Media Briefing Transcript: Dr. Allen Sills COVID-19 Updates at Special League Meeting, Dec. 15, 2021

SILLS: Good afternoon, everyone. We want to discuss a little bit about what we updated ownership about earlier today. I think all of you are aware that there's been substantial increase in our positive cases over the past several days. I think this reflects that we're entering a new phase of the pandemic. Something that's different than what we've seen before, where really the rules have changed. The dynamics of the pandemic have changed for us. I think that's going to cause us to challenge some of our previous assumptions and also update our strategies and our solutions. As I heard someone say eloquently, I think we can't apply 2020 solutions to the 2021 problems that we're having. We need to thoughtfully address the situation as we see it.

Why do we think there's this substantial increase in number of cases? I think there are several reasons that we can point to.

The first of those is, I think, Omicron. I think that the data is very clear. We've isolated several cases of Omicron in our NFL cases. That takes a little time. It doesn't happen instantaneously, but we already have some early signal in from more than one club. I think the data would suggest to us that this variant is going to take over and become the dominant variant in our country very quickly. So, I think that's a driving factor.

I think secondly, immunity is going down. We're seeing waning immunity and I'll share with you a little bit more on that point in just a minute. Then I think also seasonal variation. We know as physicians all upper-respiratory illnesses tend be worse in the wintertime.

There are some differences though, I think. It's not just that we're seeing more cases, we're seeing a different-looking set of cases. I think that's, first of all, far more players affected than staff. As you know we have about twice as many staff as we do players who are testing. Typically, we've run a higher ratio of staff cases to player cases. Over the past four to five days, we've seen that ratio inverted. So far more players affected than staff. Most importantly, a very, very large percentage of asymptomatic or mild illness. In fact, just looking at our data for the last two days, two-thirds of people have no symptoms at all that have been diagnosed. The others have very mild symptoms, symptoms that might even require them to seek a test under ordinary circumstances. So I think that this reflects a new phase of the pandemic where things are very different than what we've seen before.

Now, I mentioned that we have data about immunity and about the waning of immunity and that's coming from the study that we did. I think all of you were aware that we did a study that we spoke about last time we were together. We had 572 staff who volunteered to get their antibody levels checked. That's actually the data you have in front of you, not to have a class lecture, but if you look at this piece of paper, at the top of this is a histogram showing you the distribution of those 572 people and what their antibody levels were. The top of the chart is higher levels of antibody -- and in our scale of 2,500 is the max. Then you go all the way down to zero and you can also see on the X axis, the horizontal axis, the number of days since somebody got their vaccination series complete.

Antibodies

This data is only in vaccinated people, but what this chart shows you is that we have a lot of people in the NFL who have fairly low levels of antibodies. There are people that we would consider fully vaccinated or protected, but now they fall down to the bottom of that chart. And what you also see is we have a lot of people at the very top of the chart, and those are typically two types of people. People who've been boosted, and then those who've had recent COVID infections. Boosters clearly restore and get you to that highest level of antibody that we see on the chart.

We focused on boosters, and that was a lot of our message to the owners today. A lot of our message over the past few days is, why do we think boosters are important? Well, for several reasons, one is that the CDC is recommending them. But secondly, because of these antibody levels. By the way, this data that we show you on this histogram sort of confirms what the NBA found in their antibody study. They found a similar distribution. If you remember their data, they had a lot of people who had zero levels -- not a lot; they had about 3% of people with zero antibody levels; that rose to about 11% for people who had the J&J vaccine. So, we sort of have replicated those findings here.

But I think also we're focused on boosters because we think it's our best protection against this new variant, against Omicron. It certainly remains our best protection against Delta. People who are boosted are going to be less likely to test positive.

They're going to have less severe illness. We think here's reasonable data that they are less likely to spread their illness as well.

booster

Also, two other important points about boosters. Your antibodies don't seem to wane as quickly after you've been boosted as they do for the native vaccine, and the boosters are safe. I think we can say conclusively that significant side effects after boosters have not been seen either in NFL population or in other populations. In other words, you're still far more likely to suffer severe symptoms or outcomes from COVID infections than you are from being vaccinated or boosted.

I'll just wrap up by saying that we're having a lot of active discussions about all this data and about how we respond to this new phase of the pandemic. Those discussions include, obviously, our own experts -- infectious disease, epidemiologist, public health experts, and others. We're having active discussions with the NFLPA and their experts and public health officials. We're doing what we've always done. We're evaluating what we're doing and looking at the effectiveness of our strategies and we're measuring that against our outcome. And we do that for every phase of our program, whether that's our testing, our mitigation, how we return people, and what our outcomes are. So, we'll continue to do those things and we'll circle around our top goal which is always to have the safest possible environment for our players, coaches, and staff.

QUESTION: In light of what you mentioned about the large percentage of cases in the last two days being asymptomatic, what do you think is the prospect for adjusting the protocols in a way that would allow for a quicker return to play of a vaccinated, asymptomatic person quicker than the two negative tests now?

SILLS: Yeah, we're always looking at that aspect of how we return someone -- and again what's the goal there? You're trying to return someone when it's safe for them, when they are no longer a risk to themselves or to others. And so again, we have to learn and evaluate that against the data that's coming out and so we study our returns very carefully and we look at that in light of those outcome measures. And so, I think those are obviously ongoing discussions and things that we will consider. But again, it's not about how soon we get someone back, it's we want to bring someone back when it's safe for them and when they are not a risk to others in terms of transmission. And we just have to update that now based on what we're seeing with this new variant and its effect.

QUESTION: Have you guys thought about different ways where you could incentivize players getting the booster? And maybe in particular before the playoffs start.

SILLS: We're working really hard to get as many people boosted as possible and, you know, when it comes to players, again we've had very active discussion, and great collaboration, with the NFL Players Association -- their leaders and their advisors join us in believing that boosters are incredibly important and are the best strategy we have to keep everyone safe.

So, we're addressing that with a lot of education. Just today we sent out a video that I and a couple of other experts did, we've given presentations done to the clubs. So, we'll be sharing a lot of that information and doing everything we can to encourage and incentivize people to get boosters because we believe it's the safest thing to do medically.

QUESTION: Dr. Sills, as you work toward perhaps changing the protocols, are there other intermediate steps you can take; that you anticipate taking? Perhaps putting teams in enhanced protocols? And also, what kind of timeline do you think is necessary if there's some urgency to perhaps change the protocols in terms of getting asymptomatic players able to return quickly?

SILLS: Well, I think the urgency is dealing with what we see in front of us which is this large increase in positive cases and responding to that change in conditions that I mentioned. So, this is urgent for us just as it always has been, and I think we've, you know, adapted and changed our protocols at each at each stage really just based on what the data is telling us and where it's driving us with that. So that's what we'll continue to do here.

Your first question again? Intermediate steps? So I think there are other elements that we are focused on which is specifically masking within the facilities. How many meetings we have, the conditions of those meetings, our meal times, some of the things where we do see transmission occurring in the facility. I think that's another transition point here. Up until a week or so ago we really weren't seeing transmission in the facility, and now with this new variant I think we're seeing more exposure, so that's going to require us to make some adjustments to our policies in this facility.

I'll point out one other thing, and that is you know that we've put some of our clubs that have had large numbers of cases in an enhanced protocol. And we've actually gone back and looked at the effect of that. Does that work? And basically, we just studied five of those, we just completed the analysis, four of those five clubs had no additional positive cases after we got them into that protocol. The other one had a little bit of a trickle out. So, I think we're learning again from that, as we're learning all the time, that these measures that we put in place really do seem to stop the spread within the building and we'll have to lean on that now in this new phase.

QUESTION: The PA has been pushing for some time now, daily testing for players. What is the counter for the NFL for not doing daily testing, especially, as you say, the rules have changed, the dynamics have changed?

SILLS: Well, I think we always look at all of the tools we have at our disposal, and testing is one of the tools that we have at our disposal. And it's a very useful tool in certain areas, but what testing doesn't do is prevent transmission, and we've known that always. And that was true last year, it's still true today. And so, again, as we look at how to respond, what we're trying to do is prevent spread within the facility and keep people from testing positive. "Keeping them from testing positive" takes us back to their immunity: getting the booster, getting their antibody levels up. "Spread within the facility" is more about these other measures that I just spoke about. So, I think as we look at any measure -- whether it's testing, masks et cetera, we always have to look at what the impact is on that.

And I think it's also important to recognize that in health care, we're not doing surveillance testing of asymptomatic people. You know, I'm a physician, I work at a major academic medical center, we're not testing doctors, nurses, and other health care providers – even those who work in with very compromised patients – on an asymptomatic basis. Why is that? Well, because it just hasn't been found to be effective as a preventive strategy.

And so, I think that we're always trying to align ourselves with what healthcare is doing there, and they found that to be useful.

The last thing I would say is, we've got multiple examples where someone tested negative on one day, tested positive the following day, and was able to spread to others in that 24-hour window, right? We saw that last year and we saw that this year. And I think that tells you once again, testing doesn't prevent transmission -- you have to rely on those other measures to make sure that we're not creating spread within our facility.

QUESTION: How many teams right now are in enhanced protocols? 

SILLS: Five.

QUESTION: And the second part of that is: you talk about the asymptomatic, do you see a day when we treat this more like the flu when asymptomatic players aren't tested and go out there and play on the field? Because you guys have said repeatedly you don't think that you can transmit it on the field once you're out there.

SILLS: Yeah, I think that we have to constantly evolve our definition, again, of what's dangerous. Because, again, you got to remember what we're looking at is: when is someone dangerous to themselves and when are they dangerous to others? So, we'll have to see where the data takes us on that.

But again, those aren't decisions we make in isolation, we're going to make them in conjunction with our medical experts, with public health authorities, because they do really have a lot of broad public health implications as well. But I think what we can do is: in many ways, if you think about it, we're often at the tip of the spear in seeing some of these changes before they show up in other elements of society because we do have so many tools at our disposal, right? We are able to offer on-site testing, we can do genomic sequencing, we have the tracing technology that we have, so that I think that allows us to make some of these observations at a really early stage and help understand when things are changing.

And that's why we see some of these changes, sometimes, before other elements in society do. And I might say, along those lines too, we foresaw some of this uptick in cases coming when we got this antibody data and we understood our immunity level. That, plus the arrival of Omicron, we were fairly confident that we were going to see an uptick in cases. 

QUESTION: Dr. Sills, I'm wondering what your reaction was to Kevin Stefanski testing positive today after having already had COVID, having the vaccine, and being boosted. How unusual of circumstances is that in your opinion? 

SILLS: Well obviously, I wouldn't speak to anyone's private health matter publicly other than to say that: listen, every case that we have represents something significant to us, right? That's a patient, that's a life impacted, that's a household, so every one of those is important to us.

But I think the larger question that you're raising is, can people who are vaccinated and boosted still test positive? The answer is yes. And maybe even they've had COVID. However, if you look at the antibody chart, just because you're at the top doesn't mean you can't test positive; what we're saying is that you lessen your risk, you lessen your odds of testing positive by being vaccinated, by being boosted, and by having a high level of immunity. But it's not going to be 100% protective. What I think we can say confidently is those individuals with the highest level of protection are very likely to have shorter duration of a much milder illness without severe outcomes and that's substantial, that's significantly important.

QUESTION: A few minutes ago you said that testing doesn't prevent spread, I understand that, but wasn't one of the key elements of last year's success story that the frequency of testing allowed you all to remove a positive case from the group environment that much more quickly because you're getting that feedback every 24 hours instead of less frequently? And that that gave you more real-time information about whether games can proceed or not? Has something changed that is less so the case now or?

SILLS: Well, I think circumstances have changed substantially. First and foremost, the biggest change is vaccination, right? You look and see that we're 100% vaccinated with our staff, 95%, almost, vaccinated with our players and we have a lot more information this year than we did a year ago.

And what we actually published, if you go back to January of 2021 we published with the CDC our NFL experience. And the messaging of that wasn't that it was testing that was the key, the key was our recognition of the factors that drove transmission and our ability to adjust and pivot our protocols around those factors, which was, again, the in-person gathering, the ventilation, the use of masks, the tracing of high-risk contacts.

So again, let me clear, testing is a tool, it's a tool that can offer certain things but it has certain limitations. And I do think, as I said, you have to look at each era -- or each phase -- of the pandemic as to what the value of testing is. And while it provided us some useful information last year we were in a different phase of the pandemic now, and it's very clear, as I said, that routine surveillance testing of asymptomatic people has not provided – has not stopped spread or stopped transmission. It's these other measures that we have to focus on.