Anatomy of an American football game: Player to player contact before, during and after an NFL game in context of the 2020 COVID-19 pandemic.

OBJECTIVES: To quantify levels of potential exposure to SARS-CoV-2 surrounding a typical professional American football game, with a focus on interactions on-field between teammates and opposing players before, during, and immediately after competition.

METHODS: We examined across-Club consecutive interactions ≥2 minutes within 6 feet [1.8 meters] between athletes on opposing Clubs for all 2020 NFL regular season games (n=256). Cumulative interaction was measured for a representative subset (n=119; 46%) of games. Wearable proximity tracking devices (Kinexon) were used to measure distance and duration of interactions; these data were combined with game schedule and Club rosters for analyses. Frequency and per-game mean, median, interquartile range for consecutive interactions ≥2/≥5 minutes and cumulative interactions ≥5/≥15 were described overall and stratified by pre-game, in-game and post-game.

RESULTS: Of the1,964 distinct player-to-opponent contacts ≥2 minutes in NFL regular season games, the majority (n=1,699; 87%) were fewer than 5 minutes in consecutive length. Among the mean 7.7 distinct contacts ≥2 minutes with opponents each game (median=4; IQR=2, 8), very few were ≥5 consecutive minutes at any point (mean=1.0; median=0; IQR=0, 0). Most (n=849; 43.2%) distinct contacts were pre-game, 546 (27.8%) were during competition, and 569 (29%) were post-game. In games where cumulative interactions were analyzed, there was an average of 17.1 player/opponent interactions with cumulative exposure ≥5 minutes (median=12; IQR=4, 30), almost all of which occurred during competition.

CONCLUSION: There is limited and short contact between and among competing players in professional American football. In the setting of infectious disease such as the COVID-19 pandemic, a robust prevention program integrating masking, distancing, hygiene and ventilation when off-field can be created to minimize on-and-off-field exposures, which effectively reduces transmission risk in outdoors and/or well-ventilated stadium settings.