Competing as an Olympian is a dangerous pursuit. In the sixteen days of competition one in ten athletes will sustain an injury during the games. 

Of these injuries, one in three will prevent the athlete from competing or continuing to compete. Cycling, gymnastics, and weightlifting earn Gold, Silver and Bronze medals for the most injuries at the Olympics. Taekwondo, closely followed by football, BMX, handball, track and field, weightlifting, hockey, and badminton, judging on previous games, will be the runners-up. Archers, canoe slalomers, sprinters, rowers, shooters, and equestrians are relatively safe.

Apart from a focus on COVID and doping, little research has taken place about the health and safety of the Olympic community.

The Opening Ceremony has not yet taken place and the Tokyo games already have a chequered history. The Tokyo Olympics, which were originally scheduled to take place in 1940, were cancelled due to the outbreak of World War Two. Likewise, the 2020 Olympic Games were postponed to 2021 due to the COVID-19 pandemic. Already groups are questioning the suitability of Tokyo to host these games. 

But where else should they be held? In terms of COVID epidemiology, Australia and New Zealand are ideal locations. But, of course, neither country would allow athletes to enter without mandatory quarantining, and the 2021 Australian Tennis Open earlier this year, even on a much smaller scale, highlighted what a logistic nightmare that would be.  

The COVID pandemic holds some promise for the general health of Olympians.  Apart from a focus on doping, little research has taken place about the health and safety of the Olympic community. COVID has prodded experts in occupational safety and health, building and ventilation engineering, and infectious-disease epidemiology, as well as athlete representatives, to consider these factors and advise on a risk-management approach for the Tokyo Olympics.

The current obsession with COVID testing and vaccination is confusing to those of us who have wondered about the control of these public health phenomena at previous games. Take pneumococcal and meningococcal disease, both have high infectivity, morbidity, and mortality rates in the average age range of Olympic participants. Vaccination against these infections has never been suggested.

Seven percent of all competitors will fall ill during the games from respiratory infections. Is influenza vaccination required? Fortunately, antibiotics are accepted medications. Although women suffered 60% more illnesses than men, the rates for both sexes were higher than in the general population (86.0 for men vs 53.3 for women per 1000 athletes). The sickliest sports have been track and field, beach volleyball, football, sailing, synchronized swimming, and taekwondo. 

And it’s not just infectious diseases. Magnetic resonance studies identify heart changes, post-COVID-19, in nearly one in five affected athletes. This brings serious clinical concerns regarding the potential need for in-depth cardiac screening in athletes after COVID-19 before return to competition. 

Even though previous research has not reported any increase in mental illness post games, researchers are predicting an increase in post-traumatic stress disorder given the extreme conditions in which the athletes have found themselves before the games.

It is time that the medical profession, not just the sports physicians who have competing interests, take a more active role in determining safety and injury prevention in Olympic sports.

The games haven’t even started yet, but the medal tally will come at an even higher cost this year. The time to act is now to ensure sustainable changes to safeguard athletes’ long term health, whilst the games are still front-page news.