What business probably had one of the most sophisticated contact tracing and contact warning systems of any business in the world — and definitely better than the White House in 2020? The National Football League. During the 2020 football season, the NFL had a highly sophisticated system for contact tracing for COVID-19 that led to a tune-up of more precise social distancing protocol restrictions and quarantines to protect players, staff and the NFL business. Extensive data analysis from resources implemented by the NFL discovered that 6-foot social distancing minimum with a 15-minute maximum was not a good protective measure for preventing the spread of COVID-19 illness.
“Risk mitigation is not one intervention, but a number of interventions you stack together in the hopes that the combination will be more effective than any of them individually.”
— NFL Chief Medical Officer Dr. Allen Sills
The NFL worked closely with infectious disease experts, the CDC, public health officials and medical experts from other leagues to develop comprehensive COVID-19 protocols and partnered with equipment manufacturers like Oakley to develop innovative equipment solutions aimed at mitigating the spread of the virus, according to the NFL.
The COVID-19 pandemic created an unprecedented need for contact tracing. Traditionally, contact tracing involves interviewing infected individuals, which is a time-consuming process that relies on human memory to recall human interactions and associated durations.
The NFL turned to the technology of the Kinexon Proximity Recording Device for a more efficient and accurate solution to mitigate the spread of COVID-19 illness league-wide. Players and personnel also underwent routine PCR (polymerase chain reaction) testing during the season.
The lightweight, small wearable proximity recording device is mandatory for players and NFL staff personnel when at the club facility, during practices, and during team travel. The device is worn as a wristband or on a lanyard, or built into players’ equipment for use on-field in practice and games.
The Kinexon Proximity Recording Device device gathers information about individuals’ proximity to each other – according to distance and length of time. The device doesn’t track their geographic coordinates (like a GPS) acknowledging privacy concerns. The Kinexon data is quickly accessible to perform quick and accurate contact tracing when someone is symptomatic or tests positive for COVID-19. Data from each Kinexon Proximity Recording Device is critical to identifying, isolating and testing anyone that was in close contact with an infected individual.
Contact tracing data from the devices is analyzed by IQVIA, an independent third-party a health information research and clinical research company that works with the NFL on player health and safety-related data (finance.yahoo.com | IQV).
Proximity Recording Devices also help enforce physical distancing to help prevent the transmission of the SARS-CoV-2 virus and COVID-19 illness. The wearable device notifies users with a Contact Warning with lights and sound if they are too close to one another or too close to individuals from other tiers.
NFL COVID-19 TIERS
Tier 1 includes players, coaches, trainers, physicians and necessary personnel who must have direct access to the players.
Tier 2 includes general managers, other assistant coaches and football operations employees, video personnel, and other personnel who might be in close proximity to players.
Tier 3 includes certain operational personnel, in-house media and broadcast personnel, field manager, transportation providers and individuals who perform essential facility, stadium or event services, but don’t require close contact with Tier 1 individuals.
Players and personnel are divided into tiers – Tier 1, Tier 2 and Tier 3 –to denote the level of contact they can have with each other.
For example, if a Tier 3 staff member comes too close to a Tier 1 or Tier 2 individual, a red warning signal appears on the device to alert them to move away. After five seconds, the device emits an audible alarm.
With the available data from the Kinexon devices, an important discovery was made that among 21 NFL cases for which contact tracing indicated “likely within-club transmission”, seven infected persons had no interactions exceeding 15 cumulative minutes per day within 1.8 meters (6 feet) of a person with COVID-19. This finding led to a revised high-risk contact definition that included ascertainment of mask use and settings (open air/ventilation characteristics), in addition to duration of exposure and proximity.
The important finding within the NFL, was that SARS-Co-V2 transmission was discovered in persons with less than 15 minutes of consecutive or cumulative interaction; and illness transmission was reduced through implementation of an intensive protocol focused on environmental change, increased personal protection (e.g., masks), avoidance of high-risk interactions such as vehicle sharing, eating in the same room or common areas, and expansion of the components of contact tracing to incorporate high-risk contact designations.
According to the CDC, although proximity devices provided detailed information about possible high-risk interactions; prompt, detailed, contact tracing beyond proximity device data was needed to identify high-risk behaviors and enable quarantine of exposed persons. All high-risk contacts who subsequently received a COVID-19 diagnosis were identified, at least in part, from information obtained through interviews. Indoor unmasked activities, ridesharing in personal vehicles, and eating and drinking in close proximity were of particular risk.
The increase in cases identified in NFL clubs in October 2020 and November 2020 mirrored the increased incidence in the United States during that time. These infections were primarily related to community exposures, based on contact tracing interviews and exemplified by the high proportion of persons who contracted COVID-19 after household exposure. Although the intensive protocol and high-risk contact designations were primarily intended to prevent work-related exposures, employees were regularly educated about risks from household and community exposure. Implementation of the intensive protocol with the proximity recording device and Contact Warnings decreased within-facility exposures despite increasing community transmission of COVID-19 across the country during this time.
The CDC concluded that although the protocols implemented by the NFL were resource-intensive, strategies such as accounting for specific characteristics of the close contact, in addition to time and duration, and creation of an intensive protocol are applicable to other settings, including essential workplaces, long-term care facilities, and schools.
Mack CD, Wasserman EB, Perrine CG, et al. Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9–November 21, 2020. MMWR Morb Mortal Wkly Rep 2021;70:130–135. DOI: http://dx.doi.org/10.15585/mmwr.mm7004e2.
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