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Controversy Erupts Over Postponing Olympic Games In Midst Of Zika
Epidemic
“But
for the Games, would anyone recommend sending an extra half a million
visitors into Brazil right now?
Of
course not: mass migration into the heart of an outbreak is a public
health no-brainer.” - Amir Attaran
As the Zika virus epidemic continues to grow and spread
across South and Central America, proposals surrounding the
possibility of postponing, moving or cancelling the upcoming Olympic
games have not persuaded public officials to change course. In recent
weeks prominent public health officials and private organizations have
taken strong stances on both sides of the issue following the
publication of an open letter to the director of the WHO and an
accompanying commentary in the Harvard Public Health Review urging the
organization to recommend moving or postponing the games1,2.
The letter, co-authored by professor Amir Attaran of the
University of Ottawa, professor Arthur Caplan of the NYU
Langone School of Medicine, Dr. Christopher Gaffney of
University of Zurich, and professor Lee Igel of NYU, has now
been co-signed by over 200 experts from 40 countries in the fields of
public health, medicine and bioethics, including former scientific
advisor to the White House, Dr. Philip Rubin. However, both
the WHO and the CDC have maintained their stance that there is no
scientific justification for postponing or moving the games. Here, we
summarize the main arguments on both sides of the issue.
Argument
For Moving The Games
Dr. Attaran and colleagues cite several lines of
evidence to conclude that the games must be moved or postponed.
1. The strain of Zika virus currently circulating in
Brazil is a new and more dangerous version of the virus with complex
neurological effects that are still not fully understood.
In addition to the now well established link to microcephaly in
infants born to mothers infected during pregnancy, preliminary data
suggest that the Brazilian strain can cause Guillain-Barre syndrome
and other neurological effects
in adults. The
authors argue that in the absence of a true
understanding of the extent of the neurological effects of this newer
strain, an abundance of caution is necessary.
2. "While Zika's risk to any single individual may be low, the risk
to a population is undeniably high". The Brazilian government has
reported 120,000 probable cases of Zika and 1300 cases of microcephaly.
A recent phylogenetic and molecular clock analysis published in
Science argues that the current massive outbreak in Brazil stems from
just a single viral introduction event sometime in late
20133.
The authors argue that with Olympic visitors coming to Brazil from
every country in the world, it might only take a few such events to
produce a global health disaster.
3. The actual site of the Olympics, Rio de Janeiro, has become
heavily affected by Zika. When the outbreak began in the
northeast corner of Brazil, some experts speculated that Rio itself
would be relatively safer for Olympic visitors. However, as the
outbreak evolved and actual data have been collected, this does not
appear to be the case. In fact, Rio de Janeiro state currently has
the second highest number of suspected Zika cases in Brazil (32,000)
and the fourth highest incidence rate (195 per 100,000).
4. Rio's health system is too weak to make progress against the
epidemic in time for the games. Rio's state government has
recently declared a health sector emergency and cut funding for
mosquito-borne illnesses by 20%. In addition, a new military-led
program to kill mosquitoes in Rio does not appear to have been
successful.
While there is no historical data to assess effects on Zika
transmission, the number of cases of dengue, a virus transmitted by
the same mosquitoes, in Rio has actually increased 6 fold in the first
quarter of 2016 compared to the same period in 2015, despite
aggressive attempts to curb the mosquito population. In light of
these facts, it seems unlikely that authorities in Rio will be capable
of making significant headway against the virus in the next few
months.
5. Seasonal changes in virus transmission can't be counted on.
While decreased mosquito activity in Brazil's winter months (July-Sep)
will likely decrease risk, we have no past experience to suggest
exactly how Zika transmission will be affected and again, based on
historical patterns of dengue transmission, it is unlikely to stop
entirely. At the same time, travelers from the northern hemisphere
will be returning home during peak mosquito activity months,
increasing the likelihood of spreading the virus in their home
countries.
Argument Against Moving The Games
Despite the strong wording and support of hundreds of
experts arguing for postponing or moving the Olympics, both the WHO
and the CDC have not wavered from their earlier position that the
Olympics should carry on as planned. Following the advice of an
expert panel convened to advise the WHO on Zika, the organization’s
official statement is that, “Based
on current
assessment, cancelling or changing thelocation of the
2016 Olympics will not significantly alter the international spread of
Zika virus.”
Similarly,
CDC director Tom Frieden recently told a luncheon at the
National Press Club in Washington, “There is no public health reason
to cancel or delay the Olympics.” While neither organization has
responded specifically to the concerns raised in the published letter,
their conclusions are largely based on the idea that Olympic travel
will constitute an insignificant portion of travel in and out of Zika
affected areas. For example, they cite the following statistics:
1. Brazil is just one of 60 countries, including 39 in the Americas,
currently experiencing Zika transmission and unrestricted
international travel is currently ongoing in all of these countries
every day.
2. 20% of the world's population already lives in locations where
Zika is being transmitted and 30% of global travel involves affected
countries.
3. Frieden says that travel for the Olympics would represent less than
one quarter of one percent of all travel to Zika affected areas.
Authorities expect 500,000 visitors will be attending the Olympic
games. In comparison, Rio's Galeão International Airport handled 1.4
million international travelers from January to April. Paris
typically gets somewhere between 120,000-200,000 travelers per month
from countries with active Zika transmission during July and August.
London also gets an average of 130,000, with other major European
cities approaching those numbers.
Summing up the thinking behind the WHO’s statement,
David Heymann,
chair of Britain's Health Protection Agency
and leader of the WHO panel of independent experts on Zika
told Reuters, “The
problem is not the Olympics, the problem is other travel besides the
Olympics, if there is a problem. So it's just a false sense of
security to say that you'll postpone the Olympics and postpone the
globalization of this disease.”
Stephen Morse,
a professor of epidemiology at Columbia University told the Atlantic,
“the arguments about moving or [postponing] the Olympics are largely
based on the perception of risk.” While there is still great
disagreement among the public health community on exactly what level
of risk is tolerable in the name of a global sporting event like the
Olympics, it is becoming increasingly unlikely that anything will be
done to postpone or move the games. For their part, the International
Olympic Committee (IOC) has repeatedly said the games will go ahead as
planned and just recently Rio’s organizers told the IOC that they “are
confident the games will take place and will be very successful."
1.
https://tinyurl.com/gsotf3w
2.
http://rioolympicslater.org/
3.
https://tinyurl.com/zwhpxad
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