IMPLICATIONS OF A COVID-19 OLYMPICS
Sam Shames, Emergency Management, Health, and Hazards (EMH2) Team
Week of Monday, July 12, 2021
Tokyo Olympics 2021
Despite warnings from medical and public health experts in Japan and across the world, the Government of Japan (GoJ) and the International Olympic Committee (IOC) are still hosting the rescheduled 2020 Olympic Games in Tokyo beginning on July 23, 2021. With a mere 20% of Japan’s population fully vaccinated against COVID-19 and the recent declaration of a State of Emergency, between 60-80% of Japanese citizens are against holding the Olympics. COVID-19 cases are rising in Japan and across the world due to the emergence of the highly transmissible Delta Variant, and Japan has already reported cases among athletes in the Olympic Village and another outbreak in a nearby hotel housing athletes. Further spread of the virus would be extremely detrimental to the health and well-being of Japanese citizens and countries across the world. Additionally, the risk of a natural disaster requires special attention to emergency preparedness and response plans. If the GoJ and the IOC do not work with public health officials and Olympics attendees to tightly monitor behavior and infections, Japanese citizens and athletes’ home country populations are likely at a higher risk for facing subsequent outbreaks.
The Olympic Games were originally set to take place in July 2020 but were postponed due to the developing COVID-19 pandemic. As cases internationally and in Japan began to decline at the end of 2020, many were under the illusion that the end of the pandemic was in sight. However, the emergence of the more transmissible and infectious Delta Variant in May 2021 is quickly causing infections to rise in various countries, including Japan. While early data suggest vaccines are effective in protecting against this variant of concern, only 20% of Japan’s population is fully inoculated. As a result, there has been greater than a 200% increase in cases across the country since the beginning of July, with that statistic expected to continue rising. To accommodate these concerns, the GoJ and the IOC are continuously revising restrictions for the games, with the most recent update banning all spectators at most venues, requiring pre-departure and daily testing for athletes, and maintaining strict COVID-19 prevention measures in the Olympic Village. However, these measures are already proving ineffective, as over 40 international and domestic athletes and personnel have tested positive upon arrival to Japan after testing negative pre-departure, and there are already cases within the Olympic Village. With over 90,000 athletes and Olympic personnel expected to attend the Olympics, it is essential that the GoJ and IOC work with public health experts and remain vigilant in enforcing protocols to mitigate the possibility of further virus transmission.
The most pressing concern regarding the Olympics is the potential for it to exacerbate the current outbreak in Japan. With thousands of athletes and personnel set to attend the games, an outbreak can result from superspreader events, lack of individuals reporting symptoms, and false positives. Despite restrictions in the Olympic Village to prevent virus transmission, and the spectator ban, enclosed spaces like dining halls and fitness centers provide venues where athletes and personnel may be in close quarters and socializing without masks. 80% of the Olympic village will be vaccinated, however, public health officials in Japan have already reported multiple COVID-19 cases in the Olympic Village, providing early evidence that there is still risk of transmitting the virus in these environments. While many venues around Japan are closed to prevent residents from celebrating the Olympics, it is likely that large groups will still gather to watch the games, as demonstrated by global celebrations for the Euro 2020 games. This creates an opportunity for a superspreader event whereby even a single infected individual may pass the virus on to others, thus increasing transmission exponentially as it is continually passed on after the event. Due to the anticipation and high stakes of the Olympic Games, there is also a possibility that athletes and personnel may not report their symptoms due to shame or fear of disqualification. This scenario and potential false negatives in testing can cause outbreaks that go undetected for a period of time. Not only are outbreaks harmful to individuals and public health, but they have an extremely detrimental impact on hospital systems.
COVID-19 outbreak Japan per capita cases map
Despite having the most hospital beds per capita in the developed world, Japan struggled to accommodate the influx of COVID-19 patients earlier this year when case numbers were relatively low. Based on this information, along with a warning from a group of 6,000 Japanese doctors saying Japan’s healthcare system could not withstand another outbreak, it is highly likely that hospitals in Japan will not have enough capacity and manpower to successfully house and treat a large influx of patients. Additionally, competition for beds means that patients suffering from other illnesses may be discharged from hospitals, compromising their quality of care and potentially leading to poor health outcomes. This includes a weakened immune system that could increase their susceptibility to COVID-19, leading to additional cases and hospitalizations. As seen in other countries, outbreaks may cause shortages of supplies like oxygen, and can even trigger the spread of other deadly diseases such as Black Fungus. When hospitals experience a large influx of patients requiring the same resources, such as oxygen and ventilators, a hospital’s supply of these medications and equipment quickly diminishes. Additionally, the use of steroids to treat COVID-19 is associated with an increased risk for developing Black Fungus. High levels of stress on healthcare workers could create a hazardous environment whereby staff may be unable to provide a high quality of care and have difficulties adhering to safety protocols, leaving hospitals more vulnerable to making deadly mistakes.
There is also a possibility that athletes and personnel will bring infections back to their home countries, causing the further global spread of the Delta Variant. With 11,500 athletes and 79,000 international personnel set to attend the Olympics, there is a high likelihood that many will be infected with COVID-19 at some point during the Olympic Games. Since the incubation period for COVID-19 varies from 2-14 days, there is a possibility that an infection may not be detected until an athlete or personnel arrives back to their home country. With varying rules on quarantining upon arrival, countries with no quarantine rules are at an increased risk for experiencing outbreaks due to variability in the incubation period. Many of the athletes’ home countries are experiencing new waves of COVID-19 due to the spread of the Delta Variant, and further transmission of COVID-19 provides an opportunity for the virus to continue mutating into potentially deadlier variants. Namely, large countries like Australia, Bangladesh, India, South Africa, South Korea, and countries in Southeast Asia are all experiencing deadly surges. Many of their hospital systems have collapsed under the pressure, and the economic ramifications have led the governments to make questionable decisions, such as reopening up the country for travel or avoiding lockdowns. This creates a vicious cycle whereby a lack of restrictions fuels the further spread of the virus, leading to more pandemic fatigue. Even more concerning is the potential for further spread of the Delta Variant in smaller or poorer countries such as Burkina Faso, Mozambique, and Zimbabwe that suffer from lack of access to vaccines and poor healthcare infrastructure. As a result, low vaccine coverage paired with the spread of highly transmissible and virulent variants causes unmanageable outbreaks to occur quickly. These countries already battle other issues such as food and water insecurity, armed conflict, and large populations of internally displaced persons. As a result, the impact of an outbreak could quickly lead to a humanitarian crisis with long-term effects on their communities. Many studies indicate that the pandemic has increased food insecurity, mental health issues, poverty, and overall poor health across the world. These effects are extremely detrimental to the livelihoods of these populations, making it increasingly important to prevent the virus from spreading to these regions.
In addition to the high likelihood of further health implications, hazardous threats are particularly dangerous during a pandemic when resources are restricted and scarce. While the threat of a natural disaster during large events is not new, the Olympics are particularly stressful for Japan’s emergency services personnel due to the pandemic. Japan’s location in the Pacific “Ring of Fire” means that the country experiences heightened seismic activity, increasing the chances of an earthquake or typhoon. Experts in Japan have already warned that the next natural disaster could strike at any time. Earlier this year, a deadly 7.3 magnitude earthquake hit Fukushima, causing blackouts, landslides, and a tsunami warning. These impacts can greatly affect emergency services, making it difficult for emergency personnel to communicate and travel safely. As cases continue to rise in Japan, even a short power outage in hospitals can cause a decline in quality of care. Instead of receiving the care needed to survive, patients will only be able to get the treatment that is available based on the number of healthcare workers on staff and the quantity of supplies that are in stock. Hazards are also physically damaging to territory, which could cause evacuations and the seeking of emergency shelter. The additional presence of international athletes and personnel can lead to further confusion and mass panic as there will likely be large quantities of people who are unfamiliar with the region and are unable to communicate effectively with emergency personnel due to language barriers. As a result, it is highly likely that a disaster would result in a superspreader event as people will be in close quarters and not adhering to pandemic control measures, with many of those individuals being unvaccinated. A superspreader event would increase cases in Japan, causing the current wave of COVID-19 to inflict even more long-term damage on the economy, emergency personnel, healthcare services, and residents.
As the Olympics are near and the number of outbreaks among athletes and Olympic personnel increases despite precautions, it is increasingly important that the GoJ and the IOC continue revising restrictions to prevent further outbreaks. For example, if cases within the Olympic Village continue to rise, the IOC should consider instituting a quarantine rule for all athletes to prevent non-essential activities. Most importantly, the IOC needs to work with Olympic personnel, athletes, and coaches to ensure these measures are enforced across all teams at all times. If cases continue rising within the Olympic Village each day, the GoJ and IOC should consider canceling the Olympic Games. Aside from banning spectators, current restrictions require daily testing for athletes and “random interval” testing for other Olympic officials, mask-wearing at all times, promotion of social distancing, and the use of contact tracing applications. While these measures are helpful in theory, enforcement of these principles is crucial in preventing the spread of the virus, especially among the unvaccinated. It is essential that each Olympic team play its role in stopping the spread of COVID-19 by holding teammates accountable for wearing masks and maintaining social distancing. This is especially important in those closed-air environments such as dining halls and fitness centers where individuals are often not vigilant about following precautionary principles. Olympic officials could also improve air filtration systems in these enclosed spaces within the Olympic Village by using High Efficiency Particulate Air (HEPA) filters as another barrier to reducing transmission.
In addition to these restrictions, vaccine campaigns in Japan and among Olympic personnel should be highly enforced. For example, Japan’s Ministry of Health could set up vaccine clinics at the Tokyo International Airport and the Olympic Village to encourage incoming international attendees to at least receive their first shot. Then, the GoJ can work with other countries to create a version of a vaccine passport that allows each individual to stay in Japan to obtain their second vaccine within the appropriate timeline, or to receive it when they arrive back in their home country. While they may not be able to receive both doses while in Japan, studies indicate that even one dose of the vaccine offers 52% more protection against the virus than no vaccine. Most importantly, public health officials in Japan must push for the collection of real-time data via Whole Genome Sequencing of COVID-19 samples, contact tracing, and the use of environmental sampling technologies. Whole Genome Sequencing will allow public health experts in Japan to learn more about transmission dynamics, the severity of illness, and variants. With this data, they can determine the types of COVID-19 measures that are effective in different communities, and make adjustments to public health interventions accordingly. These efforts allow for early detection of COVID-19 which promotes immediate intervention and the mitigation of potential outbreaks.
The Counterterrorism Group’s (CTG) Emergency Management, Health, and Hazards (EMH2) Team identifies threats posed by manmade and natural disasters, along with hazardous and health-related events. With less than one week before the start of the month-long Olympic Games, the team will continue monitoring COVID-19 case rates in Japan and the impact on hospital systems. Additionally, the team will continue tracking the progress of Japan’s vaccine campaigns to determine Japan’s level of success leading up to the Olympics. Finally, the EMH2 will work with CTG’s PACOM Team to stay updated on outbreaks related to the Olympic Games to continuously evaluate the threat environment.
The Counterterrorism Group (CTG)
 ‘Like hell:’ As Olympics loom, Japan health care in turmoil, AP News, May 2021, https://apnews.com/article/japan-coronavirus-pandemic-business-olympic-games-2020-tokyo-olympics-72cc0b10127e8bab06406a6ec6bcedd6
 COVID-19 rules at the Tokyo Olympics: Spectators banned, vaccination not required, ABC News, July 2021, https://abcnews.go.com/Sports/covid-19-rules-tokyo-olympics-spectators-banned-vaccination/story?id=78225985
 Tokyo 2020: First Covid-19 case reported in Olympic village days before games opening ceremony, NBC News, July 2021, https://www.nbcnews.com/news/olympics/tokyo-2020-first-covid-19-case-reported-olympic-village-days-n1274269
 Explainer: The Tokyo Olympics by numbers, World Economic Forum, July 2021, https://www.weforum.org/agenda/2021/07/tokyo-2020-olympics-numbers/
 “File:COVID-19 outbreak Japan per capita cases map.svg” by Ythlev licensed under Creative Commons
 Japan has the most beds per capita in the developed world. So why is its health system crashing?, CNN, February 2021, https://www.cnn.com/2021/02/10/asia/japan-healthcare-coronavirus-dst-intl-hnk/index.html
 Japan doctors union warns games could lead to 'Tokyo Olympic' virus strain, Japan Times, May 2021, https://www.japantimes.co.jp/news/2021/05/27/national/doctors-covid-19-tokyo-olympics/
 Mucormycosis: The 'black fungus' maiming Covid patients in India, BBC, July 2021, https://www.bbc.com/news/world-asia-india-57027829
 Explainer: The Tokyo Olympics by numbers, World Economic Forum, July 2021, https://www.weforum.org/agenda/2021/07/tokyo-2020-olympics-numbers/
 Clinical Questions about COVID-19: Questions and Answers, CDC, March 2021, https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#:~:text=Based%20on%20existing%20literature%2C,2–14%20days.
 What countries are in the 2021 Olympics?, Fansided, July 2021, https://fansided.com/2021/07/08/2021-olympics-countries-list/
 Impact of COVID-19 on people's livelihoods, their health and our food systems, World Health Organization, July 2021, https://www.who.int/news/item/13-10-2020-impact-of-covid-19-on-people%27s-livelihoods-their-health-and-our-food-systems
 Not just COVID-19: earthquakes, typhoons pose threat at Tokyo Olympics, Channel News Asia, July 2021, https://www.channelnewsasia.com/news/sport/earthquake-typhoon-tokyo-olympics-covid-19-15204950
 Powerful magnitude 7.3 earthquake jolts Tohoku area, Japan Times, February 2021, https://www.japantimes.co.jp/news/2021/02/14/national/earthquake-fukushima/
 “Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine,” New England Journal of Medicine, 2020, https://www.nejm.org/doi/full/10.1056/nejmoa2034577