Coronavirus outbreak: Olympics one giant petri dish

If you had to design a vector to spread a highly contagious disease, it would look just like the Olympic Games.

A woman wearing a mask walks near the Olympics precinct in Odaiba, Tokyo this week Picture: AP

When organisers for the 2012 Olympics allowed themselves to imagine their worst public health fears, they always found one scenario particularly troubling: What if someone walked into a London hospital in the middle of the Games with an unusual infectious disease?

Their solution to this problem was a surveillance program unlike anything ever attempted for a global sporting event. The results were so successful that this system of targeting undiagnosed severe infectious diseases in hospitals was implemented by Britain’s National Health Service and quickly set a global standard.

Rio used it for the 2016 Olympics. Tokyo adopted it for the entire city before the 2020 Games. And earlier this year, it worked precisely as designed.

The surveillance program driven by the unique risks of the Olympics helped Japan identify the first case of a novel coronavirus within its borders, said Dr Brian McCloskey, the director of public health for the London Games.

The reason it took one of the world’s great athletic spectacles to drive innovation in public health: The Olympics are a petri dish for infectious disease.

The possibility of this summer’s Tokyo Olympics being in peril because of the novel virus was raised this week by Dick Pound, a senior member of the International Olympic Committee, who said that organisers would have to make a call whether to cancel or postpone the Games in the next three months. That would put the unofficial deadline near the end of May for an event scheduled to begin on July 24.

IOC president Thomas Bach distanced himself from Pound’s comments on Thursday, saying the organisation was “fully committed to a successful Olympic Games in Tokyo starting July 24” and declining to speculate on backup plans. World Health Organisation officials also stressed cancelling mass gatherings simply to play it safe “is absolutely something we do not recommend.”

A $20 billion decision

The virus that has rocked the global economy has already begun to disrupt everyday life in Japan. Sports games have been cancelled. Concerts have been scaled back. In the nation’s most extreme measure yet, the Japanese government recommended this week that schools close for the month of March.

But there is so much unknown about this unpredictable virus that it appears the only course of action regarding the Olympics is to buy as much time before making a decision with more than $US20 billion on the line.

“I would think they would be concerned that the Olympics really are at hazard at the present time,” said Dr William Schaffner, an infectious disease specialist at Vanderbilt University. “They’re trying to postpone this decision, and that’s understandable.”

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In his first comments about Japan hosting the Olympics amid the epidemic, President Trump said on Wednesday: “It’s a little tight. They spent billions of dollars building one of the most beautiful venues I’ve ever seen. Your prime minister is very proud of it. I hope it’s going to be fine.”

The last time a scary new virus became a pandemic was in 2009, when an outbreak of swine flu sickened hundreds of millions of people. That’s when a Canadian team of epidemiologists applied for a $US2 million research grant to study the infectious disease.

They happened to be in the right place at the right time: The Vancouver Olympics were months away.

If you had to design a vector to spread a highly contagious disease, you would imagine an environment that squeezes hundreds of thousands of people into crowded spaces and sends them back home after two weeks of mingling with strangers. The Olympics are that environment.

“We had the same situation in Vancouver,” said Dr Patricia Daly, the chief medical officer for Vancouver Coastal Health, who oversaw health services at those Winter Games. “Nobody knew months in advance exactly what might be happening. We just had to have our general planning.”

No vaccine exists

The study of swine flu didn’t work out the way they planned. Pandemics rarely do. After they were funded to research the H1N1 virus, cases decreased before the Olympics, so they pivoted to study a surprising outbreak of viral measles instead. What they found was equally interesting. Two sick travellers to the Games had managed to spark the largest measles outbreak that British Columbia had experienced in years — even though huge swathes of the population had pre-existing immunity to measles.

But no vaccine or immunological protection exists for the coronavirus that has spread to almost every continent over the past two months. Researchers fear that the potential for secondary transmission in a hotbed like the Olympics would be much greater for this virus than the measles.

Tokyo’s wait-and-see approach now hinges on the timing of the outbreak with spring and summer on the horizon. Public health experts hope that this coronavirus will follow the lead of seasonal respiratory infections and dissipate in warm weather. They expect more certainty in the situation by the time Tokyo organisers and IOC officials have to make a call.

“We will not be in the same position with coronavirus as we are now,” McCloskey said. “We’ll either get better or get worse.”

But China has placed millions of people on lockdown, Japan is beginning to embrace social distancing and the US Centres for Disease Control and Prevention has warned of severe disruptions that could include cancelling the sorts of mass gatherings that accelerate the spread of the virus.

Euro 2020 at risk

One soccer tournament presents a special kind of risk. The month-long European Championship involving 24 countries is taking place in 12 cities from Bilbao to Baku, with 2.5 million fans expected to pack the games. That doesn’t include the millions more who attend massive viewing parties during international tournaments — which might be even dicier. The exposures in the Vancouver measles outbreak were thought to be linked to large public gatherings around the city, not ticketed events in the Olympic stadiums. European soccer’s governing body, UEFA, said that it is monitoring the situation.

It’s not just sports. There are popular music festivals such as Coachella (California) and Glastonbury (England) that are scheduled to bring together huge crowds of revellers this year. But there is a reason scientists pick a billion-dollar sporting event as their own personal laboratories. It turns out few places are better at breeding illness than the Olympics.

A potential outbreak in Tokyo during the Games would only be a small part of the problem. Epidemiologists also fear the Olympics becoming a hub of transmission with asymptomatic people spreading the virus once they return home to their countries.

“It works both ways,” Schaffner said. “Who’s going to bring it in? If it spreads there, where will it go subsequently?”

The Olympic athletes’ village alone is as conducive to the spread of disease as college dorms. It consists of exhausted competitors with depleted immune systems living practically on top of each other in a cluster of tower blocks. They share showers and dining facilities. They spend much of their day shaking hands and kissing strangers (and sometimes more).

One study of Team Finland at the 2018 Winter Olympics in PyeongChang revealed 42 of the 112 athletes and staff members displayed symptoms of a respiratory infection before leaving the Games.

Mecca pilgrimage

But when it comes to millions of people meeting in a central location for a short amount of time and then returning home, it turns out there is a useful comparison for the Olympics: the annual Muslim pilgrimage to Mecca.

A review of the literature, published in 2016 by Travel Medicine and Infectious Disease, looked at more than 5000 Hajj pilgrims and found the most common viruses in symptomatic patients were rhinovirus (which causes the common cold), flu virus and existing coronaviruses. They arrived with low rates of infection, but there were significant increases when they left. While this year’s Hajj overlaps with the Olympics this summer, the government of Saudi Arabia said this week that it was suspending entry for foreign pilgrims travelling to Mecca and Medina indefinitely.

Wall Street Journal