Super Bowl 55 was memorable not only because of Tom Brady’s historic 7th Super Bowl win but also because the NFL was even able to hold a football championship in the middle of a raging pandemic. How do 22 athletes play football without one reported incident of COVID-19 transmission occurring on the football field? While friends and family members were amazed by Brady’s 7th Super Bowl ring, I was asking myself how football players, coaches, and trainers, all in close contact with one another, avoided catching a highly transmissible and deadly virus. There was no NFL Disney Bubble or NFL hub city. So how did the NFL manage to hold a football season without spreading the coronavirus throughout its ranks?
On January 29, 2021, the CDC published a scientific paper jointly authored by epidemiologists and medical experts from the National Football League and the NFL Players Association. The paper shared the benefits of the league’s strategy for mitigating the COVID-19 virus and has applications beyond the NFL. The CDC reports the data gathered by the NFL can be applied to non-sports settings, including schools, long-term care facilities, and other essential workplaces. But can it?
The cost of the NFL’s mitigation plan was a whopping 100 million dollars. This costly, performance-enhanced strategy is well beyond the practical reach of a public school district, long-term care facility, or other essential workplaces. But, costs aside, there is much to learn from the NFL’s COVID-19 blocking scheme.
Herculean Mitigation Measures, Testing and Contact Tracing
The CDC’s joint publication reported the NFL began the 2020 season in July with “extensive mitigation and surveillance measures in facilities, during travel and gameplay.” These mitigation measures included mandatory masking, physical distancing, frequent handwashing, facility disinfection, restricted access to facilities, and regular and frequent testing of players and staff. Additionally, the staff was trained to conduct contact tracing using interviews with players and staff as well as data obtained from wearable proximity devices. These innovative trackers collected data on both the consecutive and cumulative minutes of interactions among persons within six feet of each other. Wearing the trackers was required of all players and staff when inside club facilities. These trackers also warned personnel whenever they got too close to another person. Over the season, the league evaluated and tweaked its mitigation measures based on the data collected from testing, tracking, and interviewing.
The NFL medical team observed midseason the virus was transmitted between players and staff after less than 15 minutes of cumulative interaction with an infected person. This was a notable finding because the CDC defines “close contact” as any individual within 6 feet of an infected person for a total of 15 minutes or more. Even more interesting was the revelation that playing football itself did not spread the virus. Despite the inherent close physical contact during football practice or game, there were no reported on-field transmissions of the virus. What the CDC and NFL learned was that not all close contacts are equal.
The data collected through testing, tracking and interviewing prompted the NFL to create a “high-risk contact” classification that evaluated not only the duration and proximity of a person’s contact with an infected person, but also the context of the interaction. For example, a short car ride with partial mask use was classified as a high-risk contact but a prolonged interaction in a well-ventilated setting with proper mask use was considered a low-risk contact. High-risk contacts were required to quarantine after an exposure to an infected person.
The NFL also developed an intensive protocol that imposed stricter infection prevention precautions when a positive case was identified. These stricter protocols included: daily testing of players and personnel; prohibiting in-person meetings (if a meeting was necessary, it was held outdoors with strict enforcement of social distancing measures and use of masks); prohibiting the use of gaiter type and vented/valved face masks; eliminating group meals; and discouraging the use of locker rooms. These stricter protocols effectively prevented “high-risk” interactions within the NFL clubs. By implementing quarantine measures, along with testing and more intensive infection control protocols, the NFL was able to effectively reduce the spread of the virus. Of the 623,000 COVID-19 tests performed on 11,400 players and staff, only 329 (approximately 2.9%) COVID cases were identified.
Can the Measures put in Place by the NFL Translate into Other Settings?
Broader implications of the lessons learned from the NFL’s 2020 season include the importance of contact tracing. The high-risk contact definition enabled the NFL to promptly identify and quarantine those individuals in the early days of their infection, preventing the spread of the virus within the club. Assessing the context of each interaction, which included whether masks were worn, indoor versus outdoor setting, and ventilation, as well as the proximity and duration of the contact, improved the identification of high-risk contacts during contact tracing. Post-exposure quarantine based on redefined high-risk criteria, combined with testing and environment-specific intensive protocols, protected NFL clubs before and after case identification. Despite the promise of these findings, there are challenges for implementing the league’s protocols in other settings.
For example, the NFL used proximity devices and “prompt, detailed contact tracing” to identify high-risk contacts. Although digital contact tracing technology has been available since spring 2020, many people are resistant to sharing their location data with public health officials. Last spring, Apple and Google created an application programming interface (API) designed to allow iPhones and Android smartphones to interface with one another for contract tracing purposes. However, the decision to support the exposure notification technology is made by each state’s public health authority. Many states, including Texas, do not support this technology.
The NFL also implemented strict mask requirements within club facilities and prohibited the use of gaiters and valved/vented face masks. Let’s face it, as a country we dropped the ball when it came to face masks. The Free the Face movement really happened. But face masks are not an optional accessory within the NFL. Hefty fines were assessed against coaches and teams for not adhering to the mask requirements. The NFL’s mitigation plan also included mandatory testing for all players and staff, another mitigation measure that is impractical for school districts and other businesses to implement.
There is no comparing the NFL’s resources to those of a school or ordinary business. The hundred-million-dollar price tag for the NFL’s mitigation plan is simply not practical outside the world of professional football. Setting aside the costs of the league’s mitigation plan, the biggest lesson learned from the NFL was that this lethal virus can be contained.
Dr. Allen Sills, the NFL’s Chief Medical Officer, said the most impactful mitigation measures were not resource-intensive. Turns out, the most powerful COVID interventions were the good old-fashioned public health measures Dr. Fauci and others have been recommending for almost a year-universal mask use, no indoor meetings, closure of dining rooms, and strict quarantine measures when a high-risk contact is identified. Vince Lombardi once said, “The achievements of an organization are the results of the combined effort of each individual. People who work together will win, whether it be against complex football defenses or the problems of modern society.” The NFL’s 2020-2021 season taught us we all win when everyone works together to follow basic public health measures.
Lisa Paul, Associate Attorney, J. Cruz & Associates, LLC