Editor's Note: (Megan Ranney, MD, MPH, is an associate professor of emergency medicine, co-founder of Get Us PPE and a CNN medical analyst. The opinions expressed in this commentary are her own. View more opinion on CNN.)
(CNN) On February 3, the International Olympics Committee (IOC) released a playbook describing the measures to be taken to protect staff, athletes and communities from SARS-CoV-2 in the rescheduled 2021 Tokyo Summer Games, set to begin in late July. On February 25, guidelines for the Olympic Torch relay were announced.
I, like many other public health professionals, am concerned that these measures may be both too little and too late. I worry deeply about the implications of the Games for the health of three groups: the athletes and staff; the spectators and their home country; and the host community itself. Currently, there are simply too many unknowns to guarantee protection from SARS-CoV-2 at the 2021 Summer Games, should they occur as currently being planned.
The Summer Olympics do have some factors in their favor. Many (though far from all) athletes compete outdoors during warmer months -- and infections are currently on a downward trend worldwide, all of which bodes well for a lower chance of transmission during the Games. And many people in higher-income countries will have had the chance to receive vaccines by the time the Olympics roll around (though this raises justifiable questions about equity). Finally, the IOC's playbook is strict about precautions at the Games, and about precautions for the athletes and staff -- for example, banning athletes from going to bars or using public transportation.
But these positives are unlikely to outweigh the risks -- especially for spectators and for the host communities in Tokyo and other cities, none of whom will benefit from the stringent precautions being applied to athletes.
The Olympic Games are a perfect storm for infections like SARS-CoV-2 to spread, due to the density of people attending, the close quarters of athletes and the fact that people are coming from all corners of the globe. We know that prior summer Olympic Games have led to outbreaks of everything from common bugs like norovirus (a virus that causes vomiting and diarrhea) to uncommon illnesses like measles. Mass gatherings like the Hajj are well-established drivers for spreading respiratory viruses. A large conference in Boston last year is thought to have seeded more than 300,000 SARS-CoV2 cases in the United States.
Having safety precautions during the Games themselves is insufficient.
The focus on the sites of competition is short-sighted: most infections will get transmitted before, after and adjacent to the Games. So although the athletes may be protected, the host community will not be. Moreover, many of the recommended safety precautions, including some of the recommendations for the Torch Relay, are pure "hygiene theater."
Although it may make us feel good to line everyone up for a temperature check, temperature checks are useless in detecting or preventing transmission of the virus.
We do not yet know the full danger of the new variants of SARS-CoV-2, whether the B.117 variant first identified in the UK, the B.1.351 variant first identified in South Africa or any of the other new mutations being identified as I write. These variants may be more transmissible, may be more dangerous, may evade vaccines and will certainly -- like with the Biogen conference -- be encouraged to spread by this type of mass gathering. Moreover, any novel variants will be quickly taken back to the home countries of the athletes and attendees, potentially facilitating the spread of novel dangerous strains.
Importantly, the IOC must not be seduced - as so many others have - into thinking that a negative test for Covid-19 is a free pass. A test just represents a person's infection status at a single moment in time. It is great for surveillance ("is disease present, in general"), but not for individual-level prevention ("is this particular person safe"). And there is no way to avoid that some people will interpret their negative test as a license to go unmasked, whether eating and drinking in the Olympic Village, or within hotels and bars. We need only look back to the Super Bowl and images of unmasked revelers in the streets of Tampa to see how easily social distancing and protective measures break down in the face of sport-fueled celebration. Even Peter Diamandis, the founder of the XPrize and a coronavirus vaccine company founder, admitted that testing alone is an insufficient strategy -- after dozens of people got sick at a conference he hosted. Testing alone will not protect the Summer Games, either.
Finally, we do not yet know what percentage of attendees or of Japanese citizens will be vaccinated by the time the Olympics roll around. Low- and middle-income countries, in particular, are having a much harder time securing vaccines. Even Japan predicts that at best a minority of its citizens will be vaccinated by the time of the Games. Were everyone protected, the risk of the Games would be smaller. Without universal vaccination of not just athletes, but also staff, spectators and the host communities, this event will mix the vaccinated and the unvaccinated with potentially tragic consequences, both in Japan and across the world.
Ultimately, neither Japan nor the athletes' home countries can let down their guard. There is a reason that both the United States' Centers for Disease Control and Prevention and the World Health Organization strongly discourage mass gatherings in the context of continued community transmission.
I wish we would either limit the Games to just the athletes, or insist on vaccination for all -- including spectators and host communities - who are part of the celebrations. Yes, these events deserve to go on, for the sake of the athletes -- but we cannot pretend that the current recommended precautions are adequate. If the IOC doesn't do better, it risks seeding a worldwide repeat of 2020.