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An Olympic-Sized Miss in Managing COVID-19

— Did high stakes lead to foregoing prevention and mitigation?

MedpageToday
 A photo of medical staff attending to Noah Lyles after the finish of the Men’s 200 meter final.
Adams was the 20th Surgeon General of the U.S.

Noah Lyles' stunning comeback to win the men's 100-meter dash and subsequent crowning as the "world's fastest man" at the 2024 Olympics was meant to be the crowning moment of this Games. With an anticipated triumph in his signature event -- the 200 meters -- the American sprinter was poised to complete an extraordinary and historic double-gold achievement. Instead, the image many will remember is of a COVID-infected and asthmatic Lyles collapsing on the track, struggling for breath before being taken away in a wheelchair after placing third in the race. As an asthmatic myself, it was heartbreaking to watch, but this disappointing turn of events is emblematic of a larger, more troubling issue: the complete mismanagement of COVID-19 at the Olympics.

Numerous athletes, from Lyles to English swimmer Adam Peaty, arrived with gold medal aspirations, only to leave with positive COVID diagnoses. Despite comprehensive media coverage of athlete preparation -- including their diets, accommodations, and gear -- there was scant attention to the measures taken by the International Olympic Committee (IOC) to prevent and mitigate COVID-19 risks. The virus has been prevalent for 4 years, with surges arriving each summer, yet the possibility of COVID impacting a signature event -- despite a positivity rate now around 20% in and -- caught many by surprise at the Olympics.

This failure to anticipate and address the virus adequately is both shocking and tragic. As experts had warned, a rise in COVID-19 cases should not have been unexpected. Athletes prepare for years for a single moment where fractions of a second determine their fate. The lack of robust COVID-19 protocols not only jeopardized their health but also their competitive chances.

A key oversight has been the absence of a unified testing strategy. Reports indicate that larger delegations like those from Australia and the U.S. implemented their own testing measures, yet it remains unclear whether these tests were used proactively to prevent transmission or just reactively to confirm symptoms. Furthermore, it is unknown if some athletes who tested positive were given antiviral treatments while others were not. The IOC's lack of requirement to report positive tests or enforce isolation measures meant that many athletes were left to manage their own health without clear guidance.

The decision to forego stringent prevention and mitigation measures appears to have been driven by the high stakes of the Games, where denying athletes a chance to compete could impact not just their careers but also the financial interests of sponsors and countries. Despite his COVID diagnosis, Peaty too managed to medal but fell short of gold, and both him and Lyles cited the virus's impact on their preparation and performance. This underscores the folly of not implementing comprehensive prevention protocols. Early isolation of cases and masking could have limited transmission, offering a safer and fairer environment for all competitors.

The moral implications are also significant. The absence of standardized isolation protocols led to situations where infectious individuals exposed and risked the Olympic dreams of fellow athletes (and the health and safety of media, fans, and others), with justification of "The IOC said we didn't have to!" This approach plainly falls short when compared to protocols for more traditional infectious diseases like measles or tuberculosis. The IOC could and should have established universal testing and treatment access as well as prevention and mitigation strategies, potentially curbing viral spread and leveling the playing field.

Moreover, the IOC's failure to improve ventilation in Olympic Villages and issue standardized health recommendations reflects a broader issue of COVID-19 denial. While the pandemic has prompted tremendous advances in infection-control knowledge and resources, these tools were far from optimally utilized. The 2024 Olympics had the potential to showcase effective management of a large-scale sporting event amidst ongoing COVID-19 challenges. Instead, it highlighted a significant miss in applying the knowledge and resources accumulated over the past 4 years.

In essence, the 2024 Olympics represent yet another false start in our efforts to live with COVID. Coaches often say that when we fail to prepare, we prepare to fail. As we look back, it's clear that the Games fell short in adapting to a world still grappling with COVID-19, leaving us with an Olympic-sized lesson in what happens when we fail to prepare for known risks.

is director of Health Equity at Purdue University, and was the 20th Surgeon General of the U.S.