With the Tokyo Olympics set to start on July 23, several major Japanese cities are still under a state of emergency due to COVID-19.
The country also has about 40,000 active coronavirus cases, although case numbers have been dropping since mid-May. However, less than 4 percent of Japan’s population is fully vaccinated.
The situation is so tenuous that some Tokyo doctors are reportedly calling for the Games to be canceled, and many Japanese have soured on the event.
Right now, though, all signs point to the Olympics going ahead as scheduled.
In preparation, the International Olympic Committee (IOC) released a series of playbooks detailing how athletes, support staff, and others will be protected from COVID-19 during the games.
But Dr. Annie K. Sparrow, assistant professor of population health science and policy at the Icahn School of Medicine at Mount Sinai in New York City, and her colleagues say these measures fall short.
“The IOC’s playbooks are not built on scientifically rigorous risk assessment, and they fail to consider the ways in which [coronavirus] exposure occurs, the factors that contribute to exposure, and which participants may be at highest risk,” they wrote May 25 in the New England Journal of Medicine.
Vaccination
One of the protective measures outlined in the playbooks is the COVID-19 vaccine. Athletes are encouraged to get vaccinated, although it’s not mandatory.
This is complicated by the shortage of vaccines in many low- and middle-income countries.
“Many countries just don’t have access to the vaccines or authorization for the vaccines,” said Katelyn Jetelina, PhD, an epidemiologist with the UTHealth School of Public Health in Texas.
She noted that young athletes who may be getting access to vaccines now might be nervous.
“We are getting pretty close to the Games, so athletes are going to start worrying about the side effects of vaccination on their performance,” she said.
The IOC says that it expects more than 80 percent of athletes and staff staying in the Olympic Village to be vaccinated. It’s not clear yet how close they will come to that goal.
The IOC has also not indicated how many other people involved in the Games will be vaccinated.
Given the lack of high vaccine coverage across the board — including among the Japanese public — other measures will be needed to control the spread of the virus.
Testing
The IOC playbook calls for athletes to have regular temperature checks and monitor themselves for symptoms. Any athlete with symptoms will be required to undergo PCR testing.
Still, Sparrow and her colleagues say monitoring for symptoms will miss a lot of coronavirus cases.
“Because people with COVID-19 can be infectious 48 hours before they develop symptoms (and may not develop symptoms at all),” they wrote, “routine temperature and symptom screening will not be effective for identifying pre-symptomatic or asymptomatic people.”
That’s why rigorous testing strategies like PCR testing — at least once a day — is needed, says Jetelina.
“We saw that this type of testing was very effective with the National Football League and Major League Baseball here in the United States,” she said.
The IOC playbook says “in principle” athletes will be tested daily whether or not they have symptoms.
In addition to daily testing, the NFL used other measures to keep its players safe, including strict mask requirements and identifying high-risk contacts through contact tracing.
The IOC plans on giving every athlete a smartphone with a contact tracing app, something Sparrow and her colleagues don’t think will work.
“Contact-tracing apps are often ineffective,” they wrote, “and very few Olympic athletes will compete carrying a mobile phone.”
Instead, they suggest the use of wearable devices that alert athletes when they are within close contact to others. Most athletes can wear these devices even while they compete.
Event risk levels
The chance of acquiring the coronavirus when around others depends on many factors, including the number of virus particles in the air and the length of time spent in that space.
That means that not all Olympic events or venues will carry the same risk, something the IOC playbooks don’t emphasize right now.
“The playbooks maintain that athletes participate at their own risk, while failing … to distinguish the various levels of risk faced by athletes,” Sparrow and her colleagues wrote.
They call for the IOC to classify events as low, moderate or high risk depending on the activity and venue.
For example, events like sailing and equestrian events would be low risk because athletes are outside and physically distanced from others.
Outdoor sports that involve close contact — such as soccer or rugby — would be medium risk.
Indoor events would carry a higher risk because of the decreased ventilation when inside. This holds even for individual sports like gymnastics.
Given these differences in risk, “protocols for keeping athletes and everyone else involved safe could vary on the basis of these risk levels,” Sparrow and her colleagues wrote.
Venue risk levels
Likewise, venues at the Games carry different COVID-19 risks.
“[The IOC] needs to address the differences in venues,” said Jetelina. “For example, how does a competition space differ from a non-competition space like hotel rooms?”
Any area where people gather in close proximity — such as buses, stadiums and cafeterias — is higher risk than an outdoor area.
Even hotel rooms, which will be shared by three athletes, are higher risk. In addition, if one athlete in the room tests positive, the other two will need to be tested and may have to quarantine.
While the focus of the IOC and Japan right now is on the Olympic games in July, the Paralympic Games are set to start on August 24.
This event carries its own risks, especially if there is an uptick of community transmission following the Olympic games.
“We know that some of the Paralympic athletes are in higher-risk categories for COVID-19,” said Jetelina, “so we certainly want to be more careful with the Paralympics.”
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