Missouri athletics never expected to be completely immune from the coronavirus.

Facing the inevitability that at least some within its population of student-athletes, coaches and staff could be infected with the disease upon their return this month or contract the virus while on campus, the athletic department developed a protocol detailing steps to be followed in the event of positive cases.

Over the past three weeks, that plan has been put into action as five individuals within the department have been announced as having COVID-19 out of more than 300 tested.

The protocol, which the Tribune obtained Friday afternoon, includes actions to be taken immediately upon diagnosis and also framework for the recovery required for infected athletes to be integrated into team activities.

Football, men’s basketball and women’s basketball players returned to campus for voluntary workouts June 8, the first day allowed by the Southeastern Conference. The athletic department’s phased return of activities continued with the remaining fall and winter sports over the past two weeks.

Nine sports are now back on campus, with spring teams expected back July 6.

All athletes are being tested for COVID-19 before participating in workouts for the first time, a pivot from the school’s original plan to test only those who exhibit symptoms of the virus, which has killed more than 125,000 Americans and infected more than 20,000 Missourians as of Saturday. And it’s not just older Missourians at risk — a Missouri Hospital Association analysis found one week ago that people ages 20 to 44 made up more than half of all new reported cases in the state.

The tests cost MU about $150 each, athletic director Jim Sterk said in early June.

Athletes must self-isolate for five days and be symptom-free before returning to the sports park, deputy athletic director Nick Joos wrote Friday in an email.

The tests typically have been conducted about three or four days before voluntary workouts begin for each respective team. Athletes continue to self-isolate while waiting for test results, according to Joos.

Missouri initially said that testing numbers for its student-athletes would not be made public but would be disclosed to the Columbia-Boone County Department of Public Health and Human Services. However, the athletic department announced on social media Thursday that of 308 individuals (student-athletes, coaches and staff) tested so far, five have tested positive for the virus, of which four cases were asymptomatic.

Of the total number of people tested, 211 were student-athletes, including four of the positives, the university confirmed. It is not clear which sports the infected athletes are involved in.

Athletes on campus are undergoing daily temperature checks as an aspect of a seven-part pledge the athletic department is asking them to sign upon their return.

The agreement also requires athletes to self-monitor for symptoms, practice good hygiene, keep social distance, wear a mask or face covering if proper distancing is not possible, scrupulously sanitize and disinfect at home and in athletic facilities, and inform the university of any issues that may affect the wellness of teammates.

"(Our coaches) are telling them: They’re part of a team. They’re part of (something) bigger than themselves. They need to take responsibility," Sterk said of Missouri athletes earlier this month. "Will people break from that? Yeah. But I think they’re really focused on being better. Our strength and conditioning coaches said they came back in pretty good shape. More than not, in great shape. There’s a lot of focus on what they can do as a team, and I think that will keep them from probably exposing themselves and their team members to more."

In the situation of a confirmed positive test, the athletic department protocol outlines five steps to be followed:

The infected student-athlete or staff member is to continue self-isolation, practice good hygiene and social distance from roommates as well as disinfect their entire living space.
The infected individual is to participate in contact tracing with local health officials. University staff may assist in the tracing. Health officials will maintain a list of contacts, as may the MU sports medicine staff.
Individuals identified through contact tracing as possibly at risk are to follow the guidance of local health officials. The protocol states this "guidance may include self-quarantine for 14 days of no symptoms, practicing good hygiene, and proper distancing."
Athletic department staff are to identify specific areas where the infected individual engaged in activity. Those areas are to be cleaned, sanitized and disinfected. If necessary, the entire athletic facility may be shut down for the rest of the day to sanitize, with workouts resuming afterward. Tony Wirkus, associate athletic director for event and facility operations, is to be notified for cleaning and disinfecting.
Local health officials and the team physician are to determine if testing is needed for roommates or other individuals who may have had close contact with the positive individual.

MU athletics’ dining service is to set up a food delivery schedule for "door drop-off during quarantine for any affected student-athletes," the plan states.

In addition to notifying the local health department in the event of a positive test, university officials are also to alert a group of people including the athlete’s head coach and parents/guardians.

An infected athlete must meet several conditions under the guidance of the team physician and local health officials before being cleared to resume activities. The MU protocol makes clear that the thresholds for return are subject to change based on the opinion of the physician and health officials.

To be cleared, the protocol states, infected individuals who are symptomatic upon testing positive must be "temperature-free without fever-reducing medication for three consecutive days" and have "respiratory symptoms improved." The protocol originally called for at least seven days to have passed "since symptoms first appeared" before infected athletes are allowed to return, but MU has extended that to a minimum of 10 days to align with new recommendations from the U.S. Centers for Disease Control and Prevention, according to Joos.

For infected athletes who are asymptomatic upon testing, a minimum of 10 days of self-isolation is required, and the individual must be deemed symptom-free to return, Joos confirmed.

If the infected athlete meets these criteria, the team physician will determine whether a retest is appropriate, according to the protocol.

"The most current CDC guidance does not include retesting," it states.

When the athlete is determined by medical personnel to have recovered and he or she returns to the sports park, they will continue to be monitored for symptoms and be held to all team COVID-19 rules, remaining under a watchful eye "until all symptoms are resolved or a total of 14 days from symptom onset (whichever is longer)."

The MU protocol also makes clear the steps for an asymptomatic athlete to return to activities after being exposed to an individual who tests positive.

This category is split into two: low or medium exposure and high exposure.

Low or medium exposure is described as being "in the same performance workout group" as an infected individual. High exposure includes being "in the same house, apartment, or prolonged contact of 15 minutes or more within 6 feet" of someone who tests positive.

Any athlete with exposure to COVID-19 will be subject to possible testing based on the opinion of the team physician as well as local health officials and will return to activities only when cleared by medical personnel. An individual with high exposure to the virus is to self-quarantine if local health officials advise.

"We do have a plan in place, staff or student, if there were to be a positive, we have an action plan for them," Missouri head football coach Eliah Drinkwitz said during a Zoom call earlier this month, waving a stack of papers with the athletic department’s positive test protocol on top. "We have an action plan if there’s somebody that has symptoms. We have followed county and CDC guidelines.

"We’re practicing safe social distancing while we’re in the weight room, locker room, training room, facility. We’re working out in groups of 20, no closer than 6 feet apart. We are taking temperature checks every day. We are taking symptom checks every day. We’re actively monitoring those things."

Pressed for specifics on what the university would do if — and now, when — an athlete tests positive, Drinkwitz hit the main points of the plan and voiced his optimism that with the way his program is carefully repopulating its facility, there should be low risk of exposure and minimal contact tracing involved.

"We’re gonna do contact tracing. We’re gonna do isolation. We’re gonna quarantine. We’re gonna contact their families," he said. "We’re gonna make sure they’re safe. We’ve got a protocol in place to check on ‘em every single day, to make sure they are fed, to make sure they are isolated but not alone."