University of Iowa athletic trainers: The front-line workers who made sports possible

IOWA CITY — Brad Floy loves Excel sheets, even geeks out over them.

That came in handy this past year when logging thousands of COVID-19 tests of athletes across Iowa’s athletics department.

Floy is the head men's basketball trainer and although athletic training can be a round-the-clock job in normal times, Floy didn't have a single day off from the moment athletics returned in August until weeks after Iowa men’s basketball concluded its season.

And he got one day.

“I was exhausted when we came back from Indianapolis, it was like a hangover and I didn’t even drink,” Floy said. “I just felt hungover for days, I was just not functional and burnt out.”

That was the feeling across the sports medicine staff at Iowa because behind the weekly COVID-19 test numbers, there was a trainer administering each one, another recording it and another tracing paths of infection.

That’s what they were doing on top of finding innovative ways to treat behind masks or screens, making calls to psychologists, delivering supplies to quarantined athletes, instructing athletes on how to go home and come back safely or planning the procedures to play the occasional non-conference opponent.

“The athletic trainers are really the front-line people,” Iowa team physician and director of primary care sports medicine Dr. Andy Peterson said. “They’re embedded with a team and with them every day.”

Navigating the logistics

Terry Noonan, the assistant athletic director of sports medicine and performance at Iowa, said Iowa was fortunate to have a major medical center nearby for resources many other schools didn’t have.

At the same time, athletic trainers went through training for COVID-19 testing and contact tracing and that took a load off of an already busy hospital.

“They were busy with the community and knew we would have to sometimes test,” Noonan said. “We were testing more people at one time than sometimes they were.”

But the coordination between the medical staff from the hospital and the athletic trainers was instrumental in enabling Iowa’s teams to play safely and mitigate risks that came with the virus.

“To have the medical community help us as much as they did up and down the line was just amazing,” Noonan said. “Epidemiologists from the hospital come over and walk through our facilities to say, ‘OK this is where you need to prop the door open,’ and then coordinating cardiac testing.”

Every athlete who tested positive went through a heart echo/EKG and a cardiac MRI, which was not always accessible at other Big Ten campuses.

Different athletic trainers traded off the morning rapid antigen testing, which started at 6:15 a.m. for athletes at Carver-Hawkeye Arena. That meant they had to be there at 5:30 a.m. to set up. If anything came up questionable, athletes went to another building for a PCR test, which was the more accurate of the two.

For Floy, the morning testing ran into the middle of his day, when he’d do his rehab appointments. The late afternoons and early evenings were Zoom planning calls with administrators, operations staff and athletic trainers from around the Big Ten.

He spent a lot of time arranging schedules for testing, especially for playing on the road or out of conference.

“If we’re going on a road trip, or we’ve got a game that day, we need to plan our schedule and testing in a way to minimize risk as best we can for getting and spreading COVID,” Floy said.

In addition, the local infectious disease officer had to put together a report on the Iowa City-area’s positivity rate and how it compared to the university, which was then uploaded to a website that every Big Ten team could see, according to Noonan. Luckily, the community’s positivity rate wasn’t bad enough to call off a game.

Non-conference games added an extra layer of difficulty. When Iowa hosted Iowa State early in the season, Floy said the Big Ten required daily rapid testing, while the Big 12 only required three rapid antigen tests per athlete a week.

“They didn’t have access to the antigen testing every day, so we said let’s just PCR test every day for seven days up until the day of the game,” Floy said. “Both teams went through a daily PCR test, which is one of the least fun things to do since it’s a deep nasal swab. We thought it was important for both teams and for the state to play this game.”

Because the hospital was nearby, sometimes Iowa could get back its PCR tests within hours, rather than having to wait two days. But because of the sheer volume of tests being administered every day, trainers often were waiting by their computers until all hours of the night.

If tests didn’t come back until after 9 p.m., and a positive came through, they’d contact trace through the night before getting up to administer tests again at 5:30 a.m.

That meant sorting through daily questionnaires to find out who had interacted with whom over the past 48 hours.

“I used to tell people, ‘Well, you know, it's better in the morning at Starbucks because there's no line,” Noonan said.

Peterson also saw logistical duties stack up from the hospital’s side.

Before the pandemic, he estimates that he spent 10 to 20 percent of his time working in athletics, with the majority of his time spent working in clinics as an orthopedic. During the past year, he saw his role in athletics take closer to 70 percent of his time, just by answering texts, phone calls and participating in Zoom meetings. He’s had to cut back the clinic hours.

As the team doctor, and given the ever-changing policies of the Big Ten Conference, he was the top point of contact for any questions. In addition, he oversaw contact tracing protocols and placing athletes in hotel rooms.

“I counted one week and it was close to 1,000 pieces of communication in a single week,” Peterson said in February. “Even during clinic, it's not uncommon for me to have to deal with a phone call or two in between every patient.”

And while the Big Ten took a lot of heat for not having a “Policies and Procedures” manual for the pandemic, Peterson said the year was in constant flux.

“You don’t want to put something down on paper that’s going to be immediately changed,” Peterson said. “Logistically, that’s been challenging. In addition, the rules for the NCAA are slightly different from Johnson County, which are slightly different from university policy, so we make sure that we’re navigating each of those appropriately.”

Keeping up the morale

Floy wasn’t afraid of exposure while fulfilling his duties, but he shut down his life outside of that since his wife, Erin Floy, was going through her final rounds of chemotherapy and radiation for stage 2 breast cancer.

“I basically put everything in my life to the side to do my job,” Brad said. “I had to work, I didn't have an option of not working. We had a plan so if I had a known exposure, I was just going to move into the hotel or move her to her parents’ house.”

Erin, who was diagnosed in 2019, said she had just finished her worst round of chemotherapy a month before the shutdown, so although still immunocompromised, she was closer to normalcy than patients who may have just started their therapy. Erin also works in health care as a physical therapist, so her employer told her to stay home for seven weeks.

“I probably felt safer because of what they (Iowa) were doing with their testing,” Erin said. “He was getting a COVID test every single day. And some days he got tested twice a day.”

Only one athletic trainer at Iowa tested positive throughout the entire year, which was impressive, but also testament to the power of masks.

Jennie Sertterh, the head women’s basketball and golf athletic trainer, said the trainers were like the mask police during practices before Iowa adopted the rapid testing. It was their job to ensure athletes and coaches wore masks over their noses and often were advising them to not partake in activities outside of sports.

“I felt like I was nagging them all the time,” Sertterh said. “Obviously nothing that I can do if someone's positive, but the risk of spreading it and taking a team down, that's a lot of stress. We technically didn't have anything to do with it, but I kind of felt like it was on our shoulders.”

As front-line workers, athletic trainers also take on the responsibility of monitoring athletes’ mental health. They referred athletes to the sports psychologists when an athlete expressed interest in counseling. Sertterh was proactive, she had the sports psychologist give any athlete who tested positive a call.

“This can be scary, especially this time last year, when there were a lot of unknowns,” Sertterh said. “I'm like, ‘Obviously, I want you on the court, but my priorities are health over that. We know there's respiratory issues, but we don't know what's going to happen 10-12 years down the road with this. So, I'm going to stay on top of you to try to keep you healthy.’”

At home, Sertterh said while she attended some of her kids’ activities off campus, she always sat by herself away from other parents.

And while Noonan said the year brought the training staff closer in some ways, Sertterh said relationships with newer athletes were harder to grow. The time normally spent talking with them, like walking them to their physicals or moments in between rehab appointments were completely eliminated.

“With having to wear masks and everything you know that, seeing their facial expressions like that can tell you a lot when you're rehabbing and something is bothering them,” Sertterh said.

When athletes needed to rehab an injury during quarantine, Sertterh and Floy delivered supplies to their hotels and set up Zoom sessions to take them through their exercises. But this, Noonan said, can revolutionize the level of care athletic trainers are able to provide down the line.

The stress and hours of the job have worn on athletic trainers across the country to the degree that some, even within the Big Ten, have left collegiate athletics, according to Noonan.

But Iowa’s can breathe a sigh of relief, with only track and field left in season. Despite the year they’ve had, they’re proud of their work now more than ever.

“You’re sticking a Q-tip up somebody’s nose that they think you’re trying to reach their brain, but they still thank you for doing it and appreciate the work that we did,” Noonan said.

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