Ron Courson shares deep look into Georgia football COVID-19 protocol

ATHENS — There aren’t many collegiate director of sports medicine heads as celebrated as Georgia’s Ron Courson, and it’s not hard to figure out why.

Courson, who has been on staff at UGA since 1994, presented insightful and educational and background into the athletic department’s management of the COVID-19 crisis.

“Risk mitigation can be compared to a slice of Swiss cheese,” Courson said. “If you take a slice of Swiss cheese, it’s got a hole in there, and things can go through there. So it’s not one strategy, it’s multiple. Your mask is not 100%, it’s got a hole in there.

“But if I take my mask and couple it with social distancing, testing and hand washing and, so forth, hopefully we can mitigate as much as we can,” he said continuing the lesson. “I think, again, it goes back to life decisions, and it’s about educating our athletes and making sure they know the right things to do and how to go about it.”

Courson, who serves on the SEC’s Return to Activity and Medical Guidance Task Force, said Georgia has been fortunate to avoid the sort of circumstances that have led some programs to put their training on pause.

But he also credited the execution of preventative practices and techniques.

Moving forward, Georgia will stay on the more aggressive side with testing. Courson explained why UGA will go beyond the minimum of two weekly COVID-19 tests and have three, including a Friday test.

“We felt having the capability to do a rapid diagnostic test before we left on Friday, one, gives you a shorter test within 24 hours before the game,” Courson said. “It also limits the possibility of possibly taking somebody on the road, who was positive.”

Georgia coach Kirby Smart was a player for the Bulldogs early on in Courson’s career at UGA. Courson might be the only person in the football building that Smart defers to.

“In Ron Courson, we’ve got one of the best in the business as far as athletic trainers go,” Smart said earlier this year. “He has headed up several committees. He has been on a lot of Zoom calls gathering information, and he is kind of my crutch when it comes to where we are in this process of getting back.”

Georgia athletic director Greg McGarity said coaches and athletes place complete trust in Courson and his staff.

“He has complete autonomy to make medical decisions, no one questions him or circumvents his authority,” McGarity said.

“In these times right now, it’s very evident players want to be taken care of,” McGarity said. “You see some of the demands Pac-12 or in the Big Ten about the concern of care, and I think our student-athletes have total trust in Ron in their well-being.”

The NCAA has allowed for student-athletes to “opt out” of the 2020 fall season and retain their scholarship status (by Aug. 14).

Courson confirmed that to this point, none of the Georgia football player have opted out of the 2020 season.

The Bulldogs are scheduled to open the season on Sept. 26 against a yet-to-be-named opponent.

The SEC released the teams’ opponents on Friday, but has yet to release the week-by-week schedule.

Courson noted there will be challenges keeping the team healthy throughout the season, and that much of the responsibility will fall on the student-athletes, themselves.

“College can’t be a true bubble, it’s not the NBA where they took their entire travel party in, and nobody else has access into their bubble,” he said. “I guess you could say they’re in a bubble here for the four hours they are here every day. This probably the safest environment you could possibly have.

“But they’re also 18 to 20 year old college students, they’re going to have a life and they’re going to go outside and eat. They’re going to visit with their friends. So, the most important thing we do is make the right decisions.”

Here’s the full transcript from Courson’s zoom presentation with reporters on Friday:

Opening Statement

“I appreciate being here today. The biggest thing I just want to emphasize is we’ve really tried to be mindful about athlete health and safety.

We’re obviously in the middle of a global pandemic and it’s an unprecedented time, and, first and foremost, we’re trying to focus on health, safety and welfare.

We put a lot of time and energy into this. I think the committee, and I need to commend [SEC] Commissioner [Greg] Sankey, and really all the Deputy Associate commissioners in the SEC office—they’ve been great working with this. I think they have put a lot of thought into it. With the committee itself, it has been really enlightening because it’s really well rounded. A lot of times in sports medicine you tend to look in your own sphere, and you can have biases in there, but this is a well rounded committee.

We have a public health expert. We have infectious disease physicians. We have a wide variety of pain physicians from different specialties from orthopedics to sports medicine to emergency medicine and athletic trainers.

You always look through different lenses and biases so I think having a well rounded committee helps us have a good perspective and get everybody’s input. I think as a result of that we’ve got a really sound policy.”

On clarification of the masking policy and who will be required to wear a mask on the field…

“Exactly, what we want to do if you’re not competing, we want you to have a mask on. Obviously, a mask does impede your ability to breathe effectively. If you’re on the sideline and you’re not in the game, you’re expected to have a mask pulled up over your mouth and your nose. The same thing [is expected] with really anybody on the grass, coaches, or sports medicine staff, and so forth.

The athletes will have a gaiter so they have the capability when they’re in the game they have it pulled down and then when they are on the sideline they can pull it up. Obviously, at the same point, they may be hydrating on the sideline too, so it can’t be up all the time. We’re just trying to do as much risk mitigation as we can.”

On what a neck gaiter is…

“There’s different things right now. You have the surgical mask and the cloth mask and the gaiters. But the gaiters, for this aspect, are probably more functional. They are worn around the neck and is pulled up when they need them then they can pull them back down.”

On the COVID-19 testing process and if it mirrors what they are already doing to test the athletes that have come back to campus…

“Great question. What we have done from a testing standpoint—I can talk about from a Georgia standpoint of what we have been doing then lead into SEC. We tested every athlete coming back, and initially started with football as a trial. Then we bought back men’s and women’s basketball and soccer then volleyball—those are our four sports. Cross country was the last fall sport to come back.

We also have gymnastics back right now, even though they are technically not a fall sport they have a safety exception rule because with the risks that they do it is really important for them to have the coaches there so they can instruct them. Those are the sports we have back right now.

We tested everybody coming back in baseline, and we’ve done surveillance testing as well. The Autonomy Five (A-5) also has some guidelines they put out, and there’s been a separate test with working on that. We’re using those as minimum standards with the conference as well. They recommend that everything, that they have baseline tests when they come back.

When the other sports come back for example, baseball, softball, equestrian and so forth, they will be tested as well. Right now we are addressing strictly the fall with this policy, but we want to try to have a good balance from a safety standpoint. So, the minimum requirement for the A-5 is to test them 72 hours before the game. For football this will be on a Wednesday.

But we wanted to have some more safeguards in play. We felt like two tests a week, and then the capability also to test before we departed as well. One of the risks with that is if you think about it there is a long window between Wednesday and Saturday, and again, you know the reality is we’re in a pandemic and we can’t prevent things—what we want to try to do is mitigate as much risk as we can.

So, we felt having the capability to do a rapid diagnostic test before we left on Friday—one, gives you a shorter test within 24 hours before the game. It also limits the possibility of possibly taking somebody on the road, who was positive, because then you get in the issues with state health departments.

For example, if we’re going to play in Missouri, and we have a positive player there, we also have to follow the State Department pro-health guidelines in Missouri as well. So, again trying to minimize it as much as we can.”

On the difference in timing between the Wednesday test and the one given on a Friday…

“That’s a great question. Well, first of all, on the timing it is going to be left to the institution. We have some guidelines you know that we want to do on Sunday and Wednesday for two PCR tests. We have different schedules within the conference. We have some teams that schedule practice in the morning, some teams that practice in the afternoon, or the early evening. It has to work around that.

You also have to balance logistics of class schedules and things there too. So, we’re gonna leave the individual testing scheduling discretion to the institution. We’ll have a designated place on campus and then the third party provider will come in and do that. The nice thing about the third party provider is that way we’re doing it equally across the board, with all 14 schools [they] are using the exact same lab, and use exact same collection people.

We have trained lab technicians collecting it so that way we have apples and apples. The general on the PCRs, you’re looking at probably a 40 hour max to get the results back. The rapid diagnostic test on Friday is different in that’s immediate feedback. We can generally have results back in 15 minutes.

So the beauty of that is, is before you get on the plane and before you get on the bus, you can do affective screening, and it feels good as you can about your travel party before you get on the road.

Now, again, we’ll have the capabilities to test on the road as well, and that’s really important, I think, and that was something we talked about a lot. Again, you know I’ve been doing this a long time, and you’re going to be in the hotel on Friday night and Saturday morning, and somebody is going to come in with some mild symptoms. They may say, ‘Well Ron, I have a sore throat or Ron I’ve got some nasal congestion, or I’ve got some GI irritation. A year ago we probably said, ‘Hey that’s probably more viral let’s monitor the vitals and put them on some kind of medicine and see how they are.’ Now, one of the issues you have is a lot of the symptoms of COVID-19 can mask other things.

Quite honestly for completeness sake we want to be as thorough as we can. So we’ll have the capability to have that on the road as well. So, if we’re at the hotel on Friday night, or if we’re at the hotel Saturday morning we have somebody that has any concerns and we want to make sure, for completeness sake, we can test them again there and have rapid feedback.”

On what he thinks has kept Georgia from having to pause practices due to outbreaks like other programs have faced…

“That’s a great question. No, I think we’ve been really fortunate here, but I think that’s also a credit to everybody involved, and I mean everybody—like our custodians. Our building service people, our custodians, do an awesome job, and I talked to our student athletes today. We had a meeting and I said, ‘When you walk in the hallway, make sure we thank them, because they were here five o’clock this morning to disinfect your facility.’ I said they really are our front defense and infection control, and sometimes the most at-risk if you think about it for what they do. So, our building serves have done a great job.

Our coaches have been awesome. You know, making sure we communicate with our kids, and I don’t think is as much education as it is caring. We have a philosophy here that people will know how much you care before they care how much you know, and what I mean by that is you might be the best clinician the world, but if the kids don’t think you care about having their best interest at heart, and I think our kids believe that, you know, our coaches, every time we have a meeting, every time we had practice—us and our strength coaches, we try to emphasize something about risk mitigation, and I think that’s one of the reasons we’ve been effective and again, our kids have bought into it.

They’re very good about wearing their masks. They’re very good about social distancing. So as long as they’re making good decisions, and that’s important when they’re 18-22 years old, but making those good decisions help us have good outcomes right now.

.I think we’ve also got to be realistic again we’re in a pandemic. We can’t prevent anything. The best we do is mitigate, and we know we’re going to have some outbreaks at some point. Hopefully you can minimize those as much as you can.”

On what happens and the protocol if a player tests positive…

“We have our own policy here that we developed and had for several months now. That was done in conjunction with a lot of people. We actually have an infectious disease consultant here on campus with us on a regular basis, with our staff and team physicians. If we have a positive, the first thing you have to do is you have to isolate them for their protection and everyone else. So, you have an isolation protocol. Then you have to communicate with the Department of Public Health and has to be declared.

We also have to communicate with the University as well. It’s really important to understand that we are a part of the bigger University. We’re working together in conjunction with the health department and the University Health Center, and making sure that your protocols are mixing with theirs and we are overlapping well.

Then we have a testing protocol we do. For example, if somebody tests positive we follow up with some follow up tests, an antibody test and certain lab tests. We do a pretty extensive cardiac tests. Then they follow up with our team physician with our cardiologist and with our infectious disease physician.

Right now it is outlined on the protocol on a positive test that you are out 10 days, and that is by the CDC guidelines and the State Department of Health. If you’re symptomatic it is 10 days from the onset of symptoms. If you’re asymptomatic it’s 10 days from positive tests. They are isolated throughout that time. We don’t let them exercise during that time. That’s different than an ‘exposure.’ We allow the [exposure] to exercise.

For the positive test, again, we want to be safe and prudent with everything we do. We’re trying to base as much as we can on evidence-based medicine and science.”

On keeping student athletes in “bubbles” and if that will continue when students arrive back on campus…

“College can’t be a true bubble, it’s not the NBA where they took their entire travel party in, and nobody else has access into their bubble. I guess you could say they’re in a bubble here for the four hours they are here every day. This probably the safest environment you could possibly have.

But they’re also 18 to 20 year old college students, they’re going to have a life and they’re going to go outside and eat. They’re going to visit with their friends. So, the most important thing we do is make the right decisions.”

On Risk Mitigation…

“Risk Mitigation can be compared to a slice of Swiss cheese. If you take a slice of Swiss cheese. It’s got a hole in there, and things can go through there. So it’s not one strategy, it’s multiple. Your mask is not 100%, it’s got a hole in there. But if I take my mask and couple it with social distancing, testing and hand washing and, so forth, hopefully we can mitigate as much as we can.

But I think, again, it goes back to life decisions and it’s about educating our athletes and making sure they know the right things to do and how to go about it.”

On the protocol about sharing information with city leaders…

“Our philosophy is we don’t share medical information. That’s not just COVID, but that’s anything across the board whether dealing with concussions or ACLs. Again, that’s just our personal philosophy here but as private information is protected by HIPAA and FERPA. We’re not going to share that with the general public.

Now on the other hand, we’re extremely transparent within our organization. We communicate with our parents, we communicate with our staff and our medical staff, any test that we have here is automatically posted to the department public health.”

On disclosing names versus numbers…

“Again, that’s just a personal philosophy, we’re not going to release numbers. That’s our prerogative.”

On contact tracing…

“Contact tracing is done through the Department of Public Health. The reason for contact tracing is to try to minimize your risk. The general definition of high exposure is someone who was within six feet for longer than fifteen minutes.

If someone reaches the definition of high exposure they have to be quarantined. Right now the rules by the CDC and Department of Public Health require a quarantine for 14 days. They are allowed to do exercise because they didn’t have a positive test, but anyone that we have who has been exposed we automatically put them on our testing protocol immediately and in quarantine. It’s important that we do that, so again we want to communicate with our athletes and make sure that they don’t feel like they’re at risk as well.”

On the quarantine protocol if there were two quarterbacks and one tested positive after a couple of hours of exposure…

“If they missed the six feet, 15 minute rule, there will be high exposure. So, one of the things we try to do is minimize that. That’s where anywhere in the facility our athletes wear masks. All of our meetings we’ve adjusted to, they sit six feet apart at all times.

We’re still doing a significant amount of our meetings through zoom so we can minimize that. We’ve done some simple things as well like we have adjusted to HVAC in the buildings. So, we do all outside air-draw and more returns.

We have created negative pressure rooms when the facility like in the hospital. We have taken out some of our fixed seating, so we can do different configuration around the more things we could do that. you can impact your content traces on minimize exposures.”

On the approach to the more vulnerable population…

“We really want to look at it across the board, not just the vulnerable. We have vulnerable staff, but also vulnerable athletes. So the first thing we did when this came out is we took our medical files and we tried to stratify who our high risk athletes are. We broke them down into low risk, moderate risk and high risk. So, for example, an athlete who might have asthma; is his asthma controlled or uncontrolled.

Hypertension, same thing, hypertension controlled or uncontrolled.—sickle cell trait. We try to identify those athletes. But again, they’re probably less risk athletes because they’re part of the younger population. But we do have older staff members who may have comorbidities, so that’s something we have to be aware of there. Encourage them to talk with their medical professional, make sure they’re having regular physicals, and make sure they’re staying in good health.

And again the same mitigation strategies apply to them. Even when we were brought back in the phases, for example, we might have a person as a high risk that may come back in later phase because of that.”

On his confidence conducting football safely…

“As confident as we can be. Someone gave a great analogy a couple of years ago; the Stockdale Paradox. If you ever read the book, Good to Great by Jim Collins he talks about the Stockdale Paradox. When Jim Stockdale was the highest ranked official, but a prisoner of war in Vietnam. He was imprisoned for a long period of time and was tortured. They asked him how he survived, and he said being optimistic. He said it was the thought of being rescued on Valentine’s Day, Christmas or Thanksgiving, they came and went and he lost hope. He said you have to combine realistic optimism and what he called facing the brutal facts.

And that’s something I think we can look at here is the fact is we’re in a global pandemic. And, you know, you can’t fix everything. But what we can do as employees is mitigate stress and we can try to create a safe environment. And I believe we’ve done everything we can to be safe. But you have to continually look and assess because things change and it’s definitely flexible.

The way I look at it is, I’ve got four kids, some that played football here. I want to treat all my student athletes the same way I treat my son. If I didn’t think it was safe for my child to participate, I wouldn’t be doing the things we’re doing right now. My middle son who’s playing high school football right now. My daughter works in the building with the football program. So it’s personally from a family standpoint, too.

So I do think we can be safe, but we have to be very prudent while we do that and be very deliberate in what we do. Then I think we need to be flexible and adaptable.”

On players getting cardiac testing…

“We’ve been doing cardiac testing here for years. I’ve been here for 26 years now. We actually started back 26 years in the medical electrocardiogram and EKGs. I think it’s really important, the heart is the most important muscle God gave us, and we want to take care of it. So when we want to have a good grasp of our healthy cells, when they come in.

So the nice thing about that we’ve always been baseline so our guys and girls wouldn’t come in, we give them to every athlete. So there have been concerns about cardiac, and most of them are in high risk or older populations.

So, anybody and we’re trying to look at some best practice guidelines too we’ve actually consulted with a number of national cardiologists trying to put this together, but any athlete that has a positive test would come back and do an echocardiogram and EKG. We also do some cardiac labs as well, and do the clear by cardiologists before they go.”

On players opting out for safety concerns and their use of the athletic facilities…

“Nobody has opted out at this point and I think that it’s important for our athletes to understand they have the option, and they have the right to make an informed decision. Just like my son, I feel very comfortable with him playing here right now with the safeties we have in place.

But I also raised my son to make the right decisions that would be his personal decision, and I think all of of our athletes have that. If they opted out they would keep their scholarship intact. Just like any athlete here we have an injured athlete or an athlete who is medically disqualified.

Even the same thing with former athletes, all of our former NFL guys come here and use our facilities for rehab and so forth and those things will still be open now.”

On fans attending games and what it would look like…

“That’s out of my wheelhouse. A sort of bubble-concept on the field. If you watch an NFL or college game this year, it’s going to be dramatically different; a new normal.

You’re going to see a lot less people in there, who are really going to dial in and see who the truly essential people are that we have to have to run the game and be safe with that. Again there are some people that will be outside that bubble, they still have a job to do and mitigate risk as much as we can.”

On anyone else being symptomatic and hospitalized…

“No, we’ve been extremely fortunate here and again, I think that credit goes to all of our medical staff, administrators, players and coaches working together.”