The Buffalo Bills’ Covid touchdown could be the key to unlocking some normalcy

When the Buffalo Bills took the field for the first game of the NFL season, players came face-to-face with the reality of pandemic-era football. Gone were the Zubaz-clad fans known as the “Bills Mafia” who had religiously filled the 70,000-seat stadium each Sunday for years, some for hundreds of consecutive games. Instead, the team — having opted against installing cardboard cutouts of fans for most of the season — exited the tunnel week-after-week to rows of empty seats and a curated loop of pre-recorded “crowd noise” piped through the sound system.

A few months later, as the Bills led their division and faced the prospect of hosting their first home playoff game in a quarter century, team owner Terry Pegula fretted about the lack of electricity in the stadium. “The entire Bills organization misses the energy of our fans at our games,” he said. “We know they're [out] there, but we want them here.”

So even as Covid-19 raged across Buffalo and western New York last fall, Bills fans and team officials pressed for a way to bring live crowds back. They appealed their case directly to the state’s most powerful member of the “Bills Mafia,” Gov. Andrew Cuomo. “It’s something we’re looking at,” the governor hinted in late September. “I am 100 percent eager to get fans back to the games.”

The governor’s public eagerness to return fans to Bills Stadium had a second motivation: He also wanted to plot a way to reopen other long-shuttered landmarks of the state’s cultural economy, including Broadway’s iconic theaters. In an open-air stadium, masking and social distancing could keep fans safe. But that wouldn’t be enough for indoor venues like concert halls and museums. The state needed another tool.

Days after the Bills were crowned AFC East champions, state officials floated a ground-breaking plan: New York would allow 6,700 fans to attend the team’s Jan. 9 playoff game if they could first test negative for Covid-19 in addition to complying with other safety measures. The effort, touted as the only one of its kind in the NFL, allowed the state to test a hypothesis: Could Covid-19 testing, combined with other precautions, hold the key to the state’s pandemic recovery?

Three days before the game, fans lucky enough to score a ticket began lining up their cars, from sunrise to well past sunset, to get swabbed for Covid-19 at one of 30 drive-through testing stations set up outside Bills Stadium — a process which took minutes, with results reported 24 hours later.

On game day, masked fans had to show proof of their negative result, along with their mobile ticket, to enter the stadium through designated gates in assigned 10-minute increments to prevent crowding at the turnstiles. Thermal imaging cameras, meanwhile, scanned crowds at checkpoints to help identify fans who might have a fever. Once inside, fans, who were limited to either two- or four-seat pods, were further restricted to certain zones of the stadium and offered limited, cashless concession stand options through 10 p.m. in accordance with the state’s dining curfew.

The strategy worked. About 1.5 percent of the fans tested positive before the game and were denied entry. In the weeks that followed, no outbreaks were tied to the games.

New York is now working to expand the Bills strategy to reopen other large venues that have been shuttered since last March. A first test came earlier this week when Madison Square Garden and the Barclays Center became the first indoor arenas in New York to host NBA games, with maximum capacity set at 10 percent of available seats for fans with recent negative Covid tests. If all goes well, New York is hoping to extend the protocol to allow the resumption of weddings, concerts and eventually, Broadway shows, amusement parks and summer camps.

If successful, New York could offer a blueprint to other states for how to safely reintroduce large-scale events and reopen major entertainment venues even before the country is fully vaccinated and reaches so-called herd immunity. It’s a bridge, New York leaders say, to a post-Covid world. “The show will go on,” Cuomo said last month. “The fans will be back. And New York will be New York again.”

But it’s all a big if. The plan will work if vaccines get deployed as fast as hoped. If new variants of the coronavirus can be held back. If the rules laid out in New York’s plan are really followed to the letter. If the cost of administering the tests isn’t too great a burden. And even then, there’s a big assumption that underpins all of this: That the outcomes in Buffalo and at the next event to come, aren’t just an anomaly.

Since the start of the pandemic, public health experts have cautioned against an over-reliance on testing. Different tests have varied sensitivity and accuracy. And the faster the results, the less accurate the test.

The Trump administration learned this the hard way. For months, the White House relied primarily on rapid testing to screen staff and visitors for Covid, and did not require face masks, distancing or other precautions. Despite testing, the White House wound up hosting a superspreader event with the president that led to dozens of infections.

“Testing is a really powerful tool, but let’s not fall into the trap the White House did, which was to see it as a panacea,” Ashish K. Jha, dean of Brown University’s School of Public Health, said. “Because it’s not.”

State officials have likened their effort to safety precautions enacted in the wake of the 9/11 terror attacks, with reopenings under the new testing model conducted in stages and in accordance with federal guidance. In the first phase, large arenas and stadiums can reopen with limited capacity. Like fans in Buffalo, anyone attending events at such facilities must get a negative PCR test — the more accurate but slower test — within 72 hours of the event’s start time. In addition to testing negative, attendees must also wear face coverings, submit to temperature screens and engage in social distancing.

Next up: New York catering halls and other event venues can resume hosting weddings at 50 percent capacity — up to 150 guests — with approval from local health officials, beginning on March 15. All guests must show proof of a negative rapid Covid-19 test. And outdoor sports stadiums — like Yankee Stadium and Citi Field — are likely to be among the first large-scale venues to see a return of fans once the next baseball season starts. From there, the state will consider when to allow the lights to go back on at Broadway theaters and other darkened performance spaces, most of which face challenges posed by their size constraints and airflow.

Already, New York has launched a public-private partnership to organize hundreds of pop-up performances and arts events at outdoor and “flexible” venues across New York that Cuomo described as a way to “migrate to the reopening of venues for arts.” The first NY PopsUP event, featuring jazz musician Jon Batiste, dancer Ayodele Casel and opera star Anthony Roth Costanzo, took place for health care workers and New Yorkers getting vaccinated at the Javits Center in Manhattan.

“Opening sites with testing is something where New York wants to lead the way,” Cuomo said earlier this month. “You have venues like the Shed, the Apollo, Harlem Stage, Alice Busch Opera Theater that we can start to reopen with testing.”

Politically, Cuomo could use a win; while he earned plaudits early in the pandemic for his leadership, he’s been badly pummeled in recent weeks by accusations that he helped hide the rate of Covid deaths in the state’s nursing homes. So he’s eager to get reopening right, and testing is central to his plans. In recent weeks, Cuomo has pushed even harder in that direction, proposing allowing commercial real estate firms in New York City to join a partnership in which they pledge to make diagnostic Covid-19 testing available to their buildings’ tenants. And he’s floated the possibility that New York could develop a mobile app to help venues fully reopen through “the confidential transfer and verification” of testing and vaccine data for attendees.

Business-side decisions could complicate efforts to reopen events like live theater, including labor agreements with theater staff and the costs of reopening at reduced capacity — such as whether testing fees would be built into ticket prices and how it would be conducted and confirmed. Another unknown: Are audiences ready to return and, if so, how much are they willing to shell out for such experiences? The Broadway League, the trade association for the Broadway theater industry, has suspended New York City Broadway performances through the end of May — more than a year after Cuomo ordered theaters to close. The group declined to comment on the governor’s reopening strategy.

The state is still trying to sort through the challenges posed by smaller venues before making a final decision on when and if its testing-based model will work for theater venues. “Whether you’re at a wedding or sitting at a seat in the theater, what’s the difference? That's what we're working through now,” Cuomo said this month.

Moving too quickly to ease restrictions, particularly on higher risk activities like indoor weddings, which often include seated meals and can have older or more at-risk attendees, could backfire — testing or no testing. Any failure is likely to generate negative attention and backlash. And the emergence of new, more virulent forms of Covid-19 could enhance the riskiness of any such event.

“I see testing as a way to substantially lower the risk, but the question is, how high is the risk in the first place? And in high-risk situations, testing alone isn’t enough. But in medium-to-low-risk situations, testing helps a lot,” Jha said.

While New York has pinned its early Covid-19 reopening strategy on more accurate PCR tests, they can be more expensive — Bills fans paid $63 each — and take several days to process. That delay could mean people who test negative two to three days out from an event, like an NBA game, may be infectious with Covid-19 by the time they take their seat. Rapid antigen tests, like the ones used by the White House, can yield results in a matter of minutes and are often less costly, but can be less sensitive. “There’s always going to be a trade-off,” said Jon Cohen, executive chair of BioReference, a laboratory which partnered with the state to conduct PCR tests on Bills fans.

That is why the success of any testing effort should be measured based on the level of Covid-19 transmission among event attendees — not just the number of people turned away after testing positive, said Yonatan Grad, a professor of immunology and infectious diseases at Harvard’s T.H. Chan School of Public Health.

Grad, who has studied the effective sensitivity of tests conducted two or three days before an event, said the testing model used in Buffalo when coupled with mask and social distancing requirements can help reduce Covid-19 transmission. But dozens of positive individuals could still show up and get in, especially if an event takes place in an area with high rates of the virus, because of a testing failure, exposure after being tested, or because their level of infection was too low to register.

What’s really needed, he said, is something that isn’t readily available yet: a highly sensitive and inexpensive rapid test, administered close to the start of an event. “If we had a test like that, that would be ideal,” Grad said in an interview. “Because then people could walk in, confident that at least for the duration of an event — like a three-hour game or a two-hour concert — it’s unlikely that someone who had been recently exposed and tests negative will develop enough virus that they will become infectious during that time period.”

The concept of aggressive testing is not new for professional sports leagues, which were among the first to embrace it as a way to resume seasons cut short by the pandemic. But that testing primarily focused on athletes, coaches and staff. Even when fans were tested (or screened with Covid-sniffing dogs, a practice employed by the Miami Heat), it often occurred on a venue-by-venue basis, not as part of a state-led effort to reopen the economy at large.

“I don’t know of anyone else who’s talking about doing what [Cuomo’s] doing right now,” Cohen said. “I haven’t heard much about other people attempting to reopen the economy by coming up with other novel solutions.”

Companies are also looking to cash in on the opportunities posed by large-scale testing. Ticketmaster, for example, is exploring how Covid-19 testing and vaccines could be used to safely reopen performance venues. The ticketing company announced a “SmartEvent” tool in October to help venues implement socially distanced seating, contactless entry, contact tracing and other Covid-related precautions. (Ticketmaster, however, has stressed that it “does not have the power to set policies” for safe entry requirements; that remains subject to decisions by event organizers and local health officials.) Some airlines have partnered with testing providers and launched mobile apps that allow travelers to share their negative Covid-19 tests and complete forms as required by local health officials at their destinations. The CDC has yet to make Covid-19 testing a requirement for domestic travel.

New York officials are keeping an eye on those efforts. And pending the success of such apps, they could be integrated into the state’s reopening plan to give attendees “a level of confidence” of their safety. The state has recently opened nearly a dozen rapid testing sites throughout the New York City area that allow residents to get FDA-approved antigen tests for $30 and get their results within 30 minutes. Cuomo plans to open additional sites to expand the state’s testing capacity under the reopening strategy.

“I think this is going to be a big advantage for the state of New York,” he said earlier this month. “It will accelerate our economic reopening prior to reaching herd immunity where everybody has a vaccine, which is June and July. Let's accelerate that period of time.”