Anatomy of an American football game: Player-to-player contact before, during and after an NFL game in context of the 2020 COVID-19 pandemic.

OBJECTIVES: To quantify levels of potential exposure to SARS-CoV-2 surrounding a typical professional American football game, with a focus on interactions on-field between teammates and opposing players before, during, and immediately after competition. METHODS: We examined across-Club consecutive interactions ≥2 minutes within 6 feet [1.8 meters] between athletes on opposing Clubs for all 2020 NFL regular season games (n = 256). Cumulative interaction was measured for a representative subset (n = 119; 46%) of games. Wearable proximity tracking devices (Kinexon) were used to measure distance and duration of interactions; these data were combined with game schedule and Club rosters for analyses. Frequency and per-game mean, median, interquartile range for consecutive interactions ≥2/≥5 minutes and cumulative interactions ≥5/≥15 were described overall and stratified by pre-game, in-game, and post-game. RESULTS: Of the 1964 distinct player-to-opponent contacts ≥2 minutes in NFL regular season games, the majority (n = 1,699; 87%) were fewer than 5 minutes in consecutive length. Among the mean 7.7 distinct contacts ≥2 minutes with opponents each game (median = 4; IQR = 2, 8), very few were ≥5 consecutive minutes at any point (mean = 1.0; median = 0; IQR = 0, 0). Most (n = 849; 43.2%) distinct contacts were pre-game, 546 (27.8%) were during competition, and 569 (29%) were post-game. In games where cumulative interactions were analyzed, there was an average of 17.1 player/opponent interactions with cumulative exposure ≥5 minutes (median = 12; IQR = 4, 30), almost all of which occurred during competition. CONCLUSION: There is limited and short contact between and among competing players in professional American football. In the setting of infectious disease such as the COVID-19 pandemic, a robust prevention program integrating masking, distancing, hygiene, and ventilation when off-field can be created to minimize on- and off-field exposures, which effectively reduces transmission risk in outdoors and/or well-ventilated stadium settings.

Assessing Professional Fulfillment and Burnout Among CEOs and Other Healthcare Administrative Leaders in the United States.

GOAL: The objective of this study was to evaluate the prevalence of burnout and professional fulfillment among healthcare administrative leaders and examine the association between burnout and professional fulfillment and personal and professional characteristics. METHODS: Between June 7 and June 30, 2021, we performed a national survey of CEOs and other senior operational leaders to evaluate their personal work experience. Burnout and professional fulfillment-as well as a sleep-related impairment and self-valuation-were assessed using standardized instruments. PRINCIPLE FINDINGS: Of the 5,994 members of the American College of Healthcare Executives who were sent an invitation to participate, 1,269 (21.2%), including 279 CEOs, submitted usable responses. The mean overall burnout score was 2.71 (range: 0-10), and 33% of participants had burnout scores that fell in the high range (unfavorable). Mean professional fulfillment score was 7.29 (range: 0-10), with 56.6% scoring in the high range (favorable). Burnout and professional fulfillment scores varied by role. On multivariable analysis, sleep-related impairment (OR for each 1-point increase = 1.29, 95% CI [1.19-1.41]; p < .001) and self-valuation (OR for each 1-point increase = 0.63, 95% CI [0.57-0.68]; p < .001) were independently associated with burnout after adjusting for all other variables. APPLICATIONS TO PRACTICE: Results of this study suggest that healthcare leaders had lower burnout and professional fulfillment scores than clinicians. Nonetheless, one third of healthcare leaders had burnout scores that fell in the high range. At the individual level, improved sleep health and self-valuation appear to reduce risk of burnout and promote professional fulfillment.

Effectiveness and use of reverse transcriptase polymerase chain reaction point of care testing in a large-scale COVID-19 surveillance system.

BACKGROUND: Rapid COVID-19 testing platforms can identify infected individuals at the point of care (POC), allowing immediate isolation of infected individuals and reducing the risk of transmission. While lab-based nucleic acid amplification testing (NAAT) is often considered the gold standard to detect SARS-CoV-2 in the community, results typically take 2-7 days to return, rendering POC testing a critical diagnostic tool for infection control. The National Football League (NFL) and NFL Players Association deployed a new POC testing strategy using a newly available reverse transcriptase polymerase chain reaction (RT-PCR) rapid test during the 2020 season, and evaluated diagnostic effectiveness compared to other available devices using real-world population surveillance data. METHODS: RT-PCR POC test results were compared to NAAT results from same-day samples by calculation of positive and negative concordance. Sensitivity analyses were performed for three subgroups: (1) individuals symptomatic at time of positive test; (2) individuals tested during the pilot phase of rollout; and (3) individuals tested daily. RESULTS: Among 4989 same-day POC/NAAT pairs, 4957 (99.4%) were concordant, with 93.1% positive concordance and 99.6% negative concordance. Based on adjudicated case status, the false negative rate was 0.2% and false positive rate was 2.9%. In 43 instances, the immediate turnaround of results by POC allowed isolation of infected individuals 1 day sooner than lab-based testing. Positive/negative concordance in sensitivity analyses were relatively stable. CONCLUSION: RT-PCR POC testing provided timely results that were highly concordant with lab-based NAAT in population surveillance. Expanded use of effective RT-PCR POC can enable rapid isolation of infected individuals and reduce COVID-19 infection in the community.

Results from a Test-to-Release from Isolation Strategy Among Fully Vaccinated National Football League Players and Staff Members with COVID-19 - United States, December 14-19, 2021.

During December 2021, the United States experienced a surge in COVID-19 cases, coinciding with predominance of the SARS-CoV-2 B.1.1.529 (Omicron) variant (1). During this surge, the National Football League (NFL) and NFL Players Association (NFLPA) adjusted their protocols for test-to-release from COVID-19 isolation on December 16, 2021, based on analytic assessments of their 2021 test-to-release data. Fully vaccinated* persons with COVID-19 were permitted to return to work once they were asymptomatic or fever-free and experiencing improving symptoms for ≥24 hours, and after two negative or high cycle-threshold (Ct) results (Ct≥35) from either of two reverse transcription-polymerase chain reaction (RT-PCR) tests† (2). This report describes data from NFL's SARS-CoV-2 testing program (3) and time to first negative or Ct≥35 result based on serial COVID-19 patient testing during isolation. Among this occupational cohort of 173 fully vaccinated adults with confirmed COVID-19 during December 14-19, 2021, a period of Omicron variant predominance, 46% received negative test results or had a subsequent RT-PCR test result with a Ct≥35 by day 6 postdiagnosis (i.e., concluding 5 days of isolation) and 84% before day 10. The proportion of persons with positive test results decreased with time, with approximately one half receiving positive RT-PCR test results after postdiagnosis day 5. Although this test result does not necessarily mean these persons are infectious (RT-PCR tests might continue to return positive results long after an initial positive result) (4), these findings indicate that persons with COVID-19 should continue taking precautions, including correct and consistent mask use, for a full 10 days after symptom onset or initial positive test result if they are asymptomatic.

Population testing for COVID-19: an approach for infection prevention

BackgroundPopulation screening with highly sensitive diagnostic tools, such as nucleic acid amplification testing (NAAT), can enable early identification and isolation of cases and reduce transmission of SARS-CoV-2.ObjectiveTo describe the results of a rigorous, large-scale COVID-19 testing and monitoring program with confirmatory processes and adjudication of positive results.DesignDescriptive Epidemiology StudySetting32 U.S. National Football League (NFL) Clubs during the 2020 seasonParticipantsNFL players and staffMethodsThe NFL/NFL Players Association instituted a COVID-19 Testing and Surveillance Program for the 2020 Season, which included daily testing for players and staff, full medical follow-up and adjudication of cases. Clinical adjudication was based on subsequent daily testing, symptoms, and clinical history;persons remained in isolation during adjudication.ResultsBetween August 1 and November 14, 2020, a total of 632,370 RT-PCR tests were administered to 11,668 individuals;270 (2.4%) confirmed cases were observed. PPVs of the initial positive result ranged from 73–82% across RT-PCR platforms. Initial positive results were positive on re-processing 61–79% of the time. PPV increased when both results were positive to >95%;however, initial positives that were negative on confirmatory processing resulted in true cases a portion of the time, depending on machine and population prevalence. High Ct values (33 to 37) could indicate onset of infection. Infected individuals were identified and isolated early in infection, preventing spread.InterventionsDaily or frequent testing using three NAAT platforms, rapid point-of-care testing, and symptom monitoring.Main Outcome MeasurementsCOVID-19 infection.ConclusionRoutine RT-PCR testing allowed early detection of infection. Cycle threshold values provided a useful guidepost for understanding results. Confirmatory processing of initial positive values significantly improved PPV. Antigen POC testing was unable to reliably rule out COVID-19 early in infection. Adjudication processes were able to confirm or rule out SARS-CoV-2.

Observed Versus Expected COVID-19 Infections Among National Football League Players During the 2020 Season.

BACKGROUND: The National Football League (NFL) and National Football League Players Association implemented a set of strict protocols for the 2020 season with the intent to mitigate COVID-19 risk among players and staff. In that timeframe, the league's 32 teams completed 256 regular season games and several thousand meetings and practices. In parallel, community cases of COVID-19 were highly prevalent. We assess the risk of holding a 2020 NFL season by comparing community and player COVID-19 infections. METHODS: We used county-level COVID-19 test data from each team to establish baseline distributions of infection rates expected to occur in a population similar in age and sex to NFL players. We used a binomial distribution to simulate expected infections in each community cohort and compared these findings with observed COVID-19 infections in players. RESULTS: Over a 5-month period (1 August 2020 to 2 January 2021), positive NFL player infections (n = 256) were 55.7% lower than expected when compared with simulations from NFL community cohorts. For 30 of 32 teams (94%), observed counts fell at or below expectation, including 28 teams (88%) for which rates were lower. Two teams fell above baseline expectation. CONCLUSIONS: The NFL/NFLPA protocols that governed team facilities, travel, gameday, and activities outside of the workplace were associated with lower infection rates among NFL players compared with the surrounding community. The NFL's 2020-2021 season are consistent with the hypothesis that robust testing and behavioral protocols support a safe return to sport and work.

Implementation and Evolution of Mitigation Measures, Testing, and Contact Tracing in the National Football League, August 9-November 21, 2020.

The National Football League (NFL) and the NFL Players Association (NFLPA) began the 2020 football season in July, implementing extensive mitigation and surveillance measures in facilities and during travel and gameplay. Mitigation protocols* were evaluated and modified based on data from routine reverse transcription-polymerase chain reaction (RT-PCR) tests for SARS-CoV-2, the virus that causes coronavirus 2019 (COVID-19); proximity tracking devices; and detailed interviews. Midseason, transmission was observed in persons who had cumulative interactions of <15 minutes' duration, leading to a revised definition of high-risk contacts that required consideration of mask use, setting and room ventilation in addition to proximity and duration of interaction. The NFL also developed an intensive protocol that imposed stricter infection prevention precautions when a case was identified at an NFL club. The intensive protocol effectively prevented the occurrence of high-risk interactions, with no high-risk contacts identified for 71% of traced cases at clubs under the intensive protocol. The incorporation of the nature and location of the interaction, including mask use, indoor versus outdoor setting, and ventilation, in addition to proximity and duration, likely improved identification of exposed persons at higher risk for SARS-CoV-2 infection. Quarantine of these persons, along with testing and intensive protocols, can reduce spread of infection.