Why Asymptomatic, Positive Athletes Still Need To Sit Out

Should healthy, vaccinated pro athletes who test positive play on? Not yet, experts say.

By Adam Kilgore
Today at 4:57 a.m. EST

Coronavirus cases have spiked this week across North American professional sports despite sky-high vaccination rates among players and staffs. Sidelined stars, postponed games and disrupted seasons have doused any promise that vaccines would restore normalcy to the sports world. One month away from the NFL playoffs and barely a week out from the NBA’s annual Christmas Day showcase, both leagues are again mired in covid-related obstacles.

Among the rash of players unavailable to play after testing positive, the vast majority are vaccinated and many are asymptomatic. So in a time of widely available vaccines and booster shots, would it be safe for sports leagues to allow vaccinated, asymptomatic players who test positive for the coronavirus to play in games?

That day may come, public health experts say, with improved testing capability allowing players to safely return to play sooner, but it is not here yet.

“This is exactly what the virus would like us to do,” Stanford professor of global health and infectious diseases Yvonne Maldonado said. “Let’s get a whole bunch of people together who are about as close together physically as you can get and release an asymptomatic individual with lots of virus in their nose and mouth. If you want to infect a whole bunch of people, that’s the best way to do it.”

The NFL is discussing a change to its protocols that could lower the bar to return for asymptomatic players who test positive. Rather than holding vaccinated players out for 10 days or waiting until they test negative twice, the league is checking with public health officials to see whether it would be advisable to let a player return after one negative test.

“That’s probably going to become a paradigm for the general public, where if you’re fully vaccinated, they’re going to just say instead of having a one-size-fits-all, 10-day isolation period, we’re going to make that self-isolation period based on a negative test result,” said Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

“In general, if you’ve got a positive test, you need to remove that person from play until they become noncontagious. We may get to a point with fully vaccinated people where we shorten that period from 10 days to something based on antigen-test negativity, which I think there is data to do. But in general, a positive test shouldn’t be ignored.”

And a spate of positive tests have caused havoc across professional sports.

The NBA on Monday postponed two Chicago Bulls games after 10 of their players tested positive. Former MVPs James Harden and Giannis Antetokounmpo entered the league’s coronavirus protocols Tuesday, placing their status for marquee Christmas Day showcases in jeopardy. Since the league began enhanced testing on all players out of precaution following Thanksgiving, more than 40 players have entered the coronavirus protocols.

The NFL recorded its highest number of positive player tests in a single day Monday, with 37 players testing positive. Twenty-eight more players tested positive Tuesday, with clusters forcing the Cleveland Browns and Los Angeles Rams to shut down their facilities. All 11 Rams players on the covid-19 reserve list were vaccinated, Coach Sean McVay said. By Wednesday, the number of players placed on the league’s covid-19 reserve list over the past three days grew to 85, and seven teams, including the Washington Football Team, had entered in the league’s enhanced protocols.

The NHL postponed the Calgary Flames’ next three games after six Flames players tested positive; seven more Flames players and 10 staff members entered the NHL’s coronavirus protocols Wednesday. The league also rescheduled a game between the Minnesota Wild and Carolina Hurricanes after four Carolina players tested positive Tuesday. Only one active NHL player is unvaccinated.

Experts said the best weapon against disruption and disease for professional leagues has not changed: Players and staffers should get vaccines and booster shots as soon as possible.

On Wednesday at the NFL owners meetings in Irving, Tex., NFL chief medical officer Allan Sills said the league’s cases provided evidence “we’re entering a new phase of the pandemic.” Early in the pandemic, professional sports provided a harsh preview of new realities when the NBA shut down its season after one player tested positive. As the highly transmissible omicron variant arrives, the sports world may again be revealing what’s to come.

“Definitely,” said Vanderbilt University professor of infectious diseases William Schaffner, a member of the NCAA’s initial covid-19 advisory panel. “The more you look, the more you’ll find. In the general population, we’re not testing people at regular intervals. In these subgroups, these athletes, we’re finding more because we’re looking much more intensely and routinely.”

Testing in professional sports leagues could grow more extensive. In the NFL, vaccinated players are tested once a week and unvaccinated players are tested daily. The NFL Players Association called on the NFL to reinstitute daily testing for all players, which it employed in 2020, as a measure to detect cases and prevent outbreaks.

“All the models show that if you test daily, you’re going to reduce outbreaks by a huge amount,” Maldonado said.

Public health experts are hoping the omicron variant will lead to less severe disease. Early studies have suggested it could, but Maldonado pointed out that since it transmits so pervasively, the benefits from less severe outcomes could be counteracted by more cases. In the best-case scenario for sports leagues, though, a less severe strain could allow players who contract the virus to play on.

“As we learn more, we adjust our advice,” Schaffner said. “It could be that we will be more permissive, more relaxed [for] those who are without symptoms, thinking it’s omicron, letting them go about their daily activities without quarantine. That’s a possibility. I don’t think we’re there yet.”

As the pandemic continues to enter new phases, leagues should be willing to adapt their countermeasures, experts said, whether that means relaxing or strengthening them. That doesn’t mean they should rush into a change.

“It’s reasonable to continue to question the protocols,” Maldonado said. “This is an evolving pandemic, and it is helpful to move forward. We’re getting very comfortable with the virus, and I think we have to be careful with that. It is very mild in most people. That’s true. But those people who do wind up getting infected, we’re seeing long-term implications. We’re just starting to scratch the surface of that.”

Giants owner John Mara said Wednesday at the NFL owners meeting that it felt as if covid was never going to end. The way leagues, teams and players respond will evolve. But Mara was more right than he wanted to be.

“There is no covid zero,” Adalja said. “There’s never going to be a time when the NBA or NFL has zero cases or any organization has zero cases.”

Washington Post