The focus of this document is to outline guidance and recommendations for institutions as they host basketball competition in their facility. All information contained in this document should be considered recommendations and/or considerations. As with prior NCAA publications, this document reflects the relevant scientific and medical information available at the time of print. These materials should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve.

This document covers the period from when student-athletes and other team personnel arrive at the competition site through the competition. This document does not address travel, testing and officiating. For specific recommendations on COVID-19 testing and other health and safety guidance, please refer to the Core Principles of Resocialization of Collegiate Basketball document.

Communication.

1. Recommend institutions provide visiting teams and officials with information pertaining to their facility at least 72 hours prior to the scheduled game. This document should include:
   1. Which entrance to use to enter/exit the facility.
   2. Any screening requirements needed prior to entry.
   3. Availability of locker room and/or meeting space.
   4. Protocol for use of the athletic training facility, if needed.
   5. Any restrictions on fan attendance.

Personnel.

1. All individuals necessary to host a home basketball game should be divided into three tiers, as described below. Tiers are based on the ability to wear masks/face coverings, the ability to practice physical distancing (6 feet or greater) and the role played in connection with the competition.  All individuals should wear masks/face coverings and physically distance whenever possible.  Only individuals assigned to Tiers 1 and 2 will be permitted access to the inner bubble (e.g., locker rooms, athletic training room, court area). The inner bubble must always be secured.
   1. Tier 1 — This tier consists of individuals for whom physical distancing and face coverings are not possible or effective during athletic training or competition. Examples of relevant individuals include student-athletes, coaches, athletic trainers and physical therapists, medical staff, equipment staff and officials. Tier 1 individuals should be limited (e.g., 25-30). All Tier 1 individuals should wear masks/face coverings, except for student-athletes and officials on the playing surface. Physical distancing should be adhered to whenever possible.
   2. Tier 2 — This tier consists of individuals who come into close contact with Tier 1 individuals but can reasonably maintain physical distance and use face coverings during their interaction. Examples of relevant individuals include certain team staff (e.g., athletic department staff) and certain operational staff (e.g., security, event staff and league staff). Tier 2 individuals will maintain physical distance and universal masking while performing their jobs, and any interaction with Tier 1 individuals must be approved by the designated event organizer or athletics health care administrator (or designee), and both parties must maintain physical distance and wear face coverings.
   3. Tier 3 — This tier includes individuals who provide event services but are not in the same vicinity with Tier 1 individuals (and should closer contact become necessary, would be reclassified into Tier 2). Tier 3 individuals should minimize contact with Tier 2 individuals and observe masking and physical distancing at all times. Examples of relevant individuals include certain operational staff (e.g., housekeeping, catering, sanitation and transportation) and media/broadcast.
   4. Spectators are not part of Tiers 1, 2 or 3, and, if present, should observe local health official mandates and guidance with seating clearly separated from these tiered individuals at all times, and as per below.
2. Each host institution’s athletics health care administrator should maintain contact with local and state health officials regarding operations within the competition venue, including oversight of the daily screening log and any health developments of attendees.
3. Recommend that visiting band and/or cheer groups avoid travel. If the home band and/or cheer groups are permitted, they should be managed as other Tier 2 personnel.

Physical distancing/PPE/masks-face coverings.

1. Recommend all individuals, regardless of role or function, always wear a mask/face covering prior to entry and within the competition venue. The type of mask/face covering and the proper way to wear it should be consistent with CDC recommendations.
2. Cough/sneeze etiquette and hand sanitization are recommended at all times.
3. Face shields may be worn but do not replace masks/face coverings, meaning that a face shield alone is not recommended as sufficient infection control mitigation.
4. No one outside of Tier 1 and Tier 2 individuals shall be allowed in the team areas (e.g., athletic training room, locker rooms, locker room hallway) when student-athletes are present.
5. When feasible, Tier 1 and Tier 2 individuals will not enter guest and public areas of the competition venue (e.g., stands, concession stands, concourse, ticket office).
6. Tier 2 individuals may interact directly with those in Tier 1 only as necessary and upon approval. All parties must wear masks/face coverings and maintain 6 feet of physical distance.
7. Universal masking and physical distancing are the rule except in the competition or medical care areas.
8. Medical staff should follow strict hand sanitization, especially during sessions with student-athletes. Whenever feasible, athletic training staff and student-athletes they are treating should maintain masking/face coverings and physical distancing.
9. Recommend the pregame meeting between game officials and table crew be conducted virtually or in a place that allows for 6 feet of physical distance among participants. Officials should always wear masks/face coverings and maintain physical distancing during all activities except active competitive play.
10. Recommend eliminating or modifying the captains meeting from its current format.

Cleaning and disinfecting.

1. Competition venue cleaning staff shall ensure all team and game officials areas are cleaned prior to each practice and competition. This includes, but is not limited to, team and officials locker rooms, coaches’ rooms, restrooms, team bench areas, the playing court, goal unit padding, nets and the scorers’ table surfaces.
2. Time between practices and games should be adjusted to allow orderly ingress and egress and necessary cleaning protocols to be fully executed. Teams may be restricted to specific entry and exit times to allow cleaning.
3. Regular cleaning by competition venue staff of all high-touch areas, including, but not limited to, restrooms, handles, call buttons, chairs and workstations.
4. Athletic training areas, including treatment tables, stools, high-contact areas and equipment, shall be disinfected after each use.
5. Remind teams and officials to follow personal health guidelines (e.g., wash hands frequently; do not touch your eyes, nose, or mouth; use hand sanitizer; maintain physical distance and wears masks whenever possible).
6. Minimize physical interactions, such as high-fives, fist bumps and hugs, with members of other teams.
7. Provide hand sanitizer stations and disinfectant spray bottles and/or disinfecting wipes in each team locker room, bench and scorer’s table.
8. Recommend the elimination of ball persons who are not Tier 1 individuals. Designate a member of the host institution to clean game court and game balls as outlined.

Hydration and towels.

1. Hydration:
   1. Team members should drink only out of their own cup/personal water bottle.
   2. Single-use cups with proper disposal are preferred.
   3. Water bottles should be labeled for individual use.
   4. Contactless water dispensers may be used.
   5. Each team should have its own set of hydration coolers (two — one for water, one for sports drink), water bottles and bottle carriers. Cooler carts may remain behind the benches, but coolers shall be replaced once competition concludes.
2. Towels:
   1. An allotment of clean towels should be placed in the locker room prior to the arrival of the visiting team.
   2. Towels should be used by only one individual for one practice or one half of competition, then laundered.
   3. Multiple towel bins will be needed to discard used towels (locker rooms, athletic training room, bench area, game officials).
   4. An alternative is the use of disposable towels and appropriate disposal container.

Team bench layout.

1. Team benches. If spacing allows, recommend using multiple rows of seats (with appropriate distance between each seat). Seats should be assigned to specific players and coaches. If an L-shaped configuration is used (which wraps around the baseline), benches must be 6 feet from the end line and must end prior to the 3-foot run-off lane, per NCAA rule 1-3.3 (Men’s Playing Rules and Women’s Playing Rules).
2. Individual water bottle and towel. Each player and coach will have their own water bottle and towel by their seat. Players and coaches will be responsible for getting their own water and towels, including during timeouts.
3. Masks/face coverings on the bench. Require that all bench personnel who are not on the court should always wear masks/face coverings. If a face shield is used, it should be done in conjunction with a face mask.
4. Timeouts. Recommend movable chairs be used during timeouts and period breaks. At the conclusion of each timeout or period break, the timeout chairs will be removed to a location to be cleaned by team staff.

Scorers’ table layout.

1. Entry tunnels/doors to the seating area:
   1. No attendees seated or gathered next to entry/exit tunnels/doors; maintain at least 6 feet from seating area around tunnels/doors.
   2. Tier 1 and 2 members should have a different entry tunnel/door to the court than Tier 3 members, if possible. Tier 1 and Tier 2 individuals will not use the tunnel/door at the same time.
2. Plexiglass barriers on the scorers’ table are not necessary and could create a safety issue if the table is not sufficiently removed from the court area. Universal masking and distancing address infection control mitigation. Consideration needs to be given to officials who need access to replay monitors.
3. Even if a face shield is worn, masks must also be worn.  
4. Recommend adjusting the courtside setup to allow for physical distancing from playing court and benches. If spacing allows, recommend using multiple rows of seats with appropriate distance between each seat. Only Tier 2 staff at scorers’ table.
   1. Row 1: recommend 4-6 essential Tier 2 staff (e.g., official scorer, shot clock operator, video replay).
   2. Row 2: other essential Tier 2 staff.
   3. On the team bench sideline, Row 1 shall be set back from the playing court sideline a minimum of 6 feet to allow distancing from the court.
   4. Row 2 should be a minimum of 6 feet behind Row 1.
   5. Baseline and/or opposite side of the court may be used for other necessary staff.
   6. A minimum 12-foot physical distance barrier must separate the scorers’ table and bench areas from the general seating area. 
   7. Similar spacing is recommended for “broadcast tables” on the other side of the court.

Facility planning — movement in/around areas.

1. Entry/exit.
   1. All entrants shall be subject to local health official restrictions and guidance, including health screening and temperature checks, before entering the competition venue.
   2. Entrants should be advised not to enter the venue if they are experiencing any signs or symptoms of COVID-19, feeling unwell or have been in contact with someone who has tested positive.
   3. Head count controls must be in place at each entry point if local guidelines restrict competition venue capacity as needed.
   4. Entry and exit procedures for the competition venue, back-of-house areas and courtside areas will be clearly marked.
   5. No loitering in back-of-house hallways or common spaces.
   6. Entry tunnels/doors to and from the court must be kept clear; no standing in tunnels/doorways.
2. Fan seating.
   1. Subject to local health official restrictions and guidance.
   2. Recommend that courtside seating be eliminated.  If no Tier 1, 2 or 3 individuals occupy the space opposite the bench and/or scorers’ table area, recommend the first row of fan seating be a minimum of 12 feet from the sideline.  
   3. Recommend the first row of fan seating be a minimum of 12 feet from the back of the bench and/or scorers’ table area, the corners and ends of the court.
3. Isolation and quarantine rooms.
   1. Diagnostic testing should be readily available for symptomatic or suspected cases of COVID-19.
   2. Recommend that isolation and quarantine rooms be identified and ready for use. Isolation rooms are for newly positive cases or evaluation of individuals with COVID-19 symptoms. Quarantine rooms are for high-risk exposure individuals of newly infected or symptomatic individuals. Local health official reporting protocols should be followed.
4. HVAC considerations.
   1. Recommend review of HVAC-related engineering controls. Encourage three or more air changes per hour and use of more fresh recharge air vs. recirculation.
   2. Discuss temperature settings targeting a 74+F temperature and 50+% relative humidity.

Locker room.

1. Recommend all individuals, regardless of role or function, always wear a mask/face covering within the competition venue.
2. Once Tier 1 individuals reach the team bench, masks/face coverings may be removed for those individuals on the playing court.
3. Student-athletes and team bench personnel are recommended to wear masks/face coverings within their assigned team locker room.
4. If spacing allows, recommend 6 foot spacing between seats within the home and away team locker rooms.
5. Warmup:
   1. Masks/face coverings must be worn while transitioning to and from the locker room and court.
   2. On-court players must replace their masks/face coverings before leaving the court to return to their designated locker room.
6. Pregame and transitions between games (doubleheaders/MTE):
   1. Teams may stretch and warm up pregame within a designated area or their locker room.
   2. Teams must return fully to their team locker room with two minutes left in the preceding game.
   3. Teams must wait for permission to enter the floor once cleared by the previous teams and appropriate sanitation procedures have been executed.
7. Showers:
   1. Team members are encouraged to shower at their hotel after the game, as opposed to at the venue (if applicable).
   2. Teams are encouraged to depart the facility immediately after their game. If student-athletes stay in the facility to watch the next game, they should preferably shower at their hotel. If this is not feasible, showering should be limited to prevent non-physically distant interactions.

Handling equipment.

1. Each team should have its own rack (6-12 or an equal amount) of basketballs for use while in the venue. The basketballs should be cleaned by a designated member of the host institution’s game operations staff (Tier 2) according to manufacturer’s recommendations with dish soap and water, and not with a disinfectant.
2. Recommend three or four basketballs be set aside for game use only. Recommend replacing the game ball each time a ball goes out of bounds and is touched by an individual not in Tier 1 or 2. Game balls should be cleaned during media timeouts, halftime and each period break with dish soap and water.
3. Officials’ water/towels should be located behind each basket or on a table across from the scorers’ table. These must be specific to each official and handled only by the officials.

On-court operations.

1. Eliminate any coach/official/scorers’ table physical contact (e.g., handshakes, fist bumps) at all times.
2. Recommend eliminating the postgame handshake line involving the two participating teams. Consider some act of sportsmanship, such as the teams lining up at their respective free throw lines and giving congratulatory waves to each other.
3. Consider eliminating or reducing the time allotted for any halftime and/or timeout promotions to allow the court to be cleaned.
4. Recommend assigned work areas for the media to minimize the need for cleaning workstations until after media representatives have exited the venue.

Rules, policies and protocols.

1. Recommend eliminating hard copy stats to the bench.
   Options for stats on the bench:

• Conferences are encouraged to apply for the technology waiver by Dec. 1, 2020, which allows the transmission of live stats to the bench area (men’s playing rules website and women’s playing rules website).
• Institutions may place sanitized printers in close proximity to each bench area, allowing coaches to retrieve updated hard copies of stats.

2. Establish guidelines for host medical staff. Team athletic medical personnel need to follow their established institutional guidelines.
3. For doubleheaders, add additional time between games to allow for cleaning (at least one hour).
4. In-venue catering should be limited to packaged, grab-and-go-type options. No catered buffets.
5. Crowd noise piped into the facility (even during live play) would need to comply with decibel levels to be clarified by the NCAA Men’s and Women’s Playing Rules Committees, along with proper monitoring and enforcement procedures.

These frequently asked questions have been developed in support of the release of the Core Principles of Resocialization of Collegiate Basketball (Basketball Guidelines), the fourth in a series of resocialization documents intended to provide guidance to the NCAA membership about issues arising from the COVID-19 global pandemic. The Basketball Guidelines update and extend, and in some cases replace, the guidance provided in the previous three documents (Core Principles, Action Plan, and Developing Standards).  

As with prior NCAA publications, the materials are meant to be consistent with guidance published by the federal government and its health agencies. This document reflects the relevant scientific and medical information available at the time of publication. These materials are not and should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines and remain subject to revision as available data and information emerge and evolve.

Questions can be directed to SSI@ncaa.org.

Why are the Basketball Guidelines considered recommendations and not requirements?

When the Board of Governors elected to mandate the considerations described in the Developing Standards document, there was considerable uncertainty in this country regarding both unprecedented infection rates and accessibility to testing. Further, there were concerns related to student-athletes who did not wish to compete because of COVID-related health issues. In this setting, the Board believed that a mandate would expedite and facilitate membership’s identification and establishment of a reasonable and consistent baseline standard related to in-season safety and student-athlete protection regarding scholarships and eligibility. We now have a better projection regarding testing availability and options and have obtained more information regarding sport and societal resocialization. In this fluid environment, the Board agreed that the Basketball Guidelines should serve as a guidance resource, especially as we continue to assess emerging science and infrastructure.

Are there specific recommendations for student-athletes who may leave and return to campus for holiday break?

Schools should consider how best to encourage all student-athletes to continue strict health/infection control precautions while on break. Because of the combination of travel and possible social interactions, it is important that student-athletes always observe infection mitigation behavior. When they return, it is anticipated that they will self-quarantine, re-enter normal school testing protocols, and have at least one negative test prior to re-entering athletics and participate in transition period activities, as applicable. A prescribed quarantine period for student-athletes returning to campus is not specified as part of the Basketball Guidelines.

What if a school cannot obtain testing three times per week for indoor high transmission risk sports, or for outdoor high transmission risk sports and intermediate transmission risk sports where antigen testing is considered?

The suggestions described in the Basketball Guidelines are not intended to vary based on an institution’s ability to access or obtain testing. Rather, each school is encouraged to work closely with applicable institutional medical/legal/risk management personnel to evaluate all available health and safety information and guidance and to make an informed decision about whether and to what extent identified risks can be appropriately addressed through any other alternative, in each case with an eye toward unique institutional considerations and applicable state and local health agency requirements.

Will there be different guidelines for schools that can limit competitions to a single state or region?

No. The Basketball Guidelines are intended to apply to all schools, regardless of where competitions will occur and whether competing teams are from nearby locations.

Do the testing protocols described in the Basketball Guidelines change if teams are scheduled for back-to-back games over the weekend?

No. Testing is recommended to occur three times per week on nonconsecutive days, regardless of when a team plays. If a team travels to a school and there is a CLIA certified location on site or nearby, testing can be pre-arranged to be performed at this location. It is recommended that conferences and schools make plans for such arrangements in advance. Otherwise, it is anticipated that testing would resume upon return to school, ideally with tests not separated by more than three days.

Has the NCAA COVID-19 Medical Advisory Group considered the possibility of PCR testing two times per week rather than antigen testing three times per week for indoor high transmission risk sports, especially given the differences in sensitivity?

The Advisory Group discussed this matter and concluded that even though PCR testing is more sensitive, schools should still consider testing three times per week for indoor high transmission risk sports using any combination of PCR and/or antigen testing.  *See exception below for student-athletes in indoor high transmission risk sports who practice universal masking and adherence to infection risk mitigation during all training and competition.

Can you clarify the differences between Tier 1 and Tier 2 as described in the Basketball Guidelines? Are there other tiers?

A recently published article in the British Journal of Sports Medicine provides the following explanation of the use of these references:

Tier 1: This is the highest exposure tier and consists of individuals for whom physical distancing and face coverings are not possible or effective during athletic training or competition. Examples of relevant individuals include student-athletes, coaches, athletic trainers and physical therapists, medical staff, equipment staff and officials.

Tier 2: This is a moderate exposure tier and consists of individuals who come into close contact with Tier 1 individuals but can reasonably maintain physical distance and use face coverings. Examples of relevant individuals include certain team staff (e.g., executives) and certain operational staff (e.g., security, event staff and league staff).

Tier 3: This is the lowest exposure tier and includes individuals who provide event services but do not come into close contact with Tier 1 individuals (and should this occur, would be reclassified into Tier 2). Examples of relevant individuals include certain operational staff (e.g., housekeeping, catering, sanitation and transportation) and media/broadcast.

When a Tier 1 individual tests positive, it is suggested that all other Tier 1 individuals quarantine as soon as the results are known for a period of 14 days, with contact tracing beginning immediately to determine who was subject to a high-risk exposure. Does this mean that all Tier 1 individuals are immediately quarantined for 14 days, or does it mean that all Tier 1 individuals are immediately quarantined, and if contract tracing determines they did not have a high-risk exposure, they can return to activity?

It means that all Tier 1 individuals are immediately quarantined for 14 days, and that contact tracing would proceed to determine if all such individuals should remain in quarantine and if there are additional individuals who may have had a high-risk exposure to an infected individual.

The Basketball Guidelines provide that individuals who previously tested positive for COVID-19 do not need to quarantine or get tested again for up to 90 days (for example, even after a high-risk exposure) as long as they do not develop symptoms again. Do these individuals move back into the testing pool after 90 days?

Emerging information reported on the CDC website suggests retesting of these individuals is unlikely to yield useful information, even if the person has had close contact with an infected person, so retesting is not suggested during the 90 days following a positive test unless individuals develop symptoms consistent with COVID-19 and there is no other cause identified for their symptoms. Emerging evidence also suggests that individuals can continue to test positive even after 90 days, yet there is a scarcity of reports that are consistent with individual reinfection. Antibody titers can fluctuate over time, and the clinical meaning of this fluctuation is uncertain. Given such data, in a given season for individuals who have tested positive, retesting should be performed only for those individuals who develop COVID-19 symptoms that are not otherwise explained by another condition. However, after this 90-day window, it is recommended that student-athletes and other individuals who experience a high-risk exposure enter quarantine for 14 days.

Is universal masking suggested during weight training and conditioning?

Yes, masking and physical distancing are suggested whenever feasible.

Will the NCAA be providing additional information about the testing of officials?    

Considerations related to the testing of officials are being developed, and we anticipate that information will be circulated soon. Testing protocols for officials will not be managed or overseen by the NCAA but will be coordinated through conferences and schools.

The NCAA has said it is exploring potential supply arrangements with one or more testing companies. Is updated information available?

We anticipate providing additional information the week of Oct. 12, 2020.

The Basketball Guidelines include direct reference to Division I basketball timelines. Are the guidelines meant to apply equally to Divisions II and III basketball?

Yes. The Basketball Guidelines apply to all divisions. Specific reference was made to the Division I calendar for purposes of clarity, as the Division I Council had just recently determined the structure of both the men’s and women’s basketball seasons.

The Basketball Guidelines organize testing recommendations by the phase of activity that a basketball team will go through, moving from out-of-season countable athletically related activities, to preseason practice, and then competition and postseason. These phases are clearly described in the Division I basketball calendar materials but are less clear in the flexible championship frameworks created by Divisions II and III. How will schools in those divisions know how to progress their testing protocols in response to activity changes?

Blanket waivers in both Divisions II and III created flexible playing and practice season frameworks for all sports. These frameworks are intended to facilitate maximum flexibility for member schools and conferences to configure practice and competitive seasons to occur at times that make the most sense for them. But this flexibility also means that the boundaries between practice and playing seasons are less clear than usual, so it is anticipated that testing protocol decisions will be made at the institutional or conference level based on an assessment of the nature of the practice/competition activities in which the team is involved.

If practice activities are generally consistent with out-of-season activities (strength and  conditioning, team meetings, limited skill instruction), it would be reasonable to interpret the Basketball Guidelines as suggesting surveillance testing for countable athletically related activities to be appropriate. If those practice activities are consistently on-court and resemble preseason activities that preclude scrimmages with teams outside the member school, then it would be reasonable to conclude that the Basketball Guidelines would suggest weekly testing until one week before competition begins. One week before the regular season begins, and extending into the postseason, testing would transition to three times per week.

Divisions II and III have provided scheduling flexibility for the conduct of the 2020-21 basketball season. As schools and conferences begin to configure and schedule practice and competition periods, do they need to build in and account for a separate transition period prior to the start of other preseason activities to adequately address health and safety concerns?

No. Previous guidance related to considerations around variability in the physiologic readiness of student-athletes, the conduct of mandatory medical examinations, and the importance of acclimatization and transition periods would apply equally in these circumstances. Schools are expected to establish an appropriate initial transition period during which student-athletes are afforded the time to properly progress through the physiologic and environmental stresses placed upon them as they return to required activities. It is anticipated that the period would be 7-10 days, completed before the start of any other required physical activities, and otherwise consistent with Interassociation Recommendations: Preventing Catastrophic Injury and Death in Collegiate Athletes. While it is expected that these principles would be applied any time there is a material break (e.g., greater than one week) between training segments, and that teams would work closely with applicable medical and strength and conditioning personnel to intentionally identify and apply appropriate protocols that best support the needs of their student-athletes, it has not been identified as necessary to include a separate transition period distinct from the preseason period within the broader scheduling calendar.

Sports other than basketball

As data and science evolves, formal modifications to previous resocialization documents will be presented through additional process and membership discussion. In the interim, the following approaches are offered for consideration.

All sports are classified as having low, intermediate or high risk for transmission, with appropriate testing strategies for each sport. Schools and conferences are urged to consider these strategies as they make decisions regarding return to practice and competition.

What are recommended testing protocols for sports other than basketball?

The NCAA COVID-19 Medical Advisory Group has assessed other sports and provided updated guidance based on emerging information. Importantly, the updated guidance differentiates high transmission risk sports that are played indoors versus outdoors. Further, the updated guidance differentiates high transmission risk indoor sports in which Tier 1 individuals universally mask versus Tier 1 individuals who do not universally mask during practice and competition. Highlighted text indicates a change from the Developing Standards document.

Sport classification

• Low transmission risk: bowling, diving, equestrian, fencing, golf, rifle, skiing, swimming, tennis, track and field.

• Intermediate transmission risk: acrobatics and tumbling, baseball, beach volleyball, cross country, gymnastics, softball, triathlon.
• High transmission risk: basketball, field hockey, football, ice hockey, lacrosse, rowing, rugby, soccer, squash, volleyball, water polo, wrestling.

Testing strategies

• Low transmission risk: Testing is performed in conjunction with a school plan for all students, plus additional testing for symptomatic and high infection risk individuals as warranted.
• Intermediate transmission risk:
  • Out-of-season athletic activities: Testing is performed in conjunction with a school plan for all students, plus additional testing for symptomatic and high infection risk individuals as warranted.
  • In-season: Testing once weekly by PCR testing, or three times weekly by antigen testing. [This is increased from 25-50% surveillance testing every two weeks and adds antigen testing as an option.]
• High transmission risk:
  • Out-of-season athletic activities: Surveillance PCR testing, for example, 25%-50% of athletes and Tier 1 nonathlete personnel every one to two weeks if physical distancing, masking and other protective features are not maintained, plus additional testing for symptomatic and high infection risk individuals as warranted. [The option of testing every one to two weeks was added, as certain local circumstances may suggest weekly surveillance testing as a medically preferred alternative.]
  • Preseason: Testing once weekly by PCR testing, or three times weekly by antigen testing. [The antigen testing is added as an option.]
  • Regular and postseason, outdoor sports: Testing once weekly by PCR testing, or three times weekly by antigen testing. [The antigen test has been added.]
  • Regular and postseason, indoor sports: Testing three times weekly on nonconsecutive days, beginning one week prior to the first competition. PCR or antigen testing may be used. If all training and competition are done with universal masking and adherence to infection risk mitigation, then testing can be considered in a manner consistent with outdoor high transmission risk sports. [This recommendation places all indoor high transmission risk sports on a testing recommendation protocol that is consistent with basketball, and it represents an increase in suggested testing frequency from the Developing Standards document, which did not differentiate indoor from outdoor sports. It also differentiates indoor high transmission risk sports where universal masking and adherence to infection risk mitigation occurs in all Tier 1 individuals even during training and competition.]

As indicated below, these materials are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve. This document addresses basketball only, and future documents will address other winter sports. Unless stated otherwise (for example, testing recommendations), the guidance from Resocialization of Collegiate Sport: Developing Standards for Practice and Competition (Resocialization Standards) remains in place; athletics personnel are encouraged to review this document.

Introduction

The Resocialization Standards focused on the development of standards for practice and competition. Importantly, basketball was listed as a high contact risk sport with regard to COVID-19. Further, outdoor training was noted to be preferred over indoor training with good ventilation where feasible, and indoor training with good ventilation was noted to be preferred over indoor training with poor ventilation. This document serves as an update to the third publication, with a singular focus on basketball. 

The information in this publication was developed in consultation with the NCAA COVID-19 Medical Advisory Group, which includes team physicians; infectious disease and public policy experts; representatives from the membership; and representatives from the NCAA COVID-19 Advisory Panel, National Athletic Trainers’ Association, American Medical Society for Sports Medicine, the National Medical Association, the Autonomy-5 Medical Advisory Group, and the NCAA Committee on Competitive Safeguards and Medical Aspects of Sports. While the federal government has not yet published uniform federal guidance related to certain practices like diagnostic testing protocols, contact tracing and surveillance, these groups have, through their continued review and evaluation of available research data, anecdotal evidence and related analysis and discussion, identified certain practices that should be highlighted for more focused consideration by member schools. While the materials encourage consideration of various factors and actions, they do not speak to every possible scenario, and in no event should members fall below national or applicable public health standards set by their local or state communities.

As with prior NCAA publications, the materials are meant to be consistent with guidance published by the federal government and its health agencies. This document reflects the relevant scientific and medical information available at the time of print. These materials should not be used as a substitute for medical or legal advice. Rather, they are intended as a resource for member schools to use in coordination with applicable government and related institutional policies and guidelines, and they remain subject to further revision as available data and information in this space continue to emerge and evolve.

Behavioral Infection Risk Mitigation

Even with frequent testing for COVID-19, the most important risk mitigation strategy remains a combination of daily self-health checks, physical distancing, universal masking and hand sanitization. The Centers for Disease Control and Prevention recommendations include the following for proper wearing of face masks:

• Wash your hands before putting on your mask.
• Put it over your nose and mouth and secure it under your chin.
• Try to fit it snugly against the sides of your face.
• Make sure you can breathe easily.
• Masks with exhalation valves or vents should not be worn to help prevent the person wearing the mask from spreading COVID-19 to others (source control).

Basketball student-athletes and all athletics staff personnel who interact with the athletes should be appropriately educated about and actively participate in mitigation of COVID-19 infection through proper behavior at all times. Time away from athletics, especially social events, may be riskier than sport; therefore, all basketball athletes and staff should be vigilant at all times.

Testing Update

Two testing paradigms dominate the United States market at present. There continues to be no national testing standard, and testing availability remains problematic for certain tests and in certain parts of the country. We have attempted to highlight and summarize some of the considerations around recent advances in testing below but encourage all schools to work closely with applicable medical personnel to evaluate and discuss the benefits and limitations of each of these alternatives before deciding on a specific testing strategy. Further, schools are encouraged to proactively pursue discussions with local hospitals and/or local CLIA-certified labs. (The Clinical Laboratory Improvement Amendments regulate laboratory testing and require clinical laboratories to be certified by the Centers for Medicare and Medicaid Services before they can accept human samples for diagnostic testing.)

Nucleic Acid Amplification Tests

Nucleic acid amplification tests, including polymerase chain reaction, are considered the standard against which other tests are evaluated. This technology amplifies the RNA of the SARS-CoV-2 virus, thereby allowing detection of minimal quantities of virus particles. Samples are obtained via nasopharyngeal, oropharyngeal, or nasal swabs, or by collection of saliva.  Traditionally, PCR tests were limited by the following:

• Proper collection, including personal protection equipment for those obtaining samples.
• Reagent availability for test completion.
• Laboratory and personnel capacity.
• Cost (approximately $100-$150 per test). 

When access to a dedicated laboratory is not a challenge, and there are no public health contraindications to performing tests on asymptomatic or minimally symptomatic individuals, turnaround time for testing can be within 24 hours. However, due to lab access and other challenges, PCR lab-based testing in the general population will often have a turnaround time of more than 72 hours. Delayed turnaround can limit the utility of testing, especially when the individual being tested is not living within a bubble that minimizes the risk of disease transmission.

Two advances have improved PCR testing availability and turnaround time:

1. Saliva PCR testing that bypasses traditional nucleic acid extraction/reagent.
   1. SalivaDirect was developed in partnership with Yale University and the National Basketball Association and was issued an emergency use authorization from the U.S. Food and Drug Administration on Aug. 15. SalivaDirect uses the collection of saliva in a container that does not require nucleic acid preservatives at sample collection, and it replaces nucleic acid extraction with a simple step that does not require reagents that may be in short supply. Therefore, use of SalivaDirect can help bypass resource risks related to sample collection and bottlenecking of reagent supply. SalivaDirect is a protocol, not a kit, and does require an authorized lab (meaning it is not point-of-care testing). This testing methodology can be performed using several common and available reagents. Any high complexity CLIA-certified lab within the Unites States may become authorized to use SalivaDirect through a submission process. Turnaround time for testing depends on the working arrangement with the lab and its dedicated personnel and lab infrastructure. The time will be highly reliant on laboratory automation. The estimated cost is $5 per test, although commercial labs may charge up to $30 per test. Researchers at the University of Illinois at Urbana-Champaign developed a similar saliva-based PCR test, which is being used for frequent testing of students, faculty and staff. The university’s dedicated lab can process 1,000-2,500 tests every four hours. The SalivaDirect test is projected to have widespread availability over the next several weeks. More information about SalivaDirect protocol and lab authorization can be found here and on the FDA website.
   2. Ambry Genetics offers a program that includes saliva-based PCR tests that can be self-collected as part of its broader CARE for COVID program, and results can be delivered within a fast turnaround through a portal compliant with federal privacy laws on the release of medical information. PCR tests can be further expedited through custom critical delivery services to meet the turnaround time necessary for each school or conference. More information about Ambry Genetics can be found here and on the FDA website.
2. Molecular-based point-of-care tests use PCR but do not require transport to a dedicated lab. Rather, the tests are performed on-site with a dedicated machine and test kits. Abbott ID NOW is another product issued an emergency use authorization and is a prototype for this type of test. Such testing requires oversight of a CLIA-certified physician (for example, a team physician who obtains the certificate), and testing can be performed by properly trained individuals who report to the CLIA-certified physician. The test kit includes a dedicated nasal swab, and tests are run individually, taking about 15 minutes per test. Each instrument costs $5,000, and test kits cost $41 per test. Given the individual nature of testing, use of this method likely would require five to seven instruments per school. Abbott ID NOW is currently not widely available and is approved for use with symptomatic individuals only (meaning testing asymptomatic individuals would be “off-label”). Production increases may lead to more widespread availability in November or December. More information about the test can be found here and on the FDA website.

Antigen Testing

Unlike nucleic acid amplification tests, antigen testing is performed by identification of an inner nucleocapsid protein of the virus using a fluorescent immunoassay. This means that the number of viral particles per sample must be substantially higher than PCR testing (thereby possibly increasing false negative tests). Although specificity in symptomatic individuals is high (thereby decreasing false positive tests), false positive test rates in asymptomatic populations is less well understood for antigen testing. Antigen testing is used with point-of-care instruments and/or test kits. Antigen testing that has been approved or is on the horizon includes the following:

1. Quidel Sofia/Sofia 2 is FDA authorized for emergency use and includes the analyzer and test kits. The most common pathway for obtaining the instruments and test kits is through a partnership with distributors who also may provide clinical services, although there are active discussions to centralize purchasing of instruments and test kits. The Department of Health and Human Services has purchased the majority of available Sofia instruments and test kits, and the next major shipment is expected in November. There may be alternative pathways before November, and we will provide additional updates as they become available. More information about Sofia/Sofia 2 can be found here and on the FDA website.
2. Abbott BinaxNOW is a newly released antigen test with emergency use authorization. The test does not require an instrument, but rather is a simple folding card test kit with nasal swab that provides a yes or no result in 15 minutes. A kit content is 40 test cards and nasal swabs. The cost is $200 for 40 cards, meaning $5 per test. This test requires CLIA physician oversight, similar to Sofia. HHS purchased 150 million test kits, and Abbott can produce 50 million per month beginning in October. Therefore, widespread availability is expected to begin around January. More information about BinaxNOW can be found here and on the FDA website.
3. Other point-of-care antigen tests are expected to enter the U.S. market in late November or December, including Quest Diagnostics, E25Bio and BD Veritor tests, as well as additional offerings through the Ambry CARE for COVID program. We will provide additional updates on emerging point-of-care antigen tests as they become available.

Testing Protocols

Training and competing in basketball require frequent, sustained close contact among players, coaching and other essential staff, and officials in an indoor setting. Schools are encouraged to proactively define those individuals who constitute the “inner bubble” (Tier 1), which includes student-athletes and essential basketball personnel whose job function requires direct access to players on a regular basis, specifically close contact (6 feet or less) for 15 minutes or more, as per CDC guidance. Tier 1 individuals may differ from school to school (for example, some coaches maintain physical distancing at all times and therefore are not part of Tier 1). Tier 1 individuals are considered to be at higher risk of becoming infected with COVID-19 if any other individual in the group is contagious and masking/physical distancing has not been maintained. The situation is further compounded because the nature of basketball makes it challenging to train in functional units (as described in the Resocialization Standards). 

A typical basketball team has 15 players, all of whom typically train on a single basketball court at the same time in an enclosed space. Generally speaking, it is expected that the total number of Tier 1 individuals within a team would approximate 25-30. If any Tier 1 individual becomes infected, schools should consider quarantining the entire team, including coaching staff and other essential personnel who are part of Tier 1, for 14 days, provided determinations around who must be quarantined are ultimately the jurisdiction of applicable public health officials. At present, there is not a recommendation for consideration of testing out of quarantine.

Surveillance vs. Symptomatic Testing

If an individual has symptoms suggestive of or consistent with COVID-19, symptomatic testing performed via PCR is suggested. For asymptomatic surveillance screening during countable athletically related activities, the preseason, regular season and postseason, testing should be considered as outlined below via PCR or antigen testing.

Of note, CDC guidance provides that individuals who previously tested positive for COVID-19 do not need to quarantine or get tested again for up to three months (for example, even after a high-risk exposure) as long as they do not develop symptoms again. However, if such individuals develop symptoms consistent with COVID-19, they require reevaluation and may need to be tested again if there is no other cause identified for their symptoms.

Countable Athletically Related Activities

Based on the basketball start-of-season model adopted by the Division I Council, countable athletically related activities, also referred to as the transition period, run Sept. 21 through Oct. 13, 2020. During the period when countable athletically related activities are occurring but before the preseason begins, surveillance testing should be considered for 25%-50% of student-athletes and Tier 1 individuals every two weeks if physical distancing, masking and other protective features are not consistently maintained, plus additional testing for symptomatic and high contact risk individuals. This is consistent with the Resocialization Standards.

Preseason

Based on the basketball start-of-season model adopted by the Division I Council, the preseason period begins Oct. 14 and ends Nov. 24. During the preseason, it is anticipated that physical distancing and masking will be compromised. However, if there are no scrimmages with outside teams, student-athletes and other Tier 1 individuals will not be interacting with individuals outside the member school environment during practice. Based on this expectation, testing should be considered weekly for all Tier 1 individuals during this time. This is consistent with the Resocialization Standards. If scrimmages occur with outside schools, then the testing protocol for the regular season and postseason should be considered.

Regular-Season and Postseason Competition

Based on the basketball start-of-season model adopted by the Division I Council, the regular season begins Nov. 25. Because of the frequency of games and travel, coupled with the risk of infection in basketball, it is suggested that COVID-19 testing occur three times per week on nonconsecutive days for Tier 1 individuals during the regular season and postseason competition periods. It is suggested that the three-time-a-week testing begin one week before the first competition. 

Even though some tests may be less sensitive and more prone to false negative results than others (for example, antigen vs. lab-based PCR), the frequency of testing decreases considerably the mathematical odds of the same individual obtaining a false negative test repeatedly. However, because false positive tests are more likely to occur in asymptomatic populations, schools may want to consider performing a confirmatory PCR test with any asymptomatic individual who tests positive. 

As identified in the Resocialization Standards publication, game officials should be considered Tier 1 individuals during the regular season and postseason such that the same frequency of testing would be suggested for them. Schools should arrange for testing paradigms that make the most sense locally.

Membership is encouraged to work closely with school and conference medical and operations personnel to proactively identify and arrange for necessary testing paradigms that can be adequately supported through available school, local and conference resources.

Practice Without Competition

For schools that are holding basketball practice but are not competing against other schools, it is suggested that testing be performed as per the preseason recommendations.

Quarantine and Isolation Considerations

Tier 1 Individuals With High Risk Exposure

When a Tier 1 individual tests positive, it is suggested that all other Tier 1 individuals quarantine as soon as the results are known for a period of 14 days, with contact tracing beginning immediately to determine who was subject to a high-risk exposure. Ultimately, the applicable public health officials have jurisdiction to make these determinations. Schools can consider the need for and potential benefit of training on-site personnel in contact tracing through accepted courses such as the Coursera class, as access to additional trained staff can be an invaluable contact tracing resource with respect to institutional risk-management efforts and resources. 

Exercise While in Quarantine

Consistent with the Resocialization Standards, it is suggested that student-athletes who are placed in quarantine for high risk contact but who are not infected with COVID-19 be permitted to exercise individually if such exercise does not cause cardiopulmonary symptoms. If individual exercise is performed outside, schools should consider monitoring all such outdoor activities to ensure physical distancing and masking as appropriate, and such exercise should be consistent with applicable public health official guidance. Group exercise is not recommended. It is suggested that all student-athletes placed in quarantine be monitored for the development of symptoms and undergo testing if symptoms develop. 

Isolation and Return to Sport for Infected Individuals

It is suggested that schools continue to consider the isolation and return-to-sport guidance provided in the Resocialization Standards for individuals who test positive, including those considerations related to cardiac testing.

The Basketball Bench

The basketball bench has historically involved most Tier 1 individuals sitting or standing in close proximity to one another throughout the game. Because it is assumed that these Tier 1 individuals have tested negative and are already in close contact while on the court, it is not suggested that they must observe physical distancing and universal masking while on the bench. However, it is suggested that the basketball bench be physically separated from all other individuals who are not part of Tier 1. Logistics should be considered to address risks related to personnel who must be at the game but are not part of Tier 1. It is suggested that these individuals, referred to as Tier 2 individuals, including other essential basketball personnel who occasionally may need to be in close proximity to student-athletes and other Tier 1 individuals and who may need to access restricted areas periodically, observe masking and physical distancing at all times and be prevented from interacting with any of the basketball bench individuals unless physical distancing and masking are in place for all. 

Similarly, other adjustments to address close contact risks within the bench area (for example, reduction/removal of unnecessary scoring, statistics and other paperwork, moving the scorers’ table to the opposite side of the court, etc.) also are encouraged where feasible, provided it is acknowledged that these types of adjustments may require further evaluation of existing rules. 

Travel Considerations

Schools should continue to evaluate the current data regarding the risks and considerations identified in the Resocialization Standards related to commercial plane and other travel. These considerations include, among others, travel protocols that maximize the opportunity for physical distancing and call for universal masking for all individuals traveling; the availability of alternative travel by private car, van, chartered bus or chartered plane; proper communication of all travel rules, protocols and expectations to everyone in the travel party; prepackaged meals, room service, takeout and outdoor dining options as alternatives to inside restaurant dining; and, when feasible, traveling and playing on the same day to avoid overnight stays. In addition, schools should consider restricting the size of travel parties as much as possible, ideally requiring they are not greater than 30 individuals. Many states still have in place quarantine protocols that make travel impractical. Therefore, state and local guidelines must be considered before any anticipated travel for competition.

Considerations for Symptomatic Management During Travel

Schools should consider management strategies for student-athletes and other essential basketball personnel who travel for competition and become symptomatic after departure. Traveling teams should consider confirming, ahead of time, whether host schools have adequate on-site testing capabilities to address symptomatic athletes from either team and adequate health care resources to properly isolate and care for anyone who tests positive or is symptomatic. The traveling team also should consider, ahead of time, necessary arrangements for proper return transport of infected, isolated and quarantined student-athletes and personnel, in each case in accordance with applicable state and local public health requirements.

Considerations Related to the Discontinuation of Athletics

Although at the time of this writing, reported data reflects that the rate of spread of COVID-19 has been decreasing or has stabilized  in many regions of the country, athletics departments and member schools should continue to consider the parameters for discontinuing athletics, as per Resocialization Standards and the related NCAA Board of Governors mandate. Despite reported improvements, local circumstances and risks may still create uncertainty around safety in high contact risk sports such that schools should continue to work with applicable public health officials and consider pausing or discontinuing athletics activities. Some examples of such local circumstances that might trigger a conversation with applicable public health officials:

• A lack of ability to isolate new positive cases or quarantine high contact risk cases on campus.
• Unavailability or inability to perform symptomatic, surveillance and pre-competition testing when warranted and as recommended in this document.
• Campuswide or local community test rates that are considered unsafe by applicable public health officials.
• Inability to perform adequate contact tracing consistent with governmental requirements or recommendations.
• Applicable public health officials stating that there is an inability for the hospital infrastructure to accommodate a surge in hospitalizations related to COVID-19.