Don’t cancel the Tokyo Olympics. Emulate them.
No place on Earth combines higher vaccination rates and daily testing.
In the lead up to the Opening Ceremonies, many in Japan and around the world called for the Tokyo Olympics to again be postponed or scrapped entirely. But one week into the Games, it appears that the 108-acre Olympic Village may actually be one of the safest populated areas on the planet.
Yes, there have been coronavirus cases among athletes and staff, and more will occur. That was inevitable. But a close analysis reveals that the International Olympic and Paralympic Committee “playbook” seems to be working as hoped. Cases have been identified rapidly. Those with positive tests have been quickly isolated and contact tracing has been completed. As a result, the situation has never spiraled out of control. The realistic goal was never to find zero cases. The idea was to rapidly find any and all cases, act decisively, and keep everyone else safe.
The system is working. While the plan has many elements, it is rooted in one crucial idea: a testing tsunami.
Check out the data visualization that we created for Inside Medicine below‡. It demonstrates that if the Olympic Village were a country, it would be the 4th most vaccinated nation in the world, behind Gibralter (population 34,000), Pitcairn (population 67), and Malta (population 502,000), and it would lead the world in daily coronavirus testing per person by a colossal margin. In fact, if coronavirus testing were an Olympic sport, the Olympic Village would tower over the world in Gold Medal position at over 250 tests per 1,000 people each day, with Cyprus in a distant Silver Medal position at just 84 tests per 1,000 people per day. Only 9 countries on Earth are currently conducting more than 10 tests per 1,000 people daily.
One week into the Games, it appears that the 108-acre Olympic Village may actually be one of the safest populated areas on the planet.
There is no populated region anywhere on the globe currently combining such high rates of vaccination and anything close to the testing protocols being implemented at the Olympic Games. So far, around 1 in 5,000 coronavirus tests performed in the Olympic Village have come back positive, giving it the lowest “positivity” rate in the world by a factor of 5 over its four closest competitors (Austria, Singapore, Australia, and Taiwan), and a literal order of magnitude or better than the rest of the nations of the world. As of this writing, more Olympic athletes have tested positive for banned drugs leading up to and during the Games than have tested positive for SARS-CoV-2 while living in the actual Olympic Village in Tokyo.
•••
Still, some people are worried that athletes could bring coronavirus home with them at the conclusion of the Games. That’s certainly possible. But it should be rare, given the testing regimen. Moreover, with over 80% of the athletes and staff vaccinated, virtually everyone competing or working at the Olympics will actually be returning to a less vaccinated, less safe region after the Olympic torch is extinguished on August 8th.
This is hardly the recipe for the "superspreader" event that many feared. The explanation for that is straightforward. This is 2021, not 2020. In 2020 there were no authorized vaccines (which we now know decrease both serious disease and infection) and massive daily testing with fast enough turnaround times to provide actionable information was not achievable. Now we have both of those advantages in our favor in the fight against Covid-19.
We’ve also learned a lot about large events during a pandemic. For example, many purely outdoor events don’t seem to contribute to outbreaks. But outdoor events that are associated with long distance travel (and therefore hotel stays and public indoor dining) do. That’s why the Tokyo Organizing Committee has achieved in 2021 what it could not possibly have a year ago. The Committee was absolutely right to postpone the Games last year. But given 2021 knowledge and resources, moving forward with the event was a reasonable choice. In fact, as my colleague Dr. Michael Mina and I wrote last month, the Tokyo Olympics, if run properly, can provide a blueprint for safe large-scale events in the coming months and years. So far, that's just what is happening.
•••
Just how are officials keeping everyone at the Games safe? For starters, rigorous masking requirements are being enforced. In fact, the masking requirements may even be over-zealous, given the exceedingly low likelihood that a vaccinated person with a same-day negative test could be infected, let alone somehow harboring contagious virus. In addition, all participants have to follow hygiene and physical distancing protocols. They even were required to download a location-tracking (though anonymous) smartphone app that aids in the event that any contact tracing becomes necessary.
But the success of the safety protocol of the Tokyo Olympics all comes down to the testing regimen. All participants were required to be tested before arriving and on arrival in Japan. In fact, they could not leave the airport until a rapid test came back negative. Once at the Games, athletes, coaches, and other on-site staff receive daily rapid antigen saliva testing (which detects contagious virus). Others involved with staging the events are tested every few days. Any positive tests are confirmed with two different kinds of tests. Athletes testing positive are not allowed to compete and are isolated. All recent close contacts are identified and they too are tested (in these cases with PCR tests, genetic tests which are a bit more sensitive; this makes sense for ruling out infection in exposed people).
This may be why after a long period of anxiety in Tokyo and Japan, attitudes towards the Games have now improved.
•••
Can every nation of the world afford to emulate this level of precaution? Not necessarily. But the Olympics have at least shown what is possible. And I believe that there is no money better spent than on tests—especially rapid tests that provide reliable and actionable information in minutes, not hours or days. Frequent testing stops spread from the sick, and reassures the well. High-volume testing can even reduce or eliminate the need for shutting down an economy during an outbreak.
The Olympic Games have always been about inspiring us to be our best. This time, though, we should not only be inspired by the competition. We should also be inspired by the Games' commitment to keeping one another safe. Over the next 10 days, I'll be rooting for the athletes to break Olympic Records in their sports. But once the Games are over, I hope that nations around the world will try to break the Olympics' record...for testing.
•••
What do you think about the testing protocol? Would you go along with daily or every-other-day rapid testing if it meant avoiding a future “shutdown”? Please leave your thoughts below.
‡Special thanks to Dr. Kristen Panthagani for data visualization created for this Inside Medicine article and to Benjy Renton for data aggregation. Also thanks to the great Dr. Sanjay Gupta and Amanda Sealy at CNN for help on testing protocols.
References and further reading:
Tokyo Olympic playbook: https://olympics.com/tokyo-2020/en/games/tokyo-2020-playbooks/
Covid-19 at the Olympicis: https://olympics.com/tokyo-2020/en/notices/covid-19-positive-case-list
https://public.tableau.com/app/profile/benjamin.renton/viz/COVID-19attheTokyo2020OlympicGames/Dashboard1?publish=yes
Covid-19 worldwide data: https://ourworldindata.org/coronavirus
Information on Delta: https://www.nytimes.com/live/2021/07/29/world/covid-delta-variant-vaccine/the-olympics-may-be-less-safe-from-the-coronavirus-than-officials-hoped
Polls show more favorable views of the Games: https://www.bloomberg.com/news/articles/2021-06-21/japan-polls-show-weaker-public-opposition-toward-olympic-games
https://www.bloomberg.com/news/articles/2021-07-29/olympic-tone-shifts-in-japan-as-medal-success-outshines-concerns
Large outdoor events are not created equal: https://www.cdc.gov/mmwr/volumes/69/wr/mm6947e1.htm
https://www.economist.com/graphic-detail/2020/06/30/black-lives-matter-protests-did-not-cause-an-uptick-in-covid-19-cases
Why testing can save large events like the Olympics: https://www.cnn.com/2021/06/15/opinions/olympics-japan-pandemic-safety-faust-mina/index.html