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How Will the NFL’s COVID-19 Testing and Contact Tracing Work?

The NFL is the last North American pro sports league to confront the coronavirus, and it has the greatest challenge

Getty Images/Ringer illustration

NFL players reported to training camps on Tuesday as the largest pro sports league in the country becomes the last to confront the coronavirus. The NFL has already canceled the preseason and altered training camp due to the COVID-19 pandemic, but the regular season is still slated to begin with the defending Super Bowl champion Kansas City Chiefs and the Houston Texans kicking off on Thursday, September 10.

Whereas NBA and NHL teams will finish their 2019-20 seasons in contained bubbles in Orlando and Canada, respectively, the NFL is eschewing that model. The league’s 32 teams are scheduled to play games in their respective home cities across 22 states for the coming season, with more than 5,000 players, coaches, and essential staff members living in their own homes. The NFL’s goal is to mitigate the virus’s spread by testing players and essential staffers daily. Players who test positive and have symptoms must wait for 10 days after their positive test, have 72 hours without any symptoms, test negative, and be approved by a team doctor in consultation with league medical officials to return, according to reporting by NBC’s Peter King. Players who test positive and are asymptomatic must wait at least five days and test negative twice before being allowed to return, or wait 10 days.

Isolating players who test positive is an easy decision, but determining everyone who was exposed to an infected person is a challenge in a sport like football. There is no playbook for contact tracing in a contact sport. “The point of testing really is to be able to do contact tracing,” says Jill Weatherhead, an assistant professor of tropical medicine and infectious diseases at Baylor College of Medicine. “If you know you’re positive, then we can look around and see who have you been in contact with that could possibly have picked up this virus from you and those people would then be quarantined.”

The Centers for Disease Control and Prevention recommends that anyone who has spent more than 15 minutes within 6 feet of somebody who has COVID-19 should quarantine for 14 days. On the field, football players are continually within 6 feet of each other, especially at the line of scrimmage. Even if distancing 6 feet during football games and practices were possible, it might not be enough. Studies on superspreading events such as fitness classes in South Korea and choir practice in Washington state suggest that heavy breathing may spread droplets as far as 12 feet, or 4 yards, according to Gretchen Snoeyenbos Newman, an assistant professor of infectious disease at Wayne State University in Detroit. “For football players on the field while they’re playing, the linemen are really your most at-risk people [to become infected].” Snoeyenbos Newman says. “Athletes are professional droplet producers.”

According to a CDC analysis of cases from February to May, COVID-19’s mortality rate was higher in people over 65. This has led some to conclude that professional athletes in peak physical fitness would be minimally affected by contracting the virus. Snoeyenbos Newman says that isn’t the case. There is increasing evidence that COVID-19 can damage the lungs, heart, and even the brain. (Red Sox pitcher Eduardo Rodríguez confirmed this week he is dealing with myocarditis, a heart complication, as a result of COVID-19.) Snoeyenbos Newman says that while the average person who contracts and recovers from COVID-19 may not notice if they lose 2 percent of their lung capacity, elite athletes will absolutely notice, and long-lasting lung or heart problems could be career-ending. “Getting really, really sick but not dying can also have very negative life-long consequences,” Snoeyenbos Newman says. “You don’t have to die in order for it to be really bad.”

Since football players can’t social distance while they play, the NFL is experimenting with face shields on helmets to mitigate droplet spreading. But the face mask shields aren’t mandatory yet, and some players, including Texans defensive end J.J. Watt, have said they won’t wear something that restricts their breathing. But even if players do wear the face mask shields, Snoeyenbos Newman doubts the prototypes will work without filters. “The holes make it kind of useless,” she says. “It’s better than nothing, but it’s not good. … If it’s just a piece of plastic with giant holes in it, it’s not doing a ton.”

Ravens starting tight end Mark Andrews, one of the two known NFL players with type-1 diabetes, already wears a Dexcom monitor during games to manage his diabetes. He told The Ringer he is open to wearing masks during games when not playing. “I don’t think people really understand how much [wearing a mask] really can prevent the spread,” Andrews says. “I have no problems wearing it, on the practice field, on the sidelines. I don’t know if I’ll be wearing it when I’m playing, but if I’m on the sideline and my helmet’s off, I don’t see why I wouldn’t wear it. I’m going to wear it as much as possible.”

Per an agreement earlier this month, the NFL’s 32 teams were required to submit team-specific protocols. As of Tuesday, the NFL Players Association had approved 25. Teams have overhauled their facilities to accommodate daily testing, staggered player schedules for weight training, and changed facilities for eating, showering, and accessing the locker room. All team players (a maximum of 80 in training camp) and essential employees (roughly 100) will wear a device while at the facility that will track them through the building and, in the event of a positive test, identify who was in close contact so they can be isolated. The league has also created a COVID-19 reserve list, a sort of injured reserve for players who test positive or are being quarantined for exposure. (Teams won’t reveal whether a player on the list tested positive or was exposed to someone who did.)

Players who contract the virus at “high risk” indoor venues that are hosting more than 15 people—bars, nightclubs, house parties, or concerts—could be fined. Players who attend an indoor religious service at more than 25 percent capacity may also be fined. Regardless of how much teams mitigate the virus’s spread at their facilities and threaten punishments for players outside them, players and employees are still living in local communities where the league has no control over community spread.

J.C. Tretter, the Cleveland Browns center and NFL Players Association president, told The Boston Globe last week that the NFL’s current guidelines clash with the basics of football. “If a center tests positive on a Friday and there’s a quarantine period for all of his close contacts, aren’t we talking about 35 players in close contact with me?” Tretter asked the Globe. Zach Binney, a football writer and an epidemiologist at Oxford College of Emory University, said the league would be wise to change practices drastically to limit contact between football players, even if coaches disagree. “I would pitch it to a coach just from a pure self-interest perspective,” Binney says. “‘If you do have a couple cases on your team, Coach, don’t you want that to stay two than to lose like 12 guys? Because you’re not going to win a game if you lose 12 guys off your roster.’”

Given the volume of players and essential personnel for each franchise, the daily testing for all 32 teams would require about 5,760 combined tests each day they test during training camp, or 80,000 tests leaguewide in the first two weeks of August alone. The league has made a deal with BioReference Laboratories, the same lab company used by the NBA and MLS, and the NFL expects to pay about $75 million for its tests this year, according to Sports Business Daily, though that number accounts only for what the central league office is paying. Pro Football Talk reported that another 60 additional tests per day at $125 each could be charged to each team, not the league office, bringing the total figure the NFL may spend this season if they test every day closer to $100 million.

Testing won’t help the NFL unless the results come back quickly. The league expects to have test results back within 24 hours during training camp, according to Meanwhile Americans around the country are forced to wait far longer for test results, with wait times at around seven to nine days in New York City, seven to 14 days in Southwest Florida, and as long as 22 days in Arizona. “A few hundred [tests] doesn’t sound like it makes too much of a difference,” says Joseph Petrosino, who runs a lab that processes COVID-19 tests in Houston. “But it could be important for one of those 300 people that got bumped and potentially could have severe complications if they’re not diagnosed early enough.”

Petrosino, who is the Molecular Virology and Microbiology Department Chairman at Baylor College of Medicine, believes altruism has to come into play at a time when testing resources are strained in America.

“There’s a moral responsibility to prioritize the needs of the community above the needs of the entertainment industry,” Petrosino says. “Even if it’s just one person who dies because of the fact they couldn’t get access to testing, is it worth it?”

The backlog for test results is primarily about limited capacity. Petrosino uses the analogy of a pizzeria that makes 150 pizzas a day suddenly being asked for 1,500 pizzas a day. The wait time is inevitable. But Petrosino also says that a major part of the delay is about supply chain issues, which has become an issue around the country. If Petrosino’s lab runs out of pipettes or reagents, it has to find new supplies and then prove those supplies are up to government standards before resuming operations. Supply chain issues are difficult to predict, and that only makes the backlog worse. “It’s not that the [test] itself is all of a sudden taking a longer time to run,” Petrosino says. “It’s just that they have piles, and piles, and piles of [tests] to run.”

From a big-picture perspective, Weatherhead is concerned about how the NFL’s plan to play games outside of a bubble could impact the spread of COVID-19 in local communities. Major League Baseball is grappling with this issue after 15 Miami Marlins players and two coaches tested positive for the virus. Weatherhead and Snoeyenbos Newman both say that if MLB cannot sustain its season, the NFL has little chance, and traveling around the country only makes the situation in those cities worse. “Are you going to have a team from New York come down to Houston to play the Texans right now when [Houston] has a surge of cases going on?” Weatherhead asks. “Or have Arizona go up to Detroit where Detroit also got hit really hard early on and has done a great job of controlling the virus? These are the things that people need to be thinking about. What is the impact on the community?”

For now, the NFL’s schedule remains on track. Players reported to training camp this week, but must test negative three times across four days before attending in-person activities. Those who test negative three times will also begin practicing, starting a period of daily testing for players and essential staff for at least the next two weeks. More than two dozen NFL players have already opted out before the August 4 deadline, six of whom are New England Patriots. Players who aren’t at risk get a $150,000 advance from their 2021 salary, while players opting out who are at risk get a $350,000 stipend.

Andrews, the Ravens tight end, has never missed a practice for a diabetes-related reason and has no plans on opting out in 2020. He led the Ravens in receptions, receiving yards, and receiving touchdowns last year and will be a crucial part of Baltimore’s quest for a Super Bowl, but he also doesn’t want to be the guy who screws the whole thing up.

“I don’t want to be the person that spreads it or gets it,” Andrews says. “And I think if everyone has that mindset, then we’re going to be able to have a season. I think that if everyone has that mindset across the country, then we’re going to be well off.”