What are the changes from #Tokyo2020?
Despite being held six months apart, there are significant differences between Tokyo 2020 and Beijing 2022 COVID-19 screening and vaccination policies. The changes likely reflect current COVID-19 trends globally and differences in host nation policies.
Vaccination guidelines for Beijing 2022
- The emergence of the COVID-19 omicron variant has seen a return to disruptions and restrictions of elite sporting fixtures.
- The Beijing 2022 Winter Olympics and Paralympics (beginning in February and March 2022 respectively) issued the final version of its playbook in December 2021.
- This Playbook was developed by the International Olympic Committee, the International Paralympic Committee and the Beijing 2022 organising committee in collaboration with the Chinese government and local authorities .
- The Playbook advises that in order to enter the Olympic Village, athletes must be fully vaccinated at least 14 days prior to departure for China or undergo a 21 day quarantine period in Beijing, unless medically exempt .
- The Beijing 2022 protocols for vaccination of athletes seem new for an Olympics despite calls to have them previously.
- An influenza outbreak at the Calgary Winter Olympics in 1988 prompted physicians to seek mandatory vaccination prior to future games . Further outbreaks occurred at both the Nagano and Salt Lake City Winter Olympics in 1998 and 2002 respectively .
- At Tokyo 2020, while preventative advice was given, no documentation of COVID-19 vaccination status was required for athletes to enter the Olympic village .
- Tokyo 2020 had relatively low rates of COVID-19 infection with just 33 athletes testing positive amongst a total of 11,300 competitors .
- Early data on the omicron variant suggests a higher transmissibility and vaccine breakthrough rate .
COVID-19 screening for athletes – Beijing 2022 vs. Tokyo 2020
- Differences in COVID-19 screening between Beijing 2022 and Tokyo 2020 are evident  and reflect host country policy.
- At Beijing 2022, unvaccinated athletes will require an immunoglobulin antibody (IgM) test pre-arrival*. This was not required for Tokyo 2020.
- Other differences in COVID-19 prevention include mask type and close contact action planning. (see infographic)
- The specific risk that COVID-19 poses to athletes is difficult to quantify and is likely multifactorial in aetiology.
- Global travel and mass congregation can increase the risk of viral transfer for athletes .
- The systemic response to high intensity exercise; release of cortisol coupled with high levels of circulating proinflammatory cytokines can result in an “open window” when an athlete is susceptible to infection .
- Athletes with COVID-19 infection follow graduated return to play guidelines .
- Little data exists on long-COVID in the elite athlete population and the ability to return to pre-COVID levels of activity.
Athlete attitudes & vaccine side effects
- Vaccine hesitancy amongst the elite athlete population has been previously documented.
- Fear of potential side effects affecting athlete performance, missing training time following vaccination or a perceived lack of risk in contracting the virus in question are all cited as barriers to establishment of effective vaccination programmes for the elite athletic population  .
- Attitudes of elite athletes specifically with regards to the COVID-19 vaccine have yet to be elucidated.
- Following COVID vaccination, the elite athlete population have reported arm pain and fatigue as common side effects, the rates being more frequent after the second dose 
- More serious side effects such as myocarditis and thrombosis remain low, but not zero .
- Significant differences in COVID-19 screening and vaccination policy exist between the Tokyo 2020 and Beijing 2022 Olympic and Paralympic Games for athletes most notably in;
- extra precautions in the unvaccinated
- mask type
- close contact procedures
Authors and Affiliations:
Dr. Frank O’ Leary, Imperial College Healthcare NHS Trust firstname.lastname@example.org
Dr. Ajayi Abosede, Dept. Emergency Medicinem Imperial College Healthcare NHS Trust
Dr. Jonathan Korgaonkar, Dept. Sports & Exercise Medicine, Imperial College Healthcare NHS Trust
Competing interests: none
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