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The NFL COVID-19 plan isn't working. Fix it to protect players, profits and US society.

The NFL season is on the brink of collapse. So far, there have been more than 100 positive coronavirus cases among players and personnel. To date, two teams have experienced outbreaks and others have had isolated cases. Aside from routine testing and some basic risk mitigation interventions — masks for coaches and referees during the game — the league has done little to ensure a safe work environment or promote positive public health messaging.

In fact, it is promoting a harmful and counterproductive narrative that infections are the result of players misbehaving. The NFL could, however, ensure a successful season, protect players and staff, provide resources to vulnerable communities, and help change the narrative around coronavirus — all at the same time.

Thus far, the NFL has been lucky. It has administered more than 400,000 tests,and has a positivity rate below 1%, and no player or staff member has become critically ill or died. But it’s a matter of time. Even young, healthy people can have devastating short and long-term health consequences. Several cases of myocarditis (inflammation and damage to the heart muscle that is potentially fatal) from SARS-CoV-2 have been reported in young athletes, and emerging data suggests long-term effects on other vital organs. Of course, the full extent of damage from this virus will not be known for years.

NFL COVID rules need to be tighter

While the NFL has a robust testing protocol, testing is but one aspect of a comprehensive plan. Players are not required to wear masks, coaches violate mask wearing rules, and locker rooms remain small, enclosed poorly ventilated spaces making them perfect incubation chambers for SARS-CoV-2. Furthermore, games are being played in coronavirus "hot spots" with each game putting people at risk.

Unfortunately, the league has engaged in the harmful narrative that infections are the result of player misbehavior. Blaming is counterproductive to behavior change. Because of the broad influence that the NFL has on American culture, this narrative bleeds into society and makes it more difficult for public health officials to promote and disseminate pragmatic strategies for risk reduction.

What, then, is the league to do?

First, the NFL needs to address the safety of their players and staff. It has said that it will not consider the "bubble" model though this is a successful model as evidenced by other professional leagues. Opponents of this model say that it will be too difficult to implement since most games are played on Sundays, but the league is already shuffling around games so moving a few games to week nights is not so difficult and may also bring in additional advertising revenue.

Tennessee Titans outside linebackers coach Shane Bowen, left, and head coach Mike Vrabelon on Aug. 24, 2020, in Nashville, Tenn.
Tennessee Titans outside linebackers coach Shane Bowen, left, and head coach Mike Vrabelon on Aug. 24, 2020, in Nashville, Tenn.

This plan also means that there is no need for ongoing universal testing. The league can donate all of the precious unused rapid tests to congregate settings such as homeless shelters, domestic violence shelters, and nursing homes, that have few resources but a disproportionate burden of infections. By doing so, the NFL could become a true community partner.

If the league is unwilling to move to the bubble model, then they need to hold games in cities that are not coronavirus "hot spots." Rather than holding games in cities with high incidence rates, games should be moved to cities in Oregon, Vermont, and New York, reducing infection risk. This also opens up the NFL to new markets and fans, meaning more potential revenue in the long term.

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In either case, the NFL must ensure that facilities are adequate for the safety of the employees. Visiting teams’ locker rooms are small and uncomfortable. Locker rooms must have appropriate ventilation and safe distancing must be achievable. If visiting locker rooms cannot be immediately upgraded, then teams need to dress and undress in shifts or prior to arrival. All personnel need to wear masks when indoors.

These basic measures are expected of youth sports so it is reasonable to expect the same from professional athletes. Finally, the NFL Players’ Association needs to insist that long term health effects of coronavirus — whatever they may be — are covered by the NFL.

NFL can promote masks to the public

In addition to these structural changes, the league needs to develop ways to encourage players to reduce their risk and stop the dangerous yet pervasive practice of blaming people who are infected. It is well-known from experience with HIV, tuberculosis and Ebola that these messages are ineffective and harmful. Instead, the league can provide bonuses or other incentives to players and teams that avoid infections. They already provide bonuses for other things — for players who perform well enough to make it to the Pro Bowl (which is canceled) or to teams that play in the Super Bowl. A coronavirus-free season bonus is no different.

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Given the power and influence of the NFL on American culture, the league also the opportunity to make masks and infection prevention more acceptable to the general public, reaching people that scientists cannot. They can make authentic, limited release masks to be sold to fans and ask players to appear in public service announcements about the importance of masks and social distancing.

If the NFL is unwilling to do any of this, then they must cancel the season. All players and personnel must receive their full pay and benefits. An organization that generates more than $16 billion a year can afford it.

Americans need sports as an escape and a recharge. But this virus is difficult to control and can have devastating effects. The current plan is unacceptable. The NFL has the opportunity to protect players and staff and make a positive change in the U.S. in the fight against coronavirus.

Dr. Joshua Barocas is an infectious diseases physician and public health researcher at Boston Medical Center and Assistant Professor of Medicine at Boston University School of Medicine. He is also a Denver Broncos fan. Follow him on Twitter: @jabarocas

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This article originally appeared on USA TODAY: NFL needs a better COVID plan to protect players, profits and America