Could Dabo Swinney’s squad develop herd immunity?

The answer to that question isn’t a simple yes or no.

UVa athletics’ medical director and primary care team physician, John MacKnight, says the concept of herd immunity is legitimate, but the understanding of immunity when it comes to COVID-19 is insufficient.

“The herd immunity piece, I think is a very important concept, because I think ultimately when people ask about, ‘How do we get ourselves out of the pandemic situation that we’re in?’ The answer is really twofold,” MacKnight, Virginia’s representative on the ACC COVID-19 medical advisory group, explained. “One is a high-quality vaccine, where you can basically force people to have immunity by stimulating that response internally and then the other is herd immunity where either frank illness or at least exposure to the virus, even without illness, generates an antibody response that is presumed to be protective over time.”

Herd immunity exists, and it requires either a vaccine or exposure to the virus and the subsequent development of antibodies.

Unfortunately with COVID-19, some data suggests immunity can be short lived.

MacKnight says recent research suggests immunity may only last about three months. Following the three-month window from recovery, the antibody response fades.

“So that’s not exactly the way we want it to go, and it’s certainly not what we expect of our immune system,” MacKnight said. “Once you’ve seen the virus you, at least in theory, should mount a protective antibody response that we hope is much longer lasting.”

He does wonder if current antibody testing fails to give an accurate picture of immunity within our bodies. MacKnight thinks there’s a possibility our bodies produce stronger antibody responses than tests reveal. More research is needed to truly understand how our bodies respond to the virus.

If immunity only lasts about three months like some research suggests, it means there’s the potential for reinfection of individuals who already contracted the virus. Given the relative lack of experience treating and studying COVID-19 in relation to other viruses, it’s hard to know exactly how immunity works as of late July.

UVa performed antibody testing on athletes when they arrived back on Grounds — the athletic department does blood work already, so the antibody test was added to typical work – and few athletes had antibodies, according to the tests. That’s interesting data, but it doesn’t change much about the athletic department’s plans to handle athletic activity amid the pandemic.

“I don’t think we know yet whether we can tell individuals who have been sick, or who have been exposed, that they can’t necessarily get sick again, or that they’re not susceptible and even with the antibody testing … it’s interesting data to get, but I’m not sure we can make that interpretation yet to solidly or confidently tell someone if you have antibodies then you’re OK and you’re not going to put other people at risk,” MacKnight said. “I don’t think we have enough information yet to support that.”

What’s that mean for college sports, including football?

Well, UVa currently operates under the assumption that immunity lasts for three months. If a player tests positive, they then undergo the athletic department’s safety protocols. This includes 10 days of self-isolation and tests to determine that an athlete has recovered from the virus once symptoms go away or the 10 days pass.

Only after team doctors approve the return to athletic activity is an athlete allowed to compete and practice following a positive test. After that point, there’s an assumption that the player will have immunity for three months.

“The general sense is, at least for the three months where we know that people have antibodies, we are assuming that they are protected and that they’re OK and so that the likelihood of passing it to others is little to none and that the likelihood of acquiring it again is essentially zero and so we carve out the three-month window for them,” MacKnight said. “Once they’ve gotten past that point, then they will resume, if their sport is still going, the weekly screening testing like everyone else would do prior to competition, and if they were subsequently contact traced by the health department after that point, then they would serve a 14-day quarantine just like everybody else.”

During the three months of assumed immunity, athletes are not included in the weekly screenings, and they aren’t required to quarantine for two weeks if a close contact tests positive for COVID-19.

The concept of herd immunity within athletic programs becomes problematic given the length of seasons. For example, if the football season starts in September, athletes who tested positive for COVID-19 and recovered in mid-July will return to the weekly screening process in approximately mid-October.

This means the immunity won’t last throughout the duration of the season.

Additionally, and more importantly, there are unknowns about potential long-term effects of the virus. Trying to intentionally develop herd immunity would place athletes at risk of developing long-term complications. Even as teams unintentionally develop immunity, it’s still not ideal for players to test positive for COVID-19.

It’s also important to note the potential effect of positive cases within communities. While student-athletes may not show severe symptoms, they could spread the virus to vulnerable people within the community. That could lead to increased illness and strain on a community’s medical resources.

It’s in the best interest of student-athletes and their surrounding communities to avoid contracting the virus.

“I think at this stage one of the things that we really struggle with — although it seems like we’ve been dealing with this illness for a long, long time — in the grand scheme of things the United States, we’re just over four-plus months of time,” MacKnight said. “So I think we really have to be conservative and we have to be smart because we simply don’t have enough data at this point to know truly what the natural history of the illness is and what the impact on these young people will be.”