Tokyo Olympics: Do the safety measures go far enough?

The Tokyo Olympics are in full swing, with world records shattered and legends made almost every day. But hovering over the Games is a cloud of concern: Could they become a superspreader event?

As the Games progress, it’s becoming clear that this concern is not unfounded. The International Olympic Committee (IOC) is tracking COVID cases and, as of August 2, the IOC has reported a total of 281 cases linked to the Olympics since July 1. These cases include not just athletes, but Olympics organizers, employees, contractors, members of the media, and volunteers. Half the new cases reported are contractors and the majority of them are Japanese nationals, according to a BBC News report. 

In the background, cases are rising across the Japanese population. The Japan Times reported that 12,000 cases were recorded on July 31—the fourth consecutive day for record numbers of the virus. The Japanese government has now extended Tokyo’s state of emergency designation to last until at least the end of August, and five other areas of the country have declared states of emergency. 

This is particularly concerning given Japan’s low vaccination rate. According to the BBC, as of July 29, just 28% of the country’s population had been fully vaccinated. 

In May, as reported by Reuters, the Tokyo Medical Practitioners Association, which represents roughly 6,000 primary care physicians, published an open letter to Prime Minister Yoshihide Suga and the IOC, urging them to consider cancelling or postponing the Games. Numerous health experts and clinicians have publicly criticized the COVID precautions that have been put in place and denounced the fact that the Games are being held despite expert guidance.

For Aaron E. Glatt, MD, Chair of the Department of Medicine and Chief of Infectious Diseases at Mount Sinai South Nassau, there’s just one precautionary measure that matters: Vaccination. 

“In an ideal world, only vaccinated people would be allowed to participate,” Dr. Glatt said in an exclusive interview with MDLinx. “Assuming that they were in somewhat of a secluded environment … only really interacting with people in the Olympic Village, and everybody was vaccinated and all individuals there had been PCR-tested prior to coming and were negative and asymptomatic … you could really keep up pretty good control on the athletes and the people in the village. And then you could have successful Games, from a medical point of view.” 

But the IOC hasn’t required athletes and officials to be fully vaccinated to compete. Here’s a rundown of some of the measures put in place, gleaned from the Tokyo 2020 Athletes and Officials Playbook, and from an ABC News report.

Olympic COVID precautions

According to the Playbook, all participants in the Games (including athletes and officials) must wear masks when they’re not eating, sleeping, training, or competing.  

Anyone arriving in Japan for the Games, including athletes, fans, and anyone else, is required to take two COVID-19 tests on two different days, within 96 hours of their flight, noted ABC. Upon arrival at the airport, all individuals must take a quantitative saliva antigen test. Subsequently, athletes and “all those in close proximity” will take daily tests for their first three days in the country. In addition, according to the rules, residents of Japan, and those arriving from overseas who have been in the country for more than 14 days, may be asked to take a COVID-19 test before their role at the Games begins.

Beyond this, any individual entering the Olympic Village or a Games venue is required to have their temperature checked. Spectators for the Games are being kept to a bare minimum, including representatives from nations and VIP attendees. Prior to the start of the Games, officials announced that, in general, spectators would be banned from any venue in Tokyo, as well as a number of venues in other cities.

In addition, all Games participants have been banned from using public transport for their first 14 days in the country; instead, they must use designated Games vehicles to move between venues. 

The criticism 

While these measures may appear extensive, they’ve been met with concerns by various voices in the scientific and medical communities.

For example, authors of an open letter published on July 1 in the New England Journal of Medicine said that the decision to hold the Games this year is “not informed by the best scientific evidence.” The authors went on to write that preventive measures that should have been adopted by the IOC, including single hotel rooms for athletes, daily testing for all, and wearable monitors for rigorous contact tracing, rather than tracing apps. 

They pointed out that contact tracing apps “are often ineffective,” and that evidence points to wearable devices as a preferable measure. Likewise, the authors noted that not all screenings are as effective as others and that, “polymerase-chain-reaction testing, at least once (if not twice) per day, is best practice, as the NFL experience shows.”

Other scientists have pointed out that the buses used to transport the athletes are likely to promote virus spreading, and that, given the low rate of vaccination in Japan, the drivers are unlikely to be vaccinated and could carry the virus back to their communities, according to a report by Time. 

Japan’s low vaccination rate has incited other fears too. Kenyu Sumie, chairman of the Japanese Medical and Dental Practitioners Association, was quoted by Business Insider as saying that it raises the risk of new variants spreading, and concluded, “at this point, it is impossible to hold the Olympics safely.”

Vaccination rates were Dr. Glatt’s chief concern. He has worked extensively with COVID-19 from the beginning of the pandemic. 

“I gave a grand rounds on it back in January of 2020, but that was well before we knew what we were getting involved with,” he said. “You could certainly, I believe, have competitive sports, if people are willing to be vaccinated. I think that would make it a really safe type of game. The more people that you have that are unvaccinated—the more people that you have that are entering and leaving the [Olympic] village and are unvaccinated—the more you're introducing potential COVID infectivity.”

In an ideal case, he said, anyone going anywhere near an Olympic venue would be fully vaccinated, but there should still be additional measures taken, including masks, social distancing, and regular testing. Dr. Glatt pointed out that, even with vaccinated people, data indicates there will still be some people who will become infected—particularly with mutations like the Delta variant.

According to surveys conducted by USA TODAY Sports, most of the countries taking part in the Games said more than 90% of their delegations would arrive vaccinated, with some saying only 70% would be, and Italy is the only country claiming that 100% of its delegation would be fully vaxxed. The US Olympic and Paralympic Committee failed to provide an estimate of the vaccination rate among the American team. 

For Dr. Glatt, this may represent holes in the safety net. In fact, he said that the IOC’s measures “are excellent”—if you’re dealing with individuals vaccinated at a rate of 100%.

“These are usually healthier younger people that aren’t likely to get sick anyway. You're really dealing with an ideal group of people in terms of the lowest likelihood of transmitting. So, if they’re all vaccinated, you really have potential to have the Games in a pretty safe way,” he said. “But the safest way is not to have any Games. The safest way is for everybody to be in their home and not leave their house. But that’s just not practical. And I think people need to get out, I think it’s not healthy to continue that isolation for everybody in the world.”