<
>

How the NFL navigated COVID-19 this season: 959,860 tests, $100 million and zero cancellations

play
How the NFL moved through the season amid a global pandemic (0:51)

Kevin Seifert details his conversations with the NFL's chief medical officer regarding the league's response to the COVID-19 pandemic. (0:51)

Editor's note: This story originally ran on Jan. 29 but has been updated and re-posted following Super Bowl LV, the final game of the 2020 season.

Chiefs quarterback Patrick Mahomes had his barber tested for COVID-19 to ensure a safe trim. Then he turned to a game of Uno for late-night entertainment.

Former Lions QB Matthew Stafford spent a week isolated in a hotel, traveled by private plane to Minneapolis and started a game without taking a single practice snap.

Michael Dunn, a Browns offensive lineman, prepared for a playoff start by working through drills in the parking lot of an apartment building. His girlfriend assisted by calling out faux signals.

On it went. The Broncos converted a practice-squad receiver on a day's notice to serve as a starting quarterback. Jets quarterback Sam Darnold put his extended family through NFL protocols so he could visit with them for Christmas. Coaching staffs around the league game-planned virtually for months, even when they were sitting in offices next door to each other at team facilities. And two head coaches even watched a game from home while interim coaches manned the sideline.

NFL players and staff upended their lives to make it through the 2020 season, which came to an end on Feb. 7 with Super Bowl LV. They reprogrammed their long-held football habits, suspended their sense of competitive equity and embraced a well-funded and turbocharged version of the COVID-19 mitigation efforts that the entire country has been advised to follow.

The results were better than anyone could have imagined. When veterans reported to training camp on July 28, positive coronavirus cases in the United States had already reached 4.3 million in the four-plus months since the epidemic changed the country's way of life, and more than 140,000 people had died from the virus. (Nationwide cases have now surpassed 27 million.) Many questioned the viability of completing a full season, and those concerns only grew when an outbreak hit the Titans in Week 4. But in the end, the NFL postponed just five of its 256 regular-season games to allow outbreaks to run their course, and moved 10 others to accommodate them, but not a single game was canceled. How'd the league do it?

Backed by an investment that sources said exceeded $100 million, the NFL and NFL Players Association built an infection control system so robust that they submitted multiple scientific papers to recommend applications outside of football -- including one that was published last month by the Centers for Disease Control and Prevention (CDC).

The overall league positivity rate of 0.076% since Aug. 1 -- 726 infections among 959,860 tests on an average of about 7,500 employees per week -- was far lower than the national average of 6.8% over a similar period, via data compiled by The Atlantic's COVID-19 tracking project. Even as the United States suffered through its worst public health crisis in a century, there were public reports of three hospitalizations for NFL personnel: one coach, one player and one referee. "Our NFL facilities and team environments were some of the safest possible locations in those respective communities over the course of the season," said Dr. Allen Sills, the NFL's chief medical officer, in an interview with ESPN.

The effort was exhausting but might have to be repeated in at least a modified way next season, depending on the country's vaccine rollout and virus count in the coming months. Regardless, the pandemic pushed a typically slow-moving league into an era of innovation that will impact it for years to come.

"It took a concerted effort by everybody involved to be OK with doing things differently," said NFLPA president and Browns center JC Tretter. "Getting over the fact that you're going to have to do things differently and then doing those things the right way. And as we know with COVID, if there is even an opening for someone not to live by that, it could cost us."

The NFL's history made its initial decision to play amid the pandemic "suspicious" to some in the public health community, said Eric S. Rubenstein, assistant professor of epidemiology at the Boston University School of Public Health. "But in the end," he said, "the lack of real serious morbidity and sickness is evidence that what they did worked for the people they cared about."

Managing risk

At the start of the pandemic, the fundamental question surrounding professional sports was whether they should play as much as whether they could find a way to do it. Would it endanger players, coaches and their surrounding communities? Would it absorb medical resources intended for more vulnerable citizens?

NFLPA executive director DeMaurice Smith wrestled with the issue from ethical and moral positions. "We don't do anything at all costs," he said.

Sills, a neurosurgeon whom the NFL hired in 2017 largely to manage its concussion protocols, said he was assured by owners and commissioner Roger Goodell that "if at any point I felt, or any of our other advisers thought, it was unsafe to continue, they were certainly prepared to take action against that."

More broadly, Sills added, a physician's job in part is "to help our patients coexist with illness or disability while trying to move forward with their lives. That's the nature of medical practice. Sometimes that's a self-limited short-term illness, maybe a short-term viral illness or a short-term spine problem -- a herniated disk, for example. Other times, it's a chronic illness. So as physicians, we come with the philosophy of, we want our patients to enjoy things that are meaningful in their lives while at the same time managing those conditions or mitigating any risk of injury or disability. So I think that's the same approach here."

In the end, the NFL and NFLPA possibly protected their employees and members better than if they had canceled the season and disbanded everyone to their home communities. They were highly motivated, of course, and spent millions of dollars to ensure they didn't lose the billions that come with a full 17-week season. (The NFL's television contracts cumulatively were worth nearly $10 billion in 2020.)

When his season ended in January, in fact, Seahawks receiver Tyler Lockett expressed uncertainty about life without the league's inherent safeguards.

"You think about all the stuff that we've been through this whole year," he said. "Having to be tested every day, having to try to stay away from as many people as we possibly can, being careful with who we fly up here and who we're around. Now, we literally have to go back to being at home, back into the real world. It's hard being in the real world when we have been away from it for so long, and now we have to figure out where we're going to go, who we're going to see, who we're not going to see."

The league and union decided last spring that they did not want, and could not achieve, the kind of "bubble" environment that allowed the NBA, WNBA, NHL and soccer to pull off modified seasons over the summer and fall. Instead, they assumed some of their players and coaches would get infected and built a plan around the tenets public health officials have emphasized: frequent testing, physical distancing, contact tracing and isolation of infected individuals, all while committing to frequent changes where necessary.

The league contracted with BioReference Laboratories Inc., which created a network of 32 on-site testing facilities and five labs across the country to guarantee results of the traditional nasal swab (PCR) tests within 24 hours. It purchased electronic trackers from Kinexon, required anyone inside a team facility or stadium to wear them and partnered with the medical data company IQVIA to analyze the data in real time to find close contacts to any infection. In most cases, contact tracers could upload a full set of close contacts to an infected individual within minutes after receiving notice of a positive test.

While the league office reorganized its structure, pulling staff from other departments to serve on an 18-person contact-tracing group, each team was required to name an infection control officer (ICO) to serve as a point person. Teams retrofitted their facilities to ensure 6 feet of distance between players in locker and weight rooms; teams in warm weather areas (such as the Rams) built temporary outdoor meeting rooms to minimize the chance of spread. Most teams doubled the number of buses they used in travel and often added a second charter plane, all to facilitate physical distance guidelines while traveling.

A key point came in September, when the NFLPA insisted on daily testing throughout the regular season to maximize the chance of catching every infection early enough to avoid spread among the team. Newly signed players, meanwhile, were required to return negative tests on at least five consecutive days before they were allowed to enter a team facility.

"I think if we don't test every day," Smith said, "this season doesn't go on the way it did. We don't find the success we did of completing it in the time we had."

In the process of administering nearly 1 million tests through BioReference, the NFL and NFLPA contended that they did not undermine public access. "We've set up a completely independent supply and logistic pipeline," Sills said when asked about the number of tests used. "At no time during the entire season did we go and pursue testing with any existing health care agency or existing hospital. ... Our testing program was set up through an independent laboratory company with new supply and new distribution methods."

Identifying positive cases was only the first step. The league's COVID-19 task force not only traced the source of every infection but also endeavored to identify trends that could guide teams away from risky behavior. Dr. Christina Mack, the vice president of epidemiology and clinical evidence at IQVIA and an NFL consultant, said some of the early sources of team transmission came in small meeting rooms, from eating and drinking together, and even in carpools to the team facility. All were addressed in updated protocols over the course of the season.

Adapting in-season

Four other turning points arrived near midseason, when the league made cascading changes to its schedule after an outbreak among the Titans.

First, the NFL found that 90% of its infections were visible in testing between two and five days after exposure. It also found, through contact tracing, multiple instances of transmission in less than 15 minutes of exposure. With that information, it created the classification of "high-risk" close contacts to find other ways to minimize the chance that someone would become infected and begin spreading the virus before it showed up in testing.

Rather than relying only on distance and exposure time, the approach added the setting, level of ventilation and whether the exposure came with or without masks. A short car ride without masks, for example, would be high-risk, but an extended exposure outside with masks would not. High-risk close contacts were all required to isolate for five days, even if they had tested negative and were showing no symptoms. That change left some teams decidedly undermanned in games -- most notably in Week 12, when the Ravens played the Steelers with a dozen players sidelined and the Broncos were forced to play without their top four quarterbacks -- but it halted some transmission chains.

More than 40 high-risk close contacts eventually tested positive during their five-day isolation, according to Sills.

Second, the league began conducting genomic sequencing tests, a process that allows scientists to map the virus structure of each infection. In practical terms, it meant the league could know with a high degree of accuracy whether multiple infections among a team were coming from the same source -- and thus there was spreading within the building -- or had been acquired from different places in the community. That information gave the NFL and NFLPA confidence to play even when teams were returning multiple positive tests in the days leading up to the games.

Third, the league moved to intensive protocols that prohibited in-person meetings, required face coverings during practices and made all in-facility meals grab-and-go, among other things.

Fourth, it participated in the development process of a more accurate point-of-care test through Mesa Biotech that served as a supplemental security net for game days, allowing an extra data point of assurance before allowing players to participate.

Taken together, according to the paper published by the CDC, these strategies have broad relevance beyond football. The data was especially relevant because nearly 40% of the league's confirmed positive tests were asymptomatic throughout their infections.

"Although the protocols implemented by the NFL were resource-intensive," the paper read, "strategies such as accounting for specific characteristics of the close contact, in addition to time and duration, and creation of an intensive protocol are applicable to other settings, including essential workplaces, long-term care facilities, and schools."

'The virus has not crossed the line of scrimmage'

Of course, playing football in a pandemic requires at least some good fortune. In this case, the NFL benefited from the unexpected reality that games themselves -- three hours of players in close quarters, breathing heavily on each other -- were not spreading events. The NFL has not had a single infection traced to interaction during a game, according to Sills.

"I'm not aware of any transmission in a sporting competition anywhere around the world at this time," he added. "Those things are sometimes difficult to prove when you don't have as much testing and epidemiology that we have, but certainly on the NFL side we have not had any transmission in our games. The virus has not crossed the line of scrimmage to our knowledge."

The most likely explanation, Sills said, was that players interacted in games frequently but for "incredibly brief" periods of time. Data trackers worn during games showed most interactions to be six seconds or less. Even when those contacts were added up, Sills said, they fell short of time needed for transmission, which varies by context according to the study published by the CDC.

The size of stadiums and the ability to circulate air within them, outdoors or indoors, helped reduce risk as well. The NFL felt confident enough in the science of stadium size that it allowed its teams to work with state and local authorities to allow a limited number of fans to attend games if desired.

During the regular season, 19 teams allowed 1,181,066 fans to attend games, and the Cowboys accounted for 197,313 of that total. The NFL said that no outbreaks had been reported based on attendance at NFL games anywhere in the country, but Rubenstein was among many public health officials who questioned the relevance of that claim. Contact tracing at NFL games was largely left to overwhelmed public health authorities who were unable to trace every infection.

Rubenstein said it was "irresponsible" to allow tens of thousands of people, in some cases, to gather for games and added: "Absence of evidence is not evidence of absence."

Between the start of training camp and the Super Bowl, at least 22 million people were infected with COVID-19 across the country, and nearly 315,000 have died. Sills said there was an "incredibly low" number of serious cases among league employees subject to its full testing program. Jaguars running back Ryquell Armstead, Broncos defensive coordinator Ed Donatell and referee Clay Martin were among a handful of people to be hospitalized.

Early concerns about the potential for long-term heart damage have yet to be realized. Every infected player and staff member underwent cardiac screening, but Sills said "there was an incredibly low incidence of any kind of cardiac abnormality, and thankfully we did not have anyone who had a severe outcome from that."

The NFL, in fact, has joined other professional sports leagues in co-authoring a paper that Sills said will demonstrate a similar industrywide trend.

Most NFL players are relatively low-risk candidates for severe illness because of the age group and physical conditioning, especially after 69 chose to opt out for medical or other reasons before the season. (The Patriots led the league with eight.) But the NFL also demonstrated how effective a motivated and well-funded community can be in fighting the virus, as well as the importance of across-the-board compliance.

"It's not easy. But it's not complicated. We know exactly what it takes to keep people safe. When I say it's not easy, what I mean is you have to apply it every single day consistently across the board with every single member of the organization. If you don't, then you're going to have that vulnerability." Dr. Allen Sills, the NFL's chief medical officer

"One of the things that I've said repeatedly is that I think risk mitigation is not complicated," Sills said. "It's not easy. But it's not complicated. We know exactly what it takes to keep people safe. When I say it's not easy, what I mean is you have to apply it every single day consistently across the board with every single member of the organization. If you don't, then you're going to have that vulnerability."

'It does take a toll on you'

Like many players, Mahomes has made a habit over the years of getting his hair cut before games. That simple ritual required extra legwork in 2020. Before venturing in, he made sure to get his barber tested for COVID-19. The shop also needed to be empty when he arrived, Mahomes said late in the season. (During the week leading up to the Super Bowl, two Chiefs players -- center Daniel Kilgore and receiver Demarcus Robinson -- were required to isolate for five days after receiving a haircut from a barber who tested positive for COVID-19. Neither player was infected.)

After-game rituals, meanwhile, largely dissipated. Some, like jersey swaps, were creatively replaced; the NFL partnered with Tide to cover the cost of mailing and replacing one jersey to another player. On a personal level, players and coaches dealt with the same feelings of social isolation as millions of others across the country and the world.

"When I would usually hang out with the guys and hang out with different people, even hang out with my family, I had to kind of prevent that as much as possible and keep it very minimal," Mahomes said. "It does take a toll on you. You're used to being around people, enjoying stuff outside of football, enjoying stuff that's not always grind and work every single day. So you have to kind of find different ways to do that."

On one December night, that meant breaking out the Uno deck at home with his fiancée, Brittany, and brother, Jackson.

After moving past the bubble concept over the summer, the NFL and NFLPA agreed to allow players and coaches to live at home and move about in the local community, while encouraging them to avoid high-risk conduct. Players were subject to fines, for example, if they participated in group events of more than three people when away from the facility. Ten Raiders players were fined between $15,000 and $30,000 apiece for taking off their masks while attending a charity function, and Texans quarterback Deshaun Watson was fined $7,500 after attending the opening of a restaurant with dozens of others.

That left players and coaches playing a lot more Uno and a lot fewer tracks at the spin table. Lions defensive coordinator Cory Undlin, who missed a Week 16 game because he was deemed a high-risk close contact to an infected person, said his routine for more than 170 consecutive days was the same: "I go to the building, and I come home. I live by myself. I felt pretty good about being safe, but you never know."

Similar stories played out all across the league this season. Darnold said his parents and sister flew to New York from their home in Los Angeles to spend Christmas with him. Before they could see him, however, they needed to return negative test results. Through its teams, the NFL offered that service in part to protect their players and in part to address issues of mental health that could arise during the holidays.

Stafford, meanwhile, was deemed a high-risk close contact to someone who had tested positive in Week 9, requiring him to isolate for five days. That meant spending Tuesday through Friday nights in a hotel room in Michigan, with meals delivered to his door, unable to practice with the team or to visit his wife and children. If he continued to test negative throughout that process, Stafford would take a private plane to Minneapolis on Saturday, isolate in a hotel there and join the team Sunday for a game against the Vikings at U.S. Bank Stadium.

On the final night in his Michigan hotel, Stafford received a call that one of his daughters needed a trip to the hospital after falling off her high chair and onto a granite floor. His wife, Kelly, was initially unable to find someone who could stay with their other three children. So Stafford left the hotel, got in his car and headed home.

Along the way, he called Lions general manager Bob Quinn to tell him what was happening and confirm that if he entered his home, he would be breaking isolation early and thus be ineligible to play against the Vikings. When he was about a mile from home, his wife found someone to stay with the kids. Stafford turned around and returned to the hotel without breaking isolation.

"It's not something I take lightly," he said later. "I understand it's a pandemic and people's health and safety are at risk, and I would feel terrible if I brought that in and infected a bunch of teammates or coaches or whatever it is. So I understand it. Doesn't make it easy, but everybody in the league is doing it. I just hate being away from my family, you know, and finish a practice, finish a game, go hug my daughters, hug my wife. That's what sometimes makes it worth it for me, and not being able to see them and hang with them has been really tough. But there's other people dealing with the same kind of stuff I am."

'You can't play through COVID'

Unexpected phone calls and overnight drama became the norm for NFL general managers and coaches. Testing cadence varied per team, but generally speaking, BioReference aimed to return results within 24 hours. Team ICOs often received them in the middle of the night, usually with instructions to spread the word immediately. In one isolated instance during Week 13, the Ravens received WR Dez Bryant's positive test result early enough to hold him out of a night game.

"Those phone calls at 3 o'clock in the morning when the testing gets done? Those were kind of fun, to see if you have a full house or there's a few people missing," Chiefs coach Andy Reid said.

On Oct. 3, the Saints traveled to Detroit for their game against the Lions the next day. At about 10:30 p.m. ET, after they arrived at the team hotel, the Saints learned that fullback Michael Burton's test from that morning had returned positive. By protocol, Burton was required to take an additional test, as were those who sat near him on the team charter.

Those tests were completed just before 1 a.m., and, with a 1 p.m. kickoff looming, coach Sean Payton and several other team members stayed up past 3 a.m. to learn the results. Burton's original test proved to be a false positive, and the remainder were negative as well, and the game kicked off on time. Fully staffed but sleep-deprived, the Saints fell behind 14-0 before coming back for a 35-29 win.

Like most coaches, Payton wasn't happy about the interruption to routine but made a point to say: "That's just the way it is this season."

Indeed, the entire NFL community was forced to accept what ordinarily would have been considered wildly unfair competitive disadvantages. The 49ers played without most of their receiving corps as well as left tackle Trent Williams in Week 9 against the Packers, losing 34-17, and later relocated to Arizona for the final five weeks of the season after regulations in their home county of Santa Clara, California, prohibited their continued operations. They lost four of their final five games.

The Broncos converted rookie receiver Kendall Hinton to quarterback in a matter of hours before a Week 12 game against the Saints, after learning the day before that starter Drew Lock and all three of his backups had gathered for a film session without wearing masks at a time when teammate Jeff Driskel was contagious. The Broncos lost 31-3. Also in Week 12, the Ravens lost a key AFC North game against the Steelers with quarterback Lamar Jackson among 12 players who were ineligible, a game that was delayed until Wednesday as the NFL awaited the end of the outbreak. For the Steelers, it was the second game of their season to be delayed multiple times because of outbreaks emanating from their opponent.

The Lions lost to the Buccaneers 47-7 in Week 16 after interim head coach Darrell Bevell, Undlin and three other assistants were ruled high-risk close contacts. And the Browns were forced to play their first playoff game since 2002 without coach Kevin Stefanski, who tested positive. (They won 48-37.)

In many cases, the NFL turned down requests from teams to push back games until key players were eligible. Goodell's blanket refusal, codified in an October memo to clubs, was a departure from his long-held ethos of competitive equity.

Goodell has long sought to enforce the assertion that NFL competition is real and that outcomes aren't preordained or even titled by forces that would have the power to do so. In 2020, however, playing games when they were deemed safe took precedence.

"We had to abide by that principle to make it through this unique season and protect the health of the players and coaches and others," said Jeff Miller, the NFL's executive vice president of communications, public affairs and policy. "There was no alternative. When that principle was put to the test, we consistently and regularly abided it. That was well known to the clubs, and the coaches and the players, and it had to be that way for us to be able to proceed through the regular season. Once we were comfortable and confident that the game was safe to be played, we moved forward. To do so otherwise was to create variability in that principle."

Players, for one, had no argument.

"Guys want to be out there," Tretter said, "and that was one of the tougher things this year. Guys play through injury, through illness, and this is a year that that's not possible. You can't play through COVID. It's not safe for the guys around you. And there's the choices or the choice is taken away from the player of, can you do it? It's a hard 'No.' And it's a hard no if you're a close contact."

Could we see a repeat in 2021?

The severity of the pandemic has made long-term projections difficult and often heartbreaking. At the moment, all we can say about the NFL is that a return to normal operations seems far off. Soon, it will become a matter of not only health and safety but also labor relations.

"What does a post-COVID -- if there is such a thing as a post-COVID -- world look like?" the NFLPA's Smith said. "We can all imagine at some point, but the question is just when do we get there?"

The answer to that question lies largely with the pace of national vaccinations. Based on the current rate and priorities, it's hard to know whether NFL players will be inoculated by the time training camps open this summer, or whether the NFLPA would agree to make the shots mandatory. (As of this week, the CDC has reported that approximately 34 million of the nation's 328 million people have received at least one dose of vaccine.) Regardless, current national guidelines suggest a continuation of mask wearing and distancing, as well as avoiding large indoor gatherings, even after receiving a vaccination.

That means the NFL and NFLPA must decide whether they should reapply 2020 protocols and conduct traditional offseason workouts and mini-camps at team facilities or should accept a second consecutive virtual offseason. Citing the success of the 2020 season, the union already is campaigning for a permanent overhaul to on-site offseason work.

In 2020, players spent their offseasons working out in home gyms, riding Peloton bikes and using exercise bands that the NFL allowed teams to provide them.

"There is always a balance between preparation and rest," Tretter said, "and what we're seeing [in] more and more of the science is how important the rest is as you get your body right. Because again, we go through so much trauma for so long, to force guys into ramping back up so quickly after the season when we know it's not good for them just isn't right.

"I think you can prepare the way we did [in 2020]. I understand coaches, asking coaches whether you should take away practice is like asking the Cookie Monster if there should be less cookies. The answer is always going to be no, they want more. That is just kind of how it is, so that's not surprising. In the end, it's about building a better program -- building one that works for everybody involved and makes this game safer and our players healthier."

Tretter also cited the necessary shift of team meetings from in-person to virtual for much of the season as evidence that offseason work doesn't necessarily have to be on site. Naturally, coaches were split on the effectiveness of those virtual meetings. Patriots coach Bill Belichick said that his biggest takeaway from the 2020 protocols was "the limited value of the virtual meetings and the maximum value of in-person meetings and walkthroughs." Stefanski of the Browns, meanwhile, said: "We figured out a way to cover ground. ... It does not replace the physical work, but I think it is the next best thing."

In early January, Stefanski said it had been "months" since the Browns last had an in-person team meeting.

Living in hotels during training camp might be outdated as well, Tretter said. "Another change that probably the public doesn't see but affects players is we weren't in the hotels this year," he said. "We were back with our families. We were able to go home and be with them when otherwise we would be in the hotel. I think that's something that we've done constantly just because it's always been done that way. There's really no reason to do it."

In the meantime, the NFL has largely scrapped its first major offseason event, the early-March scouting combine. In its place, the league has instructed teams to conduct physical tests during campus pro days. Interviews will be virtual, and medical checks will be administered at local facilities when possible.

Smith said he expected that many of the league's 2020 innovations "are things that we're going to take a hard look at and looking at trying to make them systemic and perpetual going forward." For now, however, it seems clear that there won't be much of a choice. Those innovations, and their next iterations, will be necessary to get through the spring, summer and perhaps early fall as well.

"We all hope optimistically that these sets of protocols can go the way of the Smithsonian at some point relatively soon," the NFL's Miller said. "If not, we'll be prepared with a set of rules, and rules that evolve. We'll be prepared, and we'll do what's necessary."

NFL Nation reporters Rich Cimini, Brady Henderson, Mike Reiss, Michael Rothstein and Adam Teicher all contributed to this story. All COVID-19 figures are via data compiled by The Atlantic's COVID-19 tracking.