How the NFL tackled Covid-19

Masks, distancing, testing, and proximity sensors: The NFL’s Covid-19 playbook, explained.

Beneath the shoulder pads of every player on the field in Tampa, Florida, during Super Bowl LV on Sunday will be small, white, rectangular gadgets. These devices are proximity sensors, measuring how close players come into contact with others and for how long.

Developed by Kinexon, the units on the field are just several of the more than 11,000 such devices attached to belts and wristbands or dangling from lanyards of players and staffers at the National Football League over the past season. They’ve been providing league officials with terabytes of data, and are part of why the Kansas City Chiefs and the Tampa Bay Buccaneers are facing off at all.

Since the start of the Covid-19 pandemic, every professional sports league has had to come up with a way to cope with the widespread transmission of this deadly disease. They’ve used different approaches — like the NBA, which resumed its 2020 season in a bubble, with the final stretch of games and playoffs held at Disney World in Florida.

Surprisingly, many of the leagues found that the risk of transmission from player to player on the field, court, or ice is fairly low, which is why few players wear masks during games.

The NFL’s approach, nonetheless, one for the highlight reel.

Near the end of the regular season, the league managed to contain the virus to fewer than 10 positive cases per week out of thousands of personnel. They accomplished this through a combination of mass testing, rigorous contact tracing, isolation of suspected cases, high-levels of mask-wearing, and social distancing.

“They had a comprehensive approach,” said Davidson Hamer, a professor of global health and medicine at the Boston University School of Public Health who was not involved with the league. “It seems like they did all of these things successfully.”

So successfully that the Centers for Disease Control and Prevention (CDC) published a case study last week looking at how the NFL managed to pull this off, examining the season between August and November 2020. During this period, the NFL found 329 confirmed cases of Covid-19, a positivity rate under 0.1 percent. The Covid-19 test positivity rate for the US as a whole is still around 7 percent.

The proximity trackers were certainly useful to league officials, and the NFL also brought its immense financial resources to bear on the problem, but what sets the NFL apart is that they were able to get buy-in from their players, staffers, trainers, cooks, and coaches, all with the aim of hitting the gridiron every Sunday.

That commitment to a central goal may prove to be the biggest challenge to replicate for anyone else trying to use the NFL’s playbook.

The NFL’s Covid-19 strategy, explained

At the start of the season, the NFL was still scrambling to figure out what actually worked to contain Covid-19. Rules were somewhat arbitrary and not always followed, and teams like the Baltimore Ravens and the Tennessee Titans suffered large Covid-19 outbreaks. As the season progressed, teams started taking the pandemic more seriously, and the NFL shifted to a more aggressive set of rules to control the disease as officials gathered more information about just how the virus was being spread.

NFL

Here are some of the power players in the NFL’s lineup of tactics across its 32 teams.

Testing: The NFL conducted more than 1 million tests for Covid-19, testing players daily and using a combination of rapid point-of-care tests as well as laboratory tests that delivered results in 24 hours.

This disease surveillance allowed the league to find infections early and begin isolation protocols before the infected individual could spread the virus to more people.

Tracing: The data from the Kinexon devices helped league officials trace the footsteps of infected people and find out who else had a high likelihood of being infected based on how close contacts were and for how long. Researchers found that there were several cases of transmission between people with less than 15 minutes of exposure.

Conversely, the league found no cases of transmission on the field during games, even though players weren’t wearing face masks. That’s likely due to their movement and ventilation available on the field. “We didn’t see the virus cross the line of scrimmage,” said Allen Sills, the chief medical officer of the NFL, during the press conference on Thursday.

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The league found that after they implemented their intensive protocol, they found no high-risk contacts for 71 percent of cases that were traced, showing that the procedures made it far less likely infections would spread.

Such granular, location-based data collection was invasive, and analyzing it was labor-intensive, but it allowed the NFL to better target its approach.

Isolation: Infected individuals were told to isolate for five days and were tested during and after their isolation periods.

Mask-wearing: The NFL found very quickly that wearing masks was an important way to limit the spread of the virus. “In 100% of cases, poor mask compliance was part of the transmission,” said Christina Mack, the lead author of the CDC report and vice president for epidemiology and clinical evidence at IQVIA, a health data analysis firm, during the press conference.

However, getting just about everyone to wear masks at all times was a tall order, but players adjusted within weeks to wearing them at almost all times, even in the gym and during workouts. Players also had a little bit of peer pressure. “I think nobody wanted to be ‘that guy,’” said Anthony Casolaro, the team physician for the Washington Football Team, during the press conference.

Coupled with the data collection, the NFL was able to deduce when masks were most effective. While there was no on-field transmission, exposure risks grew the longer people were in contact. That’s why the NFL’s guidance allows players to be maskless during the game but makes them mask up as they shake hands afterward.

Reducing exposure: The league also took steps to limit opportunities for the virus to spread. Meetings were virtual. Players and staff were told not to carpool and were spread out across buses. Meals were provided in grab-and-go bags and no longer eaten together. Indoor spaces had sharp capacity limits.

Accountability: There was not only a comprehensive, centralized plan, but people were named responsible to execute it. “It was very clear how to get things done, when to get things done, and who was going to do them,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, during the press conference. “I’ve never seen anything that organized, that quickly able to take action.”

The NFL also took steps to punish individuals and organizations that failed to uphold the rules. Both the Ravens and the Titans received fines for breaching the league’s Covid-19 regulations.

The lessons we can and can’t take away from the NFL

Sills said that while the NFL invested a lot in daily testing and extensive tracing, such elements weren’t enough on their own to control Covid-19. “Those were not the things that prevented transmission because we had all those things in place and had transmission in some cases,” he said.

The things that did win the day for the league were tactics that anyone can use, like wearing masks and avoiding prolonged close contact. “These are lessons and strategies that can be applied in organizations, no matter what their resources are,” Sills said.

Tara Kirk Sell, a professor at the Johns Hopkins School of Public Health who was not involved with the NFL, said that the league’s experience does demonstrate that there are alternatives to endless isolation and boredom during the pandemic. “I think it shows us that really thoughtful approaches to Covid-19 can really allow us to do some things,” she said.

But even basic public health measures require time, effort, and money. People also have to be willing to follow the rules when no one is looking. “We can’t all have our own Covid babysitters,” Sell said. Without the shared mission and resources of an organization like the NFL, it’s much harder to build up a system to contain Covid-19.

NFL officials did not lay out how much money and personnel it took to contain the outbreak among its players and staff.

At the same time, there are hints at what might have happened if the NFL had not been so rigorous. The past college football season, which saw more than 100 canceled games and more than 6,000 infected players, might be an example. Though there are far more college football teams than NFL teams, the pandemic was far more disruptive to college athletes, despite many schools’ best efforts to contain the spread. “They didn’t really have a unified approach,” Sell said.

Meanwhile, the US as a whole has been struggling with all of the most basic measures to control Covid-19, with spotty and delayed testing, resistance to mask-wearing, and often inadequate social distancing. Not to mention the lack of granular data that could come from gadgets like proximity sensors or even tracking smartphones. So cities, states, companies, and schools are likely going to continue stumbling under the burden of new cases of the disease. But as millions of Americans tune in to watch the big game on Sunday, they’ll get a glimpse of what’s possible if they were to team up, follow the same plays, and launch a drive toward the end zone of the pandemic.