Dr. Thom Mayer
Dr. Thom Mayer speaks at a briefing of doctors who were at the Pentagon and World Trade Center attacks during the American College of Emergency Physicians annual meeting October 16, 2001 in Chicago. Mayer assisted at the Pentagon. (Photo by Tim Boyle/Getty Images)

Protecting NFL players on the field is his job

Why this matters

While the focus in the past has been to protect NFL players from concussions, COVID-19 is the new variable that has teams and the league wondering how can they safely return while getting the game back to some sense of normalcy and keeping their players healthy.

Monthly Issue COVID-19 & Sport

Diseases desperate grown, By desperate appliance are relieved, Or not at all.” – Claudius, in Shakespeare’s Hamlet

For Dr. Thom Mayer, this is what he lives for. Trying to save lives. Working every aspect of a situation and figuring out what to do for the greater good. Ignoring the noise and diving deep, knowing the goal on the other side is to protect the well-being of more than 2,000 National Football League players in the regular season and close to 3,000 (90 per team) in training camp.

They are all desperate to prepare to play the game they love and to be paid handsomely for doing so — but not automatically willing to sacrifice the health and safety of not only themselves but those close to them.

It has been an intense four months since our country’s sports and much of our society shut down to try to limit the spread of COVID-19, the novel coronavirus that has killed around 140,000 of Americans, numbers that have seen a surge in the last month.

Mayer, the medical director for the NFL Players Association, among many other things, has studied this situation closely, but in some ways he has been there before. Many times. Because he’s an emergency physician in addition to his work in sports medicine.

  • He was there on Sept. 11, 2001, as one of the command physicians coordinating medical assets during the Pentagon Rescue Operation.
  • Two months earlier, after Minnesota Vikings tackle Korey Stringer died of heat stroke on the second day of training camp, Mayer received a call from then-NFLPA Executive Director Gene Upshaw asking him to become the union’s first medical director.
  • He was there that same year as the incident commander in the Northern Virginia area for the inhalational anthrax outbreak. It was his team, according to Mayer, that “successfully diagnosed, treated and saved the lives of two postal workers when all the others across the country were dying.”

He maintains a sense of calm through every recollection.

“This is what I trained for. I trained for emergencies,” he said. “Everybody else, there’s a loud bang, a fire and explosion, and sensible people run away to save their lives. And we're trying to run to it. You know, emergency physicians, firemen, policemen, soldiers, sailors, Marines — all run to the sound of chaos. So, for me, this is the intermittent normal. Actually, I’ve never used that term before, but it's an intermittent normal.”

Listening to Mayer is a revelation as he explains, educates, drops in scenes from movies and quotes from Shakespeare and theologians, and, most importantly, gets to the heart of what the NFL and NFLPA are trying to finalize as 2020 training camps are scheduled to open soon.

The offseason was navigated as smartly as could be expected. But a virtual draft and virtual offseason program form just the tip of the iceberg compared to figuring out what to do about conducting camps with 90 players and countless other coaches and personnel involved, much less playing games with fans or without them, and traveling all over the country to play those games.

The Pro Football Hall of Fame Game and enshrinement ceremony have been canceled. Whenever camps take place, it will be without fans. And, at best, fans in the stands for games will be reduced.

But there is still much to settle for how camps will be conducted from testing players to creating a special “injury” list for those that are found to have the virus.

Setting the tone for the job

Before all that is discussed, though, Mayer passionately describes a scene from the movie Patton to give a sense of what he is overseeing and how he feels about it.

“There’s a scene that you may remember,” he begins. “It’s after a battle in Europe as Patton’s Third Army is just devastating Hitler’s forces. And it’s the morning after a night tank battle. Patton’s looking over the field with one of his lieutenant colonels standing next to him, and he surveys this carnage and smoke and everything. And he says, ‘God help me, I love it. I do love it so.’

“And, honestly, as I say this, I’m really sad and profoundly so, that the coronavirus has devastated lives, has devastated the economy. But I love dealing with this stuff. That’s what I was trained for. That’s my job.”

His job has been relentless — “It’s all coronavirus all the time,” he says. “I haven’t wanted for things to do.” — since the pandemic reared its ugly head, and there will be no letup for many months to come.

Known to say frequently that “the health and safety of players is what I live and breathe,” Mayer immediately organized a brain trust internally of seven to 10 people to help give advice on the coronavirus. Externally, Johns Hopkins University was consulted along with Duke University and the National Academy of Medicine.

From the latter is Dr. Dan Hanfling, who is chairman of the academy’s task force on global preparedness and leads the subcommittee on isolation and mitigation. Mayer cites Hanfling for a description of the coronavirus’ potential effect on the NFL: “‘This is a contact disease in a contact sport. It’s transmitted by contact; it doesn’t waft through the air like a mist or a fog and travel great distances and you get it. You have to be within six feet for more than three minutes. And it’s transmitted by respiratory droplets. So you couldn’t design an experiment in a Petri dish that would better transmit this disease than NFL football.’”

Building a team that’s up to the task

Hanfling was one of several from that original brain trust who were on a task force subcommittee that prepared recommendations for the best way to operate training camps. The NFL and NFLPA each had co-leads. The league committee was composed mostly of team physicians and trainers.

New NFLPA President JC Tretter, a center with the Cleveland Browns, is on the players’ portion as well as on all the subcommittees because, Mayer insisted, “the voice of the players is the most important voice in the room as it is in every room that has to do with NFL football.”

Also among the NFLPA appointees was Dr. Ross Zafonte from Harvard, who co-leads the union’s Harvard Football Players Health Study research project.

Said Mayer, “The focus was on science because we trust all others that bring scientific data. And the great thing about that is they have their finger on the pulse of everything worldwide coming out. Pre-publication data. Conversations with scientists is just invaluable because you have the ability to know what will be known before it's known more widely.”

A past heads-up is what led Mayer to a retired Army colonel, Dr. Geoffrey Ling, the founding director of the Defense Advanced Research Projects Agency, also known as DARPA. He is a close advisor on the NFLPA Mackey-White Health and Safety Committee and now follows everything being done on emerging infectious diseases.

Learning which information to trust

Mayer left no stone unturned in trying to get the best information available. But that wasn’t always easy because of the stark reality that so little was known about this virulent virus. In truth, much has been learned, yet everyone is still learning.

“There’s two words that I am shocked are not used more commonly or explained better and those two words are ‘novel coronavirus’ and an ‘emerging infectious disease,’” Mayer said. “So, ‘novel and emerging infectious disease’ is what inhalational anthrax was considered 20 years ago when this occurred.

“The key things about ‘novel’ and ‘emerging’ are just that they’re new. They have not been seen before. We don’t know this virus. It’s not meningitis. It's not pneumonia in the traditional sense that we’ve dealt with before and that we know how to handle and which agents — in this case, antiviral versus antibacterial agents — work.”

Another challenge has been inconsistent messaging that continues to confuse. The reality is that information is learned every day but sometimes is found to be wrong later.

“One of the hardest problems I have is finding a single source,” Mayer said. “You have to go to about 12 different things. I have to go to six sites a day to get the information I need to be able to say how are we trending? What does it look like? How far wrong were the modelers? And how do we get that information in front of the players?”

Mayer said he talks nearly every day with his counterpart at the NFL, Dr. Allen Sills, as well as with NFLPA Executive Director DeMaurice Smith and Tretter.

Mayer also holds conference calls with the players, and that, he says, “leads to emails from the players or calls with players saying, ‘Hey, could you talk to my wife, could you talk to my mom, could you talk to my dad? What do they do to harbor safely?’”

Getting down to the decisions

While the 2020 NFL game schedules were announced to be played in the usual timeframe, the league has frequently said that, based on developments, adjustments can be made. The schedule includes ways that games could be moved to later in the season. One example is that all the teams in Week 2 matchups have their byes the same week later in the season. There could be a delayed start of the season, which could result in the Super Bowl being played as late as the end of February rather than Feb. 7.

From the NFLPA perspective, these are all the balls that Mayer was juggling: Seeing where things were one day while trying to have a sense of what could happen in the fall and winter when many experts predict a second wave of the disease to coincide with the normal flu season.

“We trace it every day,” Mayer said, acknowledging that’s often not enough. “The key is thinking ahead. I don’t know if you’re a shooter, but if you’re shooting skeet, you don’t aim at where it is; you aim at where it’s going to be. And so that’s what you have to do with this disease.”

A theology major (along with biology and chemistry) at Hanover College, Mayer cites theologian H. Richard Niebuhr, who wrote in The Responsible Self, “Before we do the ultimate things, we must always do the penultimate things. We must always do the things before the last.”

Mayer continues, “And the things before the last are preparing, thinking, what if, what if that, what if the other, what would it look like? You have to say, OK, it is novel, it is emerging. But based on what we know, and based on our internal modeling, not the broad models that are used out in the community, what’s it going to look like and what we’re going to do to keep players safe, what combination of isolating them and the people they come in contact with, and testing are going to get us to a place where we can safely say, it’s not all clear, but society’s back to normal.

“If it sounds like a complex calculus, it is.”

Of course, it became more complex in recent weeks with the surge of cases in Florida, Texas, Arizona and California, homes of eight NFL teams.

During a media conference call with Tretter on July 17, Smith said, “I'm sure back in March, April, May when JC and I put that task force together, there were always a few implicit assumptions. I'm not sure there was any more implicit assumption and we all thought back then, that things would trend in a more positive direction. The reality is in a lot of states right now, that trend has been in an opposite direction.

“A couple of weeks ago, we started to raise alarms about the spikes in a number of jurisdictions. And our job as the union is to hold the league accountable to making and providing as safe a workplace as possible. That culminated (the night of July 16) with, as long as I've been on this job, the first time the union has ever called for basically what (was) an emergency meeting of all of the team doctors, who are the head of their medical practices for the teams in these ‘quote unquote,’ hot-spot areas. To address that very question once again, doing our job holding them accountable. How are you reaching a decision about whether and to what extent it is safe to start training camp in these hot-spot areas and what criteria are you going to use to continue to make decisions about whether and to what extent it's safe to continue to operate in these jurisdictions?”

Tretter added, “Football isn't in a bubble. What goes on in our communities has a direct effect on how football works this year or if it can work this year. And it will be a constant monitoring of what's going on in our local communities. Our position was we have players, as we've spoken to our membership, who are nervous about flying from a relative safe location directly into a hot spot with their families with their kids, with their wives. Like Dee said, our job is to hold the NFL accountable and have them answer those questions. And those are the questions we want answered: how safe is it to start back up a football season at this moment, with locations in this country where teams are located, going through giant spikes of this virus and that has to be something that's looked at as we make any decision? The health and safety aspect has to be taken care of for the players first and foremost.”

Tampa Bay Buccaneers left tackle Donovan Smith is one of those players. He recently posted on social media, “With the start of the 2020 NFL season fast approaching, many thoughts and questions roam my mind as I’m sure it does for many of my fellow ‘coworkers’ across the league. The unfortunate events of the COVID-19 pandemic have put a halt to a lot of things. Football is not one. To continue discussing the many UNKNOWNS do not give me the comfort. Risking my health as well as my family’s health does not seem like a risk worth taking.

“With my first child due in 3 weeks, I can’t help but think about how will I be able to go to work and take proper precautions around 80+ people everyday to then go home to be with my newborn daughter. How can a sport that requires physical contact on every snap and transferral of all types of bodily fluid EVERY SINGLE PLAY practice safe social distancing? How can I make sure that I don’t bring COVID-19 back to my household?”

This is what the players are fighting for.

Yes, there will be testing

As Mayer says, “Anytime you’re involved in disaster planning, it’s always best case, worst case, base case. And that has to be done with this disease.”

Most important, he noted, is that until recently about 30 percent of the viral tests were showing a false negative, indicating someone actually having the virus didn’t have it.

“That’s gotten better,” Mayer said. “It’s down now to somewhere around 15 to 20 percent, but that’s still one in five people testing negative but in fact being positive when you’re trying to take a cohort of people and put them together, meaning NFL football players and their support staff; coaches; trainers; docs; all the people who are involved in football ops. So, that’s gotten better, but it’s still moving — and moving quickly.”

Smith explained why the NFLPA supports daily testing.

He said, “You have to take steps based on what you are concerned about with exposure. Well, one of the ways of decreasing those actions is to test every day. Because then once you have Player A test positive, you can make decisions about the extent to where that person was in contacting somebody else, how long they were in contact with someone else, the extent to which they may have transmitted a viral load to that other person, but also engage in testing of that person every day. And we're at the ability now in some places where you can get tests back in three or four hours. I'm really loath to engage in broad hypotheticals that don't envision multiple daily testing. As well as very intensive contact tracing.”

The league recently announced that 72 players had tested positive as of July 10 and the expectations are there will be more when camps open.

Sills recently told the Boston Globe, “We absolutely expect that, and I think that’s just reflective of the fact that this disease remains endemic in our society.”

Getting on the same page

This is an area of increasing frustration for the union after numerous meetings of the task force. It ramped up when NFL Media reported in early July that an agreement was close.

That prompted a response from executive committee member and San Francisco 49ers cornerback Richard Sherman, who wrote on Twitter, “Huge outstanding issues are still unresolved. We haven’t agreed to anything in their proposal and literally just sent them a response. But all will be revealed.”

There actually had been some agreements, but not those related to the training camp plan, potential opt outs by players and economic issues related to the potential for lost revenue this season and the impact on future salary caps.

Said Tretter, “With the NFLPA and NFL experts, I sat on every one of those phone calls and sat through and learned about the science and the data behind bringing guys back and understanding that even differently than coming out of the lockout (in 2011), the facilities were closed, similar how they were now. But you could go to any private gym and work out and stay in shape. That wasn't the case this year. There were private gyms closed, so guys went over a month without being able to train so I would argue that guys are in worse physical shape coming out of this break then out of the lockout break.

“Then comparing it to the lockout and the injury spikes, the 25 percent overall injuries, 44 percent hamstring strains, over double the amount of Achilles injuries. How do you bring a guy back? So the recommendation from our joint committee was 21 days of strength and conditioning in getting your body back into shape before being thrown into the fire of a reactionary environment of a football practice, then a slow ramp up of non-padded practices, 10 days to get used to when you're cutting, reacting to other bodies out there, loading the tissue the right way in your body to make sure we don't have a spike in soft-tissue injuries. And then you start the contact acclimation phase of the 14 days of practices. That's what the experts who study the science and this data for a decade recommends as the best way to make sure guys get from zero coming out of this long break to game speed by the end of it.”

Despite those recommendations that included having no preseason games, the league has pushed back by wanting two games and raising questions about the acclimation period. The league is reportedly insisting on the five-day period in the current collective bargaining agreement that was approved by the players in mid-March just as other sports were shutting down.

Smith emphasized, “This acclimation period was agreed to by the joint task force and the protocols that ultimately were sent to the teams were a collaboration between the NFL and the NFLPA. So, everybody should be level set about the things that we came up with were between both the league and the NFL. So, part of our frustration with the acclimation period and the league's position about two preseason games and negatively impacting that acclimation period was because their group of team doctors agreed to it with us.”

As for preseason games, Smith added, “To engage in two games where players would be flying all over the country and then engaging with each other to work, and to do that prior to the season, doesn’t increase the likelihood of starting and finishing the season on time.”

Tretter voiced a similar sentiment during a recent appearance on Arizona Sports FM 98.7, the flagship station of the Cardinals, saying, “We’ve yet to get a medical reason as to why we’d play two preseason games or preseason games at all that don’t count in the standings, that just risk something happening that just shuts the season down.”

The league is hell-bent on beginning camps as scheduled, a belief confirmed Saturday (July 18) when league executive vice president Troy Vincent informed the coaches and general managers that would be the case.

Most teams’ full rosters report July 28, which is the 47 days before the season openers mandated in the CBA. Rookies can report one week earlier with quarterbacks and injured players arriving two days after the rookies. The Houston Texans and Kansas City Chiefs are scheduled to report July 25 because they meet in the Thursday night opener Sept. 10. Those teams are having their rookies report Monday although the Chiefs have none of their six draft picks signed and the Texans have two of their five signed.

As Smith said, “The start of the league or pushing it back or when does it start are all questions that we have had with the league. But starting out on this issue of, OK, we have a schedule that the league wants to stick to. And right now they've made the decision that they want training camp to open on time.”

Once the season arrives, the league is still faced with a major question: Aside from the question of how often players will be tested, what happens when the inevitable occurs and a player tests positive and has to be isolated?

There is the potential the player(s) already might have infected others, who in turn infected others. The very nature of the constant contact in the sport can result in players infecting many others.

“These are questions that we brought up to the league, because they are going to have huge effects on how the season works,” Tretter said. ”The question that we've asked is if the center tests positive on a Friday, and there's a quarantine period for all of his close contacts, well, if I just came from a practice, where I've been in a huddle with all my offensive teammates, and individual drills with all my linemen, then blocking the defensive linemen and linebackers, If they're all in quarantine for the next couple days, what does Sunday's game look like?

“And those are the questions that, you know the league needs to offer their opinion on how this will move forward. And then you talk about what changes need to be made. Maybe the schedule of how the week looks needs to be different by avoiding those situations where one positive test on a wrong day late in the week derails an entire team because all the people who are close contact, you now need to get through the protocols to make sure they're not sick and transmitting this virus to everybody else around them. You don't have enough bodies to put on the field to play.”

Meanwhile, in Canton...

For Hall president David Baker, a walking and talking pied piper for the Hall and the values it represents, it was a difficult time until the decision was made in June to postpone this year’s enshrinement until 2021.

It was made doubly difficult because the Hall also had a grandiose Centennial Celebration planned for three days around the Sept. 17, 1920 founding of the league in Canton. There was a special Centennial Class to be honored. Now, 20 players from this year will be combined with potentially eight next year to create, as Baker says, “A lot more fun in ’21.”

He said, “The game is such a wonderful metaphor for life. There’s a wonderful quote by Lincoln that says, ‘I have been driven many times upon my knees by the overwhelming conviction that I had nowhere else to go.’ And I think that, for us, there’s going to be a lot of people driven to faith. Because that’s where we feel we have no place else to go. But there’s a lot of people who are going to rely on those lessons in sports.

“But, like the game, you have to have luck, you got to be a team, we got to work together. There’s gonna be times when there are setbacks, but if you make in-game adjustments, you have to be ready, you have to be all on the same page and you have to trust each other. I still trust this next time we’re going to work together to make something good happen. And that’s exactly where we are at the Hall of Fame. That’s exactly where our country is. We need to be ready for whatever contingency or audible needs to be called.”

During the months before the postponement, Baker talked to all the living enshrinees, especially the seniors who have waited decades for this honor. Baker said that, to a man, they “kind of chimed in and said, ‘Dave, don’t you worry. We’re just happy to be here. And whether that comes in August or whether that comes a year from now, we’re happy to be here.’”

Baker concludes, “I think we can have a powerful platform for these guys to encourage America and Americans. Because as we evolve, at least a little bit out of this healthcare crisis, there’s gonna be a huge crisis to get America and Americans going again.”

Relying on the science

Mayer said he often answers questions from players, and he tells a story of a receiver who owns a condo and asked Mayer early in the pandemic about the safety of getting to the lobby.

“He asked, ‘How do I get there?’ And I said, ‘You get to the lobby the same way you run your routes: fast, precisely and with no hesitation whatsoever.’”

At the end of the day, Mayer affirms, it’s all about the science.

“That’s where the science is guiding this whole thing,” Mayer concludes. “We always say in the NFLPA we will go anywhere the science takes us but go nowhere the science doesn’t take us.”

Smith added, “I am far more focused and concerned about the accountability of the league and the teams for our player safety. That's their job. And as we go forward, we've already had coaches come out and say that these protocols don't work or can't work, and you've covered football long enough to hear that underlying theme of, well, it's just football and we have to play it. Or these are football players and they ‘quote unquote’ assume the risks. Or we've just got to get back to the business of football. Slogans and wishful thinking haven't led our country through this pandemic, and it will not lead football on any level through this pandemic.

“What we have always tried to do, whether it was back in 2009 and ringing the bell on how we need to treat concussions in a different way, or when we, the union took on team doctors and teams about Toradol and painkillers. All of that was a direct challenge to this myth that somehow guys like JC are less than human. And somehow because they have a different job, we can turn a blind eye to science and common sense. And I know that our players to a certain extent are frustrated about where we are and how long it's taken. But everybody on this call that has had experience dealing with the National Football League and change know that it is literally as close to hand-to-hand combat to effectuate change in the National Football League. And that said, have they done a good and solid job with respect to engaging with the union on coming up with ways to make it as safe as possible? Yes. But it doesn't mean that those battles are not continuing. Those battles are going to continue all season.”

Tretter concurred, saying, “For the most part we’ve worked well together. Now we have to start getting to the big issues of how football operates this year. I think player safety is something that can’t be negotiated on. There’s no choice but to keep players safe because it’s a win-win for everybody.

“It’s not something that should have to be a fight. It’s in everybody’s best interest to make decisions to keep players healthy throughout the season.”

Expanding on the importance of the acclimation period being significant and if not 21 days, much longer than five, Smith said, “I've always been a little confused when keeping guys healthy seems to be always pushed as a sole win for players and for the union. Players obviously don't want to get hurt, they want to make it through a full season. But, the fans don't want their favorite players getting hurt. And they want them to be out there playing every week for their favorite teams. And the owners should also not want their players to get hurt for that same exact reason.

“So, you know, when we talk about an acclimation period? That is not our answer. It was our joint answer between both the experts the NFLPA put forth as well as the NFL put forth. When that joint answer comes back as this is how you get to a season from where you're at right now, with the people healthy and safe. Well, that's an easy answer of what we're supposed to be doing is following the experts’ guidelines, and making sure we're eased into this process as well as getting ramped up to the right way to be able to play football games on Sundays.”

Parting Shots

*Smith on what the results were on the call with team doctors: “(They) said, with a couple of reservations, that they felt that it was safe to open training camp, and they provided their medical reasons. Some of the things we agreed with, some of the things we may not agree to. But overall, they gave their medical opinion that it was safe to open training camp. And that's where we are.”

*Smith on Dr. Anthony Fauci, “I asked someone to pull everything he said publicly and I think he has done a tremendously fantastic job not only with this, but for decades. In my personal opinion, if you're looking for heroes in this, you found one in that guy.”

*Smith on masks: “We're in a place right now where very, very simply, what's good for the country is good for sports. And as simple as something like wearing a mask will have probably the most significant impact on the extent and whether sport returns in this country. And that's not a political statement. That's a common sense and scientific statement and where, I think, our guys can probably be incredibly helpful. And stepping out onto a larger stage other than football is that nothing will bring fans back to our stadiums then a simple decision across the country to wear a mask.”

*Finally, when asked, “Have you guys discussed and have you reached any conclusions about what your options are as players individually and collectively if you don't get the answers you want if the negotiations don't lead you to conclude that the work environment is safe,” Smith succinctly said, “This is the part where De is not going to say a lot of words. But we’ve looked at all of our options.”

Meanwhile, NFL owners also communicated Friday in a videoconference and the league issued this statement: "We will continue to implement the health and safety protocols developed jointly with the NFLPA, and based on the advice of leading medical experts, including review by the CDC. We will address additional issues in a cooperative way. All decisions will be made in an effort to put us in position to play a full regular season and postseason culminating with the Super Bowl which is the shared goal of the clubs and the players."

What does that truly mean? We … shall … see.


Howard Balzer is in his 45th year covering the NFL for a wide variety of media and is one of 48 selectors for the Pro Football Hall of Fame. He is co-host of the Pro Football Hall of Fame radio show that can be heard each week on SiriusXM NFL Radio, Channel 88.


Monthly Issue

COVID-19 & Sport

COVID-19 is the rival no one in sport could game plan for. As many live events remain at a standstill and the world keeps adapting, how is sport resetting upon its staggered returns?