Patriots

Dr. Flynn: How could the Patriots-Chiefs game be played Monday or Tuesday? There is a way

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(Adam Richins for BSJ)

Cam Newton tested positive for the virus that causes COVID early Saturday morning. The positive results are from a PCR test sent Friday morning. No other players tested positive yesterday and the team is awaiting results of PCR tests sent early this morning.

Per the NFL’s COVID-19 protocol, the timing for when a player who has tested positive can return depends on symptoms. There is no word yet on whether or not Newton has symptoms. If he is symptom-free, he may return to play in as soon as 5 days with 2 consecutive negative tests 24 hours apart. If he does develop symptoms, the starting quarterback would be out for a minimum of 10 days and for at least 72 hours after symptoms resolve. Of course, in both instances, he would need to be cleared by a team physician and that may include a cardiac workup.

I think we’ve all seen now that daily testing alone does not prevent people from getting sick. The Patriots' mitigation work up until this point will be critical. Newton spends a lot of time in the Patriots facility - coaches and teammates often comment on how he is the first in and the last out. Unfortunately, that means that he likely spent a long day at Gillette on Friday, unaware that the test he had taken in the morning was positive for the virus that causes COVID.

Now that the virus has made its way into the Patriots locker room, the attention has turned to contact tracing and preventing further spread. All players were immediately sent home to avoid further potential exposure. Their tracking device data will be combed through to figure out which players and staff had close and prolonged contact with the team’s starting quarterback and captain. Those players will be watched closely. Per the NFL’s COVID-19 protocol, asymptomatic close contacts who test negative must have a second negative PCR test within 24 hrs before returning to the facility. If they return to the facility, the protocol calls for increased symptom monitoring. (Outside of the NFL, close contacts of someone who tests positive for the virus are recommended to quarantine for 10-14 days).

The NFL announced today that the Patriots-Chiefs game would be postponed until Monday or Tuesday, but I don’t see how that happens. Quarterbacks on both teams potentially exposed teammates and staff as recently as Friday. Given the incubation period of the virus, a qPCR test may not turn positive until Monday or Tuesday at the earliest. Patriots players would have to travel Monday, not yet knowing if they were infected.

We all know that the NFL doesn’t want to postpone further and pull more pieces out of an already tenuous Jenga-like schedule situation. There is no published yes/no protocol for us to know what the NFL will do in this situation because there are many variables that make each case unique. The Patriots’ situation is different than the Chiefs’ and both are different than the Titans’ and Vikings’.

You all know that I don’t love risk, but I recognize that the game of football, especially during a pandemic, involves some risk. So I’m going to lay out for you a scenario where the game could potentially happen on Tuesday night. It involves a little bit of science, so bear with me for a paragraph or two.

The best-case situation at this point is that both Newton and the guy who played Newton all week didn’t have many close contacts and “just barely” tested positive. Is that really a thing? Yes, actually, it is.

The amount of virus in an NFL athlete’s body may determine how infectious he is to people around him. Theoretically, if a team had only one athlete test positive and that player had very little virus in his body, maybe we could worry less that he could pass it on to other players or staff.

The tests that these guys take every morning give us some insight into how much virus is in their body. Very briefly, the test that the NFL uses is called quantitative polymerase chain reaction (qPCR). The nasal swab is soaked to remove saliva and extract genetic material. Then, the liquid sample is heated and “amplified” (this is the part that takes hours). As it goes through amplification cycles, the machine tries to detect viral DNA. Once it does, it calls the test positive and records the number of amplification cycles it took to get enough DNA to detect. That number is called the “cycle threshold (CT).” If there is only a tiny bit of virus in the sample, the machine will have to go through more cycle thresholds to finally detect DNA. The “q” in q-PCR means that the test doesn’t just tell us if a sample is positive, it also can give us a quantitative idea of how much virus in a patient’s airway and, potentially, how contagious they are/how early or late they are in disease. The CT isn’t a perfect number, but it can be helpful in sorting through a single NFL case, cluster, or outbreak.

If Newton’s CT number was high (meaning he may have had very little viral RNA in his airway…or at least on his swab), there may be a lower chance he spread the virus to teammates or staff. It would be reassuring if Newton had little virus. and no other players or staff test positive by Tuesday morning. On the other hand, if Newton’s CT number showed that he had a lot of virus in his airway, doctors may be more concerned about the risk of other cases popping up. The CT number is far from perfect, but it is another piece of information that doctors can use to help guide decision-making. Of course, if tracking technology shows that Cam Newton had very few or no close contacts in the facility over the past few days, that would be reassuring too.

It may sound like I’m grasping at straws here, but I want you to understand some of the thinking that goes into managing a locker room that has been breached by an infectious disease. It’s more than just positive and negative test results. For now, both team facilities are closed and contact tracing is underway. I wouldn’t expect them to open until they feel that the risk of allowing players and staff back in is low and there will likely be rapid testing before entry. For now, all I can do is hope that Newton and Jordan Ta’amu remain in good health and no new positive cases emerge.

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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 @DocFlynnNFL.

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