Introduction by Croakey: Reports of Olympian athletes competing with COVID-19 raise questions about the apparent lack of public health measures in place to better protect the athletes as well as spectators, support teams, staff and volunteers.
Elite athletes generally have a lower risk of developing severe illness than general populations – however, they are not immune to impacts from the virus, with some withdrawing from Olympic events due to COVID.
“COVID also takes a more serious toll on the body than either colds or the flu,” Dr Peter Chin-Hong, an infectious disease doctor at University of California, San Fransisco Health, told Scientific American. “While most Olympic athletes are healthy and have access to cutting-edge medications, young people sometimes display mixed responses to infection.”
The risk of COVID infection for others at Olympic venues and events also needs to be considered.
As we turn to the Paralympics on 28 August, Dr Bronwyn King AO – a public health leader and former elite swimmer and Australian Swimming Team doctor – provides some timely suggestions for how large events can be managed in the future.
King, who is also Burnet Institute special advisor on clean air, says that enhanced mitigations “could better protect everyone in the Olympic community”.
She also suggests that if it’s good enough for Australian Olympians to be supplied with an antiviral medication for COVID for free, it should be good enough for all Australians.
This is the first story in a two-part Croakey series on the COVID Olympics.
Bronwyn King writes:
Going into the Olympics, where people gather from all corners of the globe and live a communal life of sorts – in the Village – it was virtually guaranteed that COVID-19 outbreaks would occur, and for some, Olympic dreams would be dashed.
The Olympic Games provides an opportunity for a rethink on COVID-19, particularly about the way in which large-scale events are managed in the future.
Given the extraordinary commitment, sacrifice and energy required for athletes to make it to the Olympics, a robust suite of mitigations should be in place to allow every athlete to maintain their health and fitness throughout the Games.
The Olympics should be safe for everyone to attend, which includes access to clean air – air that is not contaminated with COVID-19, influenza or airborne diseases of any kind.
The riskiest indoor spaces to address are buses where air quality is notoriously poor, the dining hall where large crowds gather, and common areas in the Olympic Village accommodation.
I noticed some of the Australian teams used sensible strategies to reduce their risk of contracting COVID-19 – we saw swimmers in masks on the plane, at the airport, in the village and on the bus.
The only improvement could have been to arrange ‘mask fit testing’ for the athletes to ensure they wore masks that best suited the shape of their faces, as airborne diseases can find a way around loose masks that don’t perfectly match the face contour.
I saw reports that swimmers were encouraged to dine in their own rooms to avoid crowds, and it is well documented that they had access to high-quality testing and on-the-spot medical care including anti-viral medications.
We also know the Australian team had arranged air conditioning units for athletes’ rooms, to ensure they were kept cool. Air purifiers – portable devices that remove contaminants from the air – would afford an extra layer of protection from disease, especially in common areas used for team meetings and relaxation.
Many Paralympians have overcome enormous health challenges to get to the Paralympics, so I suspect they understand, and value, good health more than most able-bodied people could imagine.
It would be disappointing if robust protections were not in place to protect their health.
The International Olympic Committee should reflect on how enhanced mitigations could better protect everyone in the Olympic community and ensure every athlete has the best possible chance of getting to the starting line, finishing their race, coming home in good shape and enjoying ongoing good health.
Lack of leadership
The idea that repeated COVID-19 infections are inconsequential is not supported by data.
The research tells us there are significant long-term health risks associated with COVID-19, and those risks apply to every infection, so avoiding COVID-19 infection is sensible.
I’m not being critical of anyone – leaving athletes and coaches to navigate these tricky decisions themselves isn’t fair – but there has been a disappointing lack of leadership on this issue.
Regarding competing while COVID positive – the two discussion points to unpack are the risks for the athlete and the risks for everyone else.
For the athlete, competing during an acute COVID-19 infection presents both short- and long-term health risks. Short-term risks include strain on the lungs and heart and even collapse or needing to go to hospital for medical support. Strenuous exercise may lengthen the recovery time.
The most worrying long-term risk is long-COVID, a debilitating condition that can significantly de-rail wellbeing.
A report last week estimated that 400 million people have had long-COVID with the risk of developing the condition estimated to be 3.5 percent in vaccinated people, and 7.7 percent in unvaccinated people, in the Omicron-era of COVID-19.
While some people recover with time, many do not, and there are presently no approved effective treatments for long COVID. Many long COVID experts recommend several weeks of recovery from a COVID-19 infection, to reduce risk of long COVID.
There is also a growing body of data showing significant ongoing cognitive impairment in people who have had COVID-19, even in those people who have a mild acute illness and think they have fully recovered.
Research from Imperial College London suggests that a mild COVID-19 infection with full recovery by 12 weeks will still cause a degree of cognitive impairment, equating to an IQ drop of three points.
So, there’s a lot to think about for an athlete.
I understand that in the heat of the moment most Olympians will take whatever opportunity they can to have shot at a medal, but if they contract long COVID it could damage their long-term health and any future athletic pursuits.
Similar to the issue of concussion in AFL, once brushed off as ‘no big deal’ with groggy players returning to the field if they ‘felt okay’, scientific evidence of significant long-term harms drove protocol development that now prioritises the safeguarding of long-term health and overrides athlete preferences. I suspect similar thinking will be considered for COVID-19 in the future.
Community and respect
In terms of a COVID-19 positive athlete inflicting risks on everyone else, a separate set of considerations is at play.
Teammates, coaches, officials, volunteers and spectators should not be put at risk – involuntarily, without their knowledge or consent.
Yes – the athlete could wear a mask during some steps – when departing the accommodation, taking transport, visiting changerooms and waiting in marshalling area – but masks can’t be worn during warm up or during the event itself, so the air will contain infectious particles at multiple points – and we all share indoor air.
Is it okay to infect your teammate who has their best race coming up in a few days’ time? Is it okay to infect the 65-year-old official whose husband is currently being treated for cancer? Is it acceptable to infect the volunteer who will return to her day job as a primary school teacher next week? The ripple effects of those scenarios can lead to serious illness and even death.
So yes, it’s heartbreaking for an athlete to miss a precious, once-in-an-Olympiad moment to strive for a medal, for a dream, and risking your own wellbeing is one thing (albeit a gamble), but knowingly endangering the health of others seems to contradict one of the three foundational Olympic values – respect.
Conflicting messages
Olympians are role models and when we see them prioritising health and fitness it inspires us to do the same, so there is a conflicted message when the Olympians appear to be cavalier in their attitude towards COVID-19.
On the positive side – it’s brilliant when we see athletes modelling smart behaviour – like the Australian swimmers wearing masks on planes and at the airport – footage was splashed across the media at the exact moment millions of eyes were glued to the TV.
It was a great moment for public health, sending the subliminal message ‘if you want to be an Olympic swimmer – wear a mask to stay healthy and keep in top shape’.
Many Olympic athletes mentioned they had taken Paxlovid, an antiviral medication, for COVID-19.
While it is great that some athletes had access to this medication, to support their recovery and reduce the risk of long COVID, it would be interesting to understand if all athletes were afforded this level of care – was it provided by the free medical clinic inside the village – available to all – or was it only supplied by countries that brought along their own supplies?
In any case, Australian athletes reported having access to this treatment – which is excellent, but it does bring health equity into question.
To get free access to Paxlovid in Australia, you need to be 70 year or older, 50 years with two or more risk factors, an Indigenous person 30 years or older with one or more risk factors, or 18 years or older and have been hospitalised with COVID-19 or be moderately to severely immunocompromised.
Based on these criteria, very few, if any, athletes would be eligible to receive Paxlovid. For anyone who isn’t eligible but wants to access it, a five-day treatment costs around $1,200.
If it’s good enough for Australian Olympians to be supplied with it for free, it should be good enough for all Australians.
Dr Bronwyn King AO, is a former elite swimmer who worked as a Team Doctor with the Australian Swimming Team for ten years, and is also a special advisor on clean air for the Burnet Institute.
See Croakey’s archive of articles on COVID-19
