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On the mound, Chris Sale delivered an impressive performance Friday night in his return from the COVID-19-related injured list, providing the Red Sox with five solid innings in a 7-1 win. Yet in many ways, his outing was overshadowed by two letters that followed it.

“Are you vaccinated?” asked Globe colleague Julian McWilliams.

“No,” replied Sale, who became the 10th of 12 Red Sox players since late August to test positive for COVID-19.

There was no elaboration and Sale – who had also experienced a COVID infection in January – wasn’t asked any follow-up questions regarding that decision. On Saturday, through a team spokesperson, he politely declined to discuss the matter while engaged in his day-after-start routine.

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But the acknowledgment by one of the team’s most recognizable players that he is unvaccinated amplified a topic that has swirled around the Red Sox – particularly during the recent outbreak.

Major League Baseball and its teams cannot unilaterally implement a vaccination requirement for players. Medical policies have to be collectively bargained with the MLB Players Association, which – while supportive of vaccinations – has left those decisions to the individual.

“We don’t have the ability to fully mandate. We’re doing our best,” said Red Sox CEO/president Sam Kennedy. “We’ve tried to preach the importance of vaccination. We’ve been very successful with some individuals, completely and totally unsuccessful with others.”

Entering 2021, MLB established an 85 percent threshold as a vaccination target for teams to achieve among Tier 1 personnel – a 100-person group comprised of big league and Triple-A players, coaches, and support staff, along with a limited number of front office personnel.

Though no team, according to a league source, is “significantly below” 85 percent, the Red Sox are one of six teams short of it.

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The 85 percent standard hasn’t been impermeable. Clusters of positive cases in MLB this season have occurred on teams (Brewers, Yankees, and Nationals) that have surpassed it.

Still, data are clear both nationally and in MLB that while vaccinations don’t eliminate the possibility of infection or transmission, they reduce the likelihood of both as well as the severity of symptoms for those who are infected.

“The higher the vaccination rate of the team, the lower the rate of COVID-19 would be, everything being equal because we know that the vaccine is the best way to increase the resiliency of any organization against COVID-19,” said Dr. Amash Adalja of the Johns Hopkins Center for Health Security. “It doesn’t mean that there’s going to be zero cases, but the higher the vaccination rate is, the harder the virus is going to find it to penetrate the team.”

Members of the organization cite several reasons – including players who have already been infected and therefore considered themselves immunized, political and cultural sentiment, and concern about the speed of the vaccine approval process – for the failure to hit the threshold.

“It’s always been a choice. If a person makes that choice, then we all live with that,” said first base coach Tom Goodwin, whose unvaccinated status has led to two quarantines as a close contact of individuals who tested positive. “It’s not a cult that we’re involved with. This is what we feel is best for our bodies and our families. We’re going to take the consequences that come with that.”

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Across the organization, vaccination has been framed as a personal choice in an effort to avoid conflict.

“I was never going to be a guy who was like, ‘You have to get the vaccine,’” said reliever Matt Barnes, who is vaccinated but experienced a breakthrough infection. “I didn’t want to get into a position where me and a teammate were at odds over vaccination status, because that’s gonna take away from the camaraderie in the clubhouse and what we’re trying to accomplish.”

That said, the loss of players to the COVID injured list has represented an impediment to that collective goal.

Might the outbreak have been more limited with more vaccinations? As Adalja noted, the risk could have been reduced and the outbreak rendered more manageable.

Might Sale have avoided an infection and the COVID I.L. if he’d been vaccinated? Studies from Israel suggest significantly reduced risk of reinfection for those who receive at least one shot after the initial infection.

Certainly, anyone who is vaccinated would avoid being quarantined due to status as a close contact who doesn’t test positive. The team lost reliever Josh Taylor for a week as a close contact.

“We had a player that was taken out of our team and he didn’t have COVID. It was just because he was deemed a close contact and unvaccinated,” said reliever Adam Ottavino. “I got pretty annoyed with that fact – not necessarily individually to the point of having a problem with anybody. I love all my teammates. But I just felt like that’s a certain part of the protocol that like maybe guys didn’t take seriously enough in their decision-making process.”

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As much as the Sox have tried to separate vaccination status from the field, it’s impossible to do so completely. Concerns about losing players to infection or as close contacts have led the team to start sending home unvaccinated players once they finish pregame work (if they aren’t playing) or once they exit contests.

“This is a time to enjoy,” manager Alex Cora said of the team’s contention for a postseason berth. “But at the same time, we have to be very careful.”

Meanwhile, according to a league source, MLB will prohibit unvaccinated staff members – including coaches – from accessing restricted areas (such as the field) or being around players during the postseason, something that could force personnel changes for the postseason.

“[The front office is] going over the situation and we’ll make adjustments,” said Cora.

Such is the nature of a season being played against the backdrop of a pandemic.


Alex Speier can be reached at alex.speier@globe.com. Follow him on Twitter at @alexspeier.