If MLB really wants to stop its Covid outbreak, it should quarantine the whole Marlins team

As I noted yesterday in one of my updates to this post, MLB’s response to the Miami Marlins coronavirus outbreak has a built-in dilemma: Each team has a taxi squad of additional players ready to go, but how do you decide whether it’s safe to commingle them with the remaining players who haven’t tested positive but were exposed to those who have, especially when it can take as long as four days to start testing positive after infection? Really, the whole point of test-and-trace protocols is to get not just those who test positive to quarantine, but anyone else who might have been infected — Emory University epidemiologist Zachary Binney has suggested that the Marlins should really all quarantine for two weeks now, and the Philadelphia Phillies, who played against the Marlins this past weekend, should quarantine for five days, which seems reasonable from a public health standpoint, but seems unlikely for a league trying to avoid a patchwork season that ends up looking like the final standings from 1875.

So while we’re at it, how did MLB plan for an outbreak like this, anyway, and what do its protocols say about what to do now? Let’s go to the league’s famed 101-page document with its rules for social distancing while showering and see what it says.

In the section on testing, the document specifies that all players will be tested “multiple times per week,” with additional “immediate expedited diagnostic tests” for anyone who is symptomatic or has been in contact with a confirmed Covid case. Those who test positive “must immediately wear a face covering, isolate from all people (other than medical professionals, as necessary, who shall employ the appropriate infection prevention and control practice for interaction with positive individuals) and pets [ed. note: !!!]” and “restrict all activities outside the home” until given the all-clear.

For those who test negative, though, there doesn’t appear to be any further requirement for quarantine, even though a negative test could just mean that the individual hasn’t yet developed enough virus to show up on a test. In fact, other human beings are considered to be significantly less dangerous than pieces of furniture, which must quarantine from “high-risk individuals” for three days after contact with someone with a positive Covid test:

For at least 72 hours following confirmation of the positive test result, no High-Risk Individual (as defined in Section 2.4) may enter any area within a Club facility in which the Covered Individual who tested positive has recently spent time, without prior written approval from MLB’s medical advisors (with respect to Club personnel) or the Joint Committee (with respect to players).

I am not a doctor or an epidemiologist by any means, but this seems awfully like hygiene theater, where you throw a bunch of protocols at the wall and hope that nobody questions whether they’re actually enough to make a difference in the spread of the disease. And since I am not an epidemiologist, I asked one, Susan Hassig of Tulane University, who agreed that really the whole current Marlins roster should be out of commission for a week or two:

“The team should all be quarantined individually for at least a week, without contact with each other as well as their community. You could then test them all again, and possibly then allow negs back on the field. But two weeks quarantine is standard.”

Back to Binney, this time in The Athletic (paywalled, but it was quoted in Marc Normandin’s newsletter, which is also paywalled, but people gotta eat):

“This disease can take several days to show itself – by which I mean you don’t test positive immediately after you’ve been exposed. You test positive three, five, seven days after you’ve been exposed. So it’s possible that some of these players or staff are incubating the infection right now and could turn up positive when they get the results back from another round of testing, say, in a couple of days.”

And Binney again, on Twitter (again h/t to Marc for the link):

https://twitter.com/zbinney_NFLinj/status/1287822370691055627

Note that Binney is not calling for the entire MLB season to be shut down; he is calling for the current Marlins roster to be quarantined until we know that they’re not all in the process of seroconverting. This is established science for how you stop an outbreak from spreading — whether within baseball or in a larger community — even if it might be inconvenient in terms of scheduling baseball games.

No new news yet this morning on MLB’s plans, as it looks like they’re going to wait for the results of yesterday’s Marlins testing before making any kind of announcement. Meanwhile, Washington Nationals manager Dave Martinez, who had a heart procedure last fall, said he’s “scared” and “my level of concern went from an eight to a 12,” while Marlins manager Don Mattingly noted after Sunday’s game (before the additional positive tests that “They can honestly refuse not to play, right? Everybody could opt out today.” That would be a really weird way for baseball to make public health decisions, but given that the Marlins decided on whether it was safe to play Sunday’s game by texting their shortstop, probably about par for the course.

UPDATE: Oh boy.

Marlins have had four additional players test positive, sources tell The Athletic.

— Ken Rosenthal (@Ken_Rosenthal) July 28, 2020