Isaac Makwala and some thoughts on the challenge of Norovirus at major games.

By Dr Juan-Manuel Alonso  @DrJuanMAlonso

So, what initially looked like a food poisoning turned out to be a Gastroenteritis / Norovirus outbreak . The big evil all sport events medical cover organisers tried to avoid at all costs. Really bad luck! For one reason or another, the Botswana team leader and doctor did not inform the athlete of the measures, or Makwala ignored the instructions, or both, and Makwala, in a classical and predictable attitude, came himself to try to run the 400 m final.

This whole Makwala issue & Norovirus outbreak is terribly unfortunate. An outbreak is difficult to avoid. And any medical organiser needs to take urgent and stringent measures when it happens. I was wondering whether isolation/quarantine is needed or evidence-based for Norovirus outbreak. In the context of a Norovirus outbreak: is stopping a runner from running (or a worker from doing his/her job) appropriate?

I can understand the need to minimize /stop the spread of the virus and isolation /quarantine could have been considered in other settings like a school training camp or a ship’s cruise. I value the debate on the balance of protecting the majority versus individual rights of just one. Still I tend to respectfully disagree with the extreme decision to keep Makwala from racing.

An intermediate, compromise position may have been to allow Makwala to run but to ensure he avoided hand shaking or giving hugs to others. He could have worn a mask and had specific and separate call room procedures (bringing athletes to the track from their room under the stands). Right now the internet does not answer the key questions: no systematic reviews, no metanalysis, no RCT with evidence level A to support the IAAF decision as far as I am awere. In my humble opinion (IMHO) isolation /quarantine is based in level C evidence: expert opinion.

Below are more links to scientific literature.

The communication strategy of the IAAF and Local Organisers was criticised for not providing the facts, but that is difficult to do due to confidential nature of the medical data.

http://www.nhs.uk/conditions/Norovirus/Pages/Introduction.aspx …

Norovirus control measures based on general infection control principles treatment mainly supportive & non-specific https://www.ncbi.nlm.nih.gov/pubmed/25726433 

How to prevent the spread of norovirus: Stringent hygiene measures are vital to contain the virus https://www.ncbi.nlm.nih.gov/pubmed/2136600 

https://www.cdc.gov/vitalsigns/norovirus/infographic.html#infographic

 

 

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