Annie Sparrow, MD, MPH, MBBS
October 7, 2021
Beijing recently announced exceptionally strict COVID-19 restrictions for the 2022 Winter Olympics: athletes must arrive vaccinated or undergo a 3-week individual quarantine, and all participants will be isolated in a hermetically sealed « closed circuit » during the Games . But this plan begs the question of whether these restrictions are effective, let alone necessary.
While the International Olympic Committee (IOC) endorsed Beijing’s approach, the committee also claimed success for its far less stringent approach to the Tokyo Summer Games . And a closer look at the IOC data – or the lack of it – raises real questions about whether Tokyo 2020 was the success story the IOC is trumpeting.
The IOC claims its Tokyo actions – largely a virus spread adopted by large droplets and ignored the dispersal of tiny aerosols – setting a model for other major international events. Brian McCloskey, Dr.
This claim is based on a very partial publication of data indicating low case numbers and a test positive rate of 0.03%. This is supposed to be evidence that the IOC’s Olympic « bubble » took place while outside of the COVID-19 cases Tokyo was breaking new records, with an average positivity rate of 20%.
However, to this low positivity To get there, the IOC deceptively reduced the numerator by selectively reporting positive cases and artificially expanding the denominator by counting the tests that were carried out over and over again on the same participants. From July 1 to September 6, a total of 1,017,190 tests were conducted on approximately 90,000 Olympic and Paralympic participants – an average of 10 tests per person. During the same period, 888,819 tests were carried out on Tokyo’s 14 million residents – 0.1 tests per person.
The IOC’s final record of 312 cases contradicts the IOC’s parallel listing of 875 cases – 552 Olympic and 323 Paralympic cases. The IOC does not take into account the conflicting numbers. Did she decide not to count the over 500 infected local contractors, such as the 14 Japanese police officers who work for the security service, or to exclude the 40 infected volunteers?
Another cut in the numbers tells a very different story. Despite the high compliance with the droplet-focused attenuation, the transmission in heavily vaccinated Olympians was twice as high as in the lightly vaccinated Japanese population. In Paralympians, the prevalence was even higher. If the Olympic Village were a country, with a weekly rate of 15.5 cases per 100,000 people, it would be well above Japan and on a par with Russia and Brazil – hardly the success story praised by the IOC.
The IOC continued heavily on vaccines, as evidenced in President Bach’s mantra that « 85% of the athletes in the village would be vaccinated ». While vaccinations were not mandatory, athletes, a group with low risk of serious illness, were pressured to get vaccinated and those who refused were severely stigmatized. A survey in 25 countries found that 12 teams had vaccinated at least 90% of the athletes, with Italy and Spain 100% vaccinated.
Unfortunately, the IOC health advisors have forgotten the basic purpose of the COVID-19 vaccines: symptomatic illnesses and to prevent more serious consequences. This is the criterion by which they are licensed so as not to stop the spread of SARS-CoV-2. Fully vaccinated people can still test positive, more often due to subclinical than symptomatic infection. The IOC ignored this inconvenient truth, even when two fully vaccinated Ugandan team members tested positive in Tokyo in late June.
Worse, they ignored the crucial fact that COVID-19 spreads through inhalation of microscopic particles in the air although it is well known that aerosol spread is a major route of transmission for SARS-CoV-2. Accordingly, the most effective countermeasures are ventilation, air filtering and high-quality respiratory protection. Granted, upgrading ventilation systems throughout the Olympic Village and venues to five to six air changes per hour – the minimum required for COVID-19 – is expensive. However, HEPA filters clean the air very effectively and not only remove SARS-CoV-2 particles, but also pollen, dust, flakes of skin and chemicals. They are very portable and can be placed in high traffic areas and after risk assessment. In terms of face coverings, 1% respirators provide all-day protection as opposed to short-term protection from surgical masks.
However, the IOC only focused on droplet spreading measures: surgical masks and face coverings, plexiglass barriers, hand hygiene, surface disinfection and social distancing of 3 to 6 feet. When it comes to ventilation, the IOC took a homeopathic approach and advised athletes to open a window.
While masking can be beneficial for short-term exposure with the right masks, none of these more prosaic measures reliably prevent inhalation of airborne microscopic particles . COVID-19 particles can penetrate certain face coverings, bypass loose-fitting surgical masks, and bypass plexiglass « barriers ». Air currents destroy any “safety distance” indoors, and tiny particles that float in the air for hours can become infected long after the source has disappeared. While hand washing is paramount with diarrhea, its role in fighting COVID-19 is limited. And although COVID-19 appears to survive on surfaces, it cannot spread from them.
We know the virus thrives indoors, but the IOC has forced athletes into bunk beds in small apartments of 4 to 8 people to huddle in overcrowded buses and walk through tightly packed corridors. After the start of the competition, neither masks nor minimum distances could be observed. Indoors, pre-COVID ventilation meant that air sharing was inevitable.
The IOC’s failure to keep air COVID-19-free is evident. On July 15, after the first athlete tested positive, Bach insisted that there was « no risk to the athletes in the Olympic Village or to the Japanese people ». But within 48 hours, three villagers tested positive – two athletes and an Olympic official. Even as rising numbers tested positive, the IOC pretended the numbers were well within expectations. At least 22 athletes tested positive during the Games. In the Olympic Village – a heavily vaccinated and pre-filtered population – there were 36 cases within 26 days.
The IOC also lagged behind in monitoring and exchanging information. What is striking is the lack of any sequencing data. Without genome sequencing – identifying strains and testing for variants – there was no way to spot a variant or know if the Olympics were a super-spreader event. The IOC’s promise of « zero risk » to Japan was unlikely to stand up to real-time genome testing and contact tracing. The most credible reasons for the absence are political.
The IOC also did not offer an analysis of the likely source of the 875 infections and whether vaccinated asymptomatic athletes who tested positive transmitted the infection. The IOC in Tokyo should have asked and answered this question. A blanket disqualification of athletes and their partners as the sole result of a positive test is not a solution.
Finally, the lack of exit tests and follow-up after the return of the participants is regrettable, as there is a risk of missing positive cases because the athletes had to leave within 24 hours of their last event. In this way, variants could easily take up trips to unvaccinated countries. The list provided by the IOC is not helpful.
This approach has been at the expense of dozens of disqualified athletes whose Olympic dreams have been shattered by the IOC’s failures. Athletes who have been subjected to isolation describe inhumane conditions that have been deprived of fresh air and adequate nutrition. The alleged suicide of the Chinese coach of the Vietnamese swimming team during the quarantine is unknown – the cause is still being investigated. Although the IOC was warned by the players’ unions of the significant risk to the mental health of athletes and teams, it did not act.
These risks were predictable and the IOC was warned. After I published a risk management approach for the Olympics in the New England Journal of Medicine, my co-authors and I attended several IOC meetings and wrote directly to the IOC President.
For the IOC, risk management means Approach, however, to co-opt international organizations such as the World Health Organization in order to share the reputational risk of their low-cost approach and to require athlete renunciation as a condition for the competition. While exceptions may be permitted, this should not allow the IOC to bypass its failure to detect aerosol transmission and to introduce the correct controls.
Next up are the 2022 Winter Olympics in Beijing. The IOC has endorsed China’s mandatory vaccination for the 2022 Winter Games, and while vaccinations like tests are important, they are not a substitute for safe air.
Without accurate and sufficient data, which the IOC has not provided, we cannot know whether the extreme measures planned for Beijing are more necessary than the insufficient ones in Tokyo. And in a controlled information environment like the one in China, where the government has made suppressing information about the virus an art form, the IOC will only continue its irresponsible and unscientific approach.
The Olympics are designed to set the global standard not lower. It was the athletes – their achievements and their solidarity – that made Tokyo 2020 a success story – not the IOC approach. It is vital that efforts to prevent the spread of COVID-19 in Beijing are evidence-based and promote the wellbeing of athletes. Tokyo 2020 is not a model – except as a case study of what not to do.
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