Opinion: The Olympics can be held safely even amid the pandemic
Opinion by Jeremy Samuel Faust and Michael J. Mina
Barring a major change, Tokyo will host the Games of the XXXII Olympiad starting late next month. That being the case, the organizers have two choices: use the Olympics as an opportunity to demonstrate to the world how even a disease as contagious as Covid-19 can be controlled if not suppressed by a combination of vaccinations and intelligent testing, or they can roll the dice, throw vaccination and testing verification out the window and hope that a series of outbreaks don’t become the dominant headlines coming out of Japan.
The Summer Olympics may sound like a huge event, and they are. But at the core is the Olympic Village and its surrounding areas and venues, where up to 80,000 athletes, coaches, staff and journalists are slated to live, compete and work. That’s actually a manageable number of people for organizers to keep track of for six weeks or so. (The games themselves last 16 days, but figure in early arrivals and late departures).
Many observers, including Japanese citizens and institutions, have called for the Olympics to be canceled. The concerns are all the more relevant because, among developed economies, Japan has been lagging on vaccinations with less than 10% of its population fully vaccinated. But that does not mean an insular event, albeit a large one, like the Olympics, is impossible to hold safely.
The single safest way to achieve a Covid-free Olympic environment would be to require that every participant and spectator be fully vaccinated by the time they enter any official area. But the reality is that such a requirement may not be in place. Some attendees may be vaccinated, but even so, breakthrough infections can still take place, as no vaccine is 100% effective.
The answer? Testing. Already, the Olympic committee plans to test athletes and staff daily. That’s good, but the key to keeping the games running safely and not shutting down needlessly will be to combine the use of tests that detect the genetic material of the virus that causes Covid-19 (PCR test) with much more frequent use of rapid antigen tests. When used, say two or three times per week, rapid antigen tests have been shown to be over 95% sensitive to infections when the virus load is at its highest and infected individuals are most contagious.
For example, if a vaccinated individual tests positive for the virus (which, as the New York Yankees recently showed, can happen, it would not make sense to shut down the games if they never became contagious or no one becomes seriously ill. Rapid tests are designed to provide that information, and far more quickly — in minutes as opposed to hours and days for lab-based PCR, by which time the test taker could have interacted with others. Testing, and doing it right, can be the cornerstone of a safe Olympics.
Rapid tests have been tragically underused during the Covid-19 pandemic. The tests are remarkably accurate, especially when used properly. That means administering tests serially, so that any rare false negatives are picked up. Two rapid tests performed minutes or hours apart often provide the actionable information needed well before the standard lab PCR test results can become available.
It’s not that PCR tests over-diagnose coronavirus. It’s that they are not optimal for controlling outbreaks, which is the goal here. For example, earlier plans for Tokyo called for coronavirus testing every few days. That would not be adequate. A person who tests negative upon leaving their home nation, or upon arrival to Japan, could easily have been infected within 48 hours of the start of their trip. That person would not be expected to test positive until several days later. A negative test on arrival carries almost no warranty. When exposed days before travel, that same person who is negative on arrival would hit their peak contagiousness two or three days after arrival. The virus load goes from entirely undetectable on any test (whether PCR or antigen) one day to raging high just one or two days later. That’s why daily rapid testing is the smarter move.
Rapid antigen testing finds cases quickly, allowing immediate isolation, and because it only detects a contagious virus, it means that officials won’t have to shut the games down for days on end unless uncontrolled contagion occurs. Those positive on one of their daily rapid antigen tests can be temporarily pulled aside and the positive result confirmed in minutes with a second rapid antigen test or better, a rapid molecular test which, like PCR, detects the genetic code of the virus, offering a highly sensitive, fast and extremely accurate confirmation of the first test. If a rare false positive has occurred, then it will be apparent within minutes. If the test was a true positive, then an entire new chain of transmission events will have been averted by catching the infection early, potentially saving the Games.
Should a person’s infection go undetected one day because their viral load is still too low, they will be detected as positive the next day. And if the worst-case scenario happens and transmission does occur, for example in the rare but theoretically possible event that a person with a very low virus load, undetected on the rapid antigen test, manages to transmit to someone nearby, daily testing of everyone will all but ensure that any outbreak will never take off. Any new cases will be detected quickly and the outbreak will be squashed before it ever gets a chance to spread.
If someone gets exposed but not necessarily infected, daily testing can take the place of an onerous quarantine; twice daily rapid antigen testing or once daily rapid molecular testing with negative results would serve as an effective alternative. For those who do become infected, test positive and need to isolate, an isolation hotel should be identified — preferably nearby — in order to minimize any potential for onward spread.
Asking spectators to be tested at the time of entry or reentry would also permit the stands to be at least partially occupied. Even if the organizers limit spectators to fully vaccinated people, a large pool of spectators, perhaps including some Japanese health care workers who have been fully vaccinated, might materialize. Who better to fill the stands than those who have put their lives on the lines for over a year?
The plan we suggest is cost-effective. Even testing 80,000 visitors daily for 6 weeks at a cost of $5 per test would come out to under $17 million for the whole event. That’s a tiny fraction of the over $35 billion price tag that mounting the games has already cost. Even if every person inside the Olympic Village was tested two times per day with a rapid test, the cost would still be less than 0.1% of the total budget of the games. Adding the cost of testing the spectators would similarly be a drop in the bucket.
This relatively small eleventh-hour investment would seem to be worth it. If the games go off without a hitch, the organizers will have pulled off what just a year ago seemed impossible and will be the envy of would-be presenters of large events everywhere. And they will have done the world a great service. They won’t merely have given the world the inspiration and lift that the Olympics uniquely provide. They also will have issued a template for how to carry out a large event, even as the Covid-19 pandemic continues in many parts of the world.
