COVID-19 Is Sidelining Players Left and Right. Here’s What the Leagues Should Do.

With the virus decimating rosters and imperiling games, the NFL, NBA and NHL have the tools to find a way through. Will they?

The NFL, NBA and NHL began their seasons with high vaccination rates, low infection numbers and relative optimism around COVID-19. But a hectic week has turned the situation on its head and plunged all three leagues into crisis.

Sports Illustrated reached out to representatives from each, with a set of questions including whether they would contemplate pausing their season or mandating that teams restrict or eliminate crowds at their games. The NFL did not respond, the NHL said that the situation was “still fluid,” and the NBA said only that it “will continue to follow the science and data and will, in close partnership with the Players Association, update our protocols as deemed appropriate by our medical experts.”

With scores of players in each league sidelined by positive tests, teams have done their best to fix patchy, porous rosters with last-minute call-ups. Games have been postponed in the NBA and NHL and on Friday afternoon the NFL began shifting games on its schedule, amid questions about fairness and competitive integrity from fans and even players. The leagues have scrambled to address the issue by altering their protocols—some with measures, like daily testing and mask requirements, that harken back to last year.

But as the coronavirus sweeps across the country and rampages through locker rooms, the leagues are faced with an increasingly difficult question: What exactly should they do in order to continue play in a responsible way?

Experts say it can be a chance for sports to model a path for a new stage of the pandemic—one where shutting down entirely may actually not be the right answer anymore.

“These leagues have an enormous opportunity to learn and demonstrate how to coexist with COVID—how to teach the rest of us, frankly, how to do it right,” says Dr. Cameron Wolfe, an associate professor and infectious disease specialist at Duke University School of Medicine.

First, everyone must understand the nature of the challenge, and that there are several factors contributing to the current spike. One is normal seasonal variation—respiratory viruses generally tend to be worse in the winter. Another is diminished immunity among players who may have received their last vaccine shot months ago: “The longer you get from when people were either vaccinated or last infected, there’s going to be some less immune protection,” says Dr. David Dowdy, an associate professor of epidemiology at Johns Hopkins University. And while the delta variant is still dominant across the country, the highly infectious omicron variant has begun to emerge, too. (All three leagues have confirmed at least one case of omicron among their players.) This has made it more difficult for leagues to identify cases quickly with their previous standards for testing and tracing—even in vaccinated environments, such as most locker rooms; the coronavirus is simply moving too fast.

“I think what this speaks to is more infectivity and shorter incubation periods,” says Wolfe. “Which sort of throws on its head the previous ways we had done contact tracing.”

The leagues will have to develop more nimble testing and tracing plans—and fast. That means more frequent testing to identify cases, “especially omicron cases, before they can spread into big clusters and outbreaks within teams that could potentially force the postponement of games,” says Zachary Binney, a sports epidemiologist at Oxford College of Emory University. While there isn’t a singular protocol that can suddenly halt or slow the spread of the coronavirus, Binney says there are several that can work in combination. Along with improved testing, perhaps the most important is the most straightforward: booster shots, as quickly and as widely as possible, to address that diminished immunity. And finally, the third key is the sort of plan we saw last year: masking indoors and distancing or moving activity outside when possible.

That’s roughly how the leagues have responded. While none have mandated booster shots for players—just as none mandated the vaccine originally—all have said they encourage them. The NBA has updated its definition of “fully vaccinated” to include a booster, while the NFL has required all Tier 1 and Tier 2 employees get boosted by Dec. 27. Meanwhile, the NBA has temporarily instituted daily testing to assess cases, and the NHL will reportedly do the same. (The NFL Players Association has requested daily testing as well, but the league is currently holding its position of testing daily only for unvaccinated personnel while testing weekly for the vaccinated.) The other shifts are largely back toward measures that were in place last season: All three leagues have moved to require masks again for a variety of activities indoors. Meanwhile, NFL meetings will be held either virtually, or outdoors, or within the practice bubble with social distancing, and NHL players have reportedly been asked to minimize social activity outside of their teams and families.

The leagues, in other words, are on the right paths, though it would certainly help to have some more aggressive measures. For instance, stronger incentives for players to get boosters (if not mandates, which would require union approval) and finding ways to ensure that players actually do wear their masks properly (a relatively rare occurrence, if you’ve glimpsed an NBA bench this season).

Even all of that can’t stop the coronavirus from spreading completely, but ideally, these changes could “really contain” it, Binney says. The situation speaks to the new phase of the pandemic we’ve entered, where the question is less about shutting things down and more about accepting that the coronavirus isn’t disappearing anytime soon, so we must find safe ways forward, using all the tools now at our disposal.

To that end, the spike has prompted a question for those who have tested positive already: With so many players sidelined, and teams reeling as a result, should asymptomatic cases be able to return to play more quickly?

In the NFL, the current wave has featured “a very, very large percentage of asymptomatic or mild illness,” Dr. Allen Sills, the league’s chief medical officer, said in a media briefing Wednesday. “Two-thirds of people have no symptoms at all that have been diagnosed. The others have very mild symptoms. … I think that this reflects a new phase of the pandemic where things are very different than what we’ve seen before.”

The NFL announced Thursday that it would change its protocol in response to that information. Previously, players who tested positive could return to the team without a 10-day waiting period only if they had two negative test results 24 hours apart. Now, if a vaccinated player tests positive but is asymptomatic, there is a pathway to come back without the 24-hour wait—with two negative tests taken at the same time, a combination of either rapid or PCR. In other words, it’s hypothetically possible for a player to be sidelined by a positive test for just one day, if he exhibits no symptoms and tests negative twice the next day.

“If you’re asymptomatic, and you test negative, it’s very unlikely that you’re going to spread the virus to others. That's the good news about vaccines—even if you get infected, you clear the virus more quickly,” Binney says. “There’s definitely room to have discussions and lighten up those return-to-play protocols a bit.”

With new analysis of the omicron variant coming through daily, some of these measures might need to shift, perhaps even quite soon. But that ability to shift is exactly the point—leagues need to be willing to be flexible, whether that means tightening or loosening protocols, to move along with the coronavirus.

“I hope that really is the lesson here, that yes, we’re seeing cases come through, but it’s going to be manageable, because we can adjust and adapt,” Wolfe says. “We have to adapt, because the virus clearly is adapting.”

Beyond protocols for players, there’s also the question of which guidelines might be changed for fans. These are more likely to come from the city or state, rather than the league, as part of a whole suite of public-health measures. But some changes have already been seen in Canada—arena crowds are now limited in Ontario—and experts say that it could make sense to consider similar measures in high-spread areas of the U.S., too.

“I think we need to focus on interventions that are effective but not burdensome,” Binney says. “Sports leagues are not going to completely shut down. But do we need to go back to having masks or no concessions at indoor sporting events, or restricting capacity or something like that? I think those are discussions worth having right now.”

Professional sports can be like a “canary in a coal mine” for COVID-19, Binney notes. The widespread testing offers data that can hint at what might be coming in society at large. This means that leagues can potentially be a sign of what’s next—and of how to responsibly work through it.

“People like to think of COVID as an on-off sort of thing: Either it’s a big problem, or it’s not a problem at all. And I think it’s important for us to start to calibrate our responses a little bit,” Dowdy says. “Right now, cases are going up—they’re especially going up in certain parts of the country—so it makes sense to be a little more cautious for a little bit of time. But reinstituting restrictions does not mean that we’re going back into lockdown, or we’ll never be able to enjoy sports again. It just means that we need to ride the wave a little bit.”

More coverage:

• NFL's COVID-19 Protocols Need Rapid Change
• The Crossover: NBA Vs. COVID-19 With Dr. Robby Sikka
• Premier League Confronts the Potential of Another COVID-19 Stoppage