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N.C.A.A. Crisis Shows How Biden’s Surgeon General Pick Navigated the Pandemic

Vivek Murthy was a central figure in the decision to cancel the N.C.A.A. basketball tournaments in March. He’s poised to have a major role in the Biden administration’s response to the coronavirus pandemic.

The coronavirus had started to grip the United States, and the National Collegiate Athletic Association’s board convened an emergency conference call to consider the fate of the organization’s lifeblood: the annual basketball championships that generate hundreds of millions of dollars of the organization’s revenue.

There was no way to know how many cases were still undetected, Dr. Vivek H. Murthy, a former United States surgeon general, told the board minutes into the March 12 call. Murthy, a member of both the board and an N.C.A.A. medical advisory panel, warned that moving ahead with the coast-to-coast competitions could fuel a deadly crisis.

Within an hour, the board voted to cancel the men’s and women’s basketball tournaments — spectacles that typically drive millions of Americans to fill out brackets, enter office pools and watch televised games for hours.

“He was instrumental in convincing the board that the time to act was now,” said Kenneth I. Chenault, a former chairman of American Express who sits on the N.C.A.A. board.

Nine months later, the urgent deliberations inside the N.C.A.A. offer a view into how Murthy approached the pandemic’s initial threat in the United States, and how he might help shape the federal government’s response under President-elect Joseph R. Biden Jr., who said this week he had chosen Murthy for another stint as surgeon general.

A newcomer to the insular world of college athletics, Murthy proved a cautious, deliberate expert who was wary of making drastic decisions prematurely, interviews with more than a dozen people who participated in the N.C.A.A.’s meetings suggest. But they said that as the tournaments approached and more data and scientific research emerged from around the world, Murthy was a forceful and effective champion of measures that had been unthinkable to most of society only days or weeks earlier.

Now, his mandate is poised to be far larger. And in many respects, the surgeon general’s role is expected to be radically different than what it was when he left office in 2017. He is likely to become one of the most visible members of the new administration, opening his approach and his ideas to greater scrutiny from the public and from Capitol Hill, where his nomination during the Obama administration became mired in the politics of gun control before the Senate confirmed him in December 2014.

Through a spokesman for Biden’s transition team, Murthy declined to comment this week.

But in an interview on March 7, Murthy showed an early approach to the virus that sought to balance his growing worries with some bedrock principles of public health.

“It’s a judgment call at the end of the day because there is no tried and true protocol here for how to handle this kind of outbreak with Covid-19,” he said then. “We’re in a relatively new situation. We can draw on our experience with other outbreaks like SARS and MERS and H1N1 and Zika, but we know that each of these outbreaks is unique.”

He did not, he said, “want to make decisions based on panic.”

N.C.A.A. headquarters in Indianapolis on March 12, the day board members canceled the national basketball tournaments for 2020.
Michael Conroy/Associated Press

The virus was still seen as a problem mainly outside the United States on Jan. 22, when the N.C.A.A. board met at a Marriott near Los Angeles. Murthy was a recent addition, an independent member recruited for his medical expertise and appointed after college basketball’s corruption scandal.

The virus did not come up.

But by early March, officials at the N.C.A.A.’s headquarters in Indianapolis were deeply alarmed. The scarcely understood virus was gaining more footholds across the United States, and the bonanza of basketball tournaments, which can draw hundreds of thousands of spectators, was coming. Association leaders turned to a favored strategy: an advisory group.

The panel, mostly made up of doctors, began meeting twice a week to weigh options for the N.C.A.A. tournaments, with Murthy so unassuming that one member did not immediately recognize him as a former surgeon general. Trained as an internist, Murthy was not steeped in the intricacies of infectious diseases and, despite his résumé, did not try to dominate the calls.

Instead, committee members said, he would usually ask probing questions.

Dr. Brian Hainline, the panel’s chairman and the N.C.A.A.’s chief medical officer, said Murthy was often armed with the latest studies from overseas and eager to examine how trends abroad could help doctors in the United States grapple with what was ahead.

“My clear recollection is that it was always a thoughtful presentation and thoughtful analyses and asking what are the implications in our country, given that we’re two or three weeks behind what is going on in Europe,” Hainline said.

Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University, remembered Murthy having a particular interest in the effects of the pandemic and public health decisions on the mental health of students, coaches and others tied to college sports.

Most crucially, panel members said, Murthy was particularly skillful at synthesizing their complex debates to craft and communicate policy proposals that were scalable for an enterprise the size of college sports.

“He sort of listened first and then usually came out with a statement, usually very wise, that kind of incorporated everything that everyone was saying, with the added measure of someone who has been at the federal level,” said Dr. Colleen S. Kraft, an associate professor at the Emory University School of Medicine who was on the panel.

Schaffner sometimes wondered whether a day would come when the board would regard the committee’s ideas as too extreme. After all, panel members said, Murthy, a badminton player with a deepening sense of the role of college sports in society, was already clearly judging the virus to be a systemic, long-term crisis.

Charlie Riedel/Associated Press

On March 11, the N.C.A.A. Board of Governors agreed with the advisory committee and made a choice that would have seemed preposterous weeks before: The N.C.A.A. would forbid spectators at tournament games.

The very next day, after the N.B.A. had suspended its season, the advisory panel convened again. The outlook was even grimmer, with more and more evidence pointing toward a far-reaching medical calamity with no precedent in modern times. To the doctors advising the N.C.A.A., the basketball tournaments had to go.

“I recall March 11 as being deliberative, and I recall March 12 as being a fait accompli, like there was no choice,” Hainline said.

The doctors, though, were charged only with offering medical advice and could not cancel competitions. Murthy would have to make the case to a board tasked with considering myriad issues before reaching a decision.

“He has an ability to see through to the timing of decisions,” said Denis McDonough, who was then on the N.C.A.A. board and had previously been the White House chief of staff when Murthy was surgeon general. “The right decision at the wrong time is the wrong decision, and Vivek understands that. It’s not that he gets to a point and he’s got conviction and he goes to work on that conviction; it’s that he understands the time and space constraints that he’s operating in.”

Members dialed into the emergency call with the start of the national tournaments only days away. Teams were already on the road for smaller feeder tournaments, most of which had been completed or upended.

Some powerful university leaders leaned toward abandoning the national tournaments, even though they were vital to the balance sheets of the N.C.A.A. and to the schools themselves. But there were almost certainly some skeptics within the board’s ranks, members said, with many of them knowing well that coaches, players and boosters would, at the very least, be privately furious.

Murthy spoke early in the meeting. His voice was even but urgent as he delivered what his scattered audience — one board member listened from a car bound for Nashville, another from an arena in New Jersey — found to be an unmistakably dire message.

Detailing the possible trajectory of the virus, he made obvious that the tournaments could lead to deadly consequences.

“He based his opinions on sound public health science and principles and data, and that was very clear,” said Michael V. Drake, an ophthalmologist who then led Ohio State University and is now the president of the University of California. “He was the subject matter expert, but he was very respectful of his colleagues on the board, many of whom came from different perspectives and different points of view.”

Indeed, Murthy subtly beseeched members to consider not just the terrifying mathematics of disease modeling, but also the N.C.A.A.’s social responsibility. Just as notable to many members, he was also plainly aware of the financial and cultural costs of canceling the N.C.A.A.’s signature event.

“He conveyed it in such a way that he understood how painful it would be for people and for student-athletes, and he was very upfront about that,” said the Rev. James J. Maher, the president of Niagara University in New York.

“I won’t say it softened the blow,” Father Maher continued, “but you felt like somebody really understood the situation.”

Coupled with Hainline’s assessment, board members said their decision was inevitable after Murthy’s remarks, which Mary Sue Coleman, a former president of the University of Michigan and the University of Iowa, described as “a complete wake-up call.”

“I don’t think you could have left those presentations and been in doubt,” said John J. DeGioia, Georgetown University’s president, who added, “He’s just got a remarkable equanimity. There’s kind of a self-possession that reassures you. You do feel more comfortable, more confident.”

Still, the board talked a while longer. N.C.A.A. executives said that it would be hard to stage championships not only for basketball but for other winter and spring sports, too. Murthy’s presentation kept replaying in board members’ heads.

“It was all a hard realization that this was really going to happen,” Coleman said. She added: “Having him there as an adviser, as an expert helped people understand why it wasn’t going to be possible” to hold the tournaments.

The board’s vote was unanimous.

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