College football is back. For many, it's a welcome return of a fall tradition, but for some, the scenes of tens of thousands of fans packed into stadiums — all against the backdrop of a pandemic that is still raging across the country — fuels more anxiety than exhilaration.
With the delta variant of the coronavirus still causing increases in new cases, hospitalizations and deaths in parts of the United States, experts say these big events and the enormous crowds they attract may be coming at a bad time, even if they occur outdoors, where the risk of infection is typically minimized.
It's part of what some researchers are calling a frustrating "gray area" more than a year and a half into the pandemic. There is no simple answer to just how much risk there is to a mass gathering like an outdoor college football game. A variety of factors play into the risk level: local infection rates, whether a stadium requires vaccination or a proof of a negative test and even what people do before and after the game.
At one such game, University of Wisconsin's home opener against Penn State, no vaccination proof or negative test was required. Masks were required indoors but only "strongly encouraged" in outdoor spaces. More than 76,000 people attended. The Madison, Wisconsin, metro area, home to more than 660,000 people has seen a steady increase in cases since mid-July and a positive test rate of 3.4 percent, according to Public Health Madison and Dane County.
The challenge of determining the risk of these events is compounded by ongoing challenges in tracking cases. While experts still maintain that indoor transmission is far more common, being outside does not eliminate the risk.
"Being outdoors offers protection in the sense that there's more air circulating," said Dr. Bruce Y. Lee, a professor of health policy and management at the City University of New York. "But if you're in close quarters with a lot of people for a couple of hours, it's not as if the wind can just magically sweep away all of the virus."
That concern is even more pressing given the delta variant's supercharged transmissibility. In an interview on MSNBC, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, expressed alarm at the crowd sizes at recent college football games.
"People would like to say we’re done with Covid, but Covid is not done with us," Fauci told MSNBC's Joy Reid.
While research is still underway, studies have shown that people infected with the delta variant have more virus present in their system compared with previous strains, and individuals infected with delta may shed more viral particles when they cough, sneeze or talk.
Both of these factors likely contribute to why the delta variant is thought to be more than twice as transmissible as the original strain of the coronavirus, said Jamie Lloyd-Smith, a professor of ecology and evolutionary biology at UCLA.
"With this variant, it probably takes fewer viruses getting into your airways to get infected, especially if you're unvaccinated," Lloyd-Smith said. "And if you're at a game and a superspreader is two seats away, that person might be releasing more virus compared to what was spreading a year ago."
Still, the risk of mass gatherings at this stage of the pandemic is tricky to evaluate, he said. Much of it depends on location and the specific situation on the ground, including how prevalent the virus is in communities, how much of the population is vaccinated and other mitigation measures or rules that are in place.
Some schools, including Louisiana State University and the University of Oregon, are requiring fans 12 and older to provide proof of vaccination or a recent negative test to attend games. Elsewhere, there are fewer restrictions.
Penn State is planning for full-capacity crowds at football games this fall, and the school's athletic director said there are no plans to require fans to show proof of vaccination or a negative test. The University of Alabama and Auburn University have similarly not imposed any screening requirements for fans, though state health officials have partnered with the colleges to offer vaccination clinics on site.
While being outdoors is generally less risky than cramped indoor settings, people at games and other big events tend to move between the two. Oftentimes there are also other activities associated with the main event where people congregate and provide opportunities for the virus to spread.
"The risk isn't just the football game or the music festival, but what people do in the lead up, during and after," said Dr. Cameron Wolfe, an associate professor of medicine at Duke University.
This is partly what makes it difficult to track whether large events — such as concerts, sporting events and festivals — lead to subsequent spikes in cases.
Lollapalooza, a four-day music festival held in Chicago at the end of July, was linked to 203 cases of Covid-19, but the city's department of health said a certain number of infections were anticipated among the roughly 385,000 attendees and added that the uptick was "no sign" of a superspreader event. Lollapalooza required attendees to show proof of vaccination or a negative Covid test.
In August, more than 100 infections across five states were traced back to the Sturgis Motorcycle Rally in South Dakota, where hundreds of thousands of people descended for the annual event in a state that has imposed few restrictions throughout the pandemic. The same event last year was thought to have contributed, in part, to a wave of infections across the Upper Midwest.
Still, figuring out just how many cases stemmed from any one event is an imprecise science without exhaustive contact tracing and genetic sequencing.
"It's hard to link clusters of cases that you might not see until three to six days later back to an initiating event," Wolfe said. "It's not that transmission doesn't occur; it's just hard to prove without a lot of manpower and lab work."
While Wolfe expressed concerns about large gatherings at this stage of the pandemic, he said it's possible for college sports, music festivals and other big events to be held safely and responsibly.
One way could be to require proof of vaccination or a negative Covid test, he said. Limits on seating capacity could also be imposed, along with other mitigation measures such as requiring masks and spreading people out more in stadiums.
"All of these things just carve away at the risk," Lloyd-Smith said. "It knocks it down by degrees and just lowers the temperature on the whole thing."
When done right, these events could provide a model for public health measures in the broader community, Wolfe said.
"It could be a good microcosm for how elements of society can try to get back up and running," he said. "You can run a college campus carefully and be safe. You can open businesses and have them be safe. We have to find a way for people to be responsible about how they manage their risk, because that's all going to be part of our ongoing challenge of learning to live with Covid."