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Despite the SARS-CoV-2 pandemic, the Tokyo2020 Organizing Committee (TOGOC), IOC, International Paralympic Committee (IPC) and National Olympic and Paralympic Committees (NOC/NPCs) delivered events across 42 venues for over 15 000 athletes from over 200 countries. Athletes lived in congregate housing (Olympic and Paralympic Village) within a metropolis featuring to record SARS-CoV-2 infections and resistance to the Games.1 Across 2 months of operations, over 1 million tests were performed on athletes and staff. There were fewer than 500 confirmed positive results, the majority outside the Athlete’s Village, involving volunteers and contractors. Less than 40 positive tests were detected among athletes.2 3
While opinions vary on the Games’ impact on Japan,4 5 the infection mitigation strategy was mostly successful. The strategy included: (1) rigorous participant testing prior to and during the event, (2) separation of athletes and entourage from the public, (3) isolation of infected participants, (4) robust contact tracing involving mandatory cell-phone tracking and quarantine measures for close contacts of infected persons and (5) standard mitigation measures such as face masks, social distancing, hygiene protocols and a daily health questionnaire.6
The human side of isolation
In addition to lessons regarding infection control, there are important human and mental health lessons to be gained from those with positive SARS-CoV-2 testing. For these participants, the Games’ experience was characterised by a monitored 7–10-day period in a modest hotel with few daily periods for socialisation, no regular access to fresh air and an absence of designated exercise space accompanied by the stress of the pandemic and the loss of the Games’ experience.
Prior to the Games, the TOGOC, IOC and IPC created a team of international volunteer healthcare professionals to work alongside Tokyo2020 nurses and physicians at the isolation facility. This team (18 physicians, 4 nurses and 1 psychologist from 13 countries, speaking 16 languages) communicated with residents multiple times daily and contributed to their medical and psychological management.7 The unique perspective of this team allowed identification of strengths and opportunities to improve the accommodations and resources for future international sporting event isolation facilities. These considerations are based on qualitative observations to complement future quantitative reports devoted to the overall Games’ pandemic mitigation efforts and participant experience (table 1).
Addressing barriers and identifying future priorities
One domain to optimise was communication. Residents of the isolation hotel spoke numerous languages while the Tokyo2020 nursing team almost exclusively spoke Japanese. Translation devices could not convey the nuance of culture and was often inadequate for the relevant languages.
Beyond raw language differences, there were communication challenges between the facility healthcare team, residents and NOC/NPCs. Facility medical staff were not always familiar with the global variety of medications prescribed by NOC/NPCs to treat the symptoms of SARS-CoV-2 or the NOCs/NPCs understanding of testing protocols and documentation. We suggest reliable and culturally sensitive interpretation services to minimise future challenges.
A second opportunity for improvement is related to the facilities. The isolation facility, a previously existing 300-room hotel with no balconies, was reconfigured to optimise infection control and enable medical care. There was separation of residents from staff and specialised transport to and from the facility. However, there was neither easy access to fresh air nor any exercise space or equipment. To meet these needs, we suggest designing future isolation facilities with space and equipment that enable moderate physical activity and training and individual outdoor access.
There are also opportunities to optimise physical health of athletes and other residents through focus on nutrition and medication access. The facility featured a local menu with limited options for athletes with high calorie, high protein needs or residents with individual dietary needs. We suggest utilisation of food service from the Athlete’s Village to accommodate different dietary needs. For those with chronic health conditions, there were challenges with home medication acquisition. Moving forward, NOC/NPCs can be responsible for timely supplying medication, facilitated through close collaboration of NOC/NPCs with isolation facilities.
Finally, the approach to the mental health needs of residents should be improved.8 Everyone with a confirmed positive test was in an extraordinarily challenging situation. For athletes with positive tests, their Olympic dreams were destroyed. The residents, often initially emotional and later stoic, had variable personal and NOC/NPC support systems. The NOC/NPCs were at times unsupportive of affected residents and relatively unwilling to accept them back into residential areas of the Athlete’s Village after the isolation period. We observed a need for mental health screening and structured psychological support programmes including mindfulness and relaxation. We suggest guidance to NOC/NPCs on ways to interact with isolated Games’ participants and centrally organised mental health support services for those with suboptimal NOC/NPC support.
For the Beijing 2022 Games and other events featuring SARS-CoV-2 testing before and during the event, there are lessons in the successes and challenges from the Tokyo2020 Games. The human experience of those isolated can be improved through attention to communication, isolation spaces, physical health and mental health. Tokyo2020 was an unprecedented learning experience though unlikely to be the last of its kind. Prospective study of athlete well-being and the human experience should be incorporated into event planning.
Patient consent for publication
All of the authors wish to call attention to the inspirational and tireless work of Satoshi Shimada and the team of physicians and nurses that he led across the many facilities working around the clock to keep Tokyo2020 safe for competition. Although largely invisible to the public, this team’s effort made Tokyo2020 possible.
Collaborators Tokyo2020 Isolation Hotel medical support team: Dana Benedict, Gemma Harris, Gavin W Jones (Anaesthesia Cape Town (ACT), Cape Town, South Africa), Theresia Lee, Kirk O’Donnell (USA Boxing, Colorado Springs, Colorado, USA; Housecall Concierge Medicine, Tampa, Florida, USA), Yeltay Rakhmanov (Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan), Keltoum T Reddani (VidyMed Clinics, Lausanne, Switzerland), Sanka Theekshana Thebuwanaarachchi (Teaching Hospital Karapitiya, Galle, Sri Lanka), Bauyrzhan Toktarbay (Department of Biomedical Sciences, Nazarbayev University of School of Medicine, Nur-Sultan, Kazakhstan), Sergio MA Toloza (Department of Health Statistics, Ministry of Health, Catamarca, Argentina), Stephanie Tow (Department of Physical Medicine & Rehabilitation, Divisions of Sports Medicine and Pediatric Rehabilitation Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA; Sports Medicine, Scottish Rite for Children Sports Medicine Center, Dallas, Texas, USA; Pediatric Rehabilitation Medicine, Children’s Health, Dallas, Texas, USA; USA Paralympics Swimming, United States Olympic and Paralympic Committee), Selvina Uppiah (Mauritius Ministry of Sports and Youth), Chanel Van Vreden (Department of Medicine, Livingstone Hospital, Port Elizabeth, South Africa), Molie Xu (Oral and Maxillofacial Surgery, University of Miami, Jackson Memorial Hospital, Bruce W Carter VA Medical Center, Miami, Florida, USA), Irina Zelenkova (GENUD (Growth, Exercise, Nutrition and Development), University of Zaragoza, Zaragoza, Spain).
Contributors This manuscript was envisioned by the collective group of authors, including those listed as members of the Tokyo2020 Isolation Hotel medical support team. Dr HHC was responsible for the first draft of the manuscript. Drs JTO, MF, CN and SEW made extensive contributions to the vision, content and revision, and final approval to the manuscript. Other authors, listed as members of the Tokyo2020 Isolation Hotel medical support team, contributed to the design, editing and final approval to the manuscript.
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; externally peer reviewed.