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LINCOLN — In the earliest days of Nebraska Athletics’ response to the coronavirus pandemic, Dr. Scott Koepsell was the guy in the parking garage swabbing the noses of student-athletes. University administrative personnel got those initial on-campus coronavirus tests, too, back in the spring, as NU began to implement robust health and safety protocols that prepared the Huskers for a return to competition.
Nebraska is still waiting for a green light from Big Ten presidents and chancellors to play football this fall. Meanwhile, the University of Nebraska Medical Center’s main testing lab — of which Koepsell is the medical director — processes 600 tests per day from all over the state.
Now, Nebraska’s leadership and Koepsell have developed what they believe is a rational, safe testing regimen for whenever the season returns.
“Dr. Koepsell has been an absolute rock star for us,” said Nebraska football chief of staff Gerrod Lambrecht, who has coordinated and spearheaded NU’s health and safety protocols for athletes. “I don’t know how we would have made it through the last few months without this guy.”
Koepsell is about to be even more important to Nebraska’s testing efforts. Koepsell will be the interim director of a coronavirus testing lab NU plans to set up in East Stadium at the Nebraska Athletic Performance Lab. There, the Huskers will conduct rapid-response, point-of-care antigen testing currently used in professional sports and soon to be implemented in the Pac-12, which last week announced a long-term agreement with Quidel.
Through a contract with Vivature, which has partnered with Quidel, Nebraska has already received 1,200 test kits. NU will get Quidel’s Sofia-2 Analyzer machine by the end of this week and expects to incorporate the antigen testing into existing testing protocols by the end of next week.
The antigen test, which can utilize a less-invasive swab in the front of the nose, could be administered to players, coaches and staff the night before a game — in the hotel, for example — and tested for immediate results at the NAPL.
Having the materials in East Stadium, Lambrecht said, is “a huge advantage” for Nebraska.
Nebraska’s planning to accommodate its opponents, too.
“We’re building our protocol so that it can support two teams on game day,” Lambrecht said.
It’s not clear what the Big Ten’s testing supply plan might be, as it has not announced, like the Pac-12, any conference-wide approach. On Sept. 1, President Donald Trump had a phone call with Big Ten Commissioner Kevin Warren, reportedly about providing testing supplies. The federal government has ordered 150 million tests from Abbott, which is currently fulfilling that massive stockpile order before taking other orders.
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Koepsell said Big Ten schools, if their local health departments allow for it, should be able to satisfy testing requirements with two tests during the course of a game week.
The first test, administered in the middle of the week, is a more sensitive PCR test that detects the presence of COVID-19 viral RNA. The second antigen test is administered the night before a game.
Any student-athletes who test positive off the antigen test, Koepsell said, can then get a confirmation PCR test, the results of which can be processed quickly if needed. The combination of a PCR and antigen test, Koepsell said, represents a rational approach utilizing multiple tests.
“If you’re doing strictly antigen testing, you may want to do three per week,” Koepsell said. “If you’re doing antigen testing and PCR, one of each per week. But then there’s the discomfort of these tests. You feel it for a while. Having three nasal swabs a week would be very uncomfortable and lead to bloody noses.”
Three leagues — the ACC, Big 12 and Conference USA — are requiring three tests per week. Lambrecht said, to the best of his knowledge, those schools were using two antigen tests and one PCR test per week. Health departments in various locations, Lambrecht said, have differing levels of comfort with contact tracing, so schools have to find “suitable” testing approaches that fit the area. Pac-12 schools, for example, will begin to conduct daily antigen tests as part of the league’s deal with Quidel.
Koepsell said Big Ten schools can navigate testing protocols needed to play sports this fall.
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“Given the level of expertise and the universities in the Big Ten, there’s plenty of experience out there to tackle this problem,” Koepsell said. “The key there is flexibility and looking at the data as things evolve, but I certainly think that there can be enough recommendations and monitoring that football can be played safely. Absolutely.”
While Koepsell doesn’t have first-hand knowledge of work done by the Big Ten’s Sports Medicine and Emerging Infectious Diseases committees, it’s important, he said, that two medical groups advising Big Ten presidents and chancellors also consult laboratory professionals when developing testing strategies.
Other than a 10-day period over the summer when tests were spiking in the American South, Lambrecht said he hasn’t heard of any supply shortages. Mid-July through mid-August, according to the COVID-19 Tracking Project, the United States was routinely processing more than 800,000 lab tests per day. In the past three weeks, there have only been two such days.
“We’ve had, through the entire process, had multiple options for PCR tests, but far and away, UNMC and Dr. Koepsell have provided the best option with the quickest turnaround time,” Lambrecht said.
Koepsell originally got involved with COVID-19 testing in February when UNMC was asked to develop a test for passengers of the Diamond Princess cruise ship who were quarantined in Nebraska. From there, UNMC started doing broader testing on NU’s campus through the spring and summer. Koepsell has worked closely with Husker athletics — in particular Lambrecht and coach Scott Frost — in developing testing strategies.
“I’ve been so impressed with the leadership and coaching staff,” Koepsell said. “They put the players’ safety No. 1. We know so much more now than we did five or six months ago, and I’ll tell you: Every recommendation, every testing precaution, every monitoring thing we could do was done.”