Playing football vs. risking health: Inside the decisions facing college football's coaches and players

The warning came at the tail end of a quick phone call to the doctor. Catherine Clawson missed her regular check-up with her oncologist this spring because the coronavirus pandemic disrupted her schedule, and she wanted to set a new date for a visit. Clawson had seen her doctor every 3-6 months since she was diagnosed with breast cancer just days after her husband, Wake Forest football coach Dave Clawson, won the school's first bowl game in eight years back in December 2016.

She is otherwise healthy -- "a survivor," her husband says proudly -- but her doctor was still worried, and told her the pandemic held added risk because of her history.

Three years ago, Catherine Clawson went through chemotherapy, and the treatment left her with a low count of white blood cells, making her immune system vulnerable.

During dinner the night of the phone call, Dave and Catherine discussed their options. He felt a responsibility to be there for his team. She was used to the sacrifices and time spent apart. So they made a decision.

"There's no way I'm going to do anything that would put her at risk," Dave Clawson said.

Now, a month away from the scheduled kickoff of the 2020 football season, Clawson is spending most of his time at Wake's football facilities, sleeping in his office and keeping in touch with Catherine by phone.

"Coaching 110 to 120 players with a staff of 50, how could I go home at night and tell my wife there was no way I came in contact with COVID-19?" Clawson said. "I'm sure that college football will have requirements, and people will get tested, but it doesn't mean that the day before or the day after you didn't have contact with the virus."

When news of Clawson's decision broke, one of the first messages that pinged on his phone came from Penn State football coach James Franklin. "Hang in there, brother," Franklin texted. He understood Clawson's dilemma. Franklin, too, will spend the season apart from his family rather than risk infecting his daughter, who has sickle cell disease.

Clawson said these decisions also apply to other members of his staff who are at risk. In addition, there are hundreds of older coaches around the country who fall into a higher-risk age demographic. Plus, there are many more who live with older family members or have relatives with underlying health conditions. Players, too, have family battling other illnesses, or come with their own risk factors, like asthma, sickle cell disease or lupus.

On Wednesday, UConn became the first FBS team to cancelits football season because of the pandemic.

"I'd be shocked if every staff in America doesn't have someone who has to make a decision," Clawson said.

As administrators work to formulate a plan that will allow college football to be played in 2020, the discussions are bolstered by one of the few facts medical professionals know for certain about COVID-19: Risk of complications is lowest among young, healthy people, according to data from the Centers for Disease Control. But that doesn't mean there isn't a sizable portion of the greater college football ecosystem -- coaches, officials, support staff and family members -- that must make some difficult choices between the sport they love and the threat the virus might pose.

"These [college football] bubbles don't include just young people,"said Dr. Graham Snyder, the medical director of infection prevention and hospital epidemiology at the University of Pittsburgh Medical Center.

North Carolina coach Mack Brown is 68, but he said he doesn't like to think of himself as being particularly old.

"I'm just very experienced," he said in late July, a few weeks after his team shut down voluntary workouts following a COVID-19 outbreak.

By age or experience, however, Brown is in rarified air. He's the second-oldest head coach in FBS, and while he's not at the top of the risk curve for the virus, he's markedly closer to it than his players.

Brown said he's taking extra precautions. He said he has spent little time anywhere other than his house or the Tar Heels' football facility. He wears a mask everywhere he goes. He spent the spring working out, looking to get in better shape, so his body would, ideally, be better prepared to fend off the virus, should he become infected.

Still, the risk is real, and there's only so much Brown can do to mitigate that.

"It's my job to lead, especially during a time of crisis," Brown said. "What I needed to do was go by the guidelines from the CDC, and take as few risks as I can but still lead. By taking fewer risks and being in better shape, I'm being a good role model for the players."

At Kentucky, offensive line coach John Schlarman is following a similar approach. He battled cancer last year, and he understands that puts him at greater risk. That's actually been a good thing, he said. It's motivation to focus on safety.

"If I didn't have cancer, would I have been as conscientious of that? Who knows, but probably not," Schlarman said. "It puts me at a heightened level of awareness."

And yet, Schlarman said returning to football was never a particularly tough decision. It's his job, and he plans to keep doing it -- at least for now.

"I'm certainly hoping that's not a bridge I have to cross," Schlarman said.

Schlarman's approach is indicative of the wider risk-reward analysis around college football, it seems. In a JuneESPN survey of 73 college football players, more than 80% said they were comfortable practicing and playing, even if campus was not deemed safe to open for the general student population.

The positive test results that have shut down workouts at schools like North Carolina, Ohio State and Michigan State since players returned to campus haven't done much to alter that approach either, said Kentucky linebacker Josh Paschal.

"It might be the best thing possible because cases are coming out now but we're learning how to control it and deal with it early," Pascal, a cancer survivor, said. "So by the time the season comes, it's second nature."

When the virus hit, Paschal reached out to team trainers. It's been less than a year since he finished immunotherapy after being diagnosed with a malignant melanoma, and he was concerned he might be at higher risk for COVID-19, too. Kentucky's medical staff spoke with his oncologists, and the news was good. His therapy, unlike Catherine Clawson's, helped boost his immune system, they said.

"As far as being something I was really worried about," Paschal said, "that cleared up fast."

But Paschal may be the exception. Last week, The Washington Post reported on a private meeting in which SEC players pushed the league for better information on safety precautions and were told, "We're going to have positive cases on every single team in the SEC. That's a given. And we can't prevent it."

Meanwhile, players from the Pac-12 banded together to pen an open letter to the league, published by The Players' Tribune, threatening to opt out of fall camp unless a series of demands, including mandatory safety standards and abolishing liability waivers, are met. Those demands followed the announcement by Virginia Tech CB Caleb Farley (2019 first team All-ACC) that he'd sit out the season to prepare for the NFL draft rather than risk exposure to the virus.

Multiple ACC players, speaking on the condition of anonymity, said they wanted to play, but shared similar concerns about the virus, with one player saying of a potential league-wide opt-out, "It's definitely possible."

Amid Michigan State's recent quarantine, lineman Jordan Reid shared concerns via Twitter, too: "Guys are testing positive across the country left and right...why is there still discussion on a season? Why is it taking so long to make a logical decision? Hmm let me guess REVENUE."

And one ACC player said his worries don't end at the locker room door. Like Clawson and Franklin, players across the country have family members at higher risk, and they're now forced to make the same choices between playing football and seeing their loved ones.

"If I get sick and I give it to somebody I care about and they pass away because you want money?" the player said. "Now you have a problem. I'm not trying to be put in a position where I have to perform and put my body on the line and also put my family in jeopardy."

While numerous players are speaking out about safety protocols, former Boston College linebacker Mark Herzlich wonders if the bigger concern may come from players unwilling to heed medical advice.

Herzlich was diagnosed with cancer following his junior season at Boston College in 2007, and after a year sidelined for treatment, he returned to play fewer than 10 months after his final round of chemo. Looking back, he wonders if COVID-19 would've been enough to halt his remarkable comeback story.

"I might've had an immune system reduction or a weaker heart. That happens through cancer," Herzlich said. "So I'm sure my doctors would've never let me go back, but I would've wanted to go back. ... I just know how stubborn I was at 18 or 19 years old. Even if I understood the risks, I was in the mindset of, 'Put me on the field. I just want to play football.'"

Dave Clawson said Wake Forest is taking extra precautions with players it knows are vulnerable because of conditions like asthma, and he has told every player their scholarship will be honored, even if they choose to sit out the season.

Knowing the risks is one thing, but what happens if a player doesn't realize he has an underlying condition and is then exposed to the virus?

"That's the worst-case scenario," Herzlich said. "That would be devastating."

There are also potential long-term health effects. On Monday, the mother of Indiana offensive lineman Brady Feeney posted a message on Facebook about her son's battle with COVID-19, saying that despite being "in perfect health, great physical condition," Feeney ended up in the emergency room with breathing problems and now has possible heart issues as a result of the virus. She called the experience "14 days of hell."

"Bottom line," Feeney's mother wrote, "even if your son's schools do everything right to protect them, they can't protect them."

It's the unknown that presents such massive hurdles for a college football season, said Snyder, the Pittsburgh epidemiologist. So far, he said, the science suggests little long-term impact for people who recover quickly from COVID-19, but there's also little real data when it comes to such a new virus. There's clearly a correlation between underlying conditions and the severity of COVID-19 symptoms, too, Snyder said, but that's true of virtually all viruses. Just how much COVID-19 is made worse is still hard to tell, he said.

In the end, Snyder said, fall sports amount to something of a large-scale epidemiological experiment.

"We're embarking on something that's never happened before," he said.

Snyder said the success or failure of fall sports might come down to just how well the bubble around athletes can be maintained, and that, too, offers room for ample pessimism.

There are success stories. Oklahoma, for example, had a handful of positive tests as players returned to campus, but none since. On the other hand, Clemson saw its small number of positive test results spike after players were already inside the bubble.

Brown said UNC continues to work to identify just how its bubble was popped, but even when it comes to contact tracing, players are largely on the honor system.

"In theory, if you enter people into the bubble and nobody in the bubble has an infection, then it should be safe to do pretty much anything," Snyder said. "But in practice, a bubble is an extremely hard thing to maintain."

Paschal said he's been pleased with how his teammates at Kentucky have responded to the guidelines put in place by the training staff, and he believes maintaining the bubble isn't much different from other parts of the college football experience -- that it takes the whole team pulling in the same direction to find success. Players get that, he said.

Herzlich isn't so sure. It's a lot to ask of most college students to effectively isolate from anything outside sports for months at a time, he said, and the risks only ramp up if the general student body returns to campus, too.

"You can conceptualize the effects on you or your roommates or your team, but it's so hard to fathom the trickle-down effect of one guy on a team getting it during the season," Herzlich said.

And that, too, will come down to some difficult decisions. Herzlich wonders if firm rules need to be in place that would call for players to be dropped from the team if they leave their bubble.

For his part, Clawson said he has talked with players about the need to adhere strictly to the rules put in place for safety. All college football players make sacrifices, he told them, but this year is going to require more.

Yet when the Clawsons talked over dinner about the season ahead, the conversation wasn't about sacrifice. They talked about military members who leave their families for months at a time to fight overseas. This hardly compared. They talked about the medical professionals on the front lines of the COVID-19 fight, too. They were making real sacrifices.

But he acknowledged it still will be a challenge without his wife, Catherine, by his side.

"She's the one, probably more than anyone in the world, that keeps me balanced and level during the season," Clawson said.

This, Dave Clawson said, is just what needs to be done for college football to be played in 2020.

"People have texted me and said, 'Oh man, that's a really hard decision,'" Clawson said. "I keep saying it's not a hard decision. It's an unfortunate circumstance. The decision was easy. I had no choice. It just sucks we have to do that."