NHL's COVID-19 protocol won’t require quarantine for close contacts of people with positive tests

B.C.’s provincial health authorities still haven’t given approval to the NHL’s plans for the upcoming 2020-21 season and they’re evidently not alone. Ontario and Quebec haven’t signed off on the NHL’s plans, which were released on Tuesday, detailing the COVID-19 protocols for travel, restricted areas in arenas, and for positive tests.

On initial review, the NHL’s plans seem standard and comprehensive, but there are a couple of elements that jump out as potentially causing some concerns.

For instance, visiting teams are restricted to a single hotel and the arena when traveling to another city, which is expected. There are exceptions, however. 

According to the travel protocol, “Players may enter into venues other than the designated hotel, practice facility, or the game arena when the Club is on the road for the purposes of seeking medical treatment, treatment by third party wellness providers, visiting immediate family members who are present in the city the Club is visiting, or in the event of extenuating personal circumstances.”

Third-party wellness providers refers to physiotherapists, chiropractors, massage therapists, and the like. It’s understandable that players would desire additional medical care and treatment beyond that provided by their team, but that does open up the bubble of people that players come into contact with and opening up that contact while on the road rather than just at home does increase the possibility of spread of COVID-19.

There’s also the issue of allowing players to visit immediate family members while on the road. Again, it’s understandable why the players would want this possibility left open, but that again increases the contact a player has outside of the bubble of their team and opponents.

Still, it seems like those are instances where the risk could be limited with proper precautions. More alarming to my eyes is the protocol for when there is a positive COVID-19 test on a team, specifically in regards to close contacts.

If a player is determined to be a close contact with a player or staff member who tests positive for COVID-19, they won’t be required to isolate. In fact, they’ll be allowed to continue playing.

Close contacts will undergo a RT-PCR test. If negative, they’ll continue to be monitored and tested daily for 14 days, but won’t be subject to quarantine if they are asymptomatic and don’t have a fever. During those 14 days they’ll be required to remain in their households, but will still train, practice, and play with their team.

There are two immediate issues that jump out regarding this plan. One is that RT-PCR tests can return false negatives if they are administered “too early in the course of infection.”

“A negative test, whether or not a person has symptoms, doesn't guarantee that they aren't infected by the virus,” said Dr. Lauren Kucirka of John Hopkins Medicine for Science Daily. “How we respond to, and interpret, a negative test is very important because we place others at risk when we assume the test is perfect. However, those infected with the virus are still able to potentially spread the virus.”

The issue is that asymptomatic people can still spread the virus, though not to the same extent as those with symptoms. In addition, those who do not show symptoms immediately may not be asymptomatic, but pre-symptomatic: they could develop symptoms later on. Presymptomatic people are more likely to spread the virus than those who are asymptomatic, ie. people who don’t develop any symptoms.

“Viral culture studies suggest that people with SARS-CoV-2 can become infectious one to two days before the onset of symptoms,” reads a study in The BMJ.

In other words, a close contact could test negative for COVID-19 via a RT-PCR test and still be contagious, even without symptoms.

This seems a major issue with the NHL’s protocols. The problem is that if one player gets COVID-19, pretty much the entire team will be close contacts. If all close contacts have to quarantine, games simply won’t get played.

So, the NHL is taking a gamble. The odds that an asymptomatic person tests negative for COVID-19 and still has a high enough viral load to spread it to others are admittedly low, so the NHL is willing to play those odds to make the season happen.

The question is if provincial health authorities across Canada are willing to make that same gamble.