(CNN)Even before a single second was played Wednesday on opening day of the 2020-21 college basketball season, the coronavirus pandemic was putting obstacles on the long road to March Madness.
College basketball season tips off during coronavirus surge, with March Madness the ultimate goal
More than 40 men's and women's games were postponed or canceled before their scheduled tip off on Thanksgiving Day eve. The nation on Tuesday reported the highest one-day coronavirus death toll since early May and the US Centers for Disease Control and Prevention advised people not to travel for the holiday.
"Let's put it this way: Overall, the way this country is, it's probably not in the best interest of everybody to have this in an ongoing epidemic," Dr. Carlos del Rio, an infectious disease specialist who sits on the NCAA Covid-19 medical advisory group, said of the unusual start to the season.
Covid-19 already has disrupted multiple teams at schools large and small across the country.
On Wednesday, the Monmouth University men's program said it was pausing team activities after a positive Covid-19 test and entering a 14-day quarantine with cancellations to its games against Hofstra, Maryland and St. Francis-Brooklyn.
Oklahoma University's men's program also paused team activities after positive tests and contract tracing. Two games were canceled.
The Tennessee Volunteers announced a pause on Monday after a number of positive coronavirus test results, including head coach Rick Barnes. The men's program has already canceled its first three games.
Second-ranked Baylor also canceled its first three games after head coach Scott Drew tested positive on Sunday.
Stanford canceled its season opener at home on Wednesday following a positive test.
The UConn women's program also halted team activities for 14 days after a positive Covid-19 test, pushing back its first four games.
Still, the games went on Wednesday, as the NCAA hopes to make it all the way through March Madness and crown a men's and women's champion this season, unlike last season.
The majority of games in 2020-21 will be played without fans but some schools are allowing spectators.
The NCAA has set in place a regimen of testing, masking and social distancing protocols, including a suggested 14-day pause after a player, coach or staff member contracts the virus. Teams will travel during the regular season. On campus, however, they can create bubble-like environments with other students away for an extended winter break.
Earlier this month, the NCAA said it planned to play the entire men's March Madness tournament in Indianapolis.
Originally, the NCAA planned to host the single-elimination tournament in 13 different cities for early-round games but the challenges to maintain safe environments were too great.
"We have learned so much from monitoring other successful sporting events in the last several months, and it became clear it's not feasible to manage this complex championship in so many different states with the challenges presented by the pandemic," NCAA Senior Vice President of Basketball Dan Gavitt said in a statement at the time.
The NCAA was forced to cancel the 2020 edition of March Madness over concerns about the spread of Covid-19, which has continued to surge rapidly throughout the country. Previously, the men's Division I championship had been played every year since its inception in 1939.
In September, the NCAA Division I Council approved a November 25 start for men's and women's basketball teams to begin playing regular season games.
Both the NBA and the WNBA played their regular and post-season games in Florida this year in respective Orlando and Bradenton bubbles and were largely successful -- with no major outbreaks. But as sports such as college football -- and now basketball -- began, dozens of games had to be postponed or canceled because of outbreaks.
Iona College men's basketball coach Rick Pitino even suggested having a May Madness.
"I'll say it again, to anyone who will listen, push the season back to March, and then have May Madness. Give the Vaccine a chance. In the best interest of all involved!" he tweeted on Monday.
In the end, the NCAA pushed back the men's and women's college basketball season start from November 10 to Wednesday.
"Testing is going to be important," said del Rio, the associate dean of Emory University School of Medicine. "You're going to have cases. You're gonna have infections, but you need to be sure you try to prevent outbreaks. Outbreaks, in my mind, is what really worries you ... You have to monitor the situation and hopefully we'll be safe, but it's going to be hard. There's so much virus going around right now that it's going to be really hard."
The size and budgets of athletic programs matter, he said.
"It all depends on the leagues and, quite frankly, it all depends on the schools," del Rio said. "For some schools doing the testing is affordable. And for some schools doing testing, it's totally out of their budget."
Dr. Arthur Caplan, founder of the division of medical ethics at NYU School of Medicine and a member of the NCAA's Covid-19 medical advisory group, voiced concerns about allowing spectators at college games.
"I just don't think you can have fans in indoor settings," he said. "That's just my personal view. That's very tough to do. Even with social spacing, the indoor environment, when you have people lining up to go in, with a lot of these venues having poor ventilation, they may be classic but they may have air systems that are classic, too."
Del Rio said the decision on moving ahead with the season will ultimately fall on individual schools.
"At the end of the day it's really going to have to be up to the schools ... the school boards, the school directors and officers who are going to have to be responsible and say, 'This is what we can do and this is what we cannot do,'" he said.
"If they cannot do something safely for their students and their coaches I think they're going to have to decide to stay out of the season. That's going to be an individual school decision."