On April 7, 2021, the NFL hosted a webinar with medical leaders from English rugby leagues to discuss their COVID-19 mitigation strategies, explore how those strategies compare and contrast with those of the NFL and highlight key learnings from playing during a pandemic.
Watch the full event here:
NFL Chief Medical Officer Dr. Allen Sills was joined by:
- Dr. Simon Kemp – Rugby Football Union Medical Services Director
- Dr. Katy Hornby – Rugby Football Union England Women's Senior Team Doctor
- Dr. Brendan Payne – Independent Medical Virologist
- Dr. Gemma Phillips – Rugby Football League COVID-19 Medical Officer
Below are some highlights from the experts:
On the most effective COVID-19 mitigation strategies:
Dr. Sills: "It was not the extensive testing, it was not the fancy contact tracing devices, or, frankly any other technology, that kept us safe. The difference between clubs that had positive tests and some outbreaks and those that did not really boiled down to the absolute basics: wearing masks and mask compliance at all times, in meetings, in travel, in any kind of team activity.
"But I think another key element of our success was trying to reduce in-person meetings as much as possible. We really encouraged our teams to meet virtually. In fact, we took two days a week, when teams would normally be meeting and training and having sessions together, and said that the clubs could not open on those days—the only people who could come into the facility were those seeking medical care."
Dr. Hornby: "Logistically, because women's rugby is semi-professional, and they have day jobs as well, testing wasn't going to be the answer. So, we needed to think about something else. Using Dr. Philips' Risk Exposure Framework, we tried to identify the high-risk activities that were taking place and then we looked at what the occurrence of those high-risk activities were.
"We also looked at player proximity data and we actually found that for all the possible player proximity levels, no one ever really got over those 15 minutes of being in a proximity that would make them a high-risk. We needed to look more at the high-risk activities; scrummaging was something that we felt was a high-risk activity and mauls and tackles as well. So, we needed to reduce the number of scrums. We went from 19 scrums per game to around two to three, and only one reset scrum, so that reduced the amount of concern we had around that face-to-face contact and that high-risk activity."
On defining high-risk close contacts:
Dr. Sills: "We developed a system of identification of high-risk close contacts. Basically, we early on learned that not all close contacts were created equal and that, if we did detailed interviews and integrated the contact tracing data, we could, with a fairly high degree of accuracy, determine who was at high-risk for developing COVID-19 after an exposure. And our protocol was, if you were exposed to someone, and you've met those criteria for high-risk close contact, then you had to isolate for five days, regardless of test results.
"Again, we chose those numbers and those parameters based on our experience and over the course of our season we had 40 different individuals who we identified as high-risk close contacts who subsequently did test positive and so we were able to prevent those individuals from being in the team facility and potentially spreading COVID-19 to others."
Dr. Phillips: "We come from a place that said, initially, that anybody on a field would have to isolate if there was a positive case. And, you know, if you are on one side of the field to the other, you might never come into contact, so, we felt that wasn't quite applicable. So, over time, we developed, from the initial framework, which used 1 meter proximity as being what we deemed as "close," and we introduced an element that considered the ventilation in the air in which your exposure was occurring.
"So firstly, we acknowledged that indoors was significantly higher risk than outdoors. So, where we initially just considered directly face-to-face to be a risk, we broadened that to say that if you were facing each other, in the direction of your faces but, not directly in front of each other, it would count, indoors, as more significant contact. Furthermore, we recognized that over time, you get accumulation of the amount of particles of virus in the air so we recognized that the longer you spent indoors, that was much more of a problem. So, when we had the initial timeframe of 15 minutes, we reduced that really considerably right down to the one-minute accumulated exposure."
Rugby Football League used the framework above to determine high-risk close contacts as part of their contact tracing protocol.
"And I think the other real development that we made was recognized, outdoors, the risk was quite low on the field. We did not see a huge amount of transmission. Initially we had said three seconds or more, face-to-face contact, outdoors, would be a high-risk exposure but, then we doubled that. So, outdoors it would be six seconds but, indoors, again, we kept that at three seconds, recognizing the risk of being indoors.
"This [approach] got adopted by professional sports but also by community sports. It was used as a contact tracing framework but, also as a way to assess the components of your game and which activities were deemed to be high-risk or otherwise."
On preventing individual cases from becoming outbreaks in the team environment:
Dr. Kemp: "The positive cases in rugby league and rugby union clubs absolutely mirror the community prevalence. And so, at the start of this, our focus was not to let positive cases get into clubs, and I think we flexed and flipped and realized what we really needed to do was prevent outbreaks from happening."
Dr. Sills: "We said from the get-go that we are going to have positive cases because our players are out in the community and that is where they are getting exposed — not inside the facilities. But what we were trying to do was prevent that outbreak. We didn't want one case to become five and eight and ten. And obviously, we had a couple of outbreaks within clubs but, when we had those, they were from fundamental breakdowns in the basics of the protocols. It is almost impossible to prevent those isolated cases if people are out in the community, it's what can you do to prevent spread within the team."
As the leagues look ahead in 2021 and beyond, they will continue to follow the data on community transmission, share learnings with each other and remain flexible in their COVID-19 responses to ensure players feel safe and confident in the evolving protocols.