Tennessee Titans' COVID-19 outbreak: What we know about the positive coronavirus tests

The NFL has its first COVID-19 team outbreak. Ten members of the Tennessee Titans have produced confirmed positive test results in the past four days, a rash of coronavirus infections that could potentially have spread during Sunday's game against the Minnesota Vikings at U.S. Bank Stadium.

The Titans have closed their practice facility until at least Saturday, while the Vikings have closed theirs until they have further test results. Additionally, the Titans' Week 4 game against the Pittsburgh Steelers has been postponed, though a decision has not been made yet on the Vikings' matchup with the Houston Texans.

Here's what we know at the moment, with appropriate context. We will continue to update as news develops.

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Timeline for return to facilities
Week 4 game status

So this started with the Titans?

Yes. On Saturday, Titans linebackers coach Shane Bowen returned a confirmed positive test. The Titans received the results before they departed Nashville for Minneapolis, and Bowen was held back from making the trip.

Were the other nine Titans employees infected by Bowen?

We don't know. What we do know is that the entire Titans traveling party was tested Saturday, as they would ordinarily be. The Titans had those results by Sunday morning. All were negative, meaning every coach, player and staff member was eligible for Sunday's game.

The Titans stayed Saturday night at the JW Marriott, adjacent to the Mall of America in Bloomington, Minnesota, according to ESPN's Courtney Cronin. League protocol requires all members of the traveling party to have their own rooms and also prohibits them from "congregating, visiting or mingling with individuals outside of the Traveling Party once they have arrived in the game city."

On Sunday, they defeated the Vikings 31-30. The team flew home after the game ended.

So no one was tested Sunday?

Correct. The protocols call for daily testing on every day except game day. Neither the league nor the NFL Players Association (NFLPA) has explained explicitly why, but timing is likely a substantial part of the answer. Results for polymerase chain reaction (PCR) tests, performed on the morning of a game by nasal swab, probably wouldn't be returned in time for kickoff.

Point of care (POC) tests have quicker results -- PCR tests are usually returned overnight, whereas POC tests can be returned on the same day, and even before kickoff after a morning test -- but are not as accurate. At this time, POC tests are only used to help confirm initial positive tests, and the NFL doesn't yet trust them on their own. And the NFL likely didn't want to sideline a player or coach based only off a POC test.

When were they next tested?

All Tier 1 and Tier 2 employees from the Titans and Vikings, which includes players and coaches, were tested Monday morning. Of the nine Titans who returned confirmed positive tests, four were players and five were employees. The four players were placed on the COVID-19 list Tuesday: starting nose tackle DaQuan Jones, linebacker Kamalei Correa, long-snapper Beau Brinkley and practice squad tight end Tommy Hudson. Titans coach Mike Vrabel said Wednesday that some were experiencing flu-like symptoms. No members of the Vikings returned positive tests as of Wednesday morning.

What about the officials who worked the Titans-Vikings game Sunday?

Most officials travel home on the night of the game or the next morning. Per their protocol, they are tested twice per week -- once in their hometowns and once on the day before games. Referee Clete Blakeman's crew worked this game and will be tested daily this week. None of those officials will work a game in Week 4.

Does that mean the outbreak is contained?

No. General guidance from public health officials suggests it can take up to five to seven days for an infection to register in a test. That's why the Titans' facility is closed through at least Saturday. The NFL/NFLPA protocol calls for increased monitoring for eight days for anyone who had close contact with someone who returned a confirmed positive test.

How do they determine close contact?

The protocols follow CDC guidelines: within 6 feet apart for at least 15 minutes of an infected individual. The league identified 48 close contacts to monitor, based on contact tracing of the eight confirmed positive individuals, according to Graziano. It's unclear if those are all members of the Titans, or if some are members of the Vikings.

That includes contact during a game as well as data recorded by mandatory proximity devices worn by all team employees before and after the game. Per the protocol, "Tier 1, Tier 2, Tier 2M and Tier 3 Individuals will also be required to wear Kinexon Proximity Recording tracking devices at all times while engaged in team activities (including in the Club facility, during practices, and during team travel)."

So did the virus find the one hole in the protocol?

If the Titans passed the infection to the Vikings, then yes. Games are the one point in the NFL week where social distancing is impossible, and the period when it's most likely that an infected person will breathe on others. That's part of the reason the NFL has insisted on coaches and other non-players wearing masks on the sideline.

The absence of game-day testing also heightens the risk. A POC test Sunday morning might have caught at least some of the positive results the Titans eventually recorded Monday.

Right. But it seemed as though the NFL protocols were working.

They were. As of Tuesday morning, there were only four players on the NFL's COVID-19 list. Only seven players, and another 29 non-players, had returned positive results during the four testing periods from Aug. 12 through Sept. 19.

But as Zachary Binney, an epidemiologist at Oxford College of Emory University, said earlier this month: "An outbreak really can happen at any time." It's fair to wonder if this will prompt a shift to game-day testing.

When can the Vikings and Titans get back to their practice facilities?

We know the Titans won't return before Saturday at the earliest. Vikings general manager Rick Spielman said Wednesday the team is hopeful that coaches and players can return to their facility on Thursday.

How long will the infected players and staff members be kept away from the team?

It's complicated. Here is a flow chart for symptomatic and asymptomatic positive tests.

What about their Week 4 games?

The Titans' game upcoming against the Steelers was postponed Wednesday morning, according to ESPN's Dianna Russini. All options for a new date are under consideration, including Monday night. At the moment, the Vikings' game in Houston is still on the schedule for Sunday. If the Titans-Steelers game can't be played Monday, or even Tuesday, one possibility is to move it to Week 7 -- if the NFL moves the Steelers' Week 7 game against the Baltimore Ravens into Week 8, when both have byes. A potential rescheduling of the Vikings' game at the Texans is less obvious.

The NFL formed an independent committee made up of unaffiliated former league officials to advise commissioner Roger Goodell on equity and fairness in these situations. One immediate question is whether it's fair for the Titans to play the Steelers on Sunday if they have been away from their team facility, and thus unable to practice, all week.