There are several activities that are easy to do amid the COVID-19 pandemic: Golf, jogging, hiking, and cycling, for instance.
Playing football would not seem to be one of them.
“Obviously, football and physical distancing are not compatible with each other,” said Dr. Allen Sills, the NFL’s chief medical officer.
The pandemic is still raging throughout the country, yet the NFL and its players are consumed by one goal: figuring out how to play the 2020 season with as few interruptions as possible.
“You have to focus on fitting football inside of this world of coronavirus,” said J.C. Tretter, president of the NFL Players Association. "We are looking at it every day.”
Football would seem to be one of the toughest sports to bring back, with constant blocking, tackling, sweating, spitting, high-fives, and hugs. Teams employ hundreds of people just on the football side. Facilities have locker rooms, showers, meeting rooms, training rooms, and weight rooms. Outbreaks of ailments such as the flu and MRSA are common.
“It’s easier to list the challenges in some respects than to come up with the answers,” said Dr. Daniel Kuritzkes, chief of the division of infectious diseases at Brigham and Women’s Hospital.
And COVID-19 is not going anywhere this fall. The NFL knows it cannot completely eliminate the risk of infection. Players who test positive are likely going to have to quarantine and miss at least two weeks.
“We fully well expect that we will have positive cases that arise,” Sills said. “Our challenge is to identify them as quickly as possible and prevent spread to any other participants.”
“We fully well expect that we will have positive cases that arise. Our challenge is to identify them as quickly as possible and prevent spread to any other participants."
Yet some infectious disease experts are cautiously confident that the NFL can play this fall — assuming that the country’s testing capabilities significantly increase, that the virus is held at bay over the next three months, and that each team implements a widespread mitigation plan across all facets of team operations.
“I don’t think the challenges are insurmountable, especially when you’re dealing with professional athletes,” said Dr. Amesh Adalja, an infectious disease expert at Johns Hopkins and a member of the NCAA’s coronavirus task force.
“I think you can find a way to do this with informed consent and doing the best with testing, knowing that the virus is going to likely be present for a period of two years probably before there’s a vaccine.”
NFL teams will have to completely reinvent the way they do business with new social distancing and cleanliness protocols for practices, meetings, training, medicine, meal service, travel, and more.
“My hat’s off to them, because it’s a massive, massive undertaking,” said Chris Peduzzi, an athletic trainer for the Eagles from 1999-2018. “I get a headache just thinking about it.”
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The idea of having 66,000 people packed into Gillette Stadium in the fall seems highly unlikely at this point. But Forbes estimated that game-day revenue from tickets, parking, food, and the like contributes $5.5 billion in revenue for the NFL, and teams will try to find ways to bring fans into the stadium.
The Miami Dolphins have presented a plan to have 15,000 fans at Hard Rock Stadium with proper social distancing. It’s possible that teams could allow just a few hundred family members to attend.
“If everything continues in the right direction and we see really low [infection] rates, and we can stop any outbreaks from spreading because we have good testing and contact tracing, then conceivably we could [have fans],” Kuritzkes said.
But the best way to mitigate the spread of COVID-19 is to eliminate the fans altogether.
“I don’t anticipate that it would be appropriate to have fans in the stadium come fall,” said Michael Mina, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health. “I see very few avenues to responsibly do that.”
“I do think the basic principle is going to be no fans,” he said.
The two best ways to ensure the NFL doesn’t have a COVID outbreak this fall: don’t play, or quarantine everyone in the league for five months and don’t let them out into society until the season is over, not even to see their wives and children. You would have to do this with 65 players and at least 100 coaches, trainers, doctors, front office staff, chefs, locker room staff, and others per team.
“I’m not suggesting that it’s a reasonable thing to do,” said Dr. Shira Doron, an infectious disease physician at Tufts Medical Center.
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The next-best approach, then, is an extensive system of testing and contact tracing involving everyone, not just players and coaches. The NFL also will have to implement strict return-to-play guidelines that could require negative tests and an absence of at least two weeks.
Sills said Tuesday that the NFL will not command an undue share of COVID tests if it means taking them away from hospitals, but that hopefully won’t be an issue come September.
“I think it’s fair to expect that we will see a massive increase in testing,” said Zach Binney, an assistant professor of epidemiology at Emory University. “If we’re not where we need to be with testing by late July or into August, then we’ve got bigger problems than the NFL.”
Players could expect to take two types of tests. Adalja believes they probably will take a baseline antibody test “and those that have antibodies could be more likely to play.”
And they should expect frequent antigen testing, though the appropriate amount is under debate. Mina said he could envision players receiving a stash of 30-40 swabs at the beginning of each month, and having to test themselves every day before entering the team facility.
Others believe that daily testing is unnecessary or too invasive, and that once or twice per week could be sufficient. Dr. Thomas Gill, the Patriots’ team doctor from 1998-2014, envisions players being tested on Wednesday, and again on Saturday night or Sunday morning before playing in a game.
“Daily testing is feasible, but is it necessary?” Doron said. “It just depends on your appetite for risk. Daily vs. every two days vs. twice a week — every increment is going to increase the risk more.”
Since the regular season doesn’t begin until September, the NFL will be able to monitor how the UFC, the German Bundesliga, and perhaps Major League Baseball fare with their returns to play.
“Right now the German soccer league is [testing] twice a week, and I think we’ll learn from their results whether or not that’s effective,” Adalja said.
It’s possible that not everyone will get tested at the same frequency. Older coaches such as 68-year-old Bill Belichick may be tested more often. Same for players and coaches with underlying health conditions.
“Belichick is definitely high-risk,” said Dr. Richard Ellison, an infectious disease specialist at the UMass Memorial Medical Center. “The risk of someone being hospitalized or dying is about 10 folds higher for someone over the age of 60 versus someone who is in their 20s or 30s.”
A 2003 New England Journal of Medicine article studying an outbreak of MRSA across the NFL found that the players most susceptible to infection were interior linemen and linebackers. Quarterbacks, receivers, and defensive backs don’t spend much actual time engaged in combat with opponents.
“If you’ve got a young healthy defensive back who is not really involved in constant contact, maybe they get tested once a week,” Gill said. “But an offensive or defensive lineman who is an asthmatic or diabetic, and they’re smashing up against a lineman on every play, sharing perspiration, maybe those players need to be tested more often.”
Since some infections are sure to slip through the cracks, Doron said it will be imperative for teams to maintain social distancing.
“That’s fewer people that will have to quarantine and go home,” she said.
Everyone will likely have to wear a facial covering inside the facility. Everyone will likely get their temperature taken each morning, and be required to answer a checklist of questions before entering the building.
Peduzzi, the former Eagles trainer, called it “mind-boggling” how much of the team facility will have to be repurposed. Position meetings will be moved to larger rooms and staggered throughout the day. Full team meetings may have to be moved outside, or moved online to Zoom. Most film study may have to be done remotely on tablets and Zoom instead of in meeting rooms.
Food service will have to be changed from buffet-style to prepackaged meals. Training rooms, medical rooms, and weight rooms will have to be wiped down vigilantly, and their use will have to be staggered.
Gatorade bottles and towels will be specially assigned. Spitting and finger-licking will be eliminated. Locker rooms will be shut off to all non-team personnel. Teams may have to order a larger plane, or a second plane, to socially distance on flights.
Coaches may have to wear masks on the sidelines, while players will likely have to wear face shields, though that may be more for show.
“You’re not going to have people wearing surgical masks under their helmets,” Kuritzkes said. “And even if they were, I’m not sure how effective they would be in preventing transmission when you have a big pileup during a play.”
Sidelines will have to be expanded to allow proper distancing. And perhaps the most basic aspect of football — the huddle — may have to be scrapped.
“They won’t have crowd noise, so I suppose the huddling is less of an issue,” said David Chao, the Chargers’ team doctor from 1997-2013. “They might huddle up 20 yards behind the line of scrimmage and space arms-length apart.”
The most crucial aspect of the NFL’s plan will be to prevent the virus from overwhelming any one position group on a team.
“If you get three offensive linemen that are out with COVID, you’re getting to the point where you can’t play,” Peduzzi said.
So those playing the same position will have their lockers staggered instead of next to each other. Players may come to the facility in shifts instead of all at once. Full team drills at practice may be kept to a minimum.
“Tom Brady and his backup probably shouldn’t be spending a lot of time together in the same room,” Binney said.
The NFL will likely have to give teams roster exemptions for players who contract COVID, and allow teams to freely move players up and down from the practice squad. Teams may even need to expand practice squads.
“There’s absolutely no question that if they want to do the season safely they ought to have a two-week, in-season injured reserve — a COVID clause or whatever,” Gill said.
Starting the season on time is one thing. Finishing it on time is another.
“I’m more optimistic about NFL football in September than I am the season finishing,” Chao said.
No one knows how the next few weeks of social loosening will affect the infection rate. And epidemiologists are bracing for a second wave of infection late in the year as the weather gets colder.
“I think they may want to think about a shortened season,” said Dr. Davidson Hamer, professor of global health and medicine at the Boston University Schools of Public Health and Medicine. “What we normally see as the end of the season, the playoffs and the Super Bowl, that could be peak time potentially.”
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Gill said the NFL needs to determine before the season how it will handle one or more teams getting hit hard by the coronavirus, and whether the league will allow forfeits.
“Before the season starts, you say, ‘If we hit X number of cases or problems, then we’re going to suspend the season or go into a quarantine period until it comes back down,’ ” Gill said. “You don’t want those decisions made in real time.”
Even if the NFL is managing cases well, it may have to shut down if society isn’t doing as well.
“They just need to be mentally prepared for the fact that even if they’re doing OK, they may get shut down because it’s not consistent with the phase that we’re in,” Doron said.
But squeezing in an entire season may just be feasible, if the NFL is vigilant with its testing and quarantining, and gets a little lucky with the virus’s spread.
“I do think it’s feasible,” Adalja said. “Testing is getting better.
“There is a strong interest in getting this all right, so I think you will probably see some sports come back to life at modified form, but without fans and with social distancing as best as can be done.”
Ben Volin can be reached at email@example.com.