Categories
playoffs Questions

2020 NBA playoffs: 10 key questions ahead of Celtics-Heat Eastern Conference finals showdown – CBS Sports

The Boston Celtics squeaked by the Toronto Raptors in seven games to make it to the Eastern Conference finals, while the Miami Heat needed only five to take out the Milwaukee Bucks. Both teams are stingy and switchable defensively, and both get offense from a variety of sources. The third-seeded Celtics are widely considered the favorites, but the Heat are anything but a typical No. 5 seed. Here are 10 questions to preview the series, which begins on Tuesday:

1. Can the Celtics handle Miami’s zone?

Boston didn’t get past the Raptors on the strength of its offense, which looked particularly out of sorts against zone coverage. The box-and-one made it difficult for Kemba Walker to find his rhythm running pick-and-rolls and for Boston to generate shots that the same ways they usually do. Miami knows this, and it played more zone than any other team in the NBA this season. 

Maybe the second round prepared the Celtics for what’s coming. They were in problem-solving mode the entire time, and their coaching staff will make sure they won’t be surprised if the Heat start Game 1 in a 2-3 zone. It is also possible, though, that zoning up is simply an effective way to combat the best thing Boston does when it has possession of the ball: giving it to Walker and setting screens for him. 

One thing that might make a zone less tenable is having another playmaker and shooter in the lineup, which brings us to…

2. What’s up with Hayward?

Gordon Hayward went through a small group workout after practice on Monday and “looked good when he was going through it,” coach Brad Stevens said, “but there’s a big difference between doing that and actually getting into a game.” He won’t play in the opener, but if he is available after that and can approximate his play in the regular season, he can change the feel of the Celtics’ offense. 

Hayward had a usage rate of only 20.6 percent this season, but that drastically undersells his skills and how important he can be in a series like this. What makes Boston unique is that, at full strength, it can create matchup problems with four perimeter players, making it difficult for defenses to zero in on any of them or hide a weak defender. Hayward is equally comfortable creating plays for others as he is for himself, which cannot be said about Jayson Tatum or Jaylen Brown, so his presence naturally gives the offense more pop. 

3. How will the Celtics match up defensively?

The luxury of starting four multipositional defenders is that Stevens has all sorts of options. I’m most interested in who’s on Goran Dragic and who’s on Bam Adebayo at the beginning of Game 1.

First Team All-Defense guard Marcus Smart is the obvious choice to slow down Dragic, who was one of the league’s best reserves in the regular season and has been a phenomenal starter in the playoffs, an enormous driver of Miami’s success on offense. Tatum is an intriguing alternative, though, and might be able to disrupt Dragic’s rhythm with his length — he and Brown both spent a lot of time guarding Raptors guards Kyle Lowry and Fred VanVleet in the second round (and will presumably both draw Jimmy Butler duty).

Daniel Theis seems like the default matchup for Adebayo, but I’ll bet Boston gets creative at some point in the series. If Stevens experiments with Brown or even Smart on him, you can expect Adebayo to try to bully his way to the rim and get to the free throw line. In that scenario, though, the big man is often the one who gets called for the foul. Which brings us to…

4. Can the Celtics deal with the Bam stuff?

The Heat get an amazing amount of mileage out of Adebayo doing stuff that opposing teams don’t see too often. On offense he is a total weirdo, sort of a hybrid of Draymond Green and Domantas Sabonis, unconventional All-Stars in their own right, but with much more foot speed and explosiveness than either of them. 

Adebayo will push the ball off of defensive rebounds and find the Heat easy buckets off of dribble-handoffs. When he has the ball at the elbow, Miami confuses defenses the same way the Golden State Warriors did, with screens and cuts that often end with Adebayo earning an assist — and if he senses you’re playing him for the pass, he will happily attack the basket himself. Boston knows all about his chemistry with Duncan Robinson, and if it decides to hide Theis elsewhere, it is probably for the purposes of switching when the two of them are involved in an action.

5. Is matchup-hunting the answer against the Heat? 

The Celtics’ offensive approach might be completely different than it was in the second round. “Isolation is not the answer,” Stevens said two weeks ago, but it might be now. While the Heat can be a devastating defensive team, they have a few weak individual defenders in their rotation. The Indiana Pacers were at their best in the first round when they attacked Dragic, Robinson and Tyler Herro one-on-one. Miami can counter this by giving more minutes to Andre Iguodala and Derrick Jones Jr., but that would mean sacrificing spacing on the other end. 

Boston seems uniquely suited to exploit the Heat here, particularly when they are switching ball screens. In these playoffs the Celtics have been much more of a pick-and-roll team and have had little success in isolation, but championship contenders need to be able to play different ways against different opponents. This matchup makes me think of their second-round series two years ago, in which they repeatedly targeted the Philadelphia 76ers‘ J.J. Redick, Dario Saric, Marco Belinelli and Ersan Ilyasova

6. Will the Heat stay this hot from deep?

Miami changed in a fundamental way when it replaced Meyers Leonard with Jae Crowder and got Herro back from injury. Before Crowder’s debut on Feb. 9, Miami was ninth in 3-point frequency and second in accuracy, per Cleaning The Glass. In the seeding games, with Herro healthy, only the Houston Rockets shot 3s more often, but its percentage fell to 35 percent, which is around league average. In the playoffs, the Heat have had the best of both worlds: 41.9 percent of their shots have been 3s and they have made 38.5 percent of them. Both marks rank fourth. 

Miami will be tough to stop if Crowder, a former Celtic, continues shooting 40 percent on 8.3 attempts per game. Boston’s opponents typically take a lot of 3s but make a low percentage of them; in the second round, Toronto shot 30 percent or worse in all four of its losses. 

7. Can Herro keep this up?

Herro has made 40 percent of his 3s in the playoffs, but that doesn’t tell the story. He is making them in crunch time, he is making them off the dribble and, more importantly, he has earned coach Erik Spoesltra’s trust as a playmaker. In a seeding game against the Phoenix Suns, he had 25 points, 10 assists and eight rebounds; in the clincher against the Bucks, he had 14 points, six assists and eight rebounds.

The Celtics, with their army of wing defenders, are Herro’s biggest challenge yet. I could see them trying to take him out by putting Smart on him.

8. Can Boston defend without fouling?

Butler got to the line nine times a game in the regular season, and that number has climbed to 10.7 in the playoffs. Dragic and Adebayo can wreak havoc this way, too, and the Heat led the league in free throw rate in the regular season (and are second in the playoffs). This is something to watch, especially because the Celtics were 24th in free throw rate defensively and are physical both on the perimeter and in the paint.

When Boston is foul-prone, the culprit is often Theis. Grant Williams, who closed out Game 7 against Toronto at center, also tends to pick up fouls on the inside. Which brings us to…

9. What is the Celtics’ frontcourt rotation?   

When Adebayo has been off the court, Miami has either had Kelly Olynyk in his place or gone without a big man. In this respect, Boston is less predictable — if Stevens wants vertical spacing and shot-blocking, he can call on Robert Williams; if he wants switchability and sound rotations, he can go with Grant Williams; if he wants offensive rebounding and post-up scoring, he can try Enes Kanter. I wouldn’t even be shocked to see Semi Ojeleye get some minutes at the 5 against Adebayo. 

Theis typically plays 25-30 minutes per game, but he got 47 in double-overtime in Game 6. If Stevens is looking for some offensive punch, he could go with Robert Williams or Kanter when Theis goes to the bench. They both leave Boston vulnerable against Miami’s pick-and-rolls, though, so I suspect there will be an opportunity here for Grant Williams or Ojeleye, both of whom are officially listed at 6-foot-6, to play “center.” 

10. How will Miami match up defensively?

If the Heat elect not to use a ton of zone, there are several smaller questions here: 

  • If Hayward is starting, where do Dragic and Robinson hide?
  • How will they use Adebayo?
  • How much switching will they do?
  • Who guards Tatum?

Boston might bring Hayward off the bench, at least at first, but if he starts (and is effective) then Miami might have to consider taking Robinson or Dragic out of the starting lineup for Iguodala. It makes sense to put Adebayo on Theis because he can switch Walker’s ball screens and otherwise roam around as a help defender, but if Tatum gets going, Spoelstra could throw Adebayo on him. 

After guarding Giannis Antetokounmpo, Crowder could draw the Tatum assignment. Butler, however, might be more suited for it. These matchups might not matter all that much, though, should Spoelstra decide to switch everything. 

Read More

Categories
COVID Questions

Questions about COVID-19 test accuracy raised across the testing spectrum – NBC News

For Sarah Bowen, it all started with a sore throat. Not the kind of searing pain she’d feel with strep, she said, but a throat irritation that just didn’t feel right.

“By the end of the day, it just got a little worse and I didn’t feel great. I felt like I might be coming down with something. And the next day, things got worse,” Bowen, 31, of Portland, Oregon, said.

Full coverage of the coronavirus outbreak

Bowen works at a doctor’s office, where she was immediately able to get tested for COVID-19, on May 8. It came back negative, and her doctor said the symptoms were most likely allergies or another virus.

But from there, things snowballed. Bowen developed headaches, a stuffy nose, hot flash symptoms and constant headaches. By day six, she felt like she was hit by a truck. She had extreme fatigue and a burning sensation in her chest.

“I started getting shortness of breath if I went upstairs to get water or something,” Bowen said. “It got worse when I moved around.”

Two days later, she took another test for COVID. Again, it came back negative.

But despite her symptoms, her doctor didn’t believe she had the virus, because there weren’t many cases in the Portland suburb where she lives. Frustrated, Bowen continued to isolate alone in the downstairs of her home. She didn’t want to take any chances.

“It’s one thing to get sick and know it’s a cold or the flu. But to get sick during a pandemic and to be kind of dismissed, makes you feel crazy,” she said.

Bowen’s diagnosis remains unclear, but her experience raises questions about the accuracy of diagnostic tests for the disease. Indeed, as more and more people have access to testing, new data show that false negatives on COVID-19 tests may be more common than first realized.

And as the U.S. starts to reopen, accurate testing is one of the most important tools in states’ arsenals to track — and stop — the spread of the coronavirus.

Accuracy issues

Since the pandemic started spreading across the United States in March, nearly 70 tests have received emergency use authorization from the Food and Drug Administration. Many of these tests were developed at a breakneck pace in an effort to get tests out to the American people.

But while no test is perfect, experts told NBC News that these particular tests — used to diagnose COVID-19 — may be missing up to 20 percent of positive cases.

One key reason behind these so-called false negatives may be how the testing samples are collected.

“The false negatives are mainly due to specimen acquisition, not the testing per se,” said Dr. Alan Wells, medical director for the University of Pittsburgh Medical Center clinical laboratories and a professor of pathology at the University of Pittsburgh.

Most tests use a method called polymerase chain reaction or PCR. It detects coronavirus genetic material that’s present when the virus is active. Clinicians typically collect a sample for testing from the back of a person’s throat — where the virus is presumed to be — with a long nasopharyngeal swab.

Download the NBC News app for full coverage of the coronavirus outbreak

Let our news meet your inbox. The news and stories that matters, delivered weekday mornings.

But scientists say that collection method is ripe for error.

“You’re sampling blindly. You’re hoping you get the right spot. Then as the disease progresses, the virus might migrate down into your lungs,” Wells said, adding that once it’s in the lungs, that nasopharyngeal swab may not pick up any virus if it’s already been cleared from the throat.

“You have to be at the right place at the right time,” he said.

Another type of diagnostic test forgoes the uncomfortable swab altogether, and instead uses saliva collected in a test tube. Once the sample arrives in the lab, it’s tested the same way, with PCR.

But Wells said those tests could fare even worse.

“The reason for pharyngeal swabs is the virus preferentially infects and replicates starting way back in the inner cavities of the nose and not out in front,” where it may come into contact with saliva, he said, adding that saliva tests could end up missing up to 50 percent of asymptomatic positive cases.

Making things even more complicated, a May 13 study in Annals of Internal Medicine, from researchers at the Johns Hopkins Bloomberg School of Public Health in Baltimore, found that test timing is also essential to getting an accurate result.

Lead study author Dr. Lauren Kucirka, a medical resident at Johns Hopkins Medicine, said testing too early after exposure to the virus substantially raises the risk of a false negative.

“If you have someone who has been exposed and they’ve started to develop symptoms, it probably makes sense to wait a few days before testing,” Kucirka told NBC News.

Her study found that three days after the onset of symptoms is when the test is most likely valid.

But besides issues with how and when test samples are collected, questions are also being raised about the quality of the diagnostic tests themselves.

The biggest problem with that is you create a false sense of security.

In other words, even if samples are collected perfectly, at the ideal time, the tests could turn up incorrect results. A commentary published in April in Mayo Clinic Proceedings criticized the reliance on PCR tests, saying that even when tests are 90 percent accurate, that still leaves a substantial number of false test results.

The article’s co-author, Dr. Priya Sampathkumar, an infectious disease specialist at the Mayo Clinic, used California as an example in a statement: If the entire population of 40 million people were tested, there would be 2 million false negative results. Even if only 1 percent of the population was tested, there would be 20,000 false negatives.

“The biggest problem with that is you create a false sense of security,” Wells said.

Not just PCR problems

Another type of COVID-19 diagnostic test, Abbott Labs’ popular ID NOW point-of-care test, has also come under fire in recent weeks, after the FDA issued an alert that it may not always be accurate.

The test, which uses a method different from PCR, called isothermal nucleic acid amplification, can deliver results in five to 13 minutes. It’s used by doctors across the country and touted by the White House as what’s used to test President Donald Trump and other staffers.

One small study by NYU Langone Health found that the test returned false negatives for nearly 50 percent of certain samples that a rival test had found to be positive. The study has not yet been peer-reviewed.

In response, Abbott last week released interim data on several of its own studiesfinding that accuracy was significantly better, in some cases nearly 100 percent, especially when performed in patients who were tested early after their onset of symptoms.

But anecdotal reports have also found issues with accuracy, leading some of the nation’s largest medical centers to stop or never even start using it.

NBC News spoke with 10 medical centers and hospitals across the country; seven said they weren’t using the Abbott test.

All seven cited issues with accuracy, including Jackson Memorial Hospital System in Miami, which said in a statement that they “identified some issues with the accuracy, which is to be expected when the medical science is so new and evolving so quickly around this virus. The best fit for Jackson was to transition to other testing platforms that have high-quality accuracy rates and quick turnaround times for results.”

A Vanderbilt University Medical Center spokesman told NBC News that “No patient at Vanderbilt University Medical Center has been tested via the Abbott ID NOW rapid test. Here, there were concerns about the sensitivity of that test.”

Some hospitals continuing to use the Abbott test, such as Sutter Health Hospitals in California, said they often will confirm any negative results with another PCR test if there is clinical suspicion of COVID-19.

Abbott told NBC News in a statement that to date, the company has delivered more than 2 million tests to all 50 states.

“Our customers are telling us that they’re seeing positivity rates from ID NOW testing at or above local community infection rates, which means that ID NOW is detecting the virus at the same level as lab-based testing,” the statement said in part. “If there were any systemic problem with ID NOW producing false negatives, that wouldn’t be the case.”

Catching up to science

The bigger issue may be that test manufacturers just haven’t caught up to science. It’s not just COVID-19 tests that have issues with accuracy. In fact, diagnostic tests for all sorts of common diseases are not even close to perfect.

Take rapid strep throat tests, for instance. According to a Cochrane Review, those tests have a sensitivity of just 86 percent. The Centers for Disease Control and Prevention says rapid flu tests are even worse, with a sensitivity ranging from 50 to 70 percent.

Rapid strep and rapid flu tests look for antigens — proteins made by the infectious pathogen — rather than genetic material. The first antigen test for COVID-19 received an emergency use authorization from the FDA earlier this month, but questions have already been raised about its accuracy.

Taken together, it’s why Dr. Ania Wajnberg, associate director of medicine at the Icahn School of Medicine at Mount Sinai, said that diagnostic tests need to be put together with clinical suspicion.

“We still have a lot to learn, but testing itself is hugely important,” Wajnberg said. “If it’s not perfect, it doesn’t mean it’s not useful.”

Follow NBC HEALTH on Twitter & Facebook.

Read More