Dr. Jessica Flynn's Mailbag

Dr. Flynn: NFL gets first big Covid test with Titans positive results

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Tuesday morning, in the fourth week of the regular season, the NFL announced the Tennessee Titans have eight positive COVID test results. Twenty-four hours after being swabbed Monday morning, three players and five staff received confirmed positive test results.

Less than 48 hours earlier, the Titans battled the Minnesota Vikings in Nashville. So far, contact tracing has found 48 close contacts of the eight positive individuals. Those close contacts likely include some Vikings players. As soon as both teams were notified of the new positive results, they both evacuated their team facilities. The Titans announced their facility will be closed until at least Saturday.

Unfortunately, some athletes and staff were already at both facilities on Tuesday morning when they were made aware of the results. This exposes a potential issue with the league’s game-day testing protocol, which is to test everyone by 8:30 am Saturday morning for a Sunday game and not to test them again until Monday morning. We will never know if having positive result(s) Monday morning could have prevented further spread in either facility, but there is a potential that facilities could have been closed earlier. It is possible that the league will adjust its game-day testing protocol in response to these events.

The Vikings announced they have no positive tests from Monday and, like the Titans, are awaiting Tuesday’s test results. Given the incubation period of the virus that causes COVID, tests are not likely to turn positive until an average of 4-7 days after exposure. Therefore, if any exposed Vikings were to test positive, it would not likely be known until Friday at the earliest.

According to the NFL/NFLPA protocol, athletes who test positive and develop symptoms must stay out of the facility for at least 10 days after a positive test or if 5 days have passed since the initial positive test and 2 consecutive negative PCR tests at least 24 hours apart. If an athlete with a positive test develops symptoms, he must remain out for at least 10 days since the onset of symptoms, and at least 72 hours after symptoms pass. In both cases, the athlete must be cleared by the team physician.

We now have our first outbreak in the NFL. This is the big test. Now that real palpable money, fairness, and the spider web of the regular season schedule are on the line, we’ll see how the league responds. Can the Titans safely play in their home stadium only five days after learning they have an outbreak? Can they fairly compete in a game without any in-person practices all week?

We all know that an outbreak on one team doesn’t just affect that team. The Vikings are waiting to see if they escaped their exposure this weekend unscathed. If exposed athletes who become infected are most likely to test positive 4-7 days after exposure, they may not know of potential positives until Friday or maybe even early next week. When is it safe for them to practice ... and compete nose to nose with another team? Can they travel to Houston on Saturday and face the Texans on Sunday?

These questions reflect the grey area in the NFL and NFLPA’s COVID protocol. Up until this point, the league has refused to comment on what number of athletes constitutes a cluster or outbreak or how many positive tests or exposures it will take to postpone games, citing that every situation is different. Instead, the league has expressed that they must remain flexible and respond to challenges as they happen. In the days ahead, we will get to see if they make adjustments to their multibillion-dollar gameplan.


Dr. Jessica Flynn is a sports medicine physician at Lahey Hospital and Medical Center in Burlington, MA. She writes about injuries in professional sports on her blog, DocFlynn.com. You can follow her on Twitter @jessdeede.

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