


"I think football is more challenging than any of the other fall sports by far, and perhaps more than any other sport," said Dr. Brian Hainline, chief medical officer of the NCAA.


Dr. Mark Hurst, the Ohio Department of Health’s medical director, said the issues football presents are difficult but stopped short of calling them impossible to overcome.


"You have people lining up at the line of scrimmage and the offense and defense are inches apart," he said. "You have to tackle people. Wearing masks would be difficult.


"And when you look at the respiratory droplet transmission, if you’re out of breath and breathing really hard, you can see that’s going to probably expel more respiratory droplets than others would. If you’re yelling out calls and signals instead of talking, that again is something that can emit some of those.


"So a lot of work would need to be done on this. But we also have a lot of really smart people in Ohio and elsewhere in the country that have a lot of capabilities that can figure things out."


Ohio State athletic director Gene Smith has as much reason as anyone to hope they can be. Revenue from football makes it possible for Ohio State to fund 36 varsity sports.


That doesn’t erase Smith’s concern about whether football is safe enough to play without advances in treatment.


"I’m not 100 percent comfortable yet," he said in a conference call on Wednesday. "That’s one of these things about this process. You constantly get educated around the virus, around the disease. You constantly get educated around different tech tactics that you can employ from a safety point of view. We continue to learn different things from different countries and, and obviously across this country."


Smith stressed, however, that he remains hopeful.


"I’m cautiously optimistic that I’m going to reach 100% comfort level, but I’m not there yet, just like I’m not there 100% with (having) fans in the stands," he said. "I think we have to be sensitive to the fact that our medical experts — not athletic directors or commissioners or anybody else — have to give us the proper environment, and operations in that environment, that will allow us to play the game. We haven’t had that in-depth conversation. Frankly it’s still a little early because we still are studying the virus."


The Dispatch interviewed several doctors with expertise in infectious diseases. They shared Smith’s view.


"We don’t even know what we don’t know yet," said Dr. Andrew Peterson, an associate professor at Iowa who participates in a weekly conference call with Big Ten team physicians.


It has become clear that the coronavirus disproportionately affects the elderly and those with underlying health issues. College football players would seem to be at much lower risk for contracting COVID-19, or at least having a serious or fatal case of it.


"I’m not terribly concerned about the health of the players," Peterson said. "That sounds like a bad thing to say. But the reality of it is that the risk of having a bad outcome from COVID is pretty low among young and healthy people."


That doesn’t mean Peterson is dismissive of the risks in playing.


"I’m very concerned about our athletes serving as vectors and spreading this infection further," he said. "We’ve got people on our coaching staff and administration and buildings-operations people who would be in that high-risk group, people that are a little bit older and have medical co-morbidity who are definitely are at risk for having a bad outcome with this infection."


The doctors said there’s not much that can be done to make the game itself safer for players regarding the coronavirus. They suggested common-sense measures such as continually cleaning footballs and not allowing players to share water bottles.


Dr. Dele Davies, professor of pediatric infectious diseases and public health at the University of Nebraska Medical Center, suggested players consider wearing clear plastic face shields as a way of containing respiratory droplets.


"I have no idea how practical that is," he said. "And I’m sure there will be players who are thinking, ‘You want to do what?!’ But we do know that face shields would reduce the risk of the droplet going forward."


But football is football. It’s a violent sport played in close quarters. Doctors said players will have to assume a certain level of risk.


"There’s not going to be a one-size-fits-all type decision that you can make," said Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins and member of the NCAA’s coronavirus task force. "I do think there’s going to be a non-zero risk of transmissions, and for individuals who cannot tolerate that risk or have risk factors for severe disease, it probably does not make sense for them to play football."


The key, the doctors said, is to create an overall framework around football teams that would insulate them from the risk of the virus as much as possible. Ohio State football players Josh Myers and Wyatt Davis said recently that they would be willing to quarantine if that’s required to have a season.


That quarantine would have to be as air-tight as possible, doctors said. And that might be just the start of it. Doctors likened the optimal approach to layering slices of Swiss cheese on each other. Each slice has holes, but as they’re stacked onto each other, the holes are covered.


That approach would include expanded testing and contact tracing for players, which involves monitoring everyone with whom they have been in close physical vicinity. They also strongly advocated the concept of cohorting as teams begin to return. That involves separating players into small groups that attempt to be as self-contained as possible. That way, if a player becomes infected, the exposure is limited to only his group.


Nebraska’s Davies suggested that cohorts be divided in a way that players from the same position are placed in different groups. That way, if a quarterback catches COVID-19, not all quarterbacks on the team are infected.


Cohorting has its limitations. Position groups will have to meet together. Some doctors recommended having virtual meetings when feasible, or at least having meeting rooms large enough to practice social distancing.


It is also crucial, doctors said, that players understand how important it will be to be honest and selfless if they suspect they’ve contracted the virus.


"I think this is where the team culture becomes very important," Davies said. "Coaches and the (team’s) leadership must stress the fact that being symptomatic is not the end of the world. Obviously, you don’t want to miss any games, but if it means that you may have to be tested and separated for a while, it doesn’t mean that your whole season is gone."


None of the doctors would say at this point whether they’d recommend having a season or not. More than three months remain until it’s scheduled to start. Their hope is that advances in testing and treatment and teams taking appropriate measures will give them more confidence that playing football is an acceptable risk.


"All of us want to watch the Buckeyes this fall, right?" said Hurst of the Ohio Department of Health. "We don’t want to watch the reruns that we see on the Big Ten Network all the time.


"But it’s a real balance in terms of making sure that things are safe for the players. … I don’t know exactly where we’re going to be in the fall with all of that. As we develop a better understanding of this virus, which we’ve only known about for a few months, we’ll have better strategies to deal with it."


brabinowitz@dispatch.com


@brdispatch