Whether to cancel the Rio Olympics is more complicated than the presence of Zika alone and is being increasingly debated.
Almost a year and a half ago, others and I raised concerns about “Rio Sewercide” as the heavily polluted waters of Guanabara Bay are teeming with human and animal waste. As I noted then, “Shockingly, 70% of Rio’s sewage goes untreated into the bay—an enormous volume, given Rio’s population of 12 million.”
Olympic sailors will be competing here. During practice, just with being splashed, or “incidental contact,” a number of these athletes became ill. As long-distance swimmer Lynne Cox said, “Olympians shouldn’t swim through sewage.”
The swimming competitions are now scheduled to be held at Copacabana Beach, at the mouth of the bay. The Associated Press commissioned water quality tests in the region. Virologist Fernando Rosado Spilki found virus levels 1.7 million times higher than would be acceptable in California. Kristina Mena, another expert in waterborne viruses, “predicted that athletes who ingest just three teaspoons of water from the bay have a 99% chance of infection.”
The Instituto Oswaldo Cruz (of the Brazil Health ministry) found the local waters to be contaminated with multi-drug resistant organisms carrying the carbapenem-resistant Klebsiella pneumoniae enzyme, aka KPC. These are one type of Carbapenem-Resistant Enterobacteriaceae (CRE) superbugs and are resistant to almost all antibiotics. While the Olympic organizers promise the water will “meet standards,” that appears to be a pipe dream.
The water where athletes will be competing remains heavily polluted, putting the competitors at risk of serious illness and almost assuring that the highly antibiotic-resistant bacteria will be more quickly transmitted throughout the world.
Viewpoint: Games should be cancelled
This week, Amir Attaran, a public health professor at the University of Ottawa, created quite a stir, strongly recommending that the games be postponed or moved. I found his arguments compelling.
First, Attaran notes that Rio de Janeiro has the highest rate of suspected Zika infections anywhere in Brazil. Although the military has been tapped to do widespread fumigation, the incidence of dengue cases, which are also transmitted by the same Aedes aegypti mosquito that transmits Zika, are sixfold higher than last year. This is not reassuring as to the efficacy of Brazil’s enhanced mosquito control program.
About 80% of Zika infections are asymptomatic—people will not know that they’ve acquired the virus. Diagnostic tests have only recently been developed (a remarkable feat!) and are not readily available.
As we learn more about Zika, we see more and more complications becoming evident—not just birth defects with abnormally small heads, but severe retardation, blindness, deafness and other neurologic defects. In adults, Guillain-Barré, an autoimmune paralysis that can be deadly, is increasing as a result of Zika. Even with excellent medical care, 3-5% of GBS patients die of complications.
We recently learned that Zika can be transmitted sexually and can still be found in semen for months after infection. While Zika has been known to cause mild infections for decades, the link with microcephaly is relatively new. Scientists now believe that the virus has mutated, making it more virulent with pandemic potential. Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College, told the Atlantic that when comparing different strains from Africa, Polynesia and Brazil, “it also allowed us to go back to do studies showing that microcephaly and Guillain-Barré Syndrome probably first began with the Asian strain.”
Who knows what new wrinkle will become apparent in the coming months?
More than 1.3 million people were infected with Zika in Brazil just last year. More than 2.2 billion people, living in tropical and subtropical countries conducive to the Aedes mosquitoes, are now at risk of infection.
There has been remarkably rapid progress in understanding Zika and developing strategies to combat it, including Oxitec’s GMO mosquitoes and mozzies infected with Wolbachia, to make them resistant to the virus. Neither of these strategies is ready for widespread adoption, however.
Given these uncertainties, I agree with Attaran that “the mass migration of 500,000 foreigners will accelerate the virus’s global spread and make the pandemic worse” and that the Olympics should be cancelled. We need to buy time to develop these engineered mosquitoes further, to develop antivirals and better tests.
There is precedent for moving competitions. While not commonly done, Major League Baseball recently announced they were moving their series from Puerto Rico to Miami because of Zika.
(For more on this debate, listen to the Voice of America discussion, airing this weekend with Dr. Attaran, Celine Gounder, myself and Eric Farnsworth, vice president of the Americas Society and Council of Americas).
Counterpoint: Games should not be cancelled
Not everyone agrees with that risk-averse assessment. Ashish Jha, director of the Harvard Global Health Institute, believes the games should proceed. "We can't cancel the Olympics--it's the wrong response to what will become increasingly common phenomenon--globally spreading infectious outbreaks...we need to fight the virus and invest in health systems,” he told me. Instead, he suggests that efforts be intensified to minimize the risks, by boosting mosquito eradication, distributing condoms and similar preventive efforts.
Two Canadian physicians, Neil Rau and Richard Schabas, add, “ The Zika genie is already out of the bottle. It has spread like wildfire in the Western Hemisphere…and we have no effective means of stopping it…Travel advisories will be ineffective and are unreasonably punitive to affected countries.”
Dr. Margaret Chan, the director-general of the World Health Organization, stressed similar points, stating, “You don’t want to bring a standstill to the world’s movement of people. This is all about risk assessment and risk management.”
Ethics and social justice aspects
While many view cancellation of the Olympics as unfair to Brazil, others object to the disparities highlighted by the Olympics, with vast spending on the event at the same time as needs of the local people are being neglected. There is rampant pollution and a health system overwhelmed with the needs of babies with microcephaly and other birth defects. Arthur Caplan and Lee Igel question the wisdom of holding the Olympics here and here. They note the particularly difficult position female athletes are faced with as well—risking their health with their goal of competing. They conclude, “To host the Games at a site teeming with Zika, an outbreak the World Health Organization has labelled 'a public health emergency of international concern,' is, quite simply, irresponsible.”
Mark Perryman, in The Daily Beast, reported that the economic impact of the Olympics is likely negative, citing a number of examples. “Diverting scarce capital and other resources from more productive uses to the Olympics very likely translates into slower rates of economic growth than that which could be realized in the absence of hosting the Olympic Games.”
Others criticize the bastardization of the Olympics from an amateur, non-commercial endeavor, to rampant corporate competitiveness and greed, and environmental destruction.
Note again that pregnant women are advised to stay away. Men who have unrecognized Zika infections may transmit the infection to their partner, thus men are advised not to attempt conception for six months after illness or for two months after travel to a Zika endemic area if they did not become ill.
In the U.S., as well as Latin America, access to contraceptives is increasingly difficult for poor women or those in some rural areas, and abortion is rapidly becoming more unavailable.
Given all the risks—of birth defects, of Guillain-Barré and of rapidly disseminating Zika and superbug bacteria throughout the world, it seems foolhardy to me to pursue the Rio Olympics at this time. I favor canceling the games, or at least postponing them until we can be assured that effective Zika and dengue control programs have been implemented, and that athletes competing in aquatic sports will not be exposed to sewage with its resistant bacteria and risk of serious infection.
*post amended to say that Dr. Attaran said games be postponed or moved, rather than cancelled. 11:41
My new book, "Resilience: One Family's Story of Hope and Triumph Over Evil" is now available for pre-order. "Conducting Clinical Research: A Practical Guide" is available here. Twitter @drjudystone