Epidemiologist Zachary Binney on What’s Gone Wrong with MLB’s COVID Response–and Whether it Can Be Fixedon August 4, 2020 at 1:00 pm

Epidemiologist Zachary Binney on What’s Gone Wrong with MLB’s COVID Response–and Whether it Can Be Fixed

With every passing day and new positive COVID-19 test, the 2020 MLB season looks shakier and shakier. Already, the league has seen team-wide outbreaks among the Marlins and the Cardinals, forcing both squads to quarantine for days and creating huge holes in the already compressed schedule. Those absences have had a domino effect on the rest of baseball, resulting in other teams that are otherwise COVID-free being forced to put their seasons on hold or rejigger their schedules on the fly. Running through it all is a seeming reluctance on the part of MLB to shut things down or exercise control even as the problem escalates, as well as reports that players aren’t sticking closely enough to the health and safety protocols governing the sport’s return.

The situations in Miami and St. Louis have wreaked havoc on major league baseball, and it’s an open question as to whether the season can survive another team going down — or, at this point, whether it’s safe to play baseball in the middle of a pandemic. So what could Rob Manfred and the league have done differently, and what can they be doing now to try to solve the problem? On Monday, I reached out to Dr. Zachary Binney, an epidemiologist at Oxford College of Emory University, to get his thoughts on what’s gone wrong in MLB, and if it’s possible — or even wise — for baseball to continue in 2020.

This interview has been condensed and edited for clarity and length.

Jon Tayler: So what’s the situation as it currently exists?

Zachary Binney: We’ve seen two massive outbreaks on two different teams, the Marlins and the Cardinals, that are not related. The question that MLB is facing right now is whether this is going to keep happening, or is there something you can do to change it?

I got asked this morning, what would you be advising Rob Manfred right now? My answer is that I’d tell him to take a deep breath, look in the mirror, and ask and answer honestly, are things going to change? Is there something we can do to avoid the Marlins and the Cardinals happening over and over and over again? And I think that really depends on the exact circumstances around these outbreaks. One is a fluke, two is a pattern, right? You can’t just say this is only the Marlins, everybody else is being good. That excuse is out the window.

So how did this outbreak happen? Did it happen from what epidemiologists call a point-source exposure, meaning there was some risky behavior from a large number of players or staff, like they went out to a bar or a nightclub and everybody got exposed there, and then there was spread in the clubhouse? Or was there one case introduced that then spread around the clubhouse? If that’s the case, was that because MLB’s protocols were insufficient, or because they weren’t being followed? Were guys not wearing masks? Were they spending too much time indoors in large groups and not distancing?

What I think you see MLB trying to say is, the players were not adhering to our protocols. And that’s a very convenient story. This is exactly what you’d expect MLB to say to save its season. If it’s risky player behavior, that’s something you can fix. If it’s the protocols themselves, that’s harder.

Tayler: Do you think the protocols are sufficient to keep people safe?

Binney: I don’t know, because I don’t know how well they were being adhered to or not. I still don’t feel like we have a strong handle on that from a reliable source, and that ties in directly to my answer. How effective would they be under perfect adherence? I don’t know how much perfect adherence we had. If we did, my answer would be they don’t work. If people were just ignoring the protocols entirely, then my answer would be quite possibly. But we just don’t know.

Tayler: When Juan Soto tested positive, one of the things I noticed was that MLB was using the CDC guidance for close contact as within six feet for 15 or more minutes, which struck me as a loophole in MLB’s favor — that close contact was so strictly defined.

Binney: I have some very serious questions about MLB’s contact tracing procedures. Not just their definitions, but the fact that they conducted contact tracing on the four Marlins who tested positive, and that somehow did not lead them to suspend the entire organization. You’re telling me you didn’t identify a whole heck of a lot more people who would have to sit out after having four positives? I don’t even know if they’re accurately doing the six-foot/15-minute measurement. The NFL is using proximity monitors to help automate that, which I think is actually very interesting, and I applaud them for their innovation on that front. I don’t know what MLB is using. My guess would be asking.

MLB has infection control prevention coordinators, who were supposed to be in charge, according to the protocol, of making sure the protocol was adhered to. Now they’re saying they need compliance officers, which I guess is someone who will be in the traveling party. Whose duties are you adding that on top of? So I’m dubious about how successful that’s going to be. He’s the guy who has to be the buzzkill. That’s a really hard job. What you really need more broadly is a cultural alliance where everybody feels like they’re in it together, in it for each other against the virus. That’s going to be your best bet.

Tayler: Based on how the country at large is working, where some people are taking the virus seriously and some people aren’t, even with the best protocols, how likely was it going to be to work if you didn’t get 100% buy-in from all the involved people?

Binney: Well, no single intervention works 100%. You want to layer interventions on top of one another that are all partially successful in the hopes that you get something that approaches 100%. The more adherence, the better, but something doesn’t have to be 100% to be successful.

The first thing you want to have is few cases in your community. That’s the first line of defense, because even if you’re engaging in risky behavior, the risk that you become sick is lower. Now you want to have everybody trying to avoid risky situations like bars and nightclubs and house parties. Most people — but not all — are going to adhere to that. And then you want to be wearing masks, and you want to enforce that and have people re-enforcing that regularly, especially when you’re indoors. Hopefully you can have near 100% with that. You want to be distancing in the clubhouse and dugout. Hopefully adherence is going to be decent for that.

So you layer all of these things on top of one another, and even if there’s somebody who doesn’t do any of those things, then you’re hoping that the frequent testing, if the turnaround is fast enough, will catch them when they get sick before they can do any damage to anybody else. But I’m starting to wonder if testing every other day with a 48-hour turnaround is enough, especially if people are spending a lot of time in clubhouses and maybe not wearing masks as much as they should on some teams.

By the way, I think adherence is going to be not distributed evenly between the teams, because I think there’s also a cultural element. Adherence is non-linear. It’s a lot easier to find a community with 50% mask usage or 95% mask usage than it is 75%. If there’s this pervading idea that we’re all in this together and we’re gonna be careful, that’s going to drag things higher to 100% versus if you’re lax about it, which could drive adherence down.

Tayler: Leaving aside how much of this is Marlins players going out to a bar or Cardinals players going to a casino [John Mozeliak has said the team’s contact tracing suggests the outbreak originated in St. Louis], was there any real hope from the outset that teams based in states where cases were either on the rise or where mask usage is not common would be able to get through this regardless of the protocols?

Binney: I was always afraid that you would see MLB’s protocols fail for teams in areas with more virus. I thought there was a higher risk of this happening to the Marlins or the Astros or the Rangers or the Diamondbacks than the Yankees or the Mets or the Red Sox or the Phillies. I think it’s a numbers game. But there’s also an element of luck and randomness here. Somebody has to be in the wrong place at the wrong time, or the test maybe is done on the wrong day.

In terms of ways that MLB could maybe improve things, I would say if you can do more frequent testing or get the results back faster, that would help because it would cut down the amount of time that people bring the infection in from the community, and then to try to reinforce the importance of limiting indoor time in the clubhouse and of distancing when you’re in the dugout and of wearing masks all the time when you’re not on the field.

Tayler: I’m curious, if you’ve been watching, if you’ve seen a difference or any additional seriousness on the part of teams and players and the league with doing all of that.

Binney: I haven’t been watching super-closely, but it’s a really tempting narrative that we can just fix this with better behavior. And it may be true. But we need to be aware that that’s something that MLB and many MLB fans are going to want to be the case. We need more details on the investigation being done by MLB as to how the disease got in and spread, which would give us more or less confidence in how much that will work. Any steps you can take to be more careful are excellent, and I encourage them.

One thing I will say is that there’s a lot of focus on high fives, and I get it, but that’s not something I’m that worried about, because that’s very quick passing contact. If I had to guess, I think we have a lot more reason to be worried about guys sitting in the dugout talking with each other, and more to the point, what happens inside in the clubhouse and at team hotels, where guys are spending extended periods of time together. I think that’s where most of the spread is happening.

Tayler: I wanted to go back to contact tracing, that there was an element of how they had defined it and conducted it that you didn’t feel great about.

Binney: According to ESPN’s Jeff Passan, the Marlins tried to use contact tracing as an excuse for playing against the Phillies last Sunday. That really disgusted me, because you should’ve taken a step back and said, “We have four cases, we need to think that there’s an outbreak, we should not be playing this game until we have a stronger sense of whether there is one or isn’t.” Contact tracing works best if you have one case and you want to identify people you needed to immediately quarantine. That doesn’t seem to be what the use was with the Marlins. It was [perverse] to be like, if we didn’t identify anyone in contact tracing, they must be fine. And that is really not how you should be thinking about it. It’s a piece of a broader puzzle. That made me pretty angry.

The other thing I’m worried about is that we’re getting reports on the investigation into what happened in Miami and St. Louis, and the team doing the investigating is the same MLB department that’s handling things like sign stealing. That’s not an outbreak investigation. I hope they have some actual epidemiological expertise in the groups that are doing the investigating and that those people are being listened to and that they have a very strong hand in writing up the report and the recommendations for MLB.

Tayler: Based on what you know, do you think that MLB is listening to the people with expertise in this area and following the recommendations?

Binney: Rob Manfred is not speaking like an epidemiologist. Beyond that, I really don’t want to speculate, because I don’t know. I know they’ve engaged epidemiologists as experts, Dr. Ali Khan at the University of Nebraska most notably. But we really haven’t heard anything from him in months. So it’s hard to judge how many public health and epidemiology experts they may be listening to. But even what we would recommend in an ideal world is not necessarily what MLB is going to do. We may recommend a bubble, and they may say, that’s just impossible.

Tayler: I was going to ask about that. People have been bringing up what the NBA, WNBA, NHL, NWSL and MLS have done with bubbles, and for a lot of logistical reasons, that was never going to happen with MLB, and the players and owners themselves shot it down anyway. But is a bubble the only safe way to do sports in this country right now?

Binney: If you look at the landscape, you would conclude that bubble plans have a much better chance of working, and it’s maybe the only way to bring professional sports back in the U.S. safely. I can’t say that conclusively, but that’s what the data seems to be suggesting. The MLS bubble, for example, was very successful, but they did have outbreaks in Dallas and Nashville that started when teams were in their home markets and players and staff were living at home. That’s the other thing to remember. The virus can get in even if you’re doing everything right. The more under control the virus can be, the better chance you’re going to have of surviving that numbers game.

If we’re able to bring pro sports back in the U.S., it’s going to be more difficult, more expensive, and more dangerous than in other countries as a result of our weak response to the virus. When MLB was designing their plan, I bet you they were hoping things would look a heck of a lot better now than they do. And that’s understandable. But flexibility has to be part of any plan right now. If you’re creating a plan that’s contingent on us having decent control of the virus and we don’t, then maybe you have to revisit that plan and say that’s not going to work right now — we either need a tougher plan or we need to not come back. You can’t just plow ahead because it’s the plan you have.

Tayler: One of the things that came under early criticism is that the league didn’t have a number of positive tests or hard line in mind at which point they would stop play. Do you think this is something the league should have had in place to begin with?

Binney: Yes. It was a failure. I understand why leagues don’t want to draw red lines, and especially publicly. The problem is that then you have to make a decision when you’re panicked and under pressure, and that’s when you make bad choices, especially when the people who have to make that decision are the ones with a lot of money on the line, because then it’s just human nature to push things further than they probably should be.

If you don’t have an independent authority like a local or state public health department or outside board that’s unilaterally empowered to shut down the team or league, then you’re leaving yourself open to making mistakes like this, and that’s what MLB did. And who knows what red lines they drew behind the scenes, but from what we can see publicly, they seemed completely unprepared and flabbergasted that you had an outbreak like this when it was totally foreseeable, and there should have been a plan in place for what to do and how long to suspend a team. That should’ve been in place weeks ago. The fact that it apparently wasn’t is truly disturbing. They were suspending one game at a time. That really just told me that Rob Manfred was not taking this seriously.

To try to make MLB’s case for them, maybe they’d say, we really don’t want to overly punish a team, we want to keep them out the minimum amount of time that we can — a day here, two days there, waiting to see what develops. And I understand that, but then you also have situations like Mike Moustakas and Joey Votto on the Reds. Moustakas was out for like a week because he had symptoms but never tested positive, and Votto self-reported symptoms, tested negative and was back 24 hours later. So are you being cautious or are you being aggressive? And you don’t get a consistent message from MLB on that. That’s causing a lot of confusion and frustration and a worry that they’re just making it up as they go along.

Tayler: Derek Jeter was asked [on Monday] by reporters about the rumor that Marlins players were the ones who decided to play against the Phillies, and his response was that it was a decision made by the team and the league, which to me is almost worse than the players alone deciding to do it.

Binney: The Philadelphia Inquirer report was interesting, but I couldn’t imagine that they would have left the decision in the hands of players. They clearly weren’t prepared. They certainly didn’t act like [they were]. And it was really inexcusable to play that game. I wrote on June 30 that if you have three or four cases in a short span, you’d want to suspend a team. I figured that out. MLB had a lot more, smarter people working for them. Why didn’t they? To play on with that many cases is… I struggle to imagine what led to that decision.

Tayler: So if you could’ve started this process over from scratch for MLB, what, if anything, would you have done differently to try to prevent this from happening?

Binney: If this were the plan that I’d built, I would’ve recognized that it was built on the assumption that the country would look like it did in May or June, and that if things change dramatically, maybe we wouldn’t be able to do it.

If that weren’t an option, I would’ve worked with the players to try to negotiate some kind of bubble. Not in a single spot, and just generally speaking, bubbles are not ideal. It’s easy for me to sit here and be like “Create a bubble.” Well, I’m not the player going away from a family for months at a time. That’s not psychologically or emotionally pleasant. But it may be the only way you can do it safely. So maybe figure out something like smaller bubbles, home bubbles, where you rent out a couple of hotels in each market and that’s where the players and the staff stay, and they go between there, the training facility and the ballpark and don’t have contact with anyone in the community outside of that little network, and then when you travel to another city, you’re going bubble to bubble. And you have really strict regulations with actual punishments in place, negotiated with the union, for anyone who’s caught breaking protocol or leaving the bubble.

What could you do now to salvage it? Maybe pick up the frequency of testing and the turnaround time, but do we as a nation have the capacity for that right now? The answer is an emphatic no. What are you supposed to do now? Hope that this was players and staff engaging in risky behavior and that you can modify that, and that people can take a lesson and this will be a wakeup call.

Tayler: In your mind, no matter what protocols are in place, do you think it’s possible for MLB to play this season with the way things are in this country without outbreaks continuing to happen?

Binney: I don’t know. I really don’t know. I lean no, but I still don’t have a good enough understanding of what happened on the Marlins and the Cardinals. Without a lot more detail on that, it’s hard for me to judge how likely that is to happen again. If it was a behavioral issue, maybe that’s something that can be corrected. If it’s more an issue with the protocols themselves, then I foresee it continuing to happen.

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