It shouldn’t have come to this, the doctors said.


Players and coaches are lamenting the loss of a college football season. Fans are disappointed and pointing fingers in several directions.


But to medical experts who have for months urged society to take the necessary steps to mitigate COVID-19, Tuesday’s Big Ten announcement of the cancellation of fall sports felt like an acknowledgment of reality and of failure.


On a Zoom call Thursday, Dr. Brian Hainline, the NCAA’s chief medical officer, said that when experts began talking in April about a timeline for returning to sports, the expectation was that COVID-19 cases would decline in the following months and protocols would ramp up.


"(We expected) there would be a national surveillance system, national testing and national contact tracing that would allow us to really navigate this pandemic into re-socializing, both in sport and the rest of society," Hainline said. "And that hasn’t happened. It’s made it very challenging to make decisions as we approach fall sports."


Two Emory University infectious disease doctors on the NCAA’s COVID-19 advisory panel also participated in the call. They invoked the Titanic to illustrate the situation. To them, the decision by the Big Ten and Pac-12 to cancel fall sports and the discussion about whether the Southeastern Conference, Big 12 and Atlantic Coast Conference proceed feels like a sideshow.


"Yesterday we broke a record, having over 1,500 deaths from coronavirus in our country," Dr. Carlos del Rio said. "We have a serious problem. I feel it’s like the Titanic. We have hit the iceberg, and we’re trying to make decisions about what time should we have the band play.


"We need to focus on what’s important. What’s important right now is that we need to control the virus. Not having fall sports this year in controlling the virus, to me, that would be the No. 1 priority. My advice to colleges and organizations I've talked to is that if you cannot do it safely, you shouldn’t do it."


Dr. Colleen Kraft said the conferences that haven’t canceled might not have a choice eventually.


"I do predict, because we’ve already been seeing it in those that have been very diligent, that there will be transmission and they will have to stop their games," she said.


Ohio State adopted stringent protocols for its players when they were permitted to return to the Woody Hayes Athletic Center. School officials pushed for the Big Ten to delay the season instead of canceling it, saying that it believes its safeguards were working.


But the issue of whether the playing of football, with 22 players sweating, breathing and hitting one another, can be safe remains an open question. Hainline was encouraged by the early results of a helmet with masks designed to fit on facemasks.


"The preliminary data is that the prevention of droplets spread is really pretty good," he said. "Aerosolization, we aren’t quite as certain, but it is an outdoor sport."


Hainline said the bigger risk is that all teams might not follow strict protocol.


"You have to be certain that both teams have been following very strict standards so that you’re not taking one team that’s in a relatively secure bubble and all of a sudden exposing it to another that’s not," Hainline said. "That’s something we work very hard on making certain takes place."


With student bodies returning to campus, the risk of transmission becomes much greater.


"There’s some concerns about (football’s safety)," said Dr. Dele Davies, professor of pediatric infectious diseases and public health at the University of Nebraska Medical Center. "But everything that happens outside the game becomes even more concerning.


"All it’s going to take is one person to go to a weekend party and come back, and if they’re infected, they’re going to spread it. There’s a very high likelihood (of transmission) because of the closeness of the way the game is. It’s very hard not to be face to face."


The Dispatch interviewed several infectious-disease experts in May, including Davies and Johns Hopkins University’s Dr. Amesh Adalja. They expected then that more progress would have been made by now.


Adalja said on Monday that the scarcity of tests that provide rapid results will make it "extremely difficult" for college football to be played.


"We’ve seen multiple conferences cancel," Adalja said. "I think that’s likely to be the norm."


Adalja doesn’t blame college administrators. He said it goes well beyond them.


"This starts at the very top of the government," he said. "This has been widespread evasion from the very beginning from the federal government that kind of set the tone. By sidelining the Centers for Disease Control, by fouling up testing, by poor testing protocols where we weren’t able to test the people with mild illness or people who had been in China."


After stay-at-home orders were eased, Adalja said, too many people let their guard down.


"That led to the reignition of community spread," he said. "That’s the situation we’re in, and I think we continue to make the same mistake over and over again."


College athletes are a low-risk group in terms of suffering the worst effects of COVID-19. But recently, cases of myocarditis inflammation of the heart muscle has become a concern. Hainline said he knows of about 12 myocarditis cases among college athletes.


That’s just one aspect of COVID-19 that medical experts are continually learning about. That’s why doctors say it’s impossible to know whether a spring football season, as the Big Ten said it will consider, is possible. Ohio State coach Ryan Day said he will push for a season that starts in January.


"We don’t know what the spring is going to look like," Hainline said. "We obviously don’t know what a vaccine will look like."


He and the other doctors are optimistic that better testing and better treatment is on the horizon. But they also believed in the spring that more progress might have prevented the reckoning that has arrived.


"We fully expected for fall sports that we would not be where we are in this country today," Hainline said. "These are decisions that individuals in the United States in the population as a whole are making that are putting us where we are.


"It’s not just about testing. It’s about where we are as a country and where we are as humanity and making decisions for one another so that we get through this pandemic together.


"So it’s not just about football in the spring. It’s, more importantly, where we are as human beings taking care of one another, and I don’t know where we’ll be in the spring. But where we are today, it’s exceptionally disappointing."


brabinowitz@dispatch.com


@brdispatch