The NFL hosted a call with members of the media on August 4, 2021 to discuss intake COVID-19 testing at the start of 2021 NFL training camps.
- Jeff Miller, NFL Executive Vice President overseeing Player Health & Safety
- Dr. Allen Sills, NFL Chief Medical Officer
- Dr. Christina Mack, IQVIA epidemiologist and advisor to the NFL
- Dr. Deverick Anderson, Co-Founder and Co-Owner of Infection Control Education for Major Sports (ICS) and advisor to the NFL
Moderator: We do appreciate you joining us on short notice and at this hour, but we wanted to have a quick conversation led by Dr. Sills and Dr. Mack and Dr. Anderson. We also have here Jeff Miller and Megan Grant from the communications staff. And we'll spend probably the next couple minutes here with brief remarks and then get to a couple questions and then let you get back to your writing, reporting, and the rest of your night. So let's begin now, Dr. Sills.
Sills: Thanks, good evening everybody, good to visit with you as always. We wanted to provide a little bit of a snapshot of where we are with regard to our intake testing and what we've learned over the first week of our club experiences this year.
Over this first week we've tested a little over 7,000 individuals for COVID as all our teams were coming back together. And I think as all of you know, we've been testing unvaccinated individuals every day, we did a single intake test on the vaccinated individuals that have come back in. I can tell you as kind of a bottom-line story with regard to the results of that testing, that we're seeing fewer cases overall in 2021 than we did in 2020 with an intake.
Remember that [with] an intake, we're essentially taking a snapshot of where everyone is as they gather. It does not reflect what's happening inside our club facilities because people haven't been there. They're coming in from all over the country and we're taking a snapshot. So it's really a snapshot of the status of the pandemic in the country. But fewer cases overall and a lower incidence rate, and I think that both of those data points would suggest to you the positive impact of vaccination.
I think all of you are familiar with the vaccination rates among our players and staff and so I think that's what is driving this lower incidence and fewer cases. We are certainly seeing some positive test results among vaccinated individuals. Many of those individuals are asymptomatic or have no symptoms at all at the time of their positive test or following that. There are mild symptoms present in the remainder of those folks who tested positive, but no one who's been seriously ill, which I think is an important point and, again, speaks to the effectiveness of the vaccination. We also are seeing some of those vaccinated individuals with a positive test who are returning prior to 10 days from their tests. Most of you may be familiar in our protocol that if you're vaccinated and you test positive, if you test negative today or two times in a row separated by 24 hours, you can return at that point as long as you don't have any symptoms. And so they don't have to isolate the full 10 days the way we were doing in 2020 for everyone, or the way we would for unvaccinated individuals right now. So I think those couple of data points again suggests that there is a positive effect of vaccination and it is altering the illness trajectory of vaccinated individuals.
I think it's also important to note that there's a very small number of these cases overall and that's despite a tremendous increase in the number of contacts. As we look at our KINEXON data and proximity tracking, we're having many many more contacts among individuals than we did a year ago. So, again, that just suggests that despite more exposure, we're not seeing any corresponding increase in cases.
Our vaccination numbers are continuing to increase, the percentage of players that are being vaccinated. I think that's, again, a very positive development. We're still doing education, we're still having conversations. I think you'll see those numbers continue to rise, which we think is important. We have not conclusively demonstrated transmission among club personnel within the facility. There's still work going on with these positive tests. I think all of you know that we look at the genetic epidemiology and we look at, you know, transmission factors so that work is ongoing but we have not certainly seen what we would consider to be an outbreak in any of our facilities compared to what we saw in 2020.
And I would say one other point is that the implications and the causes of a positive COVID test are very different in 2021 than they were in 2020. What I mean by that is in 2020, if you tested positive for COVID, you either were infected or perhaps you had been previously infected and you were having what we call viral shedding. But in 2021, we're now seeing in vaccinated individuals a range of other causes including what we would call transient inoculation, meaning that there's virus we can measure inside the nasal cavity but again, it's not creating illness in the individual and likely not spreading to anyone else. So, there's a lot more work to be done to unpack that but that's just some insight into the fact that directly comparing positive cases is challenging and is something we'll have to continue to work through. So we will continue to work to understand the data, as I mentioned before we've got genetic analysis underway.
We're also looking at the prevalence of variants, obviously as everyone is, and we'll continue that work. And we'll review this data – as I mentioned we've only got a week's data – we'll review that with our own experts and our advisors. We'll certainly be talking about it with the NFLPA and their advisors, and we'll do just what we did last year, which is that we'll adjust our protocols based upon the data. One week into the collection process, as I said there's a lot more work to be done, but we're excited because we think that we've got a really unique opportunity here. We don't really think anyone else is out there testing the large-scale numbers of vaccinated, asymptomatic individuals like we are with these types of sensitive tests. And so we're going to have a very unique contribution that I think we can make to our understanding about what it means to have a positive test in a vaccinated individual and also the ongoing protective effects of vaccination. So with that I'll stop and turn it over to Dr. Mack, see if she wants to add any comments.
Mack: Thanks, Dr. Sills. I think to reiterate some of the good points here, first and foremost the vaccination rates among the players and the staff are very high and effective. And we know that vaccination is protective against the disease and it's really important for public health. That we know. Following that, there is a lot to learn. So just like last year, we are going over something about COVID-19 everyday once again. It's a very unique population so we had a really unique opportunity here. Within the NFL, we're testing asymptomatic individuals frequently and here, importantly, we're testing large numbers of vaccinated, asymptomatic individuals frequently. We're using a very sensitive test, we are putting forth detailed contact tracing so we will know if someone's exposed, the nature of that exposure, and who else may have been exposed. So we're going to pick up those exposures and infections that otherwise we don't know about, and we'll be able to analyze that.
We spoke to many of you last year often, and you have witnessed that this is a very-data driven exercise. It is about looking at these data at the right time, and we have an updated [inaudible] keep the teams and players safe. So staying guided by that science and evolving the protocols as needed will define if we need to change something. And so the key point is that we'll do that strong contact tracing, we'll analyze the test results combined with that KINEXON data, and then we'll make the needed changes to keep the teams and the players safe.
Anderson: Dr. Sills and Dr. Mack have made important points here. One of the things I may underscore is as at this time last year, there's certainly ongoing unanswered questions. And I think one of the unique components of the program the NFL has together is they're really putting themselves at the front edge of the ability to answer a lot of the unanswered questions at this point. So, things are very relevant, not only for the team environment but for public health in general.
What are the implications about symptomatic versus asymptomatic vaccinated individuals? How contagious are those that are asymptomatic? How long can they have viral shedding? Those are potential questions we don't know the answers to right now. But I think with some ongoing analyses within the data currently being collected, we'll be in a really good position to not only inform what keeps the players and staff safe in the NFL, but some really good public health information as well.
Moderator: Let's open up to questions.
Question 1: Dr. Sills and anyone else who wants to chime in, I'm curious between the data and the updated CDC guidance, what interest or appetite is there in, number one, testing vaccinated players more often than you are now and, two, reinstituting mask wearing indoors?
Sills: Well I think that our approach is always to be flexible and adaptable and open to what the data is showing us, and so we're going to follow the data with regards to everything in our protocols including the frequency of testing and mask guidance and so forth. We are doing, obviously, more frequent testing in subpopulations right now. We're testing the unvaccinated individuals every day. If we have vaccinated individuals who are considered significant exposure to positive cases, we're also testing them daily for several days after that exposure. And of course anyone who presents with concerning symptoms we're also testing more frequently. So there is more frequent testing that's already underway with our current protocols.
And, by the way, that's a little more stringent than what you're seeing recommended by a lot of public health authorities. Currently the CDC is only recommending vaccinated people be tested for symptoms and that's what we're doing in healthcare. For example, me as a physician working in a hospital, or Dr. Anderson, we're not routinely testing vaccinated individuals in a hospital unless they develop symptoms. So I think we are in line there with that guidance. Similarly, with regard to masks, right now our unvaccinated players are wearing masks anytime they're inside. The only time they're unmasked is outside. They are obviously not congregating in areas even with masking; and when they're inside, they are having to be distanced from other unvaccinated individuals.
So, I think many of those components are already in place. But you know, what we're going to do here is just what we did last year: we're going to continue to look at the data and see what it's telling us. And as I mentioned before, continue to try to better understand the implications of these positive tests in vaccinated individuals and use that data to drive us about what the optimal frequency of testing can be.
Question 2: Dr. Sills, the NFLPA sent out a memo saying they were going to push for more frequent testing for vaccinated individuals. It also mentioned that there has been two – according to the memo – outbreaks among teams; they cited Atlanta and Miami. To what extent is this call a response to that, and the use of the word "outbreak", and if so, what is the disconnect there between you and the NFLPA?
Sills: I don't think there is a disconnect. We've always tried to engage around health and safety issues and have an open mind to all points of view, and that's what we'll continue to do. We all have the same goal, which is to create the safest possible environment for our players, coaches and staff, so we will continue to have discussions around the data and share our thoughts back and forth as we jointly develop these protocols. In doing that, as I mentioned before, we are collecting a lot of data and we will continue to share that data with our experts. As we collect that data and analyze it, if we think we need more frequent information, vis a vis more frequent testing, then we will discuss that again with the NFLPA and make that decision jointly. But, that will be driven strictly by our data and what we're seeing, and if we think there is truly a yield on that.
With regard to your question about an outbreak, obviously I am not at liberty to discuss specifics of any team, but I would just refer you back to my opening statement. which is we have seen situations where we had multiple cases within one team, multiple positive cases. That's very different to us from an "outbreak," which we would define as uncontrolled spread without an understanding of transmission and lack of protection of individuals. And I am quite adamant that is not what we've seen at this point in any of our clubs. Obviously, we will continue to track and monitor those situations and those tests. But I do not agree that we are having outbreaks at any of our clubs at this point.
Question 3: What is the vaccination rate as of today?
Miller: We're at 90.3% of all players vaccinated. As far as club personnel goes, tier one, tier two, almost every club is 100%.
Question 4: How would a club not be at 100%?
Miller: There's I think a small handful of exemptions for specific medical reasons that are run through medical experts and reviewed with the club. I think that's a very small number, I don't even know what is on top of my head but, a handful.
Question 5: Dr. Sills, when you say that the numbers were lower in terms of the intake testing, is it possible for us to get the data from that first week of entry testing relative to last year?
Sills: Yeah we will certainly get to it. Again, we're working through that because we want to always confirm test results. We don't just take a single test. We also want to look at the illness trajectory of each individual. Did they develop symptoms? How long did the illness last? And then we want to get any of the genetic or other information back. So it just takes a little bit of time to collect that data. Obviously, as you said, we're barely a week into this and so we'll need a little bit of time. But once we get all that back, we're absolutely happy to share it in the same way that we did last year. It's our intention to be as transparent about all this as we can. We just wanted to have a chance to brief everyone about what we're seeing so far in the first week and where we are with our view on the data to this point.
Miller: And by "share," we're also talking about sharing information with the CDC, public health officials, and others to help us interpret it as they have in the past. I think that part was a really important aspect of the work that Allen led last year. So where we needed to change our protocols or be flexible and adaptable, we were able to do so reliant upon experts in the field. Same thing here. We don't necessarily rely on a few days' worth of data. We take a look at a longer trajectory and make sure that it's reviewed by experts, and their opinions are shared with us, and we share those with the PA, and then we make decisions collectively.
Question 6: I know you guys are talking about the data, but, in general how concerned are you guys about the delta variant and is there any guidance that you're getting the teams that are in particular hotspots -- particularly the three teams in the state of Florida?
Sills: Well I think all of us in medicine are concerned about the delta variant and particularly concerned about its effect on unvaccinated populations. And that's why we continue to really try to push for vaccinations among anyone who's not yet vaccinated among our NFL environment. We still believe as medical professionals that the best defense that we have against delta variant, or any of the variants that may be to come, appear to be these vaccines. They're the most effective strategy we have. So, I'm concerned about that yes, and we want to continue to promote measures that will allow us to hopefully successfully defend against that. But I think that's a message that has to resonate everywhere, because it's not just about a few hotspots. The data would suggest delta is widely distributed throughout our country, and today's spot that doesn't seem to be a hot spot may be within a few days time. And so I think it's something where we have to be vigilant and we have to be applying the same standards across all 32 of our clubs to keep everyone as safe as possible.
Moderator: OK, that's a good place to stop. Appreciate your help everyone, thank you.