The NFL hosted a media briefing on December 18, 2021, to discuss the latest NFL-NFLPA COVID-19 protocol updates.
- Dr. Allen Sills, NFL Chief Medical Officer
- Dr. Catherine O'Neal, Infectious disease expert, LSU Health Science Center
- Dr. Deverick Anderson, Co-Founder and Co-Owner of Infection Control Education for Major Sports (ICS) and advisor to the NFL
- Dr. Tony Casolaro, President, NFL Physicians Society; Chief Medical Officer, Washington Football Team
- Larry Ferazani, NFL Deputy General Counsel of Labor
Dr. Allen Sills: Good afternoon, everyone, good to be with you as always. I'd like to start by just giving a brief overview of the changes that you are all being made aware of. For starters, we are entering a very different phase of this pandemic. And in some ways, battling an almost brand-new disease and that is the Omicron variant of COVID-19 that we are seeing. We are certainly seeing it in the NFL, as most of you know, we do genomic analysis of our positive samples and we began detecting Omicron in the end of last week and certainly moving into this week. We don't have all of the testing data back but the overwhelming majority of the positive cases we've seen this week, we believe are going to be the new Omicron variant.
That variant is behaving in a very different way than what we have seen previously. Different in the sense that it is extremely contagious but it does produce a milder form of illness. Many people who are either asymptomatic or very minimally symptomatic. And also, an even shorter duration of symptoms. That's again in vaccinated people and boosted people. So, they may test positive but, they are getting over that illness very quickly and then, again, not experiencing a high burden of symptoms. And I think as we spoke Wednesday, for those of you that were there in Dallas, we have seen far more players infected than we have coaches in this round of tests, which is a little different than what we have experienced up until this point in time.
So, that data has added to our ongoing analysis—we are always analyzing our experience, we are always analyzing our data and particularly our outcomes. We are looking at our protocols, together with our experts, together with the Players Association, we are looking at them to see how we achieve the safest possible environment for everyone and that causes us to need to constantly respond to and adapt the protocols. And so clearly, with the emergence of this new variant, which, as I said, in many ways seems like a different disease, has been an opportunity to reevaluate every aspect of our protocols, and has led to some of the changes we will talk about today.
I'd like to emphasize a couple of real, I think, key aspects to our response. First and foremost, boosters remain incredibly important. I shared with the group earlier this week our own internal antibody study data which confirmed that, and the NBA's antibody study, and what is being discussed from a public health standpoint, which is, people who received their vaccine longer ago, do see waning immunity over time and boosters are the best way to restore that immunity. And that has not changed with Omicron. We certainly still believe that boosters are important, they provide the highest degree of protection for each individual. I think all of you are aware that we have taken steps to ensure our staff are boosted and we join with the Players Association in encouraging players to learn about and to receive a booster shot because we believe they are safe and extremely effective.
Secondly, we have revisited our surveillance testing program. I think all of you are aware that is something that we have been constantly looking at since the pandemic began back in 2020. With the goal, again, of how do we create the safest possible environment and what can and can we not accomplish by surveillance testing.
I think each of you are aware of the differences in the program that we outlined today with this protocol change. And I would not describe it as we are stopping testing, or we are doing less testing – I would simply say that we are trying to test smarter and test in a more strategic fashion. By that I mean that we are trying to focus our testing on symptomatic individuals. Certainly, we will continue to test all unvaccinated players every day and we are designing a testing regimen that will replace our previous surveillance testing, and will be, again, more targeted more strategic, based on what we have learned and what the data has shown us.
I would emphasize as well that players and staff have the ability to request a test at any time. So, a player, coach, staff member can be tested every day if they'd like or any time for cause. That has not changed but it's something that we are emphasizing. And we will, again, continue to test anyone who is symptomatic as well as our high-risk vaccinated contacts. Those people who we find who are exposed to someone who is positive, we will test those again in a targeted manner.
And then the last piece of testing that you are aware of that we are emphasizing is that all the players will be provided with the means to test at home, again, with the idea being that family members and others can be immediately tested.
So, that is one whole piece of the revision. We will continue with the measures that we put in place earlier in the week through this weekend and into the first of the week. That's masks in the facilities, virtual meetings, the avoidance of gatherings and so forth. We will obviously continue and we'll be reevaluating those measures at the start of the week. We put those in place initially for a seven-day period of time while we gathered data and saw the effects of what Omicron appeared to be doing so, we will continue to evaluate those parts of the protocols.
And I think you are all aware that we updated the return process of how someone can return after a positive test. Again, the goal there is very simple. We want someone to return when they are no longer a risk for themselves or a risk to others. And we've looked at our data very carefully there, we have obviously continued to evolve that definition over time and we believe we can bring a further degree of precision to that process on how people can return by fine-tuning that in a way that fits into the protocols—with two negative Mesa tests or using the lab PCR test with the cycle threshold values that we spoke about a day or so ago.
Along the way as well, I think you'll note the new protocol update as players have options around virtual meeting attendance and certainly the opt-out provisions that I will let someone else talk about.
That sort of comprises the bulk of the changes in the protocols that we are making. So, let me close my opening remarks by saying, I really think that what we are doing with these updates to the protocols are, that we are emphasizing personal responsibility, we are asking every person – player, coach or staff member—to be honest and report their symptoms. To get a booster shot, because they make themselves safer and they make the team safer. And to limit exposures and take measures that are appropriate to avoid those exposures along the way. We are also doing what I would call, testing smarter and I think in a more targeted fashion, and again, this is something that we will continue to evaluate but, we believe what we are doing actually now will mimic what we have been doing in healthcare for quite a while now. And what I mean by that is, I, as a practicing doctor, and the other doctors on this call, we are not routinely testing asymptomatic, vaccinated healthcare workers, doctors, etc. We are testing those who become symptomatic and meet certain criteria. So, we are really just joining what has been done in healthcare based on our own experience and the experience in healthcare up to this point.
And let me speak to one last point and I'll turn it over to my colleagues. We did, as you know, move several games this weekend—one from today and two from tomorrow. I can tell you, that as has been the case for the past two years, those decisions were driven purely by health and safety. We were not asked to consider competitive concerns on that. I know there are competitive implications but our job on the health and safety side is to say, let's make sure that we feel comfortable, that we understand the outbreaks that have occurred in these teams, that we've got our arms around transmission and that we feel like we can put players, coaches and staff out in a safe manner. And so, once again, we've had to evaluate that in light of the new facts that we have, in light of this new paradigm, and this has given us the chance to adjust and ensure everyone's safety. So, that is why those decisions were made the way that they were.
So, I am going to stop there, and I am actually going to turn it over for just a moment for some remarks, one of the other physicians on the line with us is Dr. Tony Casolaro. Dr. Casolaro is the president of the NFL Physicians Society and he is also the Chief Medical Officer for the Washington Football Team, which as all of you know, is one of the teams that has been hit very hard by positive cases this week and Tony, maybe I will just ask you to address the point about the disease burden you are seeing. How sick have people been on your team out of the number of cases that you had this week?
Dr. Tony Casolaro:So, we have had 23 cases of COVID this week, since Monday, and the, I would tell you, there are really only two of the athletes on the team I would've held out of a practice for any of the symptoms they have. Essentially asymptomatic, and even those that have symptoms, it's literally feeling like they have a runny nose, or a scratchy throat, and that is again, an extremely small number. I think the telling number is that there are two that I would've kept out of a practice had I not known they had COVID.
Sills:Also, on the call is Dr. Dev Anderson, who I think all of you know is an infectious disease consultant to both the NFL and the NFLPA for a number of years. Dr. Anderson is an infectious disease expert and a professor at Duke University. Dev, I might just ask you to reference the piece that I did about what we have been doing in healthcare and how we are managing this in healthcare workers and how that compares to the protocol updates.
Dr. Dev Anderson: Yeah, thanks, Dr. Sills. I think it is far to say that from the beginning, we have always kept our eyes on the various practices used in healthcare to identify what is effective in that setting, really learning from the data generated out of healthcare settings which we really consider to be one of the more high-risk locations when it comes to potential for transmission, as it relates to healthcare workers. So, just like you said, I think there are very specific parts of that, that are quite relevant to the NFL and that population where we focus on symptom-based testing, especially amongst those that are fully vaccinated. We can identify outbreaks quickly and we have steps in place to contain those when they occur. And we know a very specific prevention strategy, such as masking and distancing, which can be used.
And I think as important, which is worth noting, the similarities in the proportion of people that are vaccinated right now when it comes to healthcare workers—high levels of vaccination, just like has been achieved amongst staff and players in the NFL. And then finally, a heavy emphasis on boostering. We are really pushing the idea of boostering, as you said, amongst healthcare workers just like we are doing in the NFL, as well. So, I think there is a lot we have learned from healthcare and, just as you mentioned, I think it is very relevant to try and use some of the exact same strategies that are routinely used in healthcare when it comes to the NFL population as well.
Dr. Sills: Also on the call with us is Dr. Catherine O'Neal who is an infectious disease expert at the LSU Health Science Center in Louisiana. She has consulted with a number of sports teams around these issues throughout the pandemic as well as being a leading public policy advocate there. Katie, I might just ask you to comment on boosters and how you see them relevant to this current wave of Omicron and the role they may have.
Dr. Catherine O'Neal: Thank you, Dr. Sills, absolutely. So, you know, when we look at our immunity and how it plays into this current wave, we have a lot of our clubs who chose to get vaccinated six months or greater from now—especially our staff members—and what we are seeing in that population of people, just like we are seeing in healthcare right now as Dr. Anderson mentioned, is that many of our employees now and our club members are having waning levels of vaccination and antibodies. And for those members, the best thing that we have evidence to do now, besides mitigation and testing and contact tracing, all of those things that have been in our protocols for so long, is to add that final layer of boostering. Just like every vaccine that we have received as children, you often need multiple vaccines to finally reach the level of antibody protection that can last for quite some time.
As we see this new wave of Omicron, we are seeing evidence that the booster gives us that level of protection that we want and even people who have received two shots of the vaccine, if greater than six months out, may not have the level that they want to continue to play, to continue to play at peak performance, and cannot become symptomatic and have to stay out. For all those reasons, we are recommending that our clubs receive the booster.
Most importantly, the information that we have about Omicron, is day-to-day changing. But the constants that we have seen, are that it is much more infectious, and that boosters are absolutely key to overcoming it. That is what we are focusing on today—what are our mitigation strategies of how we can get our clubs the information that they need to improve their booster amounts.
QUESTION: This question is for Dr. Sills or maybe this is a Larry Ferazani question. But I am curious, with the targeted testing, as you know, players, when they get randomly tested for PEDs, they often post things on social media that they are being sought after for having a good game. What is the methodology for the targeted testing and what is the concern level, if any, that teams are going to feel like you're testing them and not anybody else at a specific time?
Dr. Sills: Yeah, I think we are still working out the final details of that targeted testing program. But let me assure you, it will have nothing to do with performance or competitive issues. We will actually set it up through IQIVA, our data science partner, you know, that has been receiving all of these testing results and entering all the booster information. So, it will be run by that entity, that, again, is jointly selected by the league and the Players Association and, you know, it will be setup in response strictly to what the data is telling us and what we perceive to be the vulnerabilities in real time based on that data that is coming in. And I will let Larry comment on anything he wants to add there as well.
Larry Ferazani: Your reference to the drug program is not entirely [INAUDIABLE]. We will ensure, as we do in that program, that it is applied fairly and uniformly across all 32.
QUESTION: If you have data from this last batch of positive cases that we have seen this week, about how many of those individuals have had booster shots? And then I'm also curious through the antibody testing and then other data you've collected, if you've noticed a difference between the performance of the Johnson & Johnson vaccine, specifically, and if it's had any sort of correlation to the outbreaks that we've seen this week?
Dr. Sills: Both good questions. I think we're still gathering data, again, this is happening very much in real time to understand vulnerability. I think that I can share with you that we're definitely seeing people test positive this week, with this new variant, who have been fully vaccinated and had been boosted and, in some places, even had COVID infections previously. So that's very different from what we've seen up to this point and that kind of goes back to where I started, which is in some ways we're dealing with almost a completely new disease. Which has a very, very great different profile. I think that's something we're seeing.
With regards to your other question about Johnson & Johnson, I think again, our data and our antibody study confirmed what many have seen, which is that protection after the Johnson & Johnson vaccine probably wears off more quickly. You know, we tend to have current recommendations for six months after the mRNA vaccine, Pfizer or Moderna, after six months you consider needing a booster. It's two months after the J&J. We've certainly seen that as well. As far as whether or not J&J vaccinated people who are driving this current outbreak, again still compiling that data, but that's not going to be the full answer, I don't think in my opinion. I think this is not just a function of those who got J&J, but maybe I'll ask Dr. O'Neal or Dr. Anderson to comment there also.
O'Neal: I'll take a stab. I think our numbers are challenging, exactly as Dr. Sills said, because we're so early that to make conclusions based on, as you heard, 23 cases are not going to be representative of our league, which represents thousands of people. We're going to experience, over the next couple of weeks, a large surge in Omicron cases and only when we get those numbers will we really be able to understand how these vaccines play into reinfection.
One of the other things you have to take into account is time since your last shot. We saw many people reach for J&J in the months of March and April and that's been quite some time since their last immunization. So that may not be a function of the vaccine but a function of time and that's why we're encouraging everyone to get boosted, today, if they haven't already because we know your antibody levels will be high when we're facing the surge in the next couple weeks and that's when we want high antibody levels. A lot of information can come, but a lot of other factors play into that answer besides just the vaccination.
Dr. Anderson: I think that is well said.
QUESTION: Given what you said about boosters, Dr. Sills, do you see any need to incorporate boosters into the definition of what it means for a player to be fully vaccinated between now and the end of the season or the end of the postseason? And the second one, is there any sense yet of what effect the new return to play protocol might have in the short term, especially for those teams playing on Monday and Tuesday?
Dr. Sills: Let me answer the second question first and I'll say that we're already seeing the impact of what I mentioned earlier, which is shorter duration of illness with this Omicron variant. So, historically up until about last week, I would've told you about 20% of our NFL population seemed to be testing back in, in less than 10 days, that's been our number through the season. I think that number has gone up substantially in the last few days, not so much because of the changes in our protocols and we've clarified it to reflect the facts of shorter duration of illness that we're seeing with this new variant. So, I don't have an updated number, we'll get that this week. But there is no question that we're going to see more and more people, I believe, with Omicron who are going to test positive, have very mild symptoms, clear those very quickly and then test back in, in less than 10 days. And again, I'll emphasis, Mark, that, no, you cannot test back in if you still have symptoms, you have to be asymptomatic, so that's part of that routine.
And I think we need a little more time, to understand how boosters are going to function in relationship to Omicron. We clearly believe boosters are protective, more so than people who have been unboosted because again, we talk about that waning immunity. But, as how we operate with that and how we incorporate that, I think we'll just have to continue to evolve that. We need a little bit more data to understand and make the most thoughtful choice there.
QUESTION: Dr. Sills, you said the decision to move the game was a medical one. Help me understand the medical reasoning for that considering, you know, we have lot of asymptomatic cases and, frankly, we wouldn't know about a lot of these positives going forward because these guys wouldn't test because they'd be asymptomatic and vaccinated. So, what was it about these games that we said, we've got to move them here?
Dr. Sills: I think each day this week has given us new information, new insight into this new phase of this pandemic and as I said earlier, I'm giving you a summary of where we stand today after having watched this over the preceding seven days. If you think about several days ago, as when we were needing to make decisions about games, we're still gathering data and we're still trying to understand what portion of these cases might have been Omicron, we're still looking at how the return to play was going to come out, when guys might be available and what the extent of the disease might be in the teams.
One of the intervals, just to get down in the weeds for a second, whenever you have a team outbreak and you have an exposure, you're looking at, okay, can I understand how long it appears to be for someone to go from being exposed to actually becoming sick and/or testing positive and developing symptoms. So, it's the late interval between exposure, symptomatic or positive test and then also how long will it take someone to become contagious to someone else.
So, those time points, Mike, have been different throughout the pandemic. Delta behaved a little bit differently in that regard than what we saw last year and now we've got this brand-new variant which is also going to have a different behavior. So, we have to kind of understand each of those time points, right. How long from exposure to symptomatic or positive test. How long from symptoms and exposure to contagious and how long to resolve. And when we can understand that, then we can make projections about how long someone is going to be in the protocol, how long someone may be ill for and, most importantly, who else might be at risk in the team environment. So, we've always said that we don't want to put people on the field or in the locker room or anywhere when we think that they have substantial risk of passing virus on to others. We don't want to see people become infected, full stop. But making those projections requires us having an understanding of those other variables. And then you have to add into that as well, Mike, we've kept people out of the building completely for a couple of days and we never felt it exactly fair or in the best interest of health and safety to have teams go from not gathering at all to suddenly putting them into a stadium to play. They do deserve some time to get together and to practice and, you know, condition their bodies really as much as anything. So, when I say it's health and safety, it's both parts of that equation. It's getting our arms around what is going on in terms of transmission and how we can detect that and then giving them a chance to adequately to prepare their bodies to play in the game. Factoring all that in to play, led us to the decision to postpone the games by a couple of days.
QUESTION: You said you saw infections in individuals that have been previously been infected, would that change the 90-day rule at all as far as not having to test if you've tested positive and were in the protocol and then tested out?
Dr. Sills: I think that again that's something we're going to have to continue to evaluate. What I was speaking to you about was sort of outlier cases and so you never want to make policy based on one or two cases. You want to look at a group aggregate and what the total experience is. Once again, I think we'll have more information about that. We've not changed that definition yet in our protocol but it's one of those things we'll continue to watch.
Certainly though, what we're emphasizing right now though, Mike, is you can be within your 90 days and still develop symptoms and if you are, we want you to report those. Don't just assume that, hey, I'm in my 90 days, I can't be infected. Currently though, we do still have the 90-day test holiday as part of this protocol but, we are emphasizing that symptom reporting is still to important in this group also.
QUESTION: Do you have a percentage of players that have been boosted to this point? And then, you know playing off of that a little bit, are you guys doing anything beyond education to encourage players to get boosted?
Dr. Sills: I didn't announce a number yet we're still updating that day-by-day. We have had teams that have had booster clinics. I think the events of this week have produced even more enthusiasm and interest in the booster, so we'll be updating those numbers and we're happy to share with people the percent of people who are getting boosted but it's literally happening on a day-by-day basis and we'll be glad to share that.
We are doing as much education and emphasis around this as we can. We put out a video with some of our experts, we've sent out information, talking points, obviously we've talked with our colleagues at the PA, they are having conversations as well and again, each team is approaching this much like they did the original vaccination with what are the most effective ways to get the information in people's hands. So, it is a multi-modality effort and it'll be a sustained effort, Albert, I don't think it's a one-and-done, it's something where we have to continue to have those conversations and obviously, we're going to continue to get data about the effectiveness of boosters. And I think to echo something Dr. O'Neal said, boosters are still going to matter. They're still going to be a part of the solution and the bottom line is, if you want to be as healthy as you can and give yourself the best chance to avoid infection, we think boosters are still very important. So, we will definitely continue to emphasize those.
QUESTION: Are you guys happy with where the numbers are or where things are going as far as the rate of players that have gotten boostered?
Dr. Sills: I think there's always room for improvement and again, I'd love to see everyone in our team environment be boosted. Whether it be player, coach staff member or anyone, I myself am boosted, I have my whole family boosted, that's how much I believe in it. So, we'll continue to work against that goal. Basically, I would say I'm not going to be satisfied until that's 100% but we know that we've got work to do there.
QUESTION: If a player is randomly selected for testing, has no symptoms and then tests positive, does he still go on the COVID list?
Dr. Sills: At this point, we have no plan, it is not our policy to put players, coaches or staff members who have tested positive, in the team environment. We believe that they have to be removed from the team environment until they meet the criteria of clearing via the negative test. Once we verify that it is indeed a true positive test.
QUESTION: In that memo yesterday on the games being rescheduled, it said that the league did not anticipate that they would be rescheduled again, under any circumstances. Dr. Sills, since this was a medical decision to move those games, what is the level of confidence that, specifically with the three teams, that you have stopped the uncontrolled spread of COVID in those facilities?
Dr. Sills: We have that confidence right now, today, but obviously that's something that we just always have to reevaluate. Many of you have heard me say that I like to quote Yogi Berra. It's tough to make predictions, especially about the future, right. We know that things can change very quickly so we'll continue to monitor those situations. As we sit here today, I think all of the data that we have suggests to us that we do have an understanding of those factors I mentioned earlier and that we can go forward safely with those games on the schedule as we have planned right now.