A doctor holds up a poster asking people not to come to Japan for the Olympics during a protest against the Olympic Games on June 23, 2021 in Tokyo, Japan. Protests have continued to take place in the run up to the Olympics amid concern over the safety of holding the Games during the global coronavirus pandemic.
  • An Asahi Shimbun survey found 83% of respondents are against holding the Tokyo Olympics this summer.
  • 15,000 athletes and staff from more than 200 countries will gather for two weeks for the games.
  • The Tokyo Medical Practitioners Association called to cancel the Olympics in a letter published by Reuters.
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Despite protests from its citizens, rising Covid cases, and a countrywide vaccination rate of only 20%, Japan is forging ahead and hosting the 2020 Summer Olympics and Paralympics from late July through early September.

The country's contract with the International Olympic Committee (IOC), which was signed in 2013, only grants the latter the power to cancel the event, according to a BBC analysis of its cancellation clause.

Although the latest handbook for Olympics and Paralympics attendees says that its safety policies are "based on science and expert advice," medical experts across the world caution that the current Covid-19 mitigation plan is not strong enough to prevent transmission clusters and may potentially create new strains.

"With the rate of vaccination being slow [in Japan], there is a risk of mutated strains originating in Japan," said Kenyu Sumie, chairman of the Japanese Medical and Dental Practitioners Association, in an interview with the South China Morning Post. "When that happens, there is a risk of the mutated strains spreading in Japan, so I believe at this point it is impossible to hold the Olympics safely."

Safety protocols do not adequately protect athletes, staff, or citizens

Tokyo 2020 participants are not required to be vaccinated to attend or participate.

The New England Journal of Medicine (NEJM) published an article on July 1 urging reevaluation of the IOC's current Covid-19 mitigation plan: "We believe the IOC's determination to proceed with the Olympic Games is not informed by the best scientific evidence. The playbooks maintain that athletes participate at their own risk, while failing both to distinguish the various levels of risk faced by athletes and to recognize the limitations of measures such as temperature screenings and face coverings."

Doctors have also urged that weak safety protocols will not adequately protect trainers, officials, hotel staff, transportation workers, volunteers (many who have quit), and healthcare workers who have been contracted to care for intensive cases. A spokesperson at St. Luke's International Hospital told TIME that it had been approached to coordinate care for the Olympics, but there had been no progress since late June.

Mitigation measures may not be strong enough to prevent outbreaks and new strains

Many sporting events have taken place during the pandemic, with limited numbers of coronavirus cases. NEJM attributes the success of these events to rigorous, informed protocols based on an understanding of airborne transmission, asymptomatic spread, and the definition of close contacts.

Still, cases can occur no matter how much planning is done.

Mitigation measures are designed to minimize transmission, not eradicate it. Ideal conditions, according to NEJM, would include single hotel rooms for athletes, at least daily testing, and wearable technology for monitoring contacts, all supported by rigorous contact tracing.

While testing will be frequent, athletes will still be at risk. Routine temperature and symptom screening will not help identify asymptomatic or presymptomatic participants, who may spread the infection before its detection.

Mitigation measures should also be adapted for each sport, some of which are higher risk due to venue and level of contact. However, these countermeasures are not currently outlined in the Olympic handbook.

Although testing and contract tracing are in place, many countermeasures are encouraged by the IOC rather than required and place the responsibility of mitigation on individuals. While all attendees are asked to wear masks and social distance, the IOC has not provided them individual rooms or specified social-distancing measures for shared spaces, such as cafeterias.

View NEJM's comparison between best practices and IOC's current mitigation measures here.

Insider has reached out to the IOC for comment.

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