The coronavirus pandemic will not end before the 2020 NFL season begins.
Despite well-meaning strategies and protocols, players, coaches, team personnel, support staff, and their families will be at risk of coronavirus exposure and infection. Many will test positive for coronavirus this summer, fall, and winter.
The league has remained publicly optimistic about the 2020 season. Currently, the NFL expects players to report by July 28 and intends to start the regular season on September 10 as scheduled.
September 10 is two and a half months from now. The Super Bowl is over seven months away. In pandemic terms, that’s an eternity.
The NFL will work diligently to devise protocols to minimize exposure. They will provide standards to safely return infected players and personnel to the locker room, sideline, and playing field.
But the NFL has an incredibly difficult task to begin and complete a full season.
What follows is a discussion of the many obstacles and complications facing the league, the possible framework and protocols to keep the NFL community safe, and other thoughts on how the NFL may be affected by the pandemic.
The Big Picture Questions
I am burying the lede by delaying the foundational questions. But summarizing the issues facing the league and outlining how difficult it will be to navigate the obstacles is critical to this question. We'll get to these later.
What are the obstacles facing the NFL?
Coronavirus and COVID-19
Obviously, the primary obstacle is the virus and the disease process it causes. This particular coronavirus is difficult to handle for multiple reasons.
- It spreads easily due to our lack of natural immunity
- It spreads easily because folks are contagious for days before realizing they’re sick
- Our strategies for containing community spread of the virus are highly dependent on others
- There are as yet no viable treatments known to limit an infected person’s chances of severe illness
- There are a wide range of symptoms and disease processes – some mild, some critical
- It’s not clear whether recovered people have protective antibodies and for how long
The medical community is scaling the learning curve at a rapid pace. Recommendations seemingly change on a daily basis as our knowledge base grows.
Whatever protocols the NFL implements, exposure will remain possible. And you should expect those protocols to adapt as needed should the league be appropriately proactive.
Player infections
Generally speaking, NFL players are young, elite athletes. Many are in peak cardiovascular condition and without risk factors for severe COVID-19 disease. It’s a lower risk demographic.
But it’s not that simple.
Some players may be elite athletes but carry increased risk. Linemen often choose to gain extra weight while in the league and have an elevated body mass index. A small but important number of players likely have other known risk factors like high blood pressure, diabetes, or conditions that affect the immune system.
Infected players with mild symptoms and a minor disease process will expose others connected to the league (coaches, officials, team personnel) and their families. Many of those persons will have risk factors for severe illness.
And we are still learning whether those with a mild variation of the disease – i.e. anyone not requiring hospitalization – are at risk of long-term health issues. It’s definitely possible that low-risk people with mild illness could have prolonged recovery periods. Lung scarring can lead to long-term or permanent changes in lung capacity. The aftermath of the viral infection on heart muscle or the clotting system could result in long-term cardiovascular changes.
Thankfully, these risks appear to be low. But the risk of life-threatening or career-ending complications after coronavirus infection is certainly not zero.
Community spread in NFL cities
The NBA elected to take a bubble approach, inviting a limited number of people into the bubble after testing and imposing strict distancing criteria to stay in the bubble.
The NFL may have considered a similar approach – and still may opt for some variation of the bubble. But a bubble approach over a long regular season is less feasible in football. Especially if the league has any intention of playing with fans in their home stadiums. (More on that later.)
Even with strict internal protocols, major sports leagues will be at the mercy of how their local communities manage the epidemic. Recent outbreaks in Arizona, Texas, Florida, and other states are likely to lead to additional shutdowns and community mitigation strategies that may impact the league.
Test availability
Testing availability has significantly increased. The United States reported between 400,000 and 600,000 test results per day in June.
Still, it’s easier to be tested in some areas of the country than others. Should the pandemic escalate during the fall and winter months, testing may be less available. And the league could have public relations concerns about acquiring tests if their own communities don’t have enough.
Can the league overcome these obstacles?
What strategies and protocols might the NFL use to limit risk?
The league provided teams with protocols designed to limit the risk of exposure and spread of coronavirus in early June. Recommendations included strict physical distancing rules at team complexes, virtual meeting requirements, and limits on practices and training.
The NFL has not yet finalized procedures for coronavirus testing or how to manage players who test positive. However, you can expect detailed testing and return policy prior to the opening of training camps.
Here are some speculative thoughts on what that could look like.
Testing protocols
Daily testing could be implemented but may prove impractical. At a minimum, players could be tested:
- Before arriving at training camp sites
- Shortly before the game for clearance to play
- Following each game and exposure outside their team’s environment
- When any symptom of possible infection occurs
- Following any exposure to a confirmed positive person
Isolation and clearance protocols
Players who test positive will be isolated. The league may choose to repeat tests in asymptomatic players to confirm infection. Players with confirmed infections will remain in isolation under close observation until cleared.
Isolation and clearance could take many forms. Current CDC recommendations to consider those infected with coronavirus to be recovered include test-based and symptom-based strategies.
Clearance per a test-based strategy includes:
- Two consecutive negative tests 24 hours apart
- Continued improvement in respiratory symptoms
- No fever
Clearance per a symptom-based strategy includes:
- No fever for 72 hours
- Continued improvement in respiratory symptoms
- Ten days elapsed since the first symptom of infection
Expect the league to lean heavily on the test-based approach. However, there are people who continue to test positive for days and weeks after their symptoms resolve. The league could choose a hybrid approach.
Clearance from isolation does not necessarily mean a player will be immediately cleared to play.
The NBA will reportedly institute a two-week observation period after isolation ends. NBA players would then undergo a cardiac screen before being cleared to return. The NFL may elect to do the same.
At a minimum, it’s likely a player who has a confirmed positive test will need multiple weeks of isolation, observation, and follow up testing before they’re considered recovered and cleared to play. That includes asymptomatic and mildly symptomatic players only. Those with a more complicated illness could take significantly longer.
Restrictions on workouts, practices, and meetings
The NFL’s communication to teams in early June mandated physical distancing in all areas, limited strength and conditioning workouts to small groups, and strongly encouraged virtual meetings.
Head coaches reacted immediately. Baltimore’s John Harbaugh described the rules as “humanly impossible” and openly wondered how teams would handle the changes in communication. Los Angeles head coach Sean McVay was also bluntly skeptical asking, “We’re going to social distance but…play football? I don’t get it. I really don’t.”
The league has yet to define how many full team workouts are allowed during training camp, preseason, and regular season. But – despite the difficulties these rules present – expect the restrictions to continue.
Without perfect physical distancing outside team facilities, any infected person could expose multiple members of a team’s community. The distancing requirements will be an essential component of limiting risk of spread within teams.
Expanded rosters and practice squads
The NFL may expand game-day rosters, increase practice squad slots, allow for more flexible game-day inactive rules, or enact other temporary changes to provide a buffer should multiple players test positive in a given week.
However, increasing the number of people within each team’s community increases the risk of exposure. The NFLPA has reportedly considered requesting a smaller training camp roster to limit the number of possible contacts.
The Big Picture Questions
Now that the lede has been buried, let's unearth it to address the major questions.
Will the 2020 NFL season start as scheduled?
Can the NFL finish a full season and crown a Super Bowl champion?
The league remains optimistic. I believe we’ll see the NFL do everything possible to start the regular season on time and work toward a full round of playoffs.
I think the league will test its strategies and protocols during training camps in August, limit the preseason to one or two games, and reassess progress.
League officials and players will be watching the return of the NBA (in a bubble surrounded by an active outbreak in Florida) and MLB (shortened season including travel among major cities during the summer months) with apprehension and anticipation.
If all goes well, expect to see the NFL start playing in September.
But I’m not convinced the league will be able to traverse the coming months without any adjustments to the schedule.
Containment and mitigation strategies around the country have been fragmented and inconsistently followed. Serology studies strongly suggest we’re a long, long way from having enough people recovered from coronavirus to slow down the spread naturally. And the fall and winter are the highest volume months for respiratory infections.
While I remain hopeful, I’m much less optimistic the NFL will complete a full 17-game regular season and a full round of playoffs in 2020.
Could the season be pushed back a few weeks?
While delaying the season is an option, it’s not likely to be a successful strategy.
If the risk of exposure and illness is too high to function in the fall after weeks of inconsistent physical distancing and masking compliance among the general public, it is unreasonable to expect a lesser risk from November and beyond when respiratory infections are most common.
Will players choose to opt-out of playing this season?
We’ve seen MLB and NBA players announce they will not participate in their respective league’s abbreviated seasons. It’s likely we’ll see some NFL players choose a similar path.
It’s easy to see some players choosing to remain with their families, limiting the risk of exposure to loved ones, and avoiding the risk of a potentially life-changing or career-threatening infection.
While some players may be willing to play through a pandemic, a spike in cases in a given locker room may change the minds of some. Should any players, coaches, family members, or others associated with the league have critical or prolonged symptoms, we would likely also see a shift in player comfort levels.
Will there be fans in stadiums this season?
I don’t envision a scenario in which every NFL community has enough command of the pandemic during the fall and winter months to allow large gatherings of people regardless of how well physical distancing and masking may be enforced at the stadium.
But the NFL is a business and the country seems willing to take risks. I’m also not certain whether the league might allow some teams to welcome fans and others not. Therefore, fan attendance cannot be ruled out.
How might COVID-19 affect players and teams week-to-week?
What happens if multiple players on a team test positive?
Even with frequent testing and a commitment to report symptoms promptly, there will be players infected by the coronavirus. Unfortunately, coronavirus can be spread by infected persons who do not have symptoms. Even if we assume perfect physical distancing within teams, it may prove impossible to prevent mini-outbreaks among teams and position groups. Even staggered infections will hamper teams if multiple players overlap while isolating and recovering.
As noted above, the league could institute expanded game-day rosters, expand practice squads, consider flexible game-day inactive lists or other rules to provide a buffer should multiple players test positive.
Unfortunately, you can envision multiple scenarios where a team could struggle to remain competitive.
Could player performance suffer after infection?
Yes. Recovery from mild coronavirus infection – i.e. never ill enough to require hospitalization – does not ensure full recovery without short- or long-term effects.
Some with mild infection experience significant changes in their lung capacity or heart muscle function. This could affect peak performance and stamina for weeks and months after infection. Some of these physiologic changes could be permanent.
Some with mild infection experience problems with their blood clotting too easily or frequently. These conditions occurred, though rarely, in NFL athletes before the coronavirus pandemic. They would require weeks of treatment with medication and recovery.
These complications are driving the NBA’s decision to require players to recondition for a minimum of two weeks and undergo additional screening after they’ve been cleared to return from isolation.
Are we likely to see more injuries during training camp and the early regular-season weeks?
It's an easy argument to make. Soft tissue injuries are extremely common when players first return to offseason and training camp practices.
Without open facilities, players have had very little access to their team's medical and training staff. Rehab progress may be unknown or delayed. No offseason training activities or mini-camps took place. Training camp – if it starts in late July as planned – may be the first time a player has been in his team's facility in nearly eight months.
Expect teams to carefully assess each player's conditioning as camp begins. Full speed and team drills will be limited early in camp. It is likely teams will play only one or two preseason games. Some teams may place more players than usual on their PUP list to start camp and work to acclimate and condition them slowly. And any soft tissue injury will be managed very conservatively during the preseason.
Will teams release test results and discuss a player's progress through the isolation and clearance protocols?
I expect the league will want to be as transparent as possible about players who are confirmed positive. Just how that will translate to the practice participation and injury reports remains to be seen.
Perhaps the only certainty in this pandemic – aside from the understanding that it’s not over – is that nothing about the pandemic is certain.
As we continue to learn about the virus, its disease process, study possible treatments, and promote best practices to limit risk of exposure, we must be flexible and adaptable when new knowledge is presented.
The NFL is no exception. Expect the league’s response to be fluid as conditions change. As my friend Matt Waldman put so aptly: We’re traveling to the moon while analyzing data and making calculations in real-time.
I’ll address and review the NFL’s official protocols for testing, isolation, and clearance when they’re released. And I’ll share more specific thoughts on how to assess the preseason risk of those players (e.g. Ezekiel Elliott) already diagnosed with COVID-19 (Hint: it’s not a simple, straight-forward answer).
Stay well, everyone.
Check back for more injury analysis throughout training camp and follow on Twitter @JeneBramel for breaking injury news, commentary, and analysis of injury news around the NFL. You can also reach me at bramel@footballguys.com.
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