Preventing Covid at the Tokyo Olympics
In this article, we look at the COVID-19 situation in Japan and at the measures adopted so far to ensure safe Olympic games. We also look at an important measure that the Olympic and Japanese authorities have not taken so far, yet which would likely ensure much safer games. Another aspect pointed at in the article is the issue of jet lag, which negates athletic performance, but which many athletes will have to endure, because of the Covid regulations adopted for the Tokyo Olympics.
There was suspense in the past days, with the Tokyo 2020 Coordination Commission holding an online meeting about the future of the games, amid local opposition for them being held. The games are due to open in less than 2 months, on July 23, with some 11,000 athletes from 200 countries.
There were fears in the world of sports of a cancellation of these Olympics, following a call by 6,000 local primary care medical practitioners to cancel the games. Cancellation of Olympic games is a huge decision to take, with huge consequences. It was already a very difficult decision to postpone them last year.
John Coates, Chair of the IOC Coordination Commission Tokyo 2020, issued a letter to stakeholders on May 19. He confirmed on May 21 at an online news event that the games will take place as (re-)scheduled.
https://olympics.com/ioc/news/letter-to-the-stakeholders-of-the-olympic-movement
https://www.voanews.com/east-asia-pacific/ioc-vp-gets-backlash-saying-olympics-are-virus-or-not
Cancellation would have meant a huge disappointment for some 11,000 athletes who have sacrificed years of their lives preparing for the event. It would have been a huge disappointment for billions of citizens around the world who want to watch the games on TV. It would have of course meant huge financial losses for the organizing country and the IOC.
In this article, we look at the COVID-19 situation in Japan and at the measures adopted to ensure safe games.
We also look at an important measure that the Olympic and Japanese authorities have not taken so far, yet which would likely ensure much safer games, to the benefit of the athletes, the officials, the media and other personal involved, as well as for the population of Tokyo and Japan.
COVID-19 SITUATION IN JAPAN
Japan has done remarkably well so far in dealing with the pandemic, with very low mortality rate per inhabitant compared to most of the Western world. The country has recently faced a surge in cases, hospitalizations and deaths, and Tokyo is one of the worst hit areas of the country.
Japan has so far 95 deaths attributed to C19 per million inhabitant, which can be compared to 3048 deaths per million in Hungary (presently world’s #1 country), 2067 deaths per million in Italy, 1872 deaths per million in the UK, 1809 deaths per million in the US.
See: https://www.worldometers.info/coronavirus/
In Japan, most of the mortality occurred in two waves: a first one beginning in November 2020 and waning in March 2021, and a second one starting in April 2021 and still active, yet apparently on the decline.
There are presently about 100 deaths daily attributed to C19, for a population of 126 million inhabitants in the country.
Presently, about ten of those daily deaths are in the Tokyo area, which has a population of some 37 million inhabitants, i.e. a similar population as the whole country of Canada (where COVID-19 deaths presently are at about 50 daily).
It can be noted that, despite the large number of older people in Japan, the case fatality rate has never been as high as in Western countries, where it often exceeded 10% during the first wave of the pandemic.
See official data: https://www.mhlw.go.jp/stf/newpage_18745.html
While even the current peak in cases and mortality would make the envy of most of the Western countries when it comes to tackling C19, a group that represents some 6,000 primary care health care professionals recently stated that hospitals in Tokyo were at near capacity, which brought them to call for a cancellation of the games.
https://www.si.com/olympics/2021/05/19/tokyo-doctors-urge-cancelation-2021-olympics-covid-19
The Tokyo Olympics will not be open to international spectators, and it’s not clear the Japanese public will be allowed to attend. The Japanese population appears lukewarm regarding the event. Several polls, conducted in recent months, indicate that between 60 and 80% of the population want the games to be either postponed or cancelled.
From an organizational perspective, a second postponement has always been considered by the organizers to be a non-starter.
It’s against this background that the Tokyo 2020 Coordination Commission had to decide to go ahead or to cancel.
They took the decision to uphold the games.
A “PLAYBOOK” FOR SAFE GAMES
The International Olympic Committee and International Paralympic Committee have produced a “Playbook for Athletes and Officials” with a second version published in April. The document outlines a series of measures, including:
MASKS: wearing a mask all the time, except when eating, drinking, sleeping, training or competing. This means that athletes and officials will need to wear a mask about all the time, both indoors and outdoors.
MINIMIZE PHYSICAL INTERACTION: this requires 2 meters distancing, no handshakes or hugs, avoiding crowds, avoiding the use of public transportation and only carrying out permitted activities.
TESTING: athletes must get tested twice prior to their international travel, and at their arrival. During their stay, daily testing will also take place. Testing will mostly rely on saliva tests: “The initial tests will be a saliva antigen. If the results of the first test are unclear or positive, a saliva PCR test will be conducted from the same sample of saliva,” write the playbook.
TRACING AND ISOLATION: in addition to the testing, there are procedures for tracing and isolation, and all athletes must register and use Japan’s smartphone Contact Confirming Application (COCOA) and health reporting application.
TEMPERATURE CHECKS: There will be systematic temperature checks to enter Games venues. In case the athlete records a temperature of 37.5°C or higher, after a cool down period it will be checked a second time for confirmation. In case the temperature is confirmed to be of of 37.5°C or higher, the athlete will be taken to an isolation area to wait for further measures.
QUARANTINE: upon their arrival, there is a 3 day mandated quarantine.
VACCINATION: It is encouraged but not mandates for the games. All of the rules outlined in the playbook, including daily testing, mask wearing, etc. apply, whether or not the athlete has been vaccinated.
SHORT STAY IN JAPAN: athletes are expected not to arrive in Japan more than 5 days prior to their competition, and to leave within 2 days after their competition ends.
Important Note: the prohibition to arrive more than 5 days in advance in Japan will create havoc for many athletes, especially from the Americas, because of the jet lag issue. Conventional practice in the world of high level sports is to allow for at least 1 day of recovery from jet lag per time zone. Between New York and Tokyo, for example, there are 13 time zones. To avoid jet lag, which destroys athletic performance, there is no other way for North American athletes to have a stop over in the vicinity of Japan, prior to entering the country. For athletes from Western Europe, the situation is not as bad, but they will still need to foresee a stopover location for jet lag recovery, prior to getting into Japan, if they want to optimize their chances of success. See several references in endnotes.
There are other measures spelled out in the leaflet, including regarding personal hygiene. Similar rules apply for officials and others involved in the games.
https://olympics.com/tokyo-2020/en/games/tokyo-2020-playbooks/
WHAT COULD GO WRONG?
While the measures adopted for the games may appear impressive, they may not be sufficient to avoid infections or outbreaks, for a variety of reasons. First, tests are known to be notoriously unreliable, so some athletes may have a negative test yet be positive, either following the travel, or during the stay.
Second, several delegations will have many if not all their athletes vaccinated, but it’s well known that current vaccines don’t prevent infections and only reduce, i.e. don’t eliminate transmission.
Third, a particularly worrying issue is shared accommodation, which may lead to transmission of the virus during the many hours athletes will be in their apartment / rooms.
According to Kyodo News, “some 21 buildings of between 14 and 18 stories will accommodate 18,000 beds for athletes and staff during the Olympics, and 8,000 during the Paralympics. Each of 3,800 condominiums can hold up to eight people, with up to two beds per room.”
Also, it’s not clear if air filtration measures have been taken in the accommodation buildings. Could there be a super spreader event in one of the 21 buildings, with the virus transmitting from flat/apartment to the other? Unlikely, but not impossible.
It can be noted that the organizers have already planned 300 isolation hotel rooms for athletes who would test positive during the event.
In theory, the athletes will operate in bubbles and have no contact with the local population. But with the many local personnel being present for food, maintenance, etc. and the fact that SARS-CoV-2 is an airborne virus, there will be opportunities for transmission, even if, over 80% of the residents of the Olympic village may be vaccinated, by the time of the games, according to Coates.
It must be noted that, unlike the disease of COVID-19, vaccination can lead to adverse effects among younger people, including very healthy ones such as Olympic athletes, who are normally at extremely low risk from COVID-19. A survey of 64 900 Mass General Brigham employees in the US observed acute allergic reactions in 1365 employees overall, i.e. 2.10% of the total.
https://jamanetwork.com/journals/jama/fullarticle/2777417
Even if rare, death can also occur following vaccination. Two time Olympian, Haziq Kamaruddin, 27 year old from Malaysia, who was seeking to attend the Tokyo games, died on May 14, following his second dose. According to BFM News, “The Health Ministry emphasises that there is no evidence Haziq’s death is directly linked to a COVID-19 vaccine.”
A ROLE FOR JAPAN’S WONDER DRUG
While Japan has an excellent performance in combatting C19 compared to the Western world, the therapeutic means that have been used in the country are pretty similar with those in the US, UK and similar countries, with the exception of some limited use of Favipiravir.
There is however at least one other drug, that was discovered in Japan, and that is widely used in some Asian and Latin American countries, which could help make the Olympics safer, and which is presently not used for COVID-19 in Japan.
The drug was discovered by Satoshi Ōmura, of Tokyo’s prestigious Kitasato Institute, who received the 2014 Gairdner Global Health Award and the 2015 Nobel Prize in Physiology or Medicine, which he shared with William Campbell, who collaborated in the development of the drug.
For COVID-19, the drug started being used in the spring of 2020, and was found to have both prevention and therapeutic properties, in the latter case, when combined with other agents. There are now some 56 trials where the drug has been tested. For prevention/prophylaxis, an average improvement of 85% is found, while a 78% improvement is found for early treatment.
For the Olympics, the drug could be used for both prevention and early treatment. Regarding prevention, the drug can be expected to considerably reduce the number of people testing positive following a not impossible spreading event. With prophylaxis, even if the person is exposed, he/she is much less likely to develop the disease. It’s the same prophylactic function as vaccination, but operated through an oral pill with a remarkable safety profile.
Regarding early treatment, the drug can be administered in conjunction with other agents, such as the antibiotic doxycycline, Zinc and Vitamin D, for those having tested positive and having to isolate. For athletes, this will not enable them to compete, but it’s most likely going to help them overcome COVID-19 very rapidly, within a week, without any need for hospitalization, ICU, ventilation, etc. This is the function of early (outpatient) treatment for COVID-19.
The drug is ivermectin and it enjoys a remarkable safety profile and is extremely inexpensive. Most of the prevention studies about Ivermectin have been done with health care workers, and show remarkable efficacy, for example with this study we reported upon in Argentina.
It’s important to stress that prophylaxis for a similarly sized population of 12,000 people, was successfully implemented in Brazil. This took place in a high risk meat packing industry in Brazil.. Within weeks of implementing a voluntary prophylaxis program with Ivermectin, all COVID-19 outbreaks were contained and no worker was any longer in quarantine, this in a very high risk industry, with much higher risks of transmissions than in sporting events, either outdoors or indoors.
This drug has played a very important role in this pandemic, in countries such as India, Brazil, Colombia, Peru, Bolivia and Mexico, to name just those. In Mexico, a national-wide program started in late December 2020, providing ivermectin-based home treatment kits to those testing positive. An 80% reduction in new daily infections and deaths, country-wide, has been observed in Mexico in just 4 months.
Ivermectin has unfortunately been ignored by the health authorities in most Western countries, along with other off-patent repurposed generic drugs. This led to its rejection by the World Health Organization, even if the supporting meta-analysis shows a considerable reduction in mortality associated with the drug. The WHO omitted to look at the role of Ivermectin for prevention, even if it’s the area where it appears to be the most successful when it comes to COVID-19.
WHAT SHOULD THE OLYMPIC AND JAPANESE AUTHORITIES DO
The measures implemented so far for the Tokyo Olympic games may look impressive. They are so stringent that they may make the Olympic experience of many athletes pretty unenjoyable.
In particular, having to arrive maximum 5 days prior to your event, and having to leave maximum 2 days after, is pretty harsh, and as already mentioned, creates jet lag havoc for a majority of athletes, from North America and Europe.
Wearing masks outdoors seems also over-fetched.
The reality is that, if there are people getting infected with COVID-19, and those can be vaccinated people, transmission and even outbreaks may still occur. If those occur, they are likely to occur in the Olympic village, at night. And with the time span between a possible infection and when a test becomes positive, the virus may spread and things may get out of control.
With shared accommodations, one wonders also what will be asked to those sharing accommodation with a person testing positive, yet testing negative. Will they be required to isolate (i.e. not participate in their competition) because they were in contact with a positive person, like it’s done in schools for example?
Prevention with a drug such as Ivermectin is very simple to implement. It requires taking the drug once a week, in the appropriate dose, which is typically 2 or 3 pills of 6 mg each, according to body weight. Prevention can start say 2 weeks before the games and continue during the games and then for the return to the home country.
Prevention with a drug such as Ivermectin would substantially reduce the likelihood of transmission. Like in the case of GTFoods in Brazil, it would be expected to keep at zero, or very close to zero, the number of athletes and officials needing to be put into quarantine in one of the 300 hotel rooms reserved for that purpose.
In the unlikely case a quarantine would be required, early treatment could be immediately administered to those individuals, for a prompt recovery and return home. There are now medical doctors with considerable expertise with the early outpatient treatment of COVID-19, and there should be at least one expert doctor on site for the games, to prescribe early treatment protocols, in case it would be needed.
I did not consult with him on this, but I am pretty sure that Dr Peter McCullough from Texas, who is one of the most published medical doctors in the world, but who also has lots of experience with treating COVID-19 patients early, would be most happy to get on site for the Olympics. You are invited to watch our webinar with him, to understand his depth of expertise on the prevention and early treatment of COVID-19.
Prevention could be offered on a voluntary basis to the public, for them to attend events. It would have been great of course to test that in the context of the test events that already took place for the games. But again, like for athletes and officials, the logic remains the same: use a preventative drug as a means to substantially reduce infections and outbreaks. And in the unlikely case of infection or outbreak, move immediately to early outpatient treatment.
Even at the scale of a major event such as the Olympics, the cost of such prevention program would be extremely reasonable, given the very low cost of the drug. It cost just a few cents per pill to produce, and it usually retails at less than 1$ per pill.
With prevention/prophylaxis and early treatment, it’s extremely unlikely that any of the athletes or officials at the games would end up in an hospital bed. This would alleviate the fears expressed by those 6,000 primary care medical professionals. Accordingly, most likely, zero extra pressure would be exerted on the local health care system.
From the information available at the WADA website, there does not appear to be any issue with Ivermectin regarding doping.
Because of the potentially great benefits of prevention and early treatment, this is an avenue that the Olympic and Japanese authorities should look at very seriously. Yes, the pushback may be pretty considerable for such a program of prevention and early treatment to come to existence, even on a voluntary basis. But, shouldn’t everything be done to ensure the safest and most successful Olympic games in Tokyo?
Also, some of the presently approved measures could possibly be relaxed with such a prevention and early treatment program, such as the prohibition of arriving in Japan more than 5 days before competing, which is utterly impractical and unfair for most athletes, especially those from North America and Western Europe, given the major jet lag issue.
If such prevention and early treatment program is not implemented, and if there is an outbreak at the Tokyo games, and the situation becomes out of control, for example in one of the buildings of the Olympic village, with many athletes asked to quarantine, then the Olympic and Japanese authorities will be responsible for not having done everything that could have been done to ensure the safest possible Olympic games in Tokyo.
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PS 1: to understand how and why ivermectin has been ignored as a prevention and treatment drug for COVID-19, you may want to watch this recent dialogue about it between Bret Weinstein and Heather Heying.
PS 2: if you firmly believe that ivermectin for COVID-19 is a hoax, there is an opportunity for you to win 1 million dollars. Steve Kirsh, founder of the COVID-19 Early Treatment Fund, and serial entrepreneur who made his fortune as inventor of the optical mouse, is indeed offering 1 million dollars to anyone who could prove that Ivermectin is ineffective for COVID-19.
PS 3: One of the top experts in the world when it comes to Ivermectin for COVID-19 is professor Paul Marik. Our webinar with him may be a good place to start if you want to learn about the role of the drug, especially for the prevention and early treatment of the disease.
PS4: to check the studies about the use of ivermectin for covid-19, go to: https://c19ivermectin.com/
PS5: Some notes on jet lag and athletic performance.
NOTES ABOUT JET LAG AND ATHLETIC PERFORMANCE
11 ways athletes can prevent jet lag – by Dr David Geier, orthopaedic surgeon and board member of the American Orthopaedic Society for Sports Medicine
https://www.drdavidgeier.com/ways-athletes-avoid-jet-lag/
« Although everyone responds differently, there is a general rule of thumb about the time needed to adjust. One day is usually required to adjust for each time zone crossed. If you travel across four time zones, you would ideally arrive at least four days before the competition. »
« If your team must travel from the west coast to the east (or overseas), you might think about traveling a few days earlier than normal to adjust. »
« It is hard to establish a link between injuries during intense practices shortly after travel. Theoretically though, fatigue and decreased concentration could lead to injuries. Regardless, moderate exercise and training might be better in the first few days after arrival. »
Jet Lag and Running Performance: How to Minimize the Effects
https://runnersconnect.net/the-impact-of-jet-lag-on-running-performance-and-how-to-minimize-its-effects/
« When traveling westward, your body seems to be able to adjust its internal clock by about 90 minutes per day, but when you travel eastward, your internal clock is only able to adjust by about 60 minutes per day. »
IOC Handbook of Sports Medicine and Science: Cross Country Skiing — Adjustments to travels across time zones, by Ola Ronsen MD, PhD Norwegian Olympic Sports Center
https://www.olympiatoppen.no/fagomraader/helse/fagstoff/reisemedisin/media3026.media
« A rule of thumb is that the problems should not last for a greater number of days than the number of time zones crossed; i.e. complete acclimatization to 8 h difference in local time should not take longer than 8 days. »
« Guidelines for long distance air travels — Before the flight: Schedule the arrival date at new location several days prior to first day of competition (Eastward: 1 day for each hour change. Westward: 0.5-1 days for each hour change) »
Why Jet Lag Is Worse than You Think
http://time.com/4648899/jet-lag-fitness-performance/
« The effects of west-to-east travel were stronger than those of east-to-west travel, supporting the argument that they are due to the body’s circadian clock—not just time on an airplane or scheduling issues in general, » says Dr. Ravi Allada, associate director of Northwestern’s Center for Sleep and Circadian Biology.
“The rule of thumb is that the body clock can shift about one hour a day, so if you’re traveling across three time zones, you’d want to ideally give yourself three days to adjust,” he says.
