Why Can’t Schools Get What the N.F.L. Has?

After months of planning and negotiating and establishing a Covid-19 protocol, the National Football League was rolling along. They’d decided to skip preseason games — which no one really likes anyway — and by late July, all 32 teams were deep into training camp. Every single person was given a Covid test every day — every player and coach and trainer and team employee. So far, only a handful had tested positive. Miraculously, it looked like the season would start as scheduled on September 10^th. But then, one morning in late August, it all seemed to be going sideways.

Thom MAYER: Seventy-seven total people — 44 players and 33 club employees — tested positive.

That’s Dr. Thom Mayer.

MAYER: It’s a nightmare scenario, let’s just be clear, when you start hearing that.

Mayer, whose background is in emergency medicine, was one of the command physicians at the Pentagon rescue operation on 9/11. Now he’s the chief medical officer of the N.F.L. Players Association, the union that represents the players. These positive Covid results, Mayer says:

MAYER: Started with tests that were done on the Steelers.  

The Pittsburgh Steelers, it turned out, were just one of 11 teams that had positive Covid results.

MAYER: We locked the players down and the staff down. 

How did Mayer first hear news of those 77 positive Covid tests?

MAYER: I got a call from my counterpart with the N.F.L. telling me that this is what we’re looking at. 

His counterpart is a doctor named Allen Sills.

Allen SILLS: I’m a professor of neurosurgery at Vanderbilt University Medical Center and the chief medical officer for the National Football League.

Stephen DUBNER: Were you thinking, “Oh, Lord, this is the beginning of the end”? 

SILLS: Our thinking was, “We go into our protocol, which says we immediately isolate every one of those individuals, do the confirmatory tests, start the contact-tracing process.”  

I asked Thom Mayer if he thought the positive tests meant the season might be over before it could begin.

MAYER: No, because we prepare for it so carefully; and I hate to hark back to being at the Pentagon on 9/11, but disaster preparedness is just that. It’s scenario planning for the worst-case disaster which could occur.

But as the league kicked into their Covid protocol — isolating the players who’d tested positive, tracing their contacts, etc. — the 77 positive test results started to look fishy.

SILLS: As we started diving into it — our testing partner uses five different laboratories around the country to run our specimens.

Remember, positive tests came from 11 different teams. Each of whom was holding training camp in their own home towns, because the N.F.L. didn’t set up a bubble the way the N.B.A. did. And the Covid tests from all 11 of those teams:

SILLS: All 11 of those teams go to one single lab. So that starts to raise suspicion. And none of those players, coaches or staff had any symptoms.

MAYER: When I learned it was 11 clubs and they’d all gone to the same facility in New Jersey, within seconds I’m thinking, “This has got to be a lab error. These have got to be false positives.” Why would there be an outbreak like that with 12 at the Vikings and 10 at the Bears? It just doesn’t make sense.

SILLS: As we went through the confirmatory steps, all 77 of those tests did not confirm — meaning that they had repeat testing done that was negative. We repeated two different tests and every one of those individuals had a negative follow-up test. 

Yes, it was an error at the lab. Yes, the 77 positive test results turned out to be false positives. So no, the N.F.L. was not dealing with a Covid-19 outbreak. Today on Freakonomics Radio: What happens if — or maybe when — there’s a real outbreak in the N.F.L. now that the season is beginning? And if you’re, let’s say, a schoolteacher in New York City, how jealous are you of the N.F.L.’s rapid-response protocol and daily testing? Is it worth the risk for you to go back to work? As with everything, it depends on the incentives:

Domonique FOXWORTH: I know what most football players make, and it’s the equivalent of an entire teacher’s lifetime earnings.

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DUBNER: So, let me just say, on behalf of all those who enjoy watching the N.F.L. or playing fantasy football or betting real money on football: thanks for what seems to be having a season pretty close to ready to go, yes? 

MAYER: Yeah, we’re very close. And it’s happened step by step by step. It’s a negotiated set of protocols.

That, again, is Thom Mayer, from the N.F.L. players union.

SILLS: Our process started back in March. We started meeting with a joint task force together with the N.F.L. Players Association. 

And that’s Allen Sills from the N.F.L. When we say “the N.F.L.,” what that really means is the league’s 32 teams, or clubs as they like to call themselves. Which really means the 32 owners or ownership groups. The players, meanwhile — 53 on a team, 32 teams, plus injured and inactive players, so roughly 2,000 people — they are the labor. You could, therefore, think of the N.F.L.P.A., the players union, like a teachers union or an automakers or coal miners union. But there are a lot of differences. N.F.L. players make more money but have shorter careers, are more prone to injury and are a bit more visible than your average teacher. They also play in a league that makes so much money that its resources can seem unlimited — at least compared to your local school system. That said, the relationship between the players union and the league has often been adversarial — over concussions, race relations and more. So I asked Thom Mayer whether his relationship with Allen Sills had been adversarial.

MAYER: It’s professional. No, it’s professional.

DUBNER: Well, it sounds like there’s quite a bit in that word “professional.” 

MAYER: Well, we don’t always agree, but we make every effort to make sure that we’re not disagreeable. It’s sort of like the State Department says, “We had a frank and open discussion.” It means they ripped somebody’s lungs out. I’m not saying that at all. We have a very good but professional relationship, collegial.

As Allen Sills was saying, the process of negotiating the N.F.L.’s Covid protocols started back in March.

SILLS: We had a number of subunit task forces looking at different areas. And when I say we, I don’t mean me or my counterparts at the Players Association only. We brought in scores of experts from infectious disease, epidemiology, public health, laboratory medicine, all these different areas to try to help us design and prepare what we think is the most up-to-date information. 

MAYER: We talked to DARPA, the mad scientists who work for the Defense Department. And we looked at Marine recruitment depots as the closest thing to what we might see. 

And after all those conversations, what did the N.F.L. Players Association recommend?

MAYER: We had recommended that there be, in essence, a bubble. We called it a “time-limited safe compartment.” 

DUBNER: Oh, you wanted a real bubble like the N.B.A. is having, like the N.H.L. is having. 

MAYER: Yeah. At least for a time-limited period, to get our feet under us, to get the measurements done, to get the baseline understood, and to help people understand this is what’s at stake, in terms of what you bring into that building is going to affect yourself, your family, your teammates and the game of football. 

DUBNER: Now, where would that bubble have been? Because the N.B.A. —  there’s only 14 or 15 guys on a roster, and they didn’t even take all 30 teams into the bubble. The N.F.L. has 32 teams, 53 guys on a roster. Where would you have found a big-enough place to have a bubble for all those teams and players and coaches? 

MAYER: What we meant — and that’s why we used the term “time-limited safe compartment” instead of bubble — is they would have been at the club facilities. So there would have been 32 bubbles. But everyone who went into that building would not leave that building for a two- to four-week period to make sure the virus didn’t come in. 

DUBNER: Now, N.F.L. facilities — even the best and the most beautiful — they don’t have living facilities, at least as far as I know. Where would you have put people? 

MAYER: Hotels, hotels adjacent to it. So you’d have buses that would— and the bus drivers would be tested and the buses would be wiped down. The hotels would have had locked-down floors, in some cases locked-down hotels, somewhat similar to the N.B.A.

DUBNER: But I don’t understand why the N.F.L. would have been against the bubble. What would it cost them? 

MAYER: You know, you’d have to ask them that. One of the three guiding principles for the N.F.L.P.A. is we’ll go anywhere the science takes us and nowhere the science doesn’t take us. And so when people with the N.F.L. would say, “Bubbles don’t work,” the answer is, “Show me the data. In God we trust, everybody else must bring scientific data.” And no data was put forward.

Here again is Allen Sills, the league’s chief medical officer.

SILLS: Well, I don’t think it’s a matter that we didn’t like the idea. I would say that our committees did look at many different scenarios and looked at the advantages and disadvantages of each. Because, again, there are no perfect scenarios and there are also no perfect models of how to prevent outbreaks. And so I think the groups that looked at this tried to look at the medical data. They looked at what’s been happening in other leagues and situations around the world where people have gone back to sport competitions, and they tried to balance what helps us mitigate risk and keep everyone safe with what are the practical realities for, in our case, really a seven-month-long process.

If you look at the N.F.L.’s season from the start of training camp in through the end of our postseason, it’s about seven calendar months. But we arrived at a situation that we’re calling a “virtual football bubble,” which means that when our players, coaches and staffs are together inside our facilities, everyone’s operating under the same protocol. They’re all under the same testing and screening. They’re all under the same P.P.E. requirements, etc. And then when they leave those facilities, we’re asking them to make consistent choices based on education that we’ve provided. I think if you look at it really in the bottom line, it’s impossible to keep people locked in one location over a seven-month period. We think there’s substantial mental health and other challenges with that model. 

MAYER: This is a risk-mitigation, not a risk-elimination equation. And we know that upfront. 

DUBNER: Okay, so you’ve got 32 teams. Everybody who comes into the facility every day takes the test. How does the processing happen? How is it shipped? How fast do you get the results, etc.? 

MAYER: The N.F.L., because it’s their duty as the employer to provide a safe environment, are paying for it, and we demand getting a return within 24 hours. Again, because we need to know. If somebody is positive, they’ve got to be pulled out of that environment so they’re not spreading the virus.

Thom Mayer thinks of himself as, essentially, the family doctor to every N.F.L. player and their families.

MAYER: My practice has 2,500 players. Now, multiply that and say their spouse or significant other. So now you’ve got 5,000. And then add in their kids. And in many cases, their parents. So I’ve got 10,000 people in my practice, at least. It’s set up as a benefit, if you will, for the players so that they can get somebody on the horn that they trust immediately to answer questions ranging from, “You know, I was told my kid has a heart murmur. Who should I go see?” “I was given an EKG and it was abnormal. Who should I talk to?” 

His primary patients — the players — are all male, mostly very young and, of course, extraordinarily athletic. But this does not exclude them from the Covid-19 risk pool.

MAYER: We know that if you’re African-American, if you’re Hawaiian Islander or Hispanic, your risk is higher. B.M.I. over 28, that’s about 80 percent of the league. B.M.I. over 30 is about 62 percent of the league. Then you get down into patients who have established cardiac disease, who’ve got moderate to severe asthma, who have or have had cancer in the past, sickle-cell disease and things like that.  

To date, 69 players have decided to opt out of this season because of the coronavirus.

MAYER: If you did a medical opt-out, then you were paid $350,000. It was a one-time payment and you got credit for what we call a credited season, as if you had played, and your benefits and retirement and all the issues with that. 

DUBNER: Where’s that money coming from? 

MAYER: That money’s coming from the league. So, any player can say, “I’m not playing. I don’t have a medical reason, but I’m not playing.” Some of them chose to do this because their parents were ill. They get paid $150,000. And that $150,000 is an advance on the salary for next year. 

DUBNER: How are the opt-outs treated? Were they seen as less loyal, less manly, less anything? 

MAYER: They weren’t viewed as less anything. They were viewed as men who made a decision on behalf of themselves, on behalf of their families. I mean, these are grown-ass men who get educated and make grown-ass decisions. And some decided to play and some decided not to play. 

DUBNER: Talk about how many players and others are coming every day to the facility and then what they’re doing — what the protocol calls for, what’s the testing, etc. 

MAYER: So, the testing is daily and it’s all people who are coming into that facility. So anyone who’s walking into that building and is potentially going to have any contact with the players. We felt very strongly that there had to be daily testing. Why? The risk is false negatives. False negative, of course, says you’re negative but in fact you’re positive. So you’re walking into a building, spreading the virus. And we needed to close that hole.

DUBNER: So you’re saying that daily testing helps mitigate against false negatives? 

MAYER: Absolutely. But if you take J.C. Tretter, our president, is a center for the Browns. He’s the guy that snaps the ball. So, he lines up across Pittsburgh Steelers, nose tackle, twice a year. And the question becomes: What’s the risk of either J.C. or the nose tackle spreading the virus to each other? And the answer, of course, is: it depends. If neither J.C. nor the nose tackle have virus and are shedding the virus, the risk is zero. And people don’t talk about this much. But those two individuals, if they were the only ones they came in contact with— I mean, they can swap snot. They’re down in the trenches blowing in each other’s faces. Now, if you’ve got, let’s say, the right guard for the Browns is transmitting the virus. Now you’ve got a different equation. So that’s why testing is a link in the chain that is so critical for us.

DUBNER: So what happens next? Is there contact tracing and what do you know about how the virus was transmitted to those who got it?

MAYER: So, contact tracing — yes, absolutely. If someone tests positive, even if it’s a false positive, they’re isolated immediately, okay? Contact tracing happens in three ways: No. 1, we contact the local health department and do their contact tracing. No. 2, we have a company called IQvia that does our injury surveillance for concussions, for lower-extremity injuries, for all injuries in the N.F.L., but they also do contact tracing. And they’ve done this with governments, state, local and international. So it’s not new to them.

And then third is we have a tracking device, Kinexon, that every person in that building puts on — not just the players, but the staff members as well. It’s a wristband and it gives us an electronic signature of where they were. And understandably, the players had a concern about Big Brother and tracking them outside of the building and what they’re doing and all that kind of stuff, which is — it’s not a football player concern, it’s a human being concern.

DUBNER: You’re mentioning all these resources and partnerships that the N.F.L. is using to make this environment sustainable: DARPA, the Marines, IQvia. And this sounds like what should be happening throughout society — but it’s not. And so I think about if I’m a school administrator, or if I run a nursing home or really any kind of institution or facility, I think, “Well, why is the N.F.L. doing this this way and we’re not?” And obviously, you guys are well-resourced and you do have a tradition of discipline and military-ish precision and hierarchies, which can be useful to get people to follow instructions. But still, do you ever look at what you’re doing and express some surprise that this sort of protocol is not being more widely copied? 

MAYER: We, I will say, take some pride in putting essentially an ecosystem in place that is a very effective, or so far appears to be, a very effective ecosystem to shut down the virus or to limit its transmission. We think that there’s a lot that communities even at the federal level can learn from this.

DUBNER: Now, to be fair, if everybody in the U.S. got tested every day, we’d run out of tests a lot faster than we have. There’d be less capacity than there is. There’d be longer waits than there are. Is there any level at which either you guys feel a little bit guilty or you’ve gotten pushback from the community on how many medical resources you’re consuming? You know, some of your teams are in places where the coronavirus has really taken off in the last couple of months; in Florida and in Texas, hospital facilities have been getting close to capacity. Do you feel like maybe you’re consuming medical resources, at least potentially there, that may be taking away from others? 

MAYER: Yeah, we’re very aware of that and very sensitive to that. I’m on the phone with Houston, with Miami-Dade, with Broward County, with all the hot spots at least twice a week We made it clear that if we ever got in a place where we were sucking resources — testing resources in particular — away from our community, that we needed to rethink that, shut down football if it took that. 

DUBNER: Tell me what you learned about the false-positive incident: What was the mistake and how was it made?

MAYER: The mistake — when the samples come in, they’re put under a hood, a biosecurity hood, and the samples are transferred into a rack and then the rack goes into the machine. And so what was found was that the hood was contaminated. And the reason the hood was contaminated was because the lab was mixing samples from non-N.F.L. sources and N.F.L. sources, and putting them on the same rack. 

DUBNER: Look, false positives are better usually than false negatives for sure — but if I hear that one of the major labs that I’m using for this daily testing to get the N.F.L. going and into their season has made an error that, to a layperson like me, sounds avoidable — walk me through your thinking on that and what you have been able to do to ensure that the testing will be reliable. 

MAYER: Key question, and it is: What happened, when, how and for what reasons? Once we knew that, next question was very simple: What are you going to do to assure that this never happens again? And their answers were: We are not going to mix up N.F.L. samples with the general population — and the positive rate in the general population’s much higher because they’re not being screened like ours are daily.

DUBNER: I guess it was a fire drill for you though, yeah? 

SILLS: It absolutely was. 

That again is the league’s chief medical officer, Allen Sills.

SILLS: Our clubs had to go through the contact-tracing process. They had to think about how it would affect them. And so it was a really good opportunity to see our protocols in action and to see how they would affect us if we were approaching a game day. 

DUBNER: Were there any mistakes or problems in following the protocol during the false-positive scare? 

SILLS: No, our clubs did a terrific job. They immediately did what they were supposed to do: isolated all the individuals, in some cases teams delayed or canceled practices to make sure that we had the results in hand. So I was very pleased with the response. And we got better. I mean, as a result of this episode, our testing protocols improved, our laboratory procedures have improved. 

DUBNER: What’s the name of the lab? And do you plan to continue to use them? 

SILLS: Yeah, it’s Bio-Reference Laboratories. It’s a national lab company. And overall, they’ve done a terrific job. I mean, as of today, we’ve done over 200,000 Covid tests. And the overwhelming majority have been seamless. And we’re very pleased that in this situation, they worked together with us and the Players Association to aggressively address this and to investigate what happened and to try to identify ways we could prevent it in the future. 

DUBNER: Can you talk about the fact that football itself, the playing thereof, would seem to be an awesome opportunity for transmitting the virus? So what kind of risk mitigation is the N.F.L. doing to actually counter that? 

SILLS: So, what our teams have done is really gone back and reimagined and reinvented every aspect of their operations through this lens of “What can we do to mitigate risk?” By far, the best thing we can do, in terms of on-field play, is to make sure that everyone who arrives to the field is not infected. I think that secondly, there are mitigation efforts you can take during the competition.

We’ve been working with Oakley on a mouth-shield product. It’s an extended face shield that’s modeled off the medical-type face shields that are worn by our health-care providers. I think you’ll see some players using a neck gaiter out on the field that they pull up over nose and mouth. We’ve seen teams limit the amount of time that people spend around each other, maybe how they conduct certain drills, certainly the spacing around what they’re doing. The last thing I would say is that it’s fortunate for us that our sports are played in an open-air environment.

Speaking of all that open air that surrounds a football field: some N.F.L. team owners want to admit fans to the stands, perhaps 25 percent of capacity. Because 25 percent of revenue from tickets and concessions is a lot more than 0 percent. I asked Thom Mayer how the players union thinks about fans in the stands.

MAYER: Well, from the medical perspective, the risk to the players is, just call it X. And I would say when you put fans in the stands — and I don’t think fans in the stands are necessary for football — the risk goes up. And the question is, how much does it go up with a group of people who are probably not going to be wearing masks all the time? Because apparently some of these people drink beer and eat popcorn and can’t do that with a mask. And some of these people are screaming and yelling. So we’re not against it. We just want to make sure that it’s done very carefully, very thoughtfully, and in a way where they don’t come in contact with the players. 

DUBNER: So, let’s say that I’m a member of the New York Football Giants and we’re having no fans in our home stadium; but let’s say we’re playing a road game against the Houston Texans or the Dallas Cowboys, and Texas has a different view of these things. And let’s say the New York Giants ownership agrees to play in that Texas stadium with, let’s say, 25-percent capacity. But I come to you and I say, “Thom I’m not comfortable going there with 20, 30,000 people.” So what happens with that kind of difference of opinion? 

MAYER: So that’s going to have to be bargained collectively. We’ve been very clear that if our players feel unsafe at any time, for any reason, going on the field, then they should never be punished or in any way held accountable for saying, “This equation has changed for me. I no longer feel safe on the field.” 

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Thom Mayer became chief medical officer for the N.F.L. Players Association nearly 20 years ago.

MAYER: August 1st, 2001: Korey Stringer, a tackle for the Vikings, died of heatstroke. And you think, “How is it remotely possible, even 20 years ago, for an N.F.L. player to die of heatstroke?” 

This was during training camp.

MAYER: It shouldn’t have happened. Protocols should have been in place and weren’t at that time. 

The league itself didn’t get its own chief medical officer until 2017, when it hired Allen Sills. His job covers a range of responsibilities.

SILLS: One is to work with our team medical staffs and to assist them as they’re providing care for players, coaches and staff at their respective teams. I also help with curating and evaluating our injury data and looking for opportunities to improve health and safety around the league. And then we also work with a number of external researchers who are performing work that will improve safety of athletes not just in the N.F.L. but in all levels of sport. 

At the very least, it was not a good look for the N.F.L. that it took the league so long to hire someone like Sills. For years, the league had downplayed or outright denied the link between football and brain injury. This fact is not lost on N.F.L. players — present and past.

FOXWORTH: There’s just an air of distrust that makes everything harder than it should be.

That’s Domonique Foxworth. These days, he’s a writer and broadcaster for E.S.P.N. And before that?

FOXWORTH: I was president of the N.F.L. Players Association. And from there, I went on to business school. After that, I was chief operating officer for the N.B.A. Players Association.

DUBNER: And before all that, you played some football. 

FOXWORTH: Oh, yeah, I should have included that. I played in the N.F.L. for seven years for three different teams. 

Foxworth’s last year as a player was 2011. I asked him how the historic relationship between the N.F.L. and the Players Association influenced the negotiated protocols for Covid-19.

FOXWORTH: So, I’m sure we all know people in our lives that we don’t trust. And if they tell you the sky is blue, you’ve got to check. And that’s the situation that you have in the N.F.L.; and the N.F.L.P.A.’s relationship is, if they’re bringing something to the table, we’re like, “Huh, what’s up with this?” And it makes it more complicated. And I think they probably feel the same way about the union. When the union files a grievance or is upset about something, the league — I know the league reacts like, “Man, here they go again, trying to make everything into a fight.”

DUBNER: So in terms of the negotiated protocol that they set up for daily Covid testing and all kinds of other procedures — what do you know or what have you heard about distrust from the players’ side, that either the testing is accurate enough or complete enough or that the protections are good enough, etc.?

FOXWORTH: Well, I think that the players feel comfortable and confident with the testing now. At the beginning of the negotiations, the league was not trying to test every day. And there were issues, but the players got to a point where they were comfortable with it and they accepted it.

DUBNER: When you were a player, if we had said, “In the interest of optimal safety, we’re going make a bubble and we want you, Domonique, to commit to being in this bubble from, let’s say, the beginning of July until the end of December without family, without friends, etc. Would you have done that as a player?

FOXWORTH: Absolutely. And I think most players would also. Whatever your chief motivation is to be in the N.F.L., be it making enough money to change the financial trajectory of your family or to win a championship, you understand that these opportunities are fleeting. And you’ve already made so many sacrifices. As big as that sacrifice seems, it seems small in comparison to the life’s worth of sacrifices you’ve made to get to this point. 

DUBNER: Can you just talk about the way your standard N.F.L. player thinks about risk in general and how that might differentiate their willingness to go back with Covid as a risk versus, let’s say, teachers or an automaker?

FOXWORTH: Yeah. I think of myself as a pretty cautious and thoughtful person when it comes to making decisions. But I think that football players in general — and I have to come to terms with this — we are risky. There is a sorting process that happens throughout football. And you don’t get to the highest level of football without being comfortable with acting against your own self-interest. So, just the idea of tackling somebody — let me throw my body into another body. That is a level of risk that you have to become comfortable with or you were born comfortable with that just most other people aren’t. There’s some level of risk that all football players are comfortable with, and Covid I’m not sure tilts that risk for most players in a heavy enough direction. 

DUBNER: So, as we speak, teachers in New York City are discussing going on strike because of what they perceive as unsafe workplace conditions in their schools. They’re not convinced that there’s enough testing and safety to proceed. Why do you think the N.F.L. has had so much less friction with its labor force? Is it that it’s doing a better job? Obviously, it’s hard to equate these populations. There are a lot of differences. But still, why do you think one is working out relatively well as of this point and the other has got so much friction? 

FOXWORTH: Well, without being embedded in either of those organizations, I would say the incentives are different. I don’t know what teachers make in New York in one year. But it’s probably not worth risking your health. I know what most football players make, and it’s the equivalent of an entire teacher’s lifetime earnings. So, for some players, it’s worth that. And they won’t get that time back. For someone who has a seven-year career, like me, which would be considered a long career — that is a lot of your lifetime earnings. Because whatever job you do after that is not going to make it. One year as a teacher — you’re not going to deteriorate as a teacher and not be able to get paid going forward. But one year as a football player, there’s a whole other crop of rookies coming in to take your job. And you may not have that value ever again.

After I spoke with Foxworth, the New York City teachers union decided to not strike, after the city agreed to delay in-person learning by 11 days. They became the only major U.S. school district to commit to restarting in-person this fall. The current plan in New York is for just 10 to 20 percent of students and teachers to be tested once a month.

DUBNER: How much or maybe how well do you think the N.F.L. cares about the health and welfare of its players? 

FOXWORTH: So, that’s a tough question, because back in my days of being president of the N.F.L. Players Association, I was a lot more militant and hard-line, and said that they don’t care at all and they view us as cogs in the machine, which now, I don’t believe that’s completely true. I also don’t believe it’s completely false.

I think that there is some empathy there. And they care to some degree. But I think like any of us, there is a priority stack. And making money is higher on a priority stack than health and safety of their players. History has pretty much borne that out to be — a fact is, when a decision needs to be made, the first filter it goes through is, “How’s it going to impact our pockets?” The next filter after that is — potentially, best-case scenario, the next filter after that is, “How is it going to impact our players?”

DUBNER: And the history you’re talking about is primarily around concussions, and the N.F.L.’s denial of concussion and brain injury as a product of football? 

FOXWORTH: Yeah, I think that’s the biggest one that everyone knows about. But anyone who’s been in the league recognizes how it works on a day-to-day basis, even when it’s joints and ligaments and muscles and not necessarily your brain. You know that the team — and it permeates all the way back to college. It’s just about the culture of football. You get out there and you play no matter what. If you’re capable, then you go.

DUBNER: Can you give an example from your own career where a team put your value as a player ahead of your value as a human with an injury or a potential injury? 

FOXWORTH: So, the tough thing is I also did. I recognized how fragile a professional sports career is. And especially if you’re not a No. 1 overall pick and you’re not a big star, which I wasn’t, I recognized how fragile it was. So it felt like we were on the same team. When the doctors and the trainers were offering anything to get me back on the field, I was like, “Yeah, you’re right, let’s get back on the field.” And so that culture exists for all of us. And it’s unhealthy, like, literally. It’s physically unhealthy. And it’s probably emotionally unhealthy. But damn, it’s fun to watch. 

N.F.L. chief medical officer Allen Sills, before going to work for the league, spent much of his career studying and treating sports-related brain injuries. So I asked him to talk about player safety, especially in light of the league’s history with concussions.

DUBNER: So, this is obviously a long and contorted history, but that did not exactly give the N.F.L. a credibility boost when it came to landmark medical issues. So what do you, as chief medical officer, now say to people — whether it’s players, families of the players, the public — who might think that the N.F.L. was on the wrong side of history then and they’re concerned about it being on the right side of history in Covid-19?

SILLS: Well, I can tell you my personal experience. As I was going through the interview process, I had the same exact question that you just raised, which is, “Is the N.F.L. really committed to health and safety? Is it a top priority?” And I asked that of everyone I talked to, including and up to the commissioner of the league. Do we want to really be leaders in sports medicine and do the things that are supported by medical data and science? And he unequivocally said yes and assured me that my hiring was part of that commitment to lead the N.F.L. where science was going, whether that be in concussion and soft tissue injuries or — certainly then, no one could have foreseen Covid.

And I can say that since that day back in 2017, I found that to be the case. I have found that at every level — league executives, team owners, coaches, anyone — has turned to me and not said “we can’t do that” or “we don’t want to hear about that.” They’ve said, “Tell us what the data shows. We want to make our game safer for everyone.”

DUBNER: Have you seen, whether it’s among players or maybe coaches or trainers, any remnant of that past though? The macho past where, “take a shot, patch it up, get back in there.” Or do you really think the buy-in is as complete as you’re making it sound? 

SILLS: I think the buy-in has really been remarkable. There’s been a sea change in the reporting of injuries and certainly around concussion and the recognition that that’s a serious injury. And our players, they really grew up with a concussion protocol. Since they were in high school or college, these concepts have been part of their experience, and so it’s a natural thing for them. So we’ve seen, for example, the number of concussion evaluations that have a component of self-report — meaning that the player themselves reported it, or a coach or a teammate brought it to attention — that number has continued to go up and has been substantial.

DUBNER: Let me get back to Covid for a minute. So, as a doctor, I’m sure, unless your patients are totally atypical, that you have a lot of experience with noncompliance. Patients not doing the things that you, a doctor, or some other medical professional tells them to, including taking medication and so on. I am just curious, with the N.F.L., because it does have vestiges of military hierarchy and so on — whether you think that your success so far is related to the fact that maybe N.F.L. players and staff are pretty good at complying, and whether you think this says anything about the degree to which personal responsibility and compliance needs to change a little bit, as opposed to relying on the institutions, the government, etc., to fix things? 

SILLS: I think personal responsibility and compliance is the key factor to why the N.F.L. or any other organization is going to be successful. Tests don’t prevent disease, right? They’re about disease diagnosis and containment. What prevents you from becoming sick are those individual choices and behaviors that you display throughout the course of your day. Are you wearing a mask? Are you staying physically distant? Are you washing hands? Are you staying away from sick people? Are you avoiding gatherings? All of those choices that individuals make. And in our situation, they’re not only making them at the team facility but when they’re away from the facility. Those are absolutely key to the success of the program. 

DUBNER: How many positive tests — truly positive tests — would it take to shut down a team or the league? And I guess what I’m really getting at is, what do you think is going to happen when the season starts?

SILLS: It’s hard to give you an exact number and say, “It’s this many.” I think it depends on how they’re distributed. It depends on how many close contacts. That makes it hard to have an algorithm where you say it’s this many or that many. I think what we just have to say is we will monitor the situation very much in real time and we’ll make the best and safest possible decision for everyone involved.

I asked Thom Mayer, the players union doctor, if he thought the N.F.L. season would be completed.

MAYER: First of all, I would say — and the league can speak for itself — but their goal is to play all 256 games on time, and to play the playoffs and the Super Bowl the first Sunday in February in Tampa. That’s not my goal. My goal is to keep the players safe. Could be a situation where certain clubs have, let’s say it was 10 or 12 players that go positive. Perhaps they don’t play this weekend. Perhaps that has to be postponed until the next weekend. Perhaps the season has to last longer in order to accommodate all 256 games, then the playoffs. I used to live in South Florida. Tampa’s pretty nice in April. You could play a Super Bowl in Tampa in April.

As much as Covid-19 has scrambled the future for the N.F.L., along with the rest of us, the future is also being reshaped by police shootings of Black men, the resulting protests and broader discussions about race. Nearly 60 percent of N.F.L. players are Black. The vast majority of team owners and senior executives, meanwhile, are white. As are a majority, though not quite as vast, of the league’s coaches. A few years ago, the San Francisco 49ers quarterback Colin Kaepernick, who is bi-racial, took a knee during the national anthem to protest police brutality. Kaepernick’s protest fed a movement — but the N.F.L. itself did not join the movement.

Kaepernick wound up out of football and the issue of racial equality wound up back on the margins. This year, things are different. This year, the N.F.L. is paying attention. Along with the players union, they have issued a joint directive on social-justice initiatives. They’re closing all club facilities on Election Day, for instance; they’re giving players more platforms to talk about race and equity. I asked former N.F.L. player and union president Domonique Foxworth, who is Black, what he thought about the N.F.L.’s evolution.

DUBNER: The N.F.L. back in June said that it was going to donate $250 million to help fight systemic racism. And the money is going to different organizations, including the National Urban League; Big Brothers, Big Sisters of America; the United Negro College Fund. Let’s talk about this, and what you think of that payment as representative of the league’s view of social justice, political justice, race and so on?

FOXWORTH: We all have some responsibility towards making the country we live in more perfect. I think some more responsibility should fall on those who have perpetuated the problems. And I don’t think anyone can argue, with the way that the N.F.L. handled the Colin Kaepernick protests, is that they perpetuated the problems in that situation. And so it’s hard for me to know what amount of money or amount of engagement will wipe away whatever guilt they should feel. But $250 million doesn’t seem like enough to me.

DUBNER: So why did George Floyd and the attendant protests get the N.F.L.’s attention so much more than Colin Kaepernick did?

FOXWORTH: We all exist in this broader society. And I think that’s what made it different, is because of all of us being quarantined and because of the video being so visceral, the entire country changed, it felt. And in that, the N.F.L. felt the water around them heating up. So they just wanted to go where the money is. And the money, in their view, was away from controversy.

DUBNER: But when I asked you about the money, you said that it doesn’t seem to be the amount that would necessarily wipe away their guilt.

FOXWORTH: I think I was being generous by saying guilt. I’m not sure that they feel guilty. I think it’s to cleanse their image more than anything, to wipe away the judgment and the perception that they are enemies of progress, which is what it seemed like back then.

DUBNER: If you could say to Roger Goodell, N.F.L. commissioner, “Look, look, $250 million — that’s great. And I’m sure it could be well-used, but it’s also, A, not that much money. And B, it’s directing money to places that are already doing this kind of thing.” But if you could tell him that there are, let’s say, three things the N.F.L. could actually do to address this. What would you suggest?

FOXWORTH: Well, I think the first thing they could do is probably address their own issues with race. It’s kind of absurd that there isn’t a Black owner of a team. It’s hard to look at the outside world and wish to address that when you don’t fix the problems inside. But I do think that the league is no stranger to politics and lobbying to get the things that they want, to get the money that they want, the opportunities that they want.

So I think they should adopt some policies that would show that they were serious about this. H.R. 40 is one that comes to my mind a lot. That’s a call for the government to study and develop a reparations plan, not necessarily institute it, but to study it and develop it. I think every right-minded person would understand that there needs to be some repairing done. So I think that would go a long way, if the N.F.L. got behind something like that.

DUBNER: So if I ask you, is the N.F.L. racist, what’s your answer to that?

FOXWORTH: No more than I feel like most American institutions are. So, I mean, I’d say yes, but I’m trying to think of some major American institutions that aren’t. And I’m having a hard time.

DUBNER: So, recently, Domonique, N.B.A. teams sat out a game, a playoff game, to protest the most recent police shooting of a Black man. The W.N.B.A. and M.L.S. did a similar action. Some N.F.L. players sat out a practice, but because the N.F.L. is not in season yet, it’s obviously not going to get as much attention. What do you see happening on that front as the season starts?

FOXWORTH: I think it’s pretty amazing where we’ve gotten since the Kaepernick protests. Because I, at this moment, think if something were to happen, if there was another police-involved shooting, it’s on videotape, or maybe not on videotape and just seems to have some racial implications, I’d be surprised if we have games that Sunday. I’d be shocked if they show up. I think you have to understand what leverage you have and what tools you have to achieve the means that are most important for you. And that’s one of the things that’s been incredibly encouraging about the empathy that professional athletes have and the civic responsibility that they have.

Because as a member of two of the major sports unions, and having been a part of some labor strife where players were fighting for higher salaries or better health care for themselves, in those situations, they were unwilling to go on strike or unwilling to withstand the losses of a lockout. It’s kind of mind-blowing to me that they’re willing to do that now for something that does not affect them as directly as the economics of the league.

DUBNER: Let’s pretend that you and I knew the future a little bit and that the N.F.L. season began. But after, whatever, a couple of weeks, a couple of months, it shut down. What do you think is more likely, that it would have shut down because of justice issues or because of coronavirus issues?

FOXWORTH: I don’t see it shutting down for either, honestly, because I think justice issues — they’ll follow the lead of basketball. And it’ll be a week. Coronavirus, they’ll just replace the players. Because the players — their names aren’t as important as they are in basketball. I guess if the pandemic just gets so out of control that it engulfs the whole country again, then that could bring it to a halt. And I guess the same thing could be said for justice issues, if it inflames to the point where we have tens of thousands of people in the streets in all major cities again, I could see it coming to an end. So it’s a coin flip of devastation. I think either is possible and either is not possible.

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Freakonomics Radio is produced by Stitcher and Dubner Productions. This episode was produced by Mary Diduch. Our staff also includes Alison Craiglow, Greg Rippin, Matt Hickey, Corinne Wallace, Daphne Chen and Zack Lapinski. Our intern is Emma Tyrrell. We had help this week from James Foster. Our theme song is “Mr. Fortune,” by the Hitchhikers; all the other music was composed by Luis Guerra. You can subscribe to Freakonomics Radio on Apple Podcasts, Stitcher, or wherever you get your podcasts.