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Protecting olympic participants from COVID-19: the trialled and tested process
  1. Fabio Pigozzi1,2,
  2. Bernd Wolfarth2,3,
  3. Ana Cintron Rodriguez2,4,
  4. Juergen Michael Steinacker2,5,
  5. Victoriya Badtieva2,6,7,
  6. James Lee John Bilzon2,8,
  7. Christian Schneider2,9,
  8. William O Roberts2,10,
  9. Jeroen Swart2,11,
  10. Demitri Constantinou2,12,
  11. Michiko Dohi2,13,
  12. Theodora Papadopoulou2,14,
  13. Mark Hutchinson2,15,
  14. Luigi Di Luigi2,16,
  15. Maher Zahar2,17,
  16. Raymond So2,18,
  17. Fergus M Guppy19,20,
  18. Jean-François Kaux2,21,
  19. Upul Madahapola2,
  20. Sandra Rozenstoka2,22,
  21. Pedro Manonelles Marqueta2,23,
  22. Jose Antonio Casajús2,24,
  23. Sebastien Racinais25,
  24. Konstantinos Natsis2,26,
  25. Irina Zelenkova2,24,
  26. Bulent Ulkar2,27,
  27. Elif Ozdemir2,28,
  28. Francisco Arroyo2,29,
  29. André Pedrinelli2,30,
  30. Mike Miller31,
  31. Norbert Bachl2,32,33,
  32. Michael Geistlinger2,34,
  33. Yannis P Pitsiladis2,20,35
  1. 1 Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
  2. 2 International Federation of Sports Medicine, Lausanne, Switzerland
  3. 3 Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
  4. 4 Puerto Rico Sports Medicine Federation, San Juan, Puerto Rico
  5. 5 Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
  6. 6 Sport Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russian Federation
  7. 7 Sport Medicine, Moscow Scientific and Practical Center of Medical Rehabilitation and Sports Medicine, Moscow, Russian Federation
  8. 8 Department for Health, University of Bath, Bath, UK
  9. 9 Orthopaedic Center Theresie, Munich, Germany
  10. 10 Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
  11. 11 UCT/MRC Research Unit for Exercise Science an, Universisty of Cape Town, Cape Town, South Africa
  12. 12 Centre for Exercise Science and Sports Medicine, University of Witwatersrand, Johannesburg, South Africa
  13. 13 Sport Medical Center, Japan Institute of Sports Sciences, Tokyo, Japan
  14. 14 Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
  15. 15 Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  16. 16 Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
  17. 17 Medical and Informatical Research and Education, Tunis, Tunisia
  18. 18 Hong Kong Sports Institute, Hong Kong, China
  19. 19 School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK
  20. 20 Centre for Stress and Age Related Disease, University of Brighton, Brighton, UK
  21. 21 SportS2, Liège University and University Hospital of Liège, Liège, Belgium
  22. 22 Sports Laboratory - Physical Health, Sports Medicine and Sports Traumatology Centre, Riga, Latvia
  23. 23 Department of Sports Medicine, San Antonio Catholic University of Murcia, Murcia, Spain
  24. 24 GENUD “Growth, Exercise, Nutrition and Development” Research Group, University of Zaragoza, Zaragoza, Spain
  25. 25 Research and Scientific Support Department, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
  26. 26 Laboratory of Anatomy, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
  27. 27 Sports Medicine Department, Faculty of Medicine, Ankara University, Ankara, Turkey
  28. 28 FIMS Collaborating Center of Sports Medicine, Antalya, Turkey
  29. 29 FIMS Collaborating Center of Sports Medicine, Guadalajara, Mexico
  30. 30 Department of Orthopaedics, University of São Paulo Medical School, São Paulo, Brazil
  31. 31 World Olympians Association (WOA), Lausanne, Switzerland
  32. 32 Institute of Sports Science, University of Vienna, Vienna, Austria
  33. 33 Austrian Institute of Sports Medicine, Vienna, Austria
  34. 34 Unit of International Law, Department of Constitutional, International and European Law, University of Salzburg, Salzburg, Austria
  35. 35 Centre for Exercise Sciences and Sports Medicine, FIMS Collaborating Centre of Sports Medicine, Rome, Italy, Rome, Italy
  1. Correspondence to Professor Yannis P Pitsiladis, Professor of Sport and Exercise Science, University of Brighton, Welkin House, 30 Carlisle Road, Eastbourne BN20 7SN, UK; Y.Pitsiladis{at}

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The COVID-19 pandemic has created many challenges to ensure a safe environment for competitive sport. While modern medicine has already developed effective protocols for the treatment and prevention of the disease, there are serious concerns about hosting a sporting event of the scale of the Olympic Games, where more than 11 000 athletes from over 200 nations are expected to participate. Accordingly, there have been many calls to cancel the Tokyo Olympic Games, also known as Tokyo 2020, in both the international press and the scientific literature. A recent perspective published in the New England Journal of Medicine (NEJM)1 highlights the complexity and risks of convening the Tokyo Olympic Games during the COVID-19 pandemic. Despite the many uncertainties,1 much has been learnt over the past 18 months and many policies trialled and tested to protect athletes during sports participation.

A sport and exercise medicine perspective

To develop a rapid understanding of the perspectives from the international sports and exercise medicine community, an informal survey of the International Federation of Sports Medicine (FIMS) Executive Committee, Commissions, and Collaborating Centres of Sports Medicine agreed that the Tokyo Olympic Games could go ahead safely based on the plans addressing the pandemic developed by the IOC (figure 1). This international network of 26 research laboratories and clinics has a mission to promote best practice principles in sport and exercise medicine, for athletes and active living.2 This contradiction between experts in epidemiology and sport and exercise medicine is understandable as the concerns of the authors1 seemed to be based primarily on the Tokyo 2020 playbooks.3 The playbooks focus on operational procedures and cannot convey the extensive risk assessment and risk management procedures grounded in rigorous scientific evidence developed by the IOC in cooperation with the WHO and International Sports Federations (IFs).4 Over 81% of our surveyed experts disagreed with the assertion that the IOC’s playbooks are ‘not built on scientifically rigorous risk assessment, and they fail to consider the ways in which exposure occurs, the factors that contribute to exposure, and which participants may be at highest risk’. The playbooks are constantly updated ‘living documents’ (the third edition was released after the NEJM perspective was published) and developed solely to facilitate a safe environment for all participants (eg, athletes, IFs, Olympic Family) at the Olympic and Paralympic Games and the local population in Japan. The playbooks were never intended to represent the scientific evidence that underpins the guidelines or to justify the Olympic Games proceeding or being cancelled.

Figure 1

Survey results from the International Federation of Sports Medicine Executive Committee, Commissions, and Collaborating Centres of Sports Medicine (n=33 respondents).

A network of planning

The measures being implemented in Japan are built on the IOC’s ever evolving health and safety best practices, the work of the National Olympic Committees’ Chief Medical Officers, and the work, experience and guidelines of the Japanese government and health authorities. Strict processes are in place to protect the athletes and associated entourage, and the citizens of Japan. In addition to comprehensive COVID-19 testing, athletes, support staff and others may only be in their official hotel or village, on official transport vehicles, or at an official venue, and cannot venture out into the city or even to official venues other than the one in which they compete or work. Athletes are required to depart Tokyo at the latest 2 days after their sport competition has concluded. Thus, there will be no mixing of athletes and other accredited individuals with the general population of Japan, and many strategies are in place to reduce the risk of disease spread. Similar to prior host nations, holding the Olympic Games in Japan may have a positive impact on the health of the general population in Japan as major sporting events like the Olympic Games can promote the benefits of healthy and active lifestyles, contribute to the development of infrastructure and social facilities in the host country, and popularise sport and exercise.5 These details should not be ignored when considering whether the Tokyo Olympic Games should go ahead or not.

Collaboration by global experts

The authors of the NEJM perspective call for an emergency meeting with the WHO. The authors appear unaware that there has been continuous interaction between the IOC and the WHO since the start of the pandemic. The current risk reduction strategies are also based on the experience gained by the IOC and the IFs testing their own policies during their qualifying events during the COVID-19 pandemic. The IOC has established a very experienced IOC Medical and Scientific Commission Games Group whose responsibilities include overseeing the daily provision of healthcare at the Olympic Games to athletes and their entourage and implementing real time solutions to reduce risk for all. These trialled and tested processes have served athletes and local populations well during previous Olympics Games, such as the Zika outbreak during the 2016 Rio Olympics.6 At regular intervals prior to nearly every recent Olympic Games, there have been concerns raised that major sporting events that bring together large groups of people from all corners of the world are a major public health risk. However, data from the Atlanta (1996), Sydney (2000), Athens (2004), Beijing (2008) and London (2012) Games do not uphold these concerns.7

We believe the IOC has done its due diligence to protect all those involved in Tokyo 2020, and barring drastic changes in the current pandemic situation, the Olympic Games can be held safely and without undue risk to athletes or the citizens of Japan. Recognising the many societal challenges and negative effects resulting from the COVID-19 pandemic, we should not underestimate the potential optimism and global impact of holding the Olympic Games.

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  • Twitter @JBilzon, @rinsho, @fergusguppy, @ephysiol, @irenazelenkova, @ulkarb

  • Contributors All authors shared the same concerns, took part in the FIMS-organised discussion/email exchange (facilitated by the FIMS Executive and Commissions), participated in a questionnaire to state respective opinions, provided written concerns/comments, helped draft the editorial and approved it.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.