Strategies behind near-zero COVID-19 incidence in NBA 'bubble' published

A report published today in The Journal of Applied Laboratory Medicine describes the strategies used by the National Basketball Association (NBA) to limit COVID-19 exposure among the individuals who participated in the 2019–2020 season. The success of the NBA's approach demonstrates that strict adherence to certain protocols can be highly effective in preventing disease outbreaks in a self-contained environment and serves as a model for future pandemic management.

The NBA suspended operations in response to the COVID-19 pandemic in March 2020, and resumed the 2019–2020 season in July 2020 at the Walt Disney World Resort in Orlando, Florida. This enabled basketball facilities, hotels, and medical infrastructure to be housed within a closed environment known as the "Bubble." The NBA's Bubble was the first large-scale attempt at creating a closed yet fully operational campus during the COVID-19 pandemic, and this study represents the first time the methods and protocols employed in the Bubble have been described in detail in a publication.

Prior to entering the Bubble, participants were required to quarantine and receive a negative PCR test result for COVID-19. Once the Bubble was established, only certain approved staff were permitted to leave and reenter it throughout its duration (July 1–October 11, 2020). Campus residents were required to report symptoms, temperature, and oxygen saturation daily, in addition to taking PCR tests each day, which were processed at off-site laboratories. Strict physical distancing and face masks were also mandated, with few exceptions.

Altogether, 148,043 PCR tests were performed across approximately 5,000 players, guests, team staff, league staff, media, and vendors, and only 24 cases were detected inside the Bubble. The average daily positivity rate on campus was consistently below 1%, despite the positivity rate in the outlying Orlando community reaching as high as 15% during the Bubble's operation.

This Bubble enabled the successful completion of 205 games to conclude the 2019–2020 NBA season. In addition to the interventions outlined above, the authors credit the success of the Bubble to the 40 on-the-ground, trained compliance officers who enforced adherence to protocols, as well as on-site access to mental health services that helped players and staff cope with the mental health burden of living apart from friends and family for an extended period of time.

"The NBA and National Basketball Players Association (NBPA) are well-resourced organizations that are fortunate to have the capacity to have enacted this program, but we believe that the principles we followed can be applied in settings where financial and occupational health resources are more limited," the paper authors said.

"Our experience demonstrates protocols can successfully enable a closed community to function safely within a broad community with high disease prevalence, and highlighted success factors that are broadly applicable in a pandemic caused by a respiratory virus."