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Incidence and burden of illness at the Tokyo 2020 Paralympic Games held during the COVID-19 pandemic: a prospective cohort study of 66 045 athlete days
  1. Wayne Derman1,2,
  2. Phoebe Runciman1,
  3. Maaike Eken1,
  4. Pieter-Henk Boer3,
  5. Cheri Blauwet4,
  6. Manos Bogdos5,
  7. Guzel Idrisova6,
  8. Esme Jordaan7,8,
  9. James Kissick9,
  10. Philipe LeVan10,
  11. Jan Lexell11,
  12. Fariba Mohammadi12,
  13. Marcelo Patricio13,
  14. Martin Schwellnus2,14,
  15. Nick Webborn15,
  16. Stuart E Willick16,
  17. Kazuyoshi Yagishita17
  1. 1 Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  2. 2 IOC Research Center, Pretoria, South Africa
  3. 3 Department of Human Movement Science, Cape Peninsula University of Technology, Cape Town, South Africa
  4. 4 Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  5. 5 Alzheimer’s Disease Center, Nestor Psychogeriatric Society, Athens, Greece
  6. 6 Sport and Health, Lesgaft National State University of Physical Education, St. Petersburg, Russian Federation
  7. 7 Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
  8. 8 Statistics and Population Studies Department, University of the Western Cape, Cape Town, South Africa
  9. 9 Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  10. 10 Pôle Médical, Institut National des Sports de l'Expertise et de la Performance, Paris, France
  11. 11 Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, Lund, Sweden
  12. 12 Department of Sport Medicine, Sport Sciences Research Institute, Tehran, Iran (the Islamic Republic of)
  13. 13 Trauma Observatory, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
  14. 14 Sport, Exercise Medicine and Lifestyle Institute, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
  15. 15 School of Sport and Health Sciences, Loughborough University, Loughborough, UK
  16. 16 Physical Medicine and Rehabilitation, University of Utah Orthopaedic Center, Salt Lake City, Utah, USA
  17. 17 Clinical Center for Sports Medicine and Sports Dentistry, Tokyo Medical and Dental University, Bunkyo-ku, Japan
  1. Correspondence to Professor Wayne Derman, Institute of Sport and Exercise Medicine, Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7505, South Africa; ewderman{at}


Objective To describe the incidence and burden of illness at the Tokyo 2020 Paralympic Games, which was organised with strict COVID-19 countermeasures.

Methods Daily illnesses were recorded via the web-based injury and illness surveillance system (teams with their own medical staff; n=81), and local polyclinic services (teams without their own medical staff; n=81). Illness proportion, incidence and burden were reported for all illnesses and in subgroups by sex, age, competition period, sports and physiological system.

Results 4403 athletes (1853 female and 2550 male) from 162 countries were monitored for the 15-day period of the Tokyo Paralympic Games (66 045 athlete days). The overall incidence of illnesses per 1000 athlete days was 4.2 (95% CI 3.8 to 4.8; 280 illnesses). The highest incidences were in wheelchair tennis (7.1), shooting (6.1) and the new sport of badminton (5.9). A higher incidence was observed in female compared with male athletes (5.1 vs 3.6; p=0.005), as well as during the precompetition versus competition period (7.0 vs 3.5; p<0.0001). Dermatological and respiratory illnesses had the highest incidence (1.1 and 0.8, respectively). Illness burden was 4.9 days per 1000 athlete days and 23% of illnesses resulted in time loss from training/competition>1 day.

Conclusion The incidence of illness at the Tokyo 2020 Paralympic Games was the lowest yet to be recorded in either the summer or winter Paralympic Games. Dermatological and respiratory illnesses were the most common, with the burden of respiratory illness being the highest, largely due to time loss associated with COVID-19 cases. Infection countermeasures appeared successful in reducing respiratory and overall illness, suggesting implementation in future Paralympic Games may mitigate illness risk.

  • Illness
  • Athletes
  • Covid-19

Data availability statement

No data are available. N/A.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

No data are available. N/A.

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  • EDI statement This study was conducted exclusively in athletes with disability, who are classified as a marginalised group, and was inclusive of all athletes participating at the Toko 2020 Paralympic Games. The author team is balanced. The researchers represent different genders, from both Northern and Southern hemispheres and different socioeconomic status countries. Furthermore, the research group includes individuals from marginalised groups, as well as perspectives from multiple disciplines.

  • Contributors All authors have contributed to the development, application and write up of the current study. WD stands as guarantor.

  • Funding Funding for this study was provided by the International Olympic Committee Research Centre South Africa grant and International Paralympic Committee research support.

  • Competing interests All authors have declared no competing interests. WD is an associate editor of BJSM IPHP editions.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.