Thread by @JeneBramel

Earlier this week, I questioned whether ATL (no close contacts reported, cleared to play, no subsequent positives) or TEN (cleared to play, ongoing outbreak) was the outlier situation with respect to contact tracing and testing protocols.

1/n

Lots of strong reporting this morning suggests contact tracing and practice protocols were appropriate in ATL while league is investigating how TEN handled those same protocols.

2/n

Still disconcerting to see ongoing TEN positives 5-6 days after last probable facility exposures. Hopeful this proves to be the outlier situation and tipping point for all teams to tighten protocols.

3/n

As individual situations in ATL, TEN, NE, KC evolve, NFL seems to have well-ordered plan to evaluate contact tracing & adapt testing protocols to each situation.

Still nervous about high number of NE close contacts, possible clearance to travel within 72 hours of exposure.

4/n

If - but still a very important if - NE and KC have no additional positive cases in the coming days and Tennessee proves to be a possible/hopeful outlier, it's a great sign.

5/n

Also, while I appreciate the concept of viral load and agree prolonged close contact is a higher risk exposure, I would not be willing to risk face-to-face unmasked contact of opposing players.

Team-to-team transmission may be less likely, but must be considered possible.

6/n

There's a reason we wear masks, goggles w/ each patient interaction right now - even those asymptomatic & even when we're face-to-face for a few moments of exam time.

Any face-to-face contact = risk of exposure. Multiple studies show viral load high in presymptomatic folks.

7/n

There's a reason we wear N95/shields/goggles when evaluating/testing asymptomatic exposures and symptomatic patients.

Respiratory droplets spread easily -- prolonged exposure is highest risk, but a single direct exposure could be more than enough.

8/n

This is what NFL is grappling w/ regarding NE/KC game.

At what point can you trust you've cleared close contacts with negative PCR tests. At what point is travel safe w/ possible prolonged exposure of your bubble. At what point is a second currently uninfected team at risk.

9/9