The management of COVID19 positives at the Olympic Games could be improved

Note: The views expressed in this commentary are those of the author and do not necessarily reflect the official views of BJSM.

We are one week into the Olympics and the Olympic COVID-19 pandemic worsening among Olympians and their entourage, predicted by many, has not materialized yet. Despite the enormous number of tests conducted daily, only a very small number are found positive (more than 300 000 tests so far, positivity rate 0.02%). This is certainly the result of the diligent preparation of the teams through vaccination and the strict measures implemented by the Japanese Health authorities to prevent COVID-19 infection among the participants of the Games.

On the downside, the local measures have also taken any Olympic chance from a number of athletes, who tested positive on these routine screening tests. In fact, most of the positive athletes were already vaccinated, had very low measures of viral load and were asymptomatic. In addition of being unable to compete and seeing their Olympic dream fade, they are isolated in quarantine hotels for 14 days.

Over the last year, the scientific community has gained a lot of information on the spread and potential risks of SARS-CoV-2. Many studies on transmission have been conducted, also in the context of sport (1–3). There is general consensus that transmission risk is influenced by many factors, such as environmental settings (indoor/ outdoor), and vaccination status or viral load of the potential spreader. We also know that asymptomatic infection in athletes is unlikely to lead to any relevant health sequelae.

Unfortunately, such information does not seem to be taken into account enough by the Japanese Health authorities when assessing the situation and determining the management of an athlete testing positive forSARS-CoV-2 in the daily routine test in Tokyo. As hypothetical examples, does a vaccinated, asymptomatic sailor with a high cycle threshold (cT) value indicating low viral load really constitute a risk for his peers when competing out at sea or when in his (isolated) Olympic accommodation? Does such case require the same management as a positive case in a symptomatic Judo athlete with high viral load? Is it really necessary to interrupt the preparation of entire, fully vaccinated teams through temporary isolation of all athletes because one of their members has been in contact with a positive case?

Infection control and public health is always about trade-offs and risk management. For any athlete who looks forward to compete at the Olympic Games, the stakes are high. This is a once in a lifetime chance, for which she/he has prepared for many years, and it is the culmination of a sporting career. In this context, being eliminated for infection control reasons not based on strong scientific evidence is difficult to accept for any athlete.

Based on the emerging and available scientific evidence, the Sports Medicine community should try to assist the Japanese Health authorities in developing a more appropriate and progressive management of positive cases among asymptomatic, vaccinated athletes at the Olympic Games. Can we reimagine a program that fully protects both the local Japanese community and other competing athletes, but also acknowledges the unique circumstances of asymptomatic infections in Olympic athletes who compete outdoors? Unfortunately, it may be too late to make changes for the Tokyo Games, but there is still time to learn with application in the future.

Author and Affiliation:

Yorck Olaf Schumacher
Aspetar Sports Medicine Hospital, Doha, Qatar

Competing interests: None

References

1. Schumacher YO, Tabben M, Hassoun K, Al Marwani A, Al Hussein I, Coyle P, et al. Resuming professional football (soccer) during the COVID-19 pandemic in a country with high infection rates: a prospective cohort study. Br J Sports Med. 2021 Feb 15;
2. Meyer T, Mack D, Donde K, Harzer O, Krutsch W, Rössler A, et al. Successful return to professional men’s football (soccer) competition after the COVID-19 shutdown: a cohort study in the German Bundesliga. Br J Sports Med. 2020 Sep 24;
3. Jones B, Phillips G, Kemp S, Payne B, Hart B, Cross M, et al. SARS-CoV-2 transmission during rugby league matches: do players become infected after participating with SARS-CoV-2 positive players? Br J Sports Med. 2021 Jul;55(14):807–13.