In the more than two months since the suspension of all NBA activities ushered in an unprecedented era without sports, professional leagues and the NCAA have turned from preventative health measures to evaluating when, where and under what conditions teams could safely return to normal activities without increasing the possibility of an outbreak of the coronavirus strain.
The question is uniquely pressing for teams in the NFL, which may have had the luxury of thus far avoiding any major, coronavirus-caused disruptions to the league's annual schedule — the April draft was held with teams working remotely — but must now create guidelines for juggling larger rosters and the physicality of practice along with the renewed daily interaction between players, coaches, trainers and support staffers.
To help steer the response to COVID-19 and provide recommendations for transitioning back into traditional team activities, the NFL has turned to Infection Control Education for Major Sports, or ICS,an independent organization run by two Duke University infectious-disease doctors, Deverick Anderson and Christopher Hostler.
As teams begin to ease into drastically altered preparations for the upcoming season, ICS has been the league's go-to source for how to mitigate the spread of the coronavirus through testing, disinfection and environmental distancing.
"Sports teams and leagues have an acute need at this moment, and that is specifically related to COVID and how to reopen," Anderson told USA TODAY Sports. "We believe that these teams can benefit from this type of systematic implementation of best practices moving forward."
The NFL faced a similar situation seven years ago, when a series of potentially fatal staph infections, known as MRSA, spread through the Tampa Bay Buccaneers' locker room. One of the players infected, kicker Lawrence Tynes, cited unsanitary conditions in later suing the franchise, and settled for an undisclosed sum.
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To help steer the league's response to MRSA, the NFL leaned on the expertise of the Duke Infection Control Outreach Network, or DICON, which had been providing the league with educational newsletters related to stemming the spread of infectious diseases. After pitching the NFL on installing systemic, league-wide guidelines, DICON entered into a contract as the league's infection-prevention experts.
Anderson and Hostler, who consulted extensively with the NFL as part of DICON's team of experts, formed ICS when the coronavirus started to spread in the U.S. as a separate and distinct entity as inquiries from major sports leagues increased with the rise of COVID-19.
The company is under contract with the NFL and the Big 12 Conference, and has held conversations with at least eight other professional or college leagues, including Major League Baseball, which is considering a shortened regular season beginning in July.
"They have been part of committees and working groups that are looking really at every aspect of our operation and our response to COVID, from advising us on how we conducted the draft to how we were able to reopen clubs’ facilities to now helping us think about player safety," said Allen Sills, the NFL's Chief Medical Officer.
Through conference calls with NFL owners and with three-ring binders distributed to every team, ICS has provided "really basic but really important infection-prevention strategies," Anderson said. "In some ways, a lot of these broad strokes are applicable in other parts of society as well."
At about 360 pages, the binder includes checklists, sample policies and an appendix of additional resource materials, including posters and specific documents from the Centers for Disease Control. Anderson called the more global advice provided by ICS the "Swiss-cheese model," in that no suggestion is perfect; all have holes. If you put them together, however, the holes may match up — much like stacked slices of Swiss cheese.
The steps include constant handwashing teamed with barrier precautions as a way to provide safe separation inside locker rooms and broader football facilities. NFL teams should maximize the use of face masks even as there may be times when masks may not be feasible, such as during aerobic exercise. ICS has also provided the NFL with recommendations on environmental disinfection.
"There’s effort that has to go into changing the way that we interact with people," Anderson said. "Social-distancing, redoing a lot of the environmental spacing. That’s certainly going to be true on the training side. Again, not different from other parts of society but certainly an area of emphasis in an athletic setting."
One risk that NFL teams must confront is maintaining those distancing efforts at practice, during typical moments as mundane as huddling or route running. At some point, teams will need to perform an act that has been nearly eliminated from everyday life: passing an object from one person to another — in this case, a football — without the interception of a disinfecting wipe.
Splitting players into smaller groups at practice, likely by position, and then layering on additional activities is a way to ease into traditional team events, Anderson said.
"It is clear and I think it is appropriate that most groups we’re engaged with are really trying to move in small, short steps," said Anderson. "I think that methodical approach, where you then have some time to see how things are going, is definitely a good way to do it. If you employ that strategy, it’s true that you can’t speed up the process. You have to take it one step at a time."
The biggest step will be in formulating a testing model for identifying individuals with COVID-19 and minimizing the downstream impact of a positive test. Testing has been a primary topic of conversation between ICS and the Big 12, with the conference quizzing ICS on who, when and how frequently to test athletes set to arrive back on campus early next month.
"We had a long list of questions we presented to ICS — and they’ve been going through providing us answers," said Big 12 executive associate commissioner Ed Stewart. "It’s an evolving list. I think they would probably like for us to stop reaching out to them so they can answer the questions we’ve already given them. But we keep coming up with new questions for them."
As of now, testing for the coronavirus is "imperfect," Anderson said, and ICS and others are trying to find tests that eliminate the sort of sensitivity that could lead to false negatives. Under optimal testing conditions, ICS has advised to test frequently to find the person on the verge of having symptoms before they subsequently expose teammates or coaches to COVID-19. Even then, it's unlikely that casting such a net would catch everyone that comes through.
"A key message we relay just about any time we get the opportunity to is, listen, there is no such thing as a zero-risk scenario. We’re going to do our best, but infections with this virus are going to happen whether or not sports occur," said Anderson. "So if we all kind of accept that’s the baseline that we’re living in, we then have to say it certainly has to be recognized that sports activities by their very nature will increase that risk."
Contributing: Steve Berkowitz, Mike Jones, Bob Nightengale