By Samantha Shapiro
While there are a multitude of health concerns for athletes and spectators at the 2016 Olympics in Rio de Janeiro, chief among them are Zika Virus and water-borne illnesses.
Zika Virus is carried and transmitted by the Aedes aegypti mosquito. Contrary to normal mosquitoes, the female Aedes aegypti — the main carrier of Zika — bites more aggressively indoors during the day, versus outside after dark. This could affect prevention, because many people might falsely think that as long as they use measures like insect repellant outdoors at night, when most mosquitos tend to bite, they will avoid contracting Zika. The virus, which the World Health Organization (WHO) projects will have infected 3 to 4 million people in North, Central, and South America within the next year, is especially dangerous for pregnant women due to its connection to microcephaly (a neurological condition in which babies are born with very small heads, which can also cause developmental problems and can sometimes be fatal). CNN reports that 508 cases of microcephaly have been confirmed in Brazil as of October 2015, and at least 17 of those cases have been connected to Zika Virus. Symptoms of the virus are not very severe, which leads to it going undetected in many scenarios; carriers may experience a fever, headache, rash, or conjunctivitis (pink eye). This asymptomatic quality makes the virus even more dangerous for pregnant women, because these women might not know they have the virus and therefore transmit it through amniotic fluid to their baby without realizing. Aside from mother to child transmission, Zika can also be spread when a Aedes aegypti mosquito bites an Zika-infected individual and then goes on to bite another person. People are technically contagious with Zika — meaning they are carriers of the virus — when they start to show symptoms. Healthcare professionals are also now investigating if the virus can be transmitted sexually after several individuals became infected after having sex with infected partners. Notably, it appears that men can only transmit the disease sexually, while women cannot. Sexual transmission would open the door to many more questions about the virus’s life cycle, because while professionals know that Zika stays in a person’s bloodstream for about a week, they have no idea how long it would remain in a man’s semen.
There is currently no vaccine or treatment for the virus. However, the Center for Disease Control (CDC) is reportedly requesting that OB-GYN doctors perform specific testing on their pregnant patients if their patients have recently travelled to a Zika-prevalent region. In addition, public health officials are suggesting that individuals in Zika-prone areas take extra care to use pesticides and avoid any build up of standing water (although this specific mosquito can breed in very small amounts of water, making its reproduction even harder to control and stop). A genetically-modified Aedes aegypti, dubbed OX513A, is also in the works; this insect is designed so that it genetically mutates its offspring in a way that kills them, which hopefully would help to stop the reproduction of the Zika Virus.
Public health professionals are projecting that Zika will be a different kind of beast at this year’s Olympics than other infectious diseases have been in years past (such as the outbreak of measles at the 2010 Vancouver Olympics or the spread of Norovirus at the 2006 World Cup in Germany) mostly because Rio is a different beast of a host city; according to Inverse’s Ben Guarino, “in the Olympic pantheon, Zika is an anomaly — it’s spread by animals that need warmth and wetness. Not all host countries are created equal.” Guarino elaborates that risk of infectious disease increases as you enter warmer climates, not helped by the fact that tropical regions have a reputation for being more underdeveloped, especially in terms of their healthcare. In addition, while mosquito levels will be low compared to other times of the year because the games fall during Brazil’s winter, any spectators or athletes travelling back to the Northern Hemisphere will be heading into the middle of their mosquito season, making local transmittance easier.
All in all, the International Olympic Committee plans to work side by side with WHO to protect its athletes’ health; however, many people are not feeling very confident about both organizations’ plans to eradicate Zika and move forward with the games. One skeptic in particular, NYU bioethicist Arthur Caplan, “advocates for postponing the Olympics until a vaccine is finished and widely available,” and believes that “delaying the games will cause some logistic consternation…but re-booking hotels could save even more trouble, particularly for pregnant travelers. And that Rio is mosquito-free later in the year isn’t a given.” Athletes themselves are worrying about the outbreak as well, with US women’s soccer goalie Hope Solo telling Sports Illustrated in February:
“If I had to make the choice today, I wouldn’t go [to the Olympics]…I personally reserve my right to have a healthy baby…I do not accept being forced into making the decision between competing for my country and sacrificing the potential health of a child…Competing in the Olympics should be a safe environment for every athlete, male and female alike.”
While the risk of Zika is definitely severe, the show will likely go on anyway (perhaps with the Olympic Committee crossing its fingers a little more than usual). WHO Director General Margaret Chan maintains that “the mosquito is difficult, but it cannot beat Brazil.”
While Zika and other mosquito-bred viruses are a major concern for athletes, spectators, and workers at the Olympics this summer, Rio’s water problems also pose a significant threat to attendees. The “sewage-infested waters” of the city’s bay and lagoon are particularly dangerous for athletes competing in water sports, such as sailing and rowing. The contamination is especially worrisome because it is very widespread, rather than just being contained to the shoreline. When the Associated Press conducted a water quality test in Rio in July 2015, the results showed that rates of viruses caused by human sewage were at levels 1.7 million times of those that would be considered “highly alarming” in Europe or the United States. Experts say that this contamination is in large part due to the lack of treatment to sewage waste in the city, making even locals of Rio — such as Brazilian sailor Martine Grael, who will compete for her country in the summer games — worry that “nobody seems to care that the beach is getting dirtier and dirtier.” Despite the combination of AP’s test results and the fact that Rio de Janeiro promised to clean up its sewage as a condition to hosting the 2016 Olympics (specifically, that the city would clean up 80% of it would be treated), no changes have been made to improve the city’s water quality; in fact, “Brazilian officials now acknowledge that won’t happen.”
The current state of the city’s water — including the water at Copacabana Beach, Ipanema Beach, and Guanabara Bay, all of which will be inhabited by athletes and tourists come August — has an alarming likelihood to transmit disease. Kristina Mena, a health expert specializing in waterborne disease, projects that athletes who ingest just three tablespoons of Rio’s water will have a 99% chance of contracting a virus or infection. Despite various athletes’ efforts to avoid illness through bleaching their oars, thoroughly washing their bodies immediately after leaving the water, and taking antibiotics in advance of competing in the water, they are still getting sick — and this all happened at warm-up events in Rio, well before these athletes actually have to report to the city for the summer games in August. Many of the infections found in the water, such as human adenovirus, enterovirus, rotavirus and disease caused by fecal bacteria, affect an individual’s respiratory and digestive systems. However, MRSA has also been found in the water; 26-year-old German Olympic sailor Erik Heil can attest, considering he contracted the flesh-eating bacteria after sailing in a test event in Rio last August. Besides respiratory, digestive, and skin infections, brain and heart disease have also been detected as a result of interaction with the city’s water, though they are rarer than the former three categories. Similarly to how Hope Solo spoke out about the dangers of Zika Virus and how it has impacted her decision to attend the games, former American Olympian swimmer Mel Stewart told AP that if his own daughter were to compete in open-water swimming in Rio this summer, he would advise her not to go; Stewart simply states: “a gold medal is not worth jeopardizing your health.”
 Sandee LaMotte, “5 things you need to know about Zika, CNN, February 23, 2016, http://www.cnn.com/2016/01/26/health/zika-what-you-need-to-know/index.html.
 Ben Guarino, “Zika Virus Isn’t the Problem With the Rio Olympics; Tropical Games Never Work,” Inverse, March 23, 2016, https://www.inverse.com/article/13213-zika-virus-isn-t-the-problem-with-the-rio-olympics-tropical-games-never-work.
 Ford Vox, “What real threat does Zika pose to the Rio Olympics? History has an answer,” CNN, February 12, 2016, http://www.cnn.com/2016/02/12/health/zika-olympics-threat/.
 Ben Guarino, “Zika Virus Isn’t the Problem With the Rio Olympics.”
 Grant Wahl, “Solo: As of now, I wouldn’t go to Olympics over Zika,” Sports Illustrated, February 9, 2016, http://www.si.com/planet-futbol/2016/02/09/hope-solo-olympics-zika-virus-brazil.
 Anthony Boadle, “Brazil will make Olympics safe from Zika Virus – WHO Official,” Reuters, February 24, 2016, http://in.reuters.com/article/health-zika-brazil-idINKCN0VX027.
 Brad Brooks, “AP test: Rio Olympic water badly polluted, even far offshore,” AP, December 2, 2015, http://bigstory.ap.org/article/cabd453515244bf2b1063e15f6b680c9/ap-test-rio-olympic-water-badly-polluted-even-far-offshore.
 Bonnie Ford, “The Promise Rio Couldn’t Keep,” ESPN, February 18, 2016, http://espn.go.com/espn/feature/story/_/id/14791849/trash-contamination-continue-pollute-olympic-training-competition-sites-rio-de-janeiro.
 Brad Brooks, “AP test.”
How to cite this article: “Is Rio Ready?” Written by Carrie Mittl and Sam Shapiro, Olympic Football 2016 Guide, Soccer Politics Blog, Duke University, http://sites.duke.edu/wcwp/tournament-guides/olympic-football-2016-guide/is-rio-ready/health-in-rio/, (accessed on (date)).