NFL Players, Coaches Need To Better Understand Viral Load

The novel CoronaVirus that has swept the country has presented many unprecedented challenges for the medical community as well as the nation at large. There have been wide swaths of coverage angles from countless sources and that makes it more understandable that many professional athletes and coaches have fears and misperceptions -- just like the general public – about the spread of the virus.

I have long said that using medical facts I could calm the fears of someone who has not left their house in months. While at the same time, I could put a serious scare into the minds of those who think CoronaVirus is a hoax. Right now, it seems that players and coaches need their fears calmed.

What I am presenting below is a neutral medical perspective as well as an attempt to navigate COVID-19 and football.

First and foremost, I am not an infectious disease expert but if I were still the head physician of an NFL team I would be taking the lead in coordinating the efforts between management, coaches, players and the medical staff.

Second, COVID is real and this is my attempt to clarify the misunderstandings.

Thirdly, I am not saying there are no dangers to playing football. If a player has a "zero tolerance" stance for contracting COVID, there should be no NFL season for that individual. What I want to broach is simply this: Where are the risks?

The truth is that one needs to understand the concept of viral load and how the virus is transmitted as a starting point. Moreover, the terms are not interchangeable. CoronaVirus causes COVID.

Typically, it is not instantaneous contact that transmits this disease. There is no real medical need to dodge someone coming down the grocery store aisle (of course a mask is a good idea). Additionally, one single virus does not cause infection. It takes hundreds/thousands to incite disease, which is why the danger exists with continuous contact.

The CDC guidelines for contact tracing specify being within six feet for at least 15 minutes to qualify. The very popular Johns Hopkins contact tracing course indicates an even longer time period.

Here is an analogy.
Please note that I am in no way trivializing COVID in this example but rather making it as easy to understand as possible.

If we compare the rays of the sun causing a sunburn to the CoronaVirus causing COVID, it is the most simplistic explanation for viral load. On a typical hot summer day, an individual can park their car and walk several hundred yards to the beach, set down a blanket, put up their umbrella, and then apply sunscreen without being sunburned. Catching those limited rays does not instantaneously burn your skin. It is sun exposure over time that does. This is similar with CoronaVirus. Someone with fair skin can turn red in 15 minutes, while others take longer. That is much like a person with pre-existing conditions can contract COVID more easily than a healthy individual. Of course anyone will get sunburned more easily at high noon at the equator than at 8am or 5pm. This is similar to how any individual can catch the virus more easily from a very symptomatic coughing/sneezing person than an asymptomatic carrier. Wearing a mask is like using sunscreen. A cloth mask is like SPF 10, a surgical mask is like SPF 40 and a N95 mask is like SPF 100. Yet even with good sunscreen, we can get sunburned by missing a spot or perhaps not reapplying often enough, just like anyone can get COVID with a mask.

Where this concept applies to playing football is that tackling a player and coming into direct contact for a short period of time is not how the virus is typically transmitted.

Remember, it was Rudy Gobert testing positive that shut down the NBA. Also remember that Serge Ibaka -- who guarded him for big minutes the night before -- tested negative and never got COVID. Neither did any of his Toronto Raptor teammates who were in proximity of Gobert. 

Based on these medical concepts, a player is actually more likely to contract the disease in the team facility working with the same position group of players than on Sundays for a game, with limited albeit violent interaction.

To drive this home, medically, there is more risk inside of the offensive huddle than during actual gameplay.

There is no question the specific risk and rate of transmission during a football game has yet to be studied with this novel disease. Sweat and direct contact have not been implicated yet, but heavy breathing in close proximity is a concern.

Players and coaches have expressed their fear. 
They have also underscored their misunderstanding.

Several Patriots players on Twitter posted: "you can’t social distance football.” “Ain’t no way.” and “Not a damn shot. They are trippin.”  Previously the Saints Malcolm Jenkins expressed his worries. Ravens head coach John Harbaugh said the NFL reopening protocols for football were "humanly impossible.

The mixed messages from the NFL do not help.

Banning jersey swaps post game seems to imply that it is a high-risk activity and players are right to ridicule the rule. The NFL, which is all about optics, should instead allow the jersey swaps after the game, but demand masks before meeting at midfield.

The team protocols are designed to prevent prolonged contact because that is where the real risk is.

It will be a very different season but in order to have football clubs will have to make it humanly possible to follow the distancing guidelines.

Written by
David Chao, MD -- known digitally as Pro Football Doc -- is an expert contributor for Outkick. Chao spent 17 seasons as the team doctor for the San Diego Chargers (1997-2013) and is part of the medical team at OASIS in San Diego where he treats and specializes in orthopedic sports injuries, working with high-profile professional athletes from the NFL, NBA, and MLB.