Four years ago I was sitting in the living room of my basement apartment in Ann Arbor, Michigan watching the opening ceremonies of the Olympic Games. My MCAT study guide was sitting next to me, not out of sight, but for the moment out of mind. Now I am a week away from starting my second year of medical school, and the opening ceremonies for the 2016 Rio Olympics are upon us as well. Usually by this point I have watched too many videos and read too many articles full of fun facts about the top athletes to watch. Instead, I am seeing headlines focused on the safety of spectators heading to Brazil and the numerous athletes backing out of participating, all because of a virus.
So how did a disease that in the 1960s caused little more than a mild rash get upgraded to a worldwide terror, threatening the existence of the Olympic Games? The pivotal events are as follows. From its discovery until 2007, only 14 confirmed cases of Zika were documented worldwide. Historically, the disease was found in Africa and Asia, but the first locally acquired case of Zika confirmed in the Americas was diagnosed in Brazil in May of 2015. In November health workers noticed a correlation between increased Zika infection rates and increased cases of microcephaly, a rare birth defect in which an infant’s head is significantly smaller than average. Usually these babies suffer from severe developmental delays as well. By the end of 2015, there were almost 2,800 cases of microcephaly reported in Brazil, compared to only 147 in 2014. In January, the CDC found evidence of the Zika genome in the amniotic fluid of two pregnant women whose fetuses had microcephaly. A few days later, the CDC released a health advisory for citizens, especially pregnant women, traveling in Central and South America. At the same time, other patients in Brazil were beginning to show symptoms of Guillian-Barré, a neuropathic disease that leads to paralysis. Though the evidence in January remained anecdotal, the stories of infected individuals suddenly losing the ability to walk were enough for the CDC to begin a study to determine its connection to Zika as well.
This point, seven months out from the start of the Olympic Games, would seem like a logical time to begin discussions as a global community concerning the safety of hosting the Olympics in Rio. At best, this is a disease that we do not understand fully; at worst it is the cause of an unprecedented number of two types of neuropathic diseases in Brazil in the span of a few months. Thankfully, right around this time, the International Olympic Committee (IOC) published a statement addressing the growing concern about the situation in Brazil. It reassures the public that the IOC was monitoring the situation closely and states plans for reducing the amount of mosquitoes around the Games venues. It also emphasizes the historical precedent for lower infection rates of arboviruses in the winter months when the Olympics are occurring, though this fact that may have been added to reassure the members of the IOC just as much as the athletes lining up to represent their countries.
For some, however, this was simply too little too late. In May 2016, the Harvard Public Health Review published a special commentary in which Dr. Amir Attaran questioned the safety and logic of allowing Brazil to host this summer’s Olympic Games. At this point, Dr. Attaran points out, the amount of Zika cases in Rio places it “inside [the] heart” of the outbreak in Brazil. Furthermore, Brazil is currently in the midst of an all time high of arbovirus infections for the season. Is it still safe to assume that the natural decline of disease in the winter will continue this year? No one knows, but Dr. Attaran believes that we shouldn’t wait until the Olympics are upon us to find out.
Though, here we are. The Olympics are days away, and not much has changed in the stance of the IOC, the Brazilian government, the WHO or the CDC. Currently, the CDC has placed an Alert Level 2 for travelers to the Olympic Games, which encourages athletes and spectators to “practice enhanced precautions.” This includes the typical warnings expected when traveling to South America, such as using bug spray and staying in screened in areas as much as possible. However, they also advise pregnant women or women attempting to get pregnant to not travel to the games at all.
These are good precautions to take and when done effectively can help prevent the spread of many arboviruses, including Zika. However, it is hard to look at the response of the global community and not feel a little underwhelmed. Is this the best we can offer for the estimated 500,000 tourists traveling to Rio this summer: some extra bug spray and fewer stagnant pools of water at Olympic venues? If I had a patient who wanted to go to Brazil this summer, what would I advise them about the health risks? Personally, I believe we as physicians have an obligation to protect the health of not just our patients, but the global community as well. I wish there was something more that could be offered to the athletes and spectators already packing their bags for the opening ceremonies in Rio. However, it is too late to stop the Games from happening and our scientists have run out of time to determine a vaccine or cure for the virus and its side effects. All I can do is sit back and watch the spectacle unfold, on a new couch in a new apartment, with my First Aid book sitting safely nearby.