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TOKYO – Olympics organizers didn’t reinvent the wheel on COVID-19 protection measures. Mask use and distancing, frequent testing and contact tracing have become part of daily life globally in the past 16 months.
But how effective those can be when the Olympic Games bring tens of thousands of athletes, coaches, sport officials and media from around the globe is what has public health experts worried.
With the Games set to open on Friday, they caution that the event could increase the spread of the coronavirus during the Olympics and distribute around the world after.
“No country has been fully successful in using those measures to damp down the virus,” said Lawrence Gostin, a Georgetown professor and director of the World Health Organization Collaborating Center on National & Global Health Law. “It keeps raging back, even in the most ideal settings, like an island nation.
“So I think it’s foreseeable that the Olympics are going to be an amplifying event.”
International Olympic Committee President Thomas Bach said last week that there was “zero” risk of athletes spreading the coronavirus to Japanese people or others in the village.
On Wednesday, it was announced that a Chilean taekwondo athlete and a Dutch skateboarder will miss the Games after becoming the first known athletes to be ruled out after testing positive for the coronavirus upon arrival in Tokyo.
Since the beginning of July, 79 coronavirus cases have been tied to the Games, with 46 confirmed among residents of Japan. Already in the lead-up to the Games, two soccer players from South Africa who were staying in the Olympic Village tested positive.
“We can give them a level of satisfaction that everything is being done by us that there'll be safe and secure Games,” said IOC spokesman Mark Adams.
"The amount of testing that is going on and the isolation (called for) in the playbooks are very, very strict indeed. There can never be zero risk, but we've reduced it as far as it can be."
Public health experts raised key questions about organizers’ plans, which have been outlined in playbooks for all participants. For the prevention measures to work, organizers need widespread compliance and quick responses to testing indicators.
But those same playbooks lacked key measures that could have further protected the largely unvaccinated Japanese public and the largely vaccinated international visitors, they argued.
“There’s absolutely no way these Games should be happening,” said Amir Attaran, an immunologist and professor of law and medicine at the University of Ottawa. “It is unethical. It is immoral. It is dangerous, and it is not in any way motivated by anything apart from profit.”
Factors contributing to exposure
The success or failure of the plan begins with compliance with the measures, including mask use outside visitors’ accommodations and social distancing. Access to the athletes' village is restricted, and all participants are barred from public transit for their first 14 days in the country.
Callum Skinner, a double Olympic cycling medalist in the Rio Olympics in 2016 and athlete lead for Global Athlete, said Olympians are already cautious and are likely to follow virus prevention measures.
“All of them are just desperate to have an Olympic Games,” he said. “They realize it’s teetering on a knife’s edge, and they’ll take as many tests as they need to take, they’ll wash their hands and they’ll keep their masks on.”
But that may not be enough.
Athletes will compete unmasked, and in sports such as basketball, field hockey, rugby or wrestling, they'll be in close contact with their opponents.
An article by four top U.S. public health experts in the New England Journal of Medicine noted several of the gaps in Tokyo organizers’ playbooks. Among them is high-risk areas like athletes’ living quarters and dining facilities, where athletes will be among others unmasked. They criticized organizers’ decision to have athletes share rooms in the village.
“We believe the IOC’s determination to proceed with the Olympic Games is not informed by the best scientific evidence,” the article states. “The IOC’s playbooks are not built on sufficiently rigorous risk assessment, and they fail to consider the ways exposure occurs, the factors that contribute to exposure, and which participants may be at highest risk.”
Frequent testing doesn't create safety
Organizers’ prevention measures rely heavily on testing and contact tracing. But public health experts cautioned those are not without difficulties and could come too late.
First is just the volume.
Tens of thousands of people make up the groups that will be tested daily – athletes, team officials, international federation officials and photographers. Generally, the closer people are to the field of play, the more frequently they will be tested.
At least 51,000 people are traveling to Japan from overseas, according to numbers from Tokyo organizers.
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Tara Kirk Sell, senior scholar at Johns Hopkins Center for Health Security and a 2004 Olympic silver medalist in swimming, said the question becomes whether organizers can execute the tests as planned. She said she has been assured they can.
“I think the plan itself is very good,” said Kirk Sell. “The final question will be: Can the plan be implemented in the way it was intended? And I hope that’s the case, but we will have to see how well it works on the ground.”
Even if Tokyo organizers have the testing capacity, the question becomes following up on that information and containing the spread of infection. Tokyo organizers are requiring all participants to download an app to their smartphones to help identify close contacts in cases of positive tests.
In the New England Journal of Medicine, experts argued that contact tracing should rely on wearable technology rather than apps, because athletes don’t compete with their phones on them.
“You cannot by testing frequency alone create safety,” Attaran said. “Testing only tells you when things have become unsafe.”
Public health experts said positive cases will come, but Tokyo’s effectiveness will come in how well it uses that as part of its plan rather than as a backstop for other measures.
“Testing per se sounds good, but it becomes effective only when other measures are combined effectively,” Kentaro Iwata, a professor of infectious diseases at Kobe University in Japan, wrote in an email.
No vaccine requirement
For all the measures organizers put in place, several key ones are lacking, public health experts said.
Attaran pointed to the lack of a vaccine requirement for the visitors who will arrive from more than 200 countries.
The International Olympic Committee has said since the spring that it would urge participants to get vaccinated but not require it, and in May it struck a deal with Pfizer to secure doses of its vaccine for countries that wanted them.
Despite the lack of a requirement, the IOC estimated that at least 85% of delegations from national Olympic committees – who make up the largest segment of visitors – will arrive vaccinated.
“Vaccines are prevention,” Attaran said. “Testing is detection of the disaster after it’s occurred. The IOC has chosen a strategy of detecting disaster rather than preventing disaster.”
Japan, meanwhile, lags behind other developed countries in vaccination, with only 20% of people fully vaccinated.
Tokyo has been under a state of emergency, which prohibits bars and restaurants from serving alcohol, since July 12. New coronavirus cases hit a six-month high just more than a week before the opening ceremony.
The Olympics are hugely unpopular in Japan, where polling shows 60% to 80% of residents said the Games should not be held this summer, and Iwata said the effect on people’s daily lives probably is part of that.
“The sense of unfairness made the Olympic Games very unpopular to some, in my opinion,” he wrote. “It is nothing to do with cases directly, but is very closely related to countermeasures they took against increased cases.”
Belatedly, Tokyo organizers reversed course on their decision to allow fans from within Japan to attend the Games. They announced this month that they would hold most events without spectators.
Given the country’s low vaccination rate and the likelihood of people congregating at venues, bars and restaurants, public health experts agreed it was the only reasonable option.
“You take a whole level of risk out of it. I do wish that it was a situation where fans could be allowed,” Kirk Sell said, “but it just seems like this was the only move that could be made.”
Iwata cautioned that a euphoric atmosphere during the Games could still induce outbreaks.
Organizers have less control over that, but public health experts worried about how they would respond if cases tied to the Games rise.
Gostin has been advising colleges and universities about reopening in the United States, cautioning that they should relax mitigation measures incrementally and then watch for signs of increased spread of the coronavirus.
With 16 days between the opening and closing of the Summer Olympics, he doesn’t expect that type of caution.
“That can’t and won’t happen at the Olympics,” Gostin said. “There’s just too much at stake.
“They’ve already reached the tipping point and there’s no going back, and that’s what worries me more than anything. Because I don’t trust the Olympic organizers to pull back if they see safety signals.”
This article originally appeared on USA TODAY: Tokyo Olympics COVID-19 protocols raise red flags among health experts