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NLL COVID-19 Policy & Protocol 2021-22

(Revised March, 2022)

Introduction

This document sets out the COVID-19 policies and protocols applicable to the 2021/22 NLL Season (“Policy” or “Protocol”) and is intended to help protect against the contraction and spread of COVID-19. All individuals involved with the 2021/22 Season are expected to familiarize themselves with this document and maintain strict adherence to these policies and protocols.

While comprehensive, the measures outlined in this document cannot mitigate all risk. A range of clinical scenarios exists for those who contract COVID-19, from very mild to fatal. COVID-19 generally adversely affects older age groups and those with previously existing medical conditions, more so than younger, and otherwise healthy, individuals, and we recognize that Players and Club personnel have family and household members who may fall into these vulnerable categories.  For these reasons, the NLL Medical Committee, the NLL and the NLLPA strongly recommend that any individual involved with the 2021/22 Season get fully vaccinated.  As outlined in more detail below, more restrictive rules apply to any individuals who are not fully vaccinated.  Being unvaccinated puts you and others in the NLL ecosystem at increased risk of contracting and transmitting COVID-19.  For more information about getting vaccinated, please contact your Team Physician.

Adherence to the provisions in this Policy is important both during Training Camp and throughout the NLL Season for the purpose of maintaining the health and safety of the Players and Club personnel, as well as to maintain the integrity of competition among the Clubs. This Policy sets forth a layered approach: no one aspect can stand on its own. Violations of, and/or lack of compliance with, the NLL COVID-19 Policy will result in significant Club and individual sanctions, including potential forfeiture of games, fines and reimbursements of expenses, loss of draft choices, and/or ineligibility for participation in Training Activities and/or NLL Games. Concerns regarding compliance with the Policy requirements shall be reported directly to Jessica Berman or Brian Lemon. Players may also contact the NLLPA and/or their NLLPA Player Representatives if they have concerns regarding compliance with the provisions of this NLL COVID-19 Policy.

This document was established by the NLL Medical Committee in coordination with the NLL, NLLPA, as well as best practices from other sports organizations and federal, local and provincial Health Authority guidance. This protocol is subject to change.

In the event your Club home market, or travel domestically or internationally, requires stricter guidelines than what is set forth in this document, those will apply.  Nothing herein supersedes any government restrictions related to COVID-19.

If you have any questions or concerns about this policy, please contact any of the following: (i) your Team Physician, (ii) your Club Compliance Officer, (iii) Marcus Robinson, (iv) Brian Lemon, or (iv) Jessica Berman.

Marcus Robinson, Chair, Medical Committee ([email protected])

Brian Lemon, EVP, Lacrosse Operations ([email protected])

Jessica Berman, Deputy Commissioner ([email protected])

General Preventative Measures

The situations that pose the greatest risk of infection are social gatherings and in-person interactions. It is critical for all individuals participating in the NLL’s 2021/22 Season to adopt preventative measures during their time away from the Club’s facilities, in addition to the measures adopted while in the more controlled environment of the Club facility. The following is strongly recommended for your health and safety and to minimize risk of transmission:

  • Stay at home to the greatest extent possible and do not engage in unnecessary interactions with individuals living outside your household.
  • Stay at home if you are feeling sick.
  • Wash your hands frequently with soap.
  • Wear face coverings unless actively eating, drinking or exercising.
  • Diligently practice physically distancing.
  • Get vaccinated.
  • Get a COVID-19 PCR test if experiencing symptoms.

Vaccination Guidelines

HOW TO BE CONSIDERED FULLY VACCINATED

“Fully Vaccinated” is defined as an individual who is at least 14 days past their final vaccination dose.

“Unvaccinated” is defined as anyone who: (i) is not 14 days past their final vaccination dose, or (ii) does not disclose their vaccination status.

For the sake of clarity, someone who has had COVID-19 within 90 days but has not received their complete vaccine course of an authorized vaccine will still be considered Unvaccinated.

GENERAL VACCINATION INFORMATION

There are three COVID-19 vaccines currently authorized for use in the United States:

  • The Pfizer-BioNTech COVID-19 vaccine (mRNA) – two shots, 21 days apart
  • The Moderna COVID-19 vaccine (mRNA) – two shots, 28 days apart
  • The Johnson&Johnson/Janssen COVID-19 vaccine (viral vector) – one shot

There are four COVID-19 vaccines currently authorized for use in Canada:

  • The Pfizer-BioNTech COVID-19 vaccine (mRNA) – two shots, 21 days apart
  • The Moderna COVID-19 vaccine (mRNA) – two shots, 28 days apart
  • The AstraZeneca COVID-19 vaccine (viral vector) – two shots, 4-12 weeks apart
  • The Johnson&Johnson/Janssen COVID-19 vaccine (viral vector) – one shot
  • When the first dose in a COVID-19 vaccine series is an mRNA vaccine, the same mRNA vaccine product should be offered for the subsequent dose whenever possible. When the same mRNA vaccine product is not readily available, another mRNA COVID-19 vaccine product may be considered interchangeable.
  • With respect to AstraZeneca,
    • Individuals who have already received two doses of the AstraZeneca/COVISHIELD vaccine are considered protected in Canada and the US (according to the CDC).
    • Individuals who have mixed dose vaccines with AstraZeneca plus and mRNA vaccine are also considered vaccinated in Canada and the US. The US changed its position on mixed dose vaccines on October 15, 2021 because it is authorized for use by the World Health Organization, in addition to other countries.

Booster shots are now available in nearly all jurisdictions. These vaccinations will help restore fading immunity and are strongly recommended.

To learn more about available COVID-19 vaccinations visit:

Vaccines for COVID-19 – Canada.ca

Vaccines for COVID-19 | CDC

When You’ve Been Fully Vaccinated | CDC

VACCINATION STATUS

Upon request of the Club, and to the extent permissible under state or provincial laws, members in the Club’s Group 1 (see below in Participant Group) shall provide the Club with vaccination cards or other documentation verifying their vaccinated status.  Please note that players will be asked to upload that information into Privit.  For Officials, this information will be provided to the League.  Individuals who fail to provide such information shall be considered Unvaccinated for the purposes of this Protocol and shall be subject to the provisions applicable thereto as set forth in this Protocol.

Please be advised that travel restrictions for unvaccinated individuals and/or arena/facility requirements prohibiting entry for unvaccinated persons may make you unable to perform your job duties and those matters may be addressed by the League or the Club, as appropriate. 

PREVENTATIVE MEASURES (VACCINATED and UNVACCINATED)

  1. Face Coverings

Vaccinated individuals are not required to wear a mask, unless required by a facility or government body. Unvaccinated individuals must wear a mask at all times while in confined areas or not physically distanced (less than 6 feet) with others for extended periods of time (greater than 15 minutes), except while playing, practicing, or exercising.

  1. Testing

Fully Vaccinated individuals require testing when: a) required for travel; or b) if symptomatic. If symptomatic, molecular testing (e.g., PCR, LAMP) is preferred.

Unvaccinated players are required to have a PCR test twice per week, with one of the tests occurring within 72 hours of any team gathering.

Roles and Compliance

PARTICIPANT GROUPS

In this Protocol, participants assigned to Group 1 are required to be provided access to Player areas (hereafter, “Restricted Areas”), which include without limitation, locker rooms, team benches, penalty benches, on-floor, training rooms, rehabilitation areas, exam/procedure rooms, weight rooms, equipment rooms, coaches’ rooms, strength and conditioning areas, laundry rooms, dressing rooms, areas of ingress and egress into the Club Facilities (including to and from the parking area), General Managers’ work spaces and seating areas, On-Floor Official rooms, Off-Floor Officials work spaces and seating areas, and the corridors and paths of travel connecting each of the foregoing (to the greatest extent practicable).

As a guiding principle, the greater the number of persons permitted in the Restricted Area, the greater the risk of possible infection and the potential for an outbreak.

In order to limit the possible exposure and risk of transmission, staff should be limited to the minimum number of people who are necessary and essential to carrying out the planned activities, and to having in-person interactions with Players.  The Club should maintain a list of individuals in each of the Groups below.

GROUP 1

Group 1 individuals include: (a) Players; and (b) other personnel whose job function requires them to have access to Restricted Areas and be in close proximity to Players on a frequent and extended basis. Efforts should be made to limit the number of individuals in Group 1 to essential personnel only.

Group 1a individuals could include:

  • Players
  • Coaches, including Video Coaches
  • Athletic Trainers/ Athletic Therapists/ Team Trainers
  • Strength and Conditioning Coach(es)
  • Equipment Managers
  • Massage, chiropractic and other performance personnel
  • Club Physicians and dentists
  • On-Floor Officials
  • Club Compliance Officer

Group 1b (Club) personnel may include:

  • General Managers and Assistant General Managers
  • Other necessary Lacrosse Operations Personnel
  • Club Public Relations/Communications/Broadcast/Social Media Personnel Limit of no more than 4 individuals at any one time
  • Club Transportation Personnel
  • Club Travel Coordinators/Club Services Coordinator
  • Club Video Replay Technicians
  • Club IT Support requiring access to Restricted Areas (e.g., during interviews)
  • X-Ray Technician(s)
  • Locker Room Attendants (if different from Club-engaged cleaning crews), limit of 2 individuals per Club
  • COVID-19 Collection and Testing Personnel

Anyone else with frequent or prolonged contact with Players (to be approved by the Club Compliance Officer on a case-by-case basis and then disclosed to the League Office).

CREDENTIAL AND GROUP LISTS

Credentials shall be produced for all individuals in Group 1 and that credential must be color-coded as “green” to identify the individual’s authorized access to Restricted Areas. The credentials must be worn around the neck, and exposed, at all times when in the Club facility (and for Club personnel, during travel for away games) other than when individuals are in their own hotel room or while practicing and playing in games.

CLUB COMPLIANCE OFFICER

Each Club shall appoint a Club Compliance Officer, who will be responsible for monitoring and enforcing the Club’s compliance with the following aspects of the Protocol:

  • GROUP LISTING: Identify and maintain list of designated members in Group 1.
  • CERTIFICATION FORM: Ensure everyone in Group 1 completes a Certification Form (included in this Policy in Appendix 1).
  • CREDENTIALS: Ensure that credentials are issued and assign necessary personnel to ensure that access to Restricted Areas are enforced in accordance with this Protocol. Establish processes to ensure that credentials are worn at all times (other than for Players who will not be required to wear credentials during Games/Practice, or while in the locker room).
  • SIGNAGE: Ensure that there is sufficient and proper signage showing delineation of Restricted Areas and which groups are permitted (or not permitted) access to each zone.
  • SIGNAGE REGARDING HYGIENE: Ensure there is sufficient and proper signage to communicate information and Protocol requirements related to physical distancing, face coverings, and hand washing/sanitizing.
  • PROPER CLEANING AND DISINFECTING: Oversee administration of the cleaning and disinfecting requirements in this Protocol, including communication with facility cleaning personnel in respect of such requirements.
  • CLEANING SUPPLIES: Oversee procurement and distribution of hand sanitizer stations and disinfectant wipes throughout the Club Facilities (and ensure that all relevant parties have such supplies in their working areas) and ensure such stations are refilled on an as needed basis. Cleaning supplies must have proven activity against SARS-CoV-2 (EPA list N).

    List N Advanced Search Page: Disinfectants for Coronavirus (COVID-19) | US EPA

  • SCREENING: Ensure Group 1 complete their required screening and temperature checks. Ensure compliance with the requirement that any individuals who have symptoms, fever, or answer in the affirmative to the exposure questions follow the Protocol.
  • CONTACT TRACING: Contact tracing may be required within Group 1. Report to the league and the local Health Authority as needed in the event of a positive test.
  • TESTING: Ensure compliance with the required testing.
  • FACE COVERINGS: Ensure players and all other Club Personnel wear face coverings properly when required by this Policy or jurisdictional regulations.
  • REPORTING: On every Sunday, the Club Compliance Officer shall, on a weekly basis, prepare a report certifying that each of the foregoing requirements has been satisfied. Information shall be provided detailing the circumstances of any non-compliance with these requirements immediately. A copy of the reports shall be provided to the League. A reporting template will be distributed to the Club Compliance Officers.

Any change in the Club Compliance Officer must be reported to the League immediately.

Travel

All travel in connection with the 2021/22 NLL Season shall be pursuant to, and in accordance with, the provisions of the travel regulations outlined below. Nothing in this 2021/22 Season Protocol shall supersede the requirements for domestic travel within Canada or the US and/or international travelers to Canada or the United States. Relevant links with more information can be found below:

Orders In Council – Search (canada.ca)

List of Acts and Regulations (Canada)

Executive Order on Promoting COVID-19 Safety in Domestic and International Travel | The White House

White House Announces New COVID-19 Vaccination Entry Requirements for Foreign Nationals | U.S. Embassy in Trinidad & Tobago (usembassy.gov)

CROSSING BORDERS

PRE-DEPARTURE/POST-ARRIVAL MONITORING

Individuals remain subject to all monitoring and reporting requirements set forth by the federal/state/provincial/local health authorities both prior to departure and upon arrival.

If someone tests positive for COVID-19 in Canada, they must remain in isolation pursuant to local and/or provincial laws. A person in isolation is not allowed to leave Canada before the expiration of the isolation period, unless authorized by a quarantine officer or by local public health official.

The CDC recommends that you self-isolate and delay travel until it is safe to break isolation.  According to the CDC, it is safe to break isolation and be around others after:

  • 5 days since symptoms first appeared; and
  • 24 hours with no fever without the use of fever-reducing medications; and
  • Other symptoms of COVID-19 are improving.

If someone tests positive for COVID-19 and is asymptomatic, it is safe to break isolation and be around others after 5 days have passed since you had a positive molecular test for COVID-19.

A non-U.S. citizen who tests positive for COVID-19 in Canada may not enter the U.S. until it is safe to break isolation. Once isolation has ended, a non-U.S. citizens may travel to the U.S. and must provide documentation of recovery from COVID 19 (only if flying).

A U.S. citizen who tests positive for COVID-19 in Canada, may return to their home in the U.S.  during the isolation period, but he or she must drive, and the following conditions must be met:

  • Must use a private vehicle. Public transportation is prohibited.
  • Must continue to self-isolate upon arrival to final destination in the U.S.
  • Must always wear a suitable mask, unless alone in a private vehicle.
  • Must always practice physical distancing.
  • Must avoid stops and contact with others while in transit. If gas is needed, pay at the pump. If food is needed, use a drive through.
  • Must remain in the vehicle as much as possible.
  • Must sanitize hands frequently and avoid touching surfaces.
  • Must comply with all federal, state, and local regulations during travel and upon arrival to final destination in the U.S.

See https://travel.gc.ca/travel-covid/travel-restrictions/isolation

Please note that all individuals travelling into Canada or the U.S. could be subject to a review of COVID-19 symptoms, arrival COVID-19 testing, and temperature screening (anyone with a temperature over 38°C will result in immediate quarantine/isolation) when arriving at the airport or the land border.

TRAVEL REQUIREMENTS TO ENTER CANADA AND THE UNITED STATES (BY LAND OR BY AIR TRAVEL) – FULLY VACCINATED AND UNVACCINATED INDIVIDUALS

For current border restrictions and requirements, visit:

Canadian Border: https://travel.gc.ca/travel-covid

United States Border: https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html

DOMESTIC TRAVEL

As of November 30, 2021, all air passengers flying on domestic, transborder or international flights departing from airports in Canada must be fully vaccinated, with very limited exceptions.

Mandatory COVID-19 vaccination requirements for federally regulated transportation employees and travellers – Canada.ca

Clubs shall establish operational processes for all Club travel to facilitate safe, clean, and hygienic travel, and to reduce interactions and maintain appropriate distancing as much as possible.

When travelling domestically by air, individuals should maintain hand hygiene and wear a mask at all times, except when actively eating or drinking.  On buses, the number of passengers in the Travelling Party shall be limited to only those in Group 1.  When on the road, individuals in the Club’s Travelling Party shall adhere to the local public health regulations of the market being visited.

For commuting in ride-share situations, particular consideration shall be paid to the following additional precautionary measures:

  • Encouraging hand hygiene before and after entry/exit of the vehicle and avoiding contact with surfaces frequently touched by passengers or other drivers;
  • Having members of the Club’s Travelling Party handle their own personal bags and belongings during pick-up and drop-off;
  • Avoiding, if possible, using the recirculated air option for the car’s ventilation during passenger transport;
  • Using the car’s vents to bring in fresh outside air and/or open the vehicle windows; and
  • Having members of the Club Travelling Party sit in the back seat.

PPME

PRE-PARTICIPATION MEDICAL EVALUATION (PPME)

All Players must undergo a Pre-Participation Medical Examination (PPME) prior to participating in any Training Camp activities, after which the Club doctor will issue a medical clearance if the Player is “fit to play”. Medical histories should be submitted by Players electronically via PRIVIT, in advance of the PPME in-person evaluation in order to reduce the in-person time needed during a PPME with Players.

Players who have tested positive for COVID-19 with at least moderate severity symptoms and have not yet had their post-COVID cardiac screen with ECG, echo and high-sensitivity troponin, should endeavor to have such testing prior to coming to Training Camp. The provision of these materials, however, does not replace the requirement for Players to undergo a PPME at the start of Training Camp.

Every player must receive a negative PCR test within 72 hours of his PPME (if traveling internationally to the PPME or if unvaccinated).  Members of the Club in the building during PPME examinations, including Team Physicians performing the examinations, must perform a temperature and symptom check upon arrival at the Club facility.

Clubs shall arrange PPME appointment times for each Player so as to limit the number of individuals in the Club facility at any one time. The PPME shall include, at a minimum:

  • Medical history review and focused examination
  • Orthopedic history review and focused examination
  • Post-COVID cardiac questionnaire and investigation

During the PPME it shall also be determined whether persons sharing a home with the person being evaluated currently have symptoms or have tested positive for COVID-19 or are otherwise at high-risk for severe illness from COVID-19.

All Players, Medical Staff, and other Officials present during the PPME are required to maintain appropriate preventative measures including masking, physical distancing, cleaning and disinfection, and hand hygiene.

MENTAL HEALTH AND WELLNESS

Given recognition of the mental health stresses associated with the COVID-19 pandemic, Players and Club staff shall also be reminded of, and encouraged to access mental health and wellness resources available to them.

ADDITIONAL MEDICAL CARE AND TREATMENT FOR PLAYERS

Players are reminded that any third-party wellness services providers (e.g., physiotherapists, athletic therapists, chiropractors, massage therapists) must maintain infection control measures at consistent standards to those outlined in this document and by the local health authorities.

Symptom Monitoring & Testing

Monitoring and testing by their nature are for the purpose of early detection of infection and are not replacements for the hygiene, distancing, and cleaning methods outlined in this Protocol that can help prevent infection in the first instance.

Everyone in Group 1 is expected to self-monitor, complete symptom screening reporting, and test as per this section of the Policy.  Symptom screening must occur three times weekly. Vaccinated individuals need only test if required to travel or if symptomatic. Unvaccinated individuals in Group 1 must undergo two molecular tests per week.

If someone makes a mistake in reporting their symptoms (via Privit or Jotform), please ask that person to send an email to the Club Compliance Officer explaining the circumstances. If the Club Compliance Officer is satisfied with the response, no further action is required in terms of reporting to the League.

SYMPTOM MONITORING:

Symptom screening is a critical tool for early identification of possible COVID-19 infection and remains an important step for all members of Group 1. The following are common symptoms of COVID-19:

  • New or worsening cough
  • Shortness of breath or difficulty breathing
  • Feeling feverish, chills
  • Muscle or body aches or fatigue (not exercise-related)
  • New loss of smell or taste
  • Gastrointestinal symptoms (nausea, vomiting and/or diarrhea)
  • Sinus or cold-like symptoms (headache, congestion/runny nose, sore throat).
  • Fever (temperature > 100.4°F or > 37.5°C)

Whether you are self-monitoring or reporting your symptoms, you will be asked to answer these questions on a daily basis:

  1. Have you travelled outside North America in the last 14 days? Yes/No

If you answered “YES”: Follow the Government of Canada Travel, Testing, Quarantine

and Borders instructions, including any requirements for exempt travelers related to attending high-risk environments. Proceed to question 2.

If you answered “NO”: Proceed to question 2

  1. Have you had any known close contact with a case of COVID-19 in the last 14 days? Yes/No

Close Contact: Face-to-face contact within 2 meters for 15 minutes or longer, direct physical contact such as hugging or contact with infectious body fluids.

If you answered “YES” and:

  • You are not vaccinated against COVID-19: Do not enter the site for 14 days from the last day of exposure
  • You are partially vaccinated against COVID-19: Do not enter the site for 10 days from the last day of exposure
  • You are fully vaccinated against COVID-19: Proceed to question 3
  • You have previously tested positive for COVID-19 in the last 90 days before exposure: Proceed to question 3

If you answered “NO” or if you have symptoms, proceed to question 3

  1. Do you have any new onset (or worsening) of the following symptoms:
  • Fever (temperature > 38 degrees Celsius or 100 degrees Fahrenheit) or feeling feverish/chills
  • Cough
  • Shortness of Breath or difficulty breathing
  • Gastrointestinal symptoms (nausea, vomiting, diarrhea)
  • Sinus or cold-like symptoms (sore throat, runny nose, headache)
  • Loss of sense of test or smell
  • Muscle/body aches or fatigue (not related to exercise)

Players are required to complete this questionnaire on Wednesdays, Fridays and Sundays via Privit.  Other Group 1 members (non-players) are required to answer these questions via a Jotform link which will be provided to your Club Compliance Officer.  Each team has a dedicated Jotform link for its staff to record the necessary information as directed by the League. The forms are set up such that each submission will be e-mailed to the respective Club Compliance Officers upon completion. If necessary, the League is able to provide each Club Compliance Officer a record of all completed submissions from their Club upon request.

COVID-19 TESTING

Vaccinated individuals are required to test if: a) required for travel; or b) experiencing symptoms. If experiencing symptoms, a molecular test is the diagnostic gold standard and must be used in all cases except when unavailable by reasonable means.

Unvaccinated individuals will be required to take a Rapid or Standard molecular test (also known as a PCR, NAAT, or LAMP). Rapid/Standard molecular tests can be accessed at major airports or local pharmacies, for example Walgreens in the United States, and Shoppers Drug Mart, SRx Health Solutions, or CVM Medical in Canada, or may be administered via telehealth (e.g., Switch). These establishments will provide documentation (either electronic or hardcopy) to show proof of negative test results at the US-Canada border.

All test results must be shared with the Club Compliance Officer.

Teams may elect to test their players above and beyond the NLL testing protocols outlined above.  Any positive test results from these additional tests must then follow the protocol outlined in the NLL Policy with appropriate confirmatory testing, contact tracing, isolation, and notification to the League.

Management of Symptomatic (and/or COVID-19-Positive) Persons

Any individual with COVID-like symptoms must report the symptoms in PRIVIT, begin isolation immediately, and obtain a confirmatory molecular test.

Any individual with a positive molecular test must begin isolation immediately.

Any individual with a positive antigen test must begin isolation immediately and obtain a confirmatory molecular test (or confirmatory antigen test 24 hours after the first positive antigen test). 

DEFINITION OF COVID-19 POSITIVE

An individual is considered to have active COVID-19 infection if they have:

  • A positive molecular test; or
  • A positive antigen test AND symptoms; or
  • Two positive antigen tests (24 hours apart).

DEFINITION OF A NEGATIVE TEST

A negative test pursuant to this policy is defined as:

  • Symptoms and a negative molecular test; or
  • Symptoms and two negative antigen tests at least 24 hours apart.

Note that once confirmation of COVID-19 infection status has been confirmed no more tests should be performed.  In other words, there is no “testing out” with further antigen or molecular tests.

ISOLATION UPON CONFIRMATION OF COVID-19 POSITIVE STATUS

A person whose COVID-19 positive status has been confirmed shall remain in isolation and shall not have any contact (other than remotely) with any other personnel for the duration of their isolation.

How to Isolate:

  • Limit contact with others, engage in frequent hand hygiene, keep surfaces clean, avoid sharing personal items,
  • Monitor yourself for symptoms
  • Arrange to have access to needed supplies
  • If living in a shared accommodation, protect co-living individuals by:
    • Limiting contact by using separate bathrooms, if possible
    • Not sharing personal items
    • Maintaining a 6 ft (2m) distance (if unable to maintain physical distance, consider alternate accommodation)
    • Clean and disinfect frequently touched surfaces often
    • Have others wear personal protective equipment such as a medical mask, disposable gloves and eye protection when within 6 ft (2m) of the ill/positive person.

During such period, the person shall be in daily contact with and receive remote care from Club medical staff or such other physicians as considered appropriate.

ENDING ISOLATION

Players or Club personnel whose test has been confirmed positive, but remain ASYMPTOMATIC, shall remain in isolation until all of the following conditions have been satisfied:

  • At least 5 days have passed since the collection of the positive test (note that Day 1 is the first day after the positive test);
  • Training is permitted during isolation;
  • The player may return to game play on Day 6 with documented verbal clearance from a qualified medical professional; and
  • The termination of the isolation requirement is consistent with applicable local public health regulations or other requirements.

Players whose test has been confirmed positive, and have MILD SYMPTOMS* shall remain in isolation until all of the following conditions have been satisfied:

  • At least 5 days have passed since the earlier* of symptoms first appearing or a positive test, and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms (e.g., cough, shortness of breath) have improved;
  • The Club Physician or any other treating physician providing care to the individual in consultation with the Club Physician, must conclude that the individual no longer presents a risk of infection to others and that it is medically appropriate (given individual and local circumstances) to terminate the requirement for isolation;
  • Training is permitted 24 hours from the start of symptom improvement and with documented verbal clearance from a qualified medical professional;
  • Return to game play is permitted following at least one full practice (or guided high intensity workout), 24 hours, and documented clearance from a physician (requires a focused physical exam and diagnostics as appropriate); and
  • The termination of the isolation requirement is consistent with applicable local public health regulations or other requirements.

Players whose test has been confirmed positive, and have MODERATE SYMPTOMS* shall remain in isolation until all of the following conditions have been satisfied:

  • At least 5 days have passed since the earlier* of symptoms first appearing or your positive test, and at least 24 hours have passed since last fever without the use of fever-reducing medications, and symptoms (e.g., cough, shortness of breath) have improved,
  • The Club Physician or any other treating physician providing care to the individual in consultation with the Club Physician, must conclude that the individual no longer presents a risk of infection to others and that it is medically appropriate (given individual and local circumstances) to terminate the requirement for isolation, and
  • The termination of the isolation requirement is consistent with applicable local public health regulations or other requirements.

Return to training and game play will follow the algorithm below.

*To distinguish between mild vs. moderately symptomatic: moderate is defined as having any of: fever, chest pain/palpitations, shortness of breath, myalgia, or persistent cough lasting longer than 72 hours.

* Note: symptoms must be reported in PRIVIT as soon as they are noted, and cannot be retrospectively assessed to determine the first day of isolation.

CARDIAC SCREENING

Upon completion of the period of isolation, any Player who has been characterized as moderately symptomatic must have cardiac testing and consultation (see Section 1.7, JAMA Cardiology: A Game Plan for the Resumption of Sport and Exercise After Coronavirus Disease 2019 (COVID-19) Infection) including, at a minimum,

  • ECG,
  • Echocardiogram,
  • serum troponin, and
  • medical clearance by a cardiologist

The following is a summary of the guidelines (from Coronavirus Disease 2019 and the Athletic Heart Emerging Perspectives on Pathology, Risks, and Return to Play; Jonathan H. Kim, MD, MSc1; Benjamin D. Levine, MD2,3; Dermot Phelan, MD, PhD4; et al; JAMA Cardiol. 2021;6(2):219-227.)


TERMINOLOGY

  1. INDEX PERSON: An individual who tests positive for COVID-19.
  2. CLOSE CONTACT: Any such person shall be considered a “Close Contact” if they have been within six (6) feet of the Index Person for a cumulative total of 15 minutes or more over a 24-hour period, starting from 2 days before illness onset, until the time the Index Person is isolated.
  3. HIGH-RISK CLOSE CONTACT (HRCC): Any such person shall be considered a “High-Risk Close Contact” if they have been within six (6) feet of the Index Person for a prolonged period of time. Significant others and family members may fit these criteria.
  4. QUARANTINE: not be permitted to leave his home or hotel room for any purpose, including, if at a hotel, to use common facilities such as the hotel gym, bar or restaurants. No visitors shall be permitted, and all meals and medications must be delivered to the individual’s home or hotel in a contactless manner.
  5. ISOLATION: Isolation is required following a positive COVID-19 test, consistent with the rules in place for anyone in quarantine.
  6. PREVENTATIVE MEASURES: Masking, distancing, and daily symptom and temperature monitoring.

CARE OF AFFECTED INDIVIDUALS AWAY FROM THEIR HOME NLL CITY

Club Physicians may be required to oversee care of visiting Players or those in the Traveling Party should an individual remain in the visiting city due to severe illness or isolation/quarantine mandates.  Players may test positive during the week while away from team medical personnel and their care will be under the direction of local public health authorities and hometown physicians.  In these situations, players must immediately notify their Club Physician.  Coordination between local and team medical personnel will be critical to ensure a safe and appropriate travel home and return to sport based on the criteria above.  Following clearance to return to play, the first game back may be on the road.  In these cases the affected player’s Club Physician may request assistance from the host Team Medical staff to assess the player upon their arrival.

OUTBREAK STATUS & SHUT-DOWN PROTOCOL

An outbreak is considered to include more than one (1) club personnel/players that have confirmatory positive test results. In the event that an outbreak occurs, the NLL and NLL Medical Committee will convene to determine appropriate enhanced health and safety measures. Such measures may be required where more than one Player or Staff member has tested positive for COVID-19 and/or are exhibiting symptoms of the disease, and where there is evidence of close contacts having occurred in or outside of the Club’s facilities. Such measures may include:

  • Use of FDA or PHAC approved rapid Point-of Care Testing prior to any group training, practice, or scheduled game;
  • Implementing more frequent PCR testing for some or all of the persons in the facility;
  • Resumption of masking and distancing measures for all (regardless of vaccination status);
  • Restrictions on the number of individuals who may occupy, at any one time, the Club’s training rooms, practice facilities, weight or conditioning rooms, locker rooms, showers, or treatment areas, and the amount of time that an individual may be permitted to access these areas of the Club’s facilities;
  • Restrictions on the size and duration of any group in-person meetings between Players and/or Club Staff;
  • Restrictions on the provision of meals to be consumed at the Club’s Facilities;
  • Restrictions on Players/Club Personnel behavior outside of the Club Facilities; and/or
  • Implementing a temporary closure of any Club Facilities, including the Club’s training rooms, practice facilities, weight or conditioning rooms, locker rooms, showers, treatment areas, or arenas. Such closures should be of sufficient duration to mitigate COVID-19 transmission risk and also allow for remediation of any factors which may have increased the risk of COVID-19 transmission. In such cases, and at the time any decision to close is made, a structured plan shall be developed to determine appropriate re-opening strategy and timing.

Clubs shall notify the League of the unilateral introduction of any of the enhanced health and safety measures contemplated above. Further, the NLL Medical Director shall have an opportunity to consult with the Club’s Physician prior to the implementation of the enhanced health and safety measures recommended by the Club.

CONTACT TRACING NOTIFICATION

The Club Compliance Officer shall promptly notify the NLL Deputy Commissioner upon receiving information about initial positive tests. The Club shall notify the NLL Deputy Commissioner with the following information:

  • Any individual(s) testing positive:
  • Name
  • Date(s) of positive test(s)
  • Symptomatic vs asymptomatic status
  • Any HRCC who have been quarantined

The Club shall also notify Jessica Berman and Brian Lemon when a Player has been medically cleared to resume activities.

Interactions Involving Players/Club Personnel and Third Parties

A.  INTERACTIONS WITH MEDICAL PERSONNEL

Club physicians, dentists, therapists, and other members of the Club’s Medical Personnel must use face coverings at all times when interacting with players.

B.   INTERACTIONS WITH FANS AND PROMOTIONAL ACTIVITIES

Teams shall be permitted to engage in fan experiences and promotional activities (e.g., autograph signings, photo opportunities, camps and clinics), provided, all participants must show proof of vaccination prior to participating.

NOTE: for large group fan experiences in unrestricted areas where asking for proof of vaccination may not be possible, Group 1 personnel should not interact with any one or group of fans for an extended period of time.

C.     BROADCAST AND MEDIA

Players who are Unvaccinated must remain masked during interviews in team spaces, or alternatively may conduct such interviews unmasked so long as a distance of at least six (6) feet is maintained at all times. Virtual or remote interviews are also an option.

D.  SEATING MANIFEST/GUEST EXPERIENCE

Seating manifests in Club Facilities will be determined according to local health authority guidance.

Similarly, teams/arenas shall regulate fan experience (e.g., mascot, fan handouts, promotions, and in-facility host interactions) in accordance with local health authority guidance.

Facility Safety Measures

SAFETY PRECAUTIONS

All individuals shall follow the following safety precautions:

  • Wash hands frequently with soap and water for at least 20 seconds (sing “Happy Birthday” twice), or, if soap and water are not readily available, use an alcohol-based hand sanitizer, as follows:
  • Wash or disinfect hands before and after eating or drinking.
  • Wash or disinfect hands and face after touching possibly contaminated surfaces (such as high-touch areas like elevator buttons, countertops, door handles, water coolers, etc.).
  • Use disinfectant wipes on items that may have been touched by others (such as pieces of luggage, chairs, office equipment, menus, etc.).
  • Avoid touching your eyes, nose, and mouth, including adjusting your mask/face covering while wearing it.
  • Avoid close contact with people who are sick or appear symptomatic.
  • Cover your cough or sneeze with a tissue, then throw the tissue in the trash and wash your hands with soap or use alcohol-based sanitizer. If you do not have a tissue, cough or sneeze into your elbow, not your hands, and then wash your hands with soap or use alcohol-based sanitizer.
  • Minimize handshakes, high fives and fist bumps.

Additional safety precautions can be found on the CDC and PHAC websites.

  • CDC COVID-19 Resources
  • PHAC Awareness Resource

Hand sanitizer and disinfectant must be procured and made readily available throughout the Club practice and arena facility, as well as in connection with Club travel.

USE OF GLOVES BY CLUB PERSONNEL AND OTHER GAME-RELATED STAFF

Glove use is not a replacement for hand hygiene practices such as hand washing, use of approved alcohol-based sanitizer and avoiding touching of one’s face.

Gloves should be discarded after each use, and after your face is touched. Hands and face should be washed when changing gloves.

Glove use is required in the following circumstances:

  • All Club game staff and Club staff interacting with the Player gloves, equipment, jerseys, water bottles, and towels are required to wear latex (or similar material) gloves when tending to the benches/penalty boxes/locker-room areas.
  • Off-floor Officials while working in the penalty box during games shall wear gloves (and a face covering) when handling bottles and towels.
  • Glove use by training staff for other purposes, such as prevention of blood borne pathogens through universal precautions, shall continue.
  • Cleaning and disinfecting staff, including staff designated for between period bench cleanings and locker room cleaning and disinfecting.
  • PES testing personnel during drug testing collections.
  • Test collection personnel during COVID-19 testing.

PLAYER USE OF TUBS/SAUNAS/STEAM ROOMS

  • Use of hot and cold tubs is permitted, but the following conditions apply:
  • They must be well maintained to keep bleach/bromine concentration at appropriate levels;
  • Physical distancing of 6 feet must be maintained at all times, whether by spacing of the tubs, or the Players within larger tubs.
  • Saunas and steam rooms remain prohibited.

RELIEF GELS/BALMS/CREAMS/STICKS

  • Use of common (i.e., shared) creams, gels, balms, and sticks are prohibited.
  • Players shall be provided with individual cream/gel/balm/stick products for use at the Club Facilities.

SHOWERING

  • Given the importance of personal hygiene in infection control, Players are encouraged to shower in the Club Facilities after workouts and games, provided that distancing can be maintained. If they prefer, Players can choose to shower at home.
  • Players shall not share towels, toiletries, or any personal items.
  • Players must wear their own footwear at all times, including in the shower stalls.

FAMILY/GUEST SEATING

  • To the extent permitted by local regulations, Clubs shall arrange for arena seating areas for Players’ families which are separate from other patron seating areas.
  • Pre- and post-game interactions between Players and their guests at the Club facilities is not permitted, given their disparate access restrictions.

HVAC-R SYSTEM EVALUATION FOR NLL VENUES

The NLL recognizes the importance of indoor environmental quality (IEQ) in arenas and the optimization of Heating, Ventilation, Air Conditioning and Refrigeration (HVAC-R) systems in NLL Arenas and Practice Facilities to mitigate viral exposure from aerosolized particles. The American Society of Heating, Refrigerating and Air-Conditioning Engineers’ (ASHRAE) position statement on SARS-CoV-2 and the operation of HVAC-R systems in response to the COVID-19 pandemic states:

Ventilation and filtration provided by heating, ventilating, and air-conditioning systems can reduce the airborne concentration of SARS-CoV-2 and thus the risk of transmission through the air.

No intervention to prevent the transmission of COVID-19 is 100% effective, but risk levels are reduced when ventilation rates are increased, air filtration (central and local) is enhanced and inactivation technologies are deployed. In conjunction with third party experts, the NLL has established requirements and recommendations for mechanical and HVAC-R systems intended to mitigate the risk of transmission of COVID-19 in facilities. All facilities hosting NLL games or team practices during the NLL’s 2021/22 season are to adhere to requirements of all applicable local regulations and building codes, including any further restrictions or direction (if any) by local, state, provincial, and federal health authorities.

MECHANICAL/HVAC-R SYSTEMS EVALUATION:

The NLL recognizes that all NLL Arenas and Practice Facilities (hereafter “Venues”) differ based on various factors such as building vintage, type of HVAC-R systems currently installed, region-specific climatic considerations, and even day-specific outdoor temperature and humidity conditions particularly during “shoulder-month” periods (typically late spring and early fall times of the year when daily temperatures can vary between about 45°F and 65°F). The League further acknowledges that facilities where Clubs practice range from older rinks to newer, state-of-the-art facilities.

Given the multitude of considerations, the NLL recommends Venues to undergo an HVAC-R system review prior to hosting NLL games or team practices, where feasible, to understand current HVAC-R system configuration and operations, and to inform proposed upgrades, retrofits or enhancements to reduce risk of airborne viral transmission.

It is also recommended that the Club perform an independent ventilation analysis and air balance report (air handling unit-level Testing Adjusting Balancing (TAB) report) for all occupied spaces, which will confirm supply, outdoor air and exhaust ventilation rates by a certified TAB contractor and establish whether the existing system is performing to the basis of its design. For clarity, the testing of individual VAV boxes and distribution ductwork in occupied spaces is not a requirement. In addition, please be advised of the following recommendations:

  • All areas planned for occupancy should be analyzed to determine total Air Changes per Hour (ACH) and Outdoor Air Changes per Hour (OACH), and an air change rate table for each occupied space should be developed to indicate the current rates for analysis. Expected occupancy counts for these areas should be provided as part of this overall review.
  • Review central and local air filtration including Minimum Efficiency Reporting Values (MERV) ratings on existing filters to ensure they are within service life and appropriately installed. Review filter maintenance and replacement schedule as indicated in filter manufacturer’s published operations manual.
  • Consider independent review of supply and exhaust systems and controls including exhaust fan inspections by a mechanical contractor or commissioning agent.

Venue operators both of NLL Arenas and Club Practice Facilities are encouraged to use a professional engineer to do an overall evaluation of the above considerations. The analysis of each venue may take between 2-4 weeks, or longer, based on industry demand and scope of work.

AIRFLOW MANAGEMENT: VENTILATION AND FILTRATION

The NLL recommends improving airflow (demonstrated by increasing ACH as compared to existing performance levels) and increasing outdoor air flow rates to all occupied spaces, based on an analysis of the venue’s existing configuration of the HVAC-R system and current air balance report with analysis by a professional engineer.

Recommendations:

  • Calibrate HVAC-R system controls and airflow measurement devices to coordinate with increased outdoor airflow rates, particularly in areas such as team spaces (visiting and home) back-of-house staff areas, and the main bowl area.
  • Any mechanical system allowing for potentially contaminated exhaust air to bypass into the incoming outdoor air stream is not recommended and should be disabled. Proper separation of exhaust sources and intakes should be maintained, and energy recovery should be carefully controlled to limit any bypass airflow.
  • Venues should consider disabling automatic demand-controlled ventilation (DCV) system configurations.
  • CO2 Monitoring: Venues should consider monitoring CO2 levels in occupied spaces to account for any air pollution (parts per million) due to the increased outside air intake.
  • A note on CO2 Sensor Applications: Venues are encouraged to establish baseline CO2 concentrations by monitoring each space, while unoccupied, prior to planned occupancy. If possible, simulate event occupancy of each space and chart CO2 levels at different occupancy counts. Establish maximum occupancy count such that CO2 levels are maintained below 1,000 ppm and implement procedures for reducing occupancy count in the event CO2 levels exceed 1,000 ppm (Ref. ASHRAE 62.1-2016, Appendix D7). During occupied periods, monitor CO2 levels in occupied spaces and track whether ventilation systems are operating properly. If currently installed, CO2 sensors in return air systems serving occupied spaces may be utilized in lieu of sensors in the occupied space level, in addition to any permanently mounted individual sensors, or handheld portable sensors.
  • Install duct- or air-handling-unit-mounted UVGI, upper-room UVGI (with possible in-room fans) or portable UVGI air treatment technology to treat the supply air flow, in order to inactivate airborne viruses particularly in high occupancy spaces, team spaces, back of house staff areas or mission-critical operations areas like Security and Command Center-type rooms. See section: Viral Inactivation Technologies below for further information.
  • In elevators, implement local treatment such as UVGI technology or HEPA filtration where direct ventilation is not present or not practical, due to the inability to ventilate the elevator cab. Venues are encouraged to obtain industrial hygienist and medical guidance for further consideration on elevator ventilation concerns, and to implement appropriate occupancy count limits as may be recommended.
  • In all restrooms, locker rooms, wet areas and showers, engage exhaust systems to run continuously during occupancy. If the HVAC-R system cycles on/off with a thermostat, run the fan constantly during occupied hours.

PURGE CYCLES AND OUTDOOR AIR FLOW

In addition to the airflow management guidance above, per ASHRAE general guidance, pre- and post-occupancy purge cycles are outlined below for Team Spaces, and Other Occupied Spaces (Non-Team Spaces) in NLL Venues:

Team Spaces

  • Prior to each occupancy by Players and staff (e.g., Groups 1 and 2), the NLL requires flushing all home and visiting Team Spaces with outdoor air for a time required to achieve three air changes of outdoor air (3 OAC). Such team spaces include, without limitation, changing rooms, locker areas, weight rooms, training rooms, medical rooms, coaches room, equipment room, strength and conditioning areas, rehabilitation areas and eating or recreation lounge-type spaces areas.
  • For HVAC-R systems serving such occupied spaces that are unable to achieve 3 OAC, the venue must attempt to achieve six air changes per hour (6 ACHs). Venues shall seek assistance from a professional engineer, infectious disease specialist or industrial hygienist to assess their specific needs for this evaluation.
  • Post-occupancy, the NLL recommends the continued operation of the HVAC-R ventilation system for approximately 1 hour to achieve 6 ACHs. In facilities with nighttime setback modes, the NLL recommends disabling those settings or at a minimum overriding them to allow for the system flush after occupied periods.

Other Occupied Spaces (Non-Team Spaces)

  • The NLL recommends flushing all Other Occupied Spaces with outdoor air for a time required to achieve three air changes of outdoor air (3 OAC) prior to significant occupancy of the arena and between consecutive spectator events.
  • For HVAC-R systems serving occupied spaces that may not be able to achieve 3 OAC, or in situations where the arena bowl ventilation system may not have the capacity to condition outdoor air per the recommendation above while maintaining NLL criteria for temperature and relative humidity for floor conditions, the venue may consider an equivalent of 3 OAC which may include effect of outdoor air, particulate filtration and air cleaners (see below section: Viral Inactivation Technologies). Venues are encouraged to seek assistance from a professional engineer to assess their specific needs for this evaluation.

AIR FILTRATION AND AIR CLEANING

Per ASHRAE Position Document on Filtration and Air Cleaning (January 2015), filtration and air cleaning can be used to improve indoor air quality and to mitigate airborne viral transmission. The NLL recommends improving central air and other local HVAC-R filtration above code minimums to MERV-13 (ASHRAE 2017b) or the highest level achievable, without impacting system air flow and pressure based on existing HVAC-R system configuration. Consult with a professional engineer or qualified professional to determine the appropriate scope of this work. Venues should review filter maintenance and replacement schedules; filter replacements should be achieved as indicated in filter manufacturer’s published operations manual. For enhanced air cleaning, particularly in areas with low air flow, in high occupancy spaces, back of house staff areas or mission-critical operations areas like Security and Command Center-type rooms, Venues should consider deploying additional portable room air cleaners with HEPA or high-MERV filters with due consideration to the Clean Air Delivery Rate (CADR) (AHAM 2015).

VIRAL INACTIVATION TECHNOLOGIES

There are numerous technologies that may actively kill or inactivate organics, including viruses, in airstreams and/or on surfaces. There are HVAC unit-mounted options, products installed in central air handlers, and in-space options for use in occupied rooms or in guest-accessible spaces. The following technologies are deployed in varying capacities in sports and entertainment venues and are worth considering, particularly in occupied spaces with lower air change rates. At this time, neither ASHRAE nor the CDC specifically recommend nor warn against their use.

Additionally, the NLL continues to monitor guidance from both ASHRAE and CDC as well as other industry experts and authorities on appropriate guidance regarding COVID-mitigating technologies and their efficacy in real-world applications.

  1. Ultra-Violet (UV) Germicidal Irradiation. Such technologies include unit mounted UV, induct UV, and Upper-Air UV. Unit mounted UV has proven to be effective at reducing organics on unit components such as cooling coils. The use of in-duct UV systems for airstream applications requires careful review of air velocities, which must be kept low for the UV to be effective. Upper-Air UV has long been considered effective against infectious aerosols within occupied spaces but requires careful design to prevent occupants from being exposed to the UV source. Manufacturers offer UV at multiple wavelengths with varying degrees of potential danger to occupants. We recommend consulting both the manufacturers and experienced professional engineers when evaluating which options may be appropriate in a specific venue.
  2. Photo-Catalytic Oxidation (PCO). This technology uses UV lamps along with a photo-catalyst surface to create hydroxyl radicals which oxidize contaminants onto the catalytic surface. This equipment is effective at removing contaminants within the targeted airstream but has limited effectiveness in occupied spaces.
  3. Bi-Polar Ionization (BPI). This technology utilizes energy to produce positive and negative ions, which then react with particles and contaminants to remove them for the air and ultimately to improve air quality. Some manufacturers claim the ions also deactivate viruses although limited industry testing is available to independently validate these claims. Manufacturers indicate independent testing procedures are under development. These products may produce ozone which can be harmful to occupants. When considering BPI technology ensure the equipment carries a UL 2998 listing as “zero ozone emission.”
  4. Photo-Hydro Ionization (PHI). Like PCO, this technology utilizes UV lamps along with a catalytic target to create hydroxyl radicals which oxidize contaminants. However, PHI produces hydroxyl radicals in gaseous form, and this “gaseous hydrogen peroxide” travels with the airstream into the occupied spaces. Some manufacturers produce PHI equipment meant for direct installation in the occupied space, and this equipment may prove useful in targeted locations within a particular venue. Testing suggests PHI is effective at killing viruses within an occupied zone, but there is limited independent research available and currently no industry standard to measure efficacy. Manufacturers suggest such standards are currently under development. Like Bi-Polar ionization, PHI equipment should carry a UL 2998 listing as “zero ozone emission.”
  5. Dry Hydrogen Peroxide (DHP). DHP is very similar to PHI, with patented variations in the combination of UV and catalyst material. This technology is often deployed through equipment installed at, or near, the occupied space. Like PHI, manufacturers indicate testing and efficacy standards are under development. DHP equipment, if used, should carry a UL 2998 listing as “zero ozone emission.”

Limited testing and lack of industry standards or consensus throughout the HVAC-R industry makes it impossible to specifically recommend the technologies noted above. Because of this, the NLL recommends consulting engineering professionals to evaluate options specific to each venue.

For more up-to-date information and guidance on these technologies, please visit ASHRAE Technical Resources: Filtration and Disinfection:

https://www.ashrae.org/technical-resources/filtration-disinfection#mechanical

Cleaning and Disinfecting

Each Club shall continue to adhere to the requirements for regularly cleaning its facilities (i.e., practice and game arenas), as set forth in the attached 2021/22 NLL/NLLPA Medical Handbook. Please note that these Requirements have been updated to include specific guidance regarding the maintenance and use of water bottles, towels, hand cleaners, tissues, anti-bacterial wipes and gloves, and a recommendation for the use of electrostatic sprayers. These standards are consistent with CDC recommendations on actions to help prevent the spread of respiratory diseases, including the coronavirus.

NLL