NFL Scores With Some Infection Prevention Efforts

The coronavirus disease 2019 (COVID-19) pandemic has meant that infection prevention efforts were infused just about everywhere. From airports to movies and even restaurants. For many of us working in infection prevention and/or public health, many of these lessons were things we wish would’ve been implemented before. Personally, when I think of the investment into contact tracing, hand hygiene, cleaning and disinfection, and even ventilation, it’s something we should’ve seen earlier as all of these strategies increase health outcomes.

More recently, large organizations have shared their approval of COVID-19 prevention and response, which is pulling back the curtain on how they have used multi-disciplinary experts and infection prevention strategies. The National Football League (NFL) and the NFL Players Association (FLPA) has been one such organization that struggled to return to operations during the pandemic. When they did start to re-institute games and practices, this had to include strict protocols.

First, I think it’s important to share that these organizations are exceedingly well-funded and professional sports is not an essential business. I bring this up for 2 reasons—the first being that they did not have to reopen, but did so for several reasons and one in particular is the number of people supported by such a large industry. The second is that the decision to utilize these control measures is unique and not necessarily one that hospitals can employ. Simply put, a well-funded industry can invest in multiple avenues and especially when they are likely to be considered more short-term.

Saskia v. Popescu, PHD, MPH, MA, CIC

That said, a recent report (that can be found on the website of the Centers for Disease Control and Prevention) on their efforts sheds some light into what worked well in this arena—meaning, what infection prevention efforts were utilized and were successful. First, they used proximity tracking devices and detailed interviews for contact tracing. High-risk exposures were reviewed for quarantine and they also included data on mid-season transmission, which occurred in people interacting for less than 15 minutes but in settings without masks and indoors, which led to them changing their “close contact” definition. Adaptability of contact tracing is a helpful approach but also one that is not always easy to implement in a health care setting. The authors noted that “The intensive protocol effectively prevented the occurrence of high-risk interactions, with no high-risk contacts identified for 71% of traced cases at clubs under the intensive protocol. The incorporation of the nature and location of the interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to proximity and duration, likely improved identification of exposed persons at higher risk for SARS-CoV-2 infection. Quarantine of these persons, along with testing and intensive protocols, can reduce spread of infection.”

The NFL also took additional measures, such as strict masking, closure of eating areas, and surveillance testing. All of these are important facets of infection prevention. Of the 189 players and staff quarantined after an exposure and 20 total infections, they had no additional spread occur when implementing stronger protocols and expanding the definition of close contact. These are especially poignant lessons as we learn more about risk and the increased transmissibility of the new SARS-CoV-2 variants. Realistically, contact tracing, as we’ve learned is not perfect, but continued review and revisions can only serve to help refine the process. That said, contact tracing is reactive—the goal is to avoid these close contact exposures in which people are interacting without masks and indoors. Practice makes permanence after all.