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Were Zika Fears Overrated?
I came to Rio de Janeiro this year with the memories of many great Olympic
Games I've attended. But I had a lot of other considerations in mind.
As part of the Medical Committee for the Fédération Internationale
de Football Association (FIFA), I oversaw the medical preparations for
the soccer tournament, including drug tests. News reports leading up to
the event had focused on the Zika virus, doping scandals, water pollution,
and heat, sometimes threatening to obscure the Games themselves.
Having returned home to Santa Monica, California, I can now say that the
Olympics are just what the doctor ordered. The Games have demonstrated
once again how well people from around the world can put aside their differences
and work together to celebrate human achievement.
Sports physicians don't typically have to concern themselves much about
infectious diseases. This year fears about Zika were everywhere. Some
researchers had theorized that the virus arrived in the Americas with
spectators from French Polynesia during the 2014 World Cup, which Brazil
also hosted. But a subsequent analysis suggests the virus arrived in Brazil
the previous year.[1]
And the Centers for Disease Control and Prevention's (CDC's) modeling
suggests that the games were not likely to increase the spread of the virus.[2]
One factor working in favor of the games is that Brazil is in the Southern
Hemisphere, so it's winter there now. The relatively cool, dry weather
makes the mosquito population smaller this time of year. In addition,
Brazil already receives many visitors from countries most vulnerable to
the virus, so the arrival of the spectators and athletes didn't add
much to the risk for dissemination.
The organizers in Brazil undertook a large-scale mosquito abatement protocol.
And we on the medical team emphasized the use of mosquito repellants.
Also, because the virus may be sexually transmitted, we encouraged the
use of condoms not only during the Games but at least 8 weeks after a visit.[3]
As a result, so far, Zika has affected the Games only by discouraging some
spectators, top-ranked golfers, and a handful of other athletes from attending.
Most of those who didn't come probably regret making an uninformed decision.
Competing When the Weather Is Hot
Another concern about the Games, Rio's water pollution, has also not
emerged as a major problem. So far, only one athlete has reported any
ill effects out of the 11,000 who are attending.[4]
Because it is winter in Brazil now, heat has not affected the athletes
as severely as it might in summer. Temperatures in Manaus, the largest
city on the Amazon, in the north-central part of the country, were forecasted
to reach the 90s this week, but most venues, including those in Rio, on
the southeastern coast, have seen temperatures in the 80s or lower.
That's still warm, and we took a number of precautions.
For soccer we have instituted a policy of cooling breaks. If the WetBulb
globe temperature (WBGT)—which accounts for temperature, humidity,
wind speed, sun angle, and cloud cover—reaches 32º C (89.7º
F), we stop for 3 minutes at the 30th and 70th minutes to cool down. We
pass out towels soaked in ice water, which drops the athletes' core
temperature.
We instituted the first such cooling break in 2014 during the World Cup
in Brazil, when Mexico was playing Holland. I was the person behind the
scenes pulling it off.
Soccer is a very traditional game; you can't affect its integrity.
We had to work with the media and the officials to optimize the game and
the players' performance. In the beginning there was a lot of resistance,
but ultimately we saw almost complete acceptance.
Strategies for Coping With Heat
Strategies for coping with heat vary from one sport to another. If you're
working with a marathon runner or cyclist, you might schedule the event
early in the day before temperatures rise. In soccer, you might hold the
event later in the day when the WBGT sinks.
Some aspects of human physiology are simply adaptive techniques. We are
built to adapt to heat better than many animals and primates do; our skin
can lose heat, our sweating systems work, and we're not covered with
hair like a dog or an ape.
This evolutionary adaptation goes back to a time when our ancestors practiced
pursuit hunting. Running at a slow, steady pace, some early hominids could
catch impalas and antelopes, which didn't have the capacity to regulate
their temperatures as well and would overheat.
After chasing an animal for 2-3 hours, the only way our ancestors made
it back to camp was to rehydrate by drinking the blood of their prey.
This hypertonic fluid, high in salt, was the optimum drink.
In intense environments, if we try to rehydrate with just water, we can
become hyponatremic. That's why I recommend sports drinks that contain
a full complement of electrolytes to athletes competing during high temperatures.
I also recommend a comprehensive diet to maintain liver glycogen levels.
People who eat a balanced diet and wish to avoid the carbohydrates in
sports drinks may want to combine their water with a salt pill of the
sort that American football teams have used for years.
Tailoring Acclimatization to the Individual
Another key strategy for coping with heat is acclimatization. Just as teams
practice at high altitudes if they plan to compete in such an environment,
so should they practice in climates similar or more extreme in heat and
humidity to those in which they will compete. If you're going to play
in 95-degree heat, you have to train in 98-degree heat.
These concepts matter not just in athletics but also in many nonsports
professions, such as farming and the military.
Sports give us an opportunity to witness the challenges of rehydrating
properly. Even in the National Basketball Association this past season,
where trainers and team doctors were on hand, some players suffered from
dehydration. One reason may be the variation from one individual to another;
athletes in their 20s may need different rehydration from athletes in
their 30s, and men may differ from women.
Measuring urine's specific gravity can reveal a lot about proper rehydration.
But athletes who don't have a urine-specific gravity test at their
disposal can get a rough estimate of their hydration levels by looking
at the color of their urine: Too dark suggests dehydration.
Performance-Enhancing Drugs
Another medical issue that has attracted attention in the Rio Games is
doping. I oversaw the drug tests for soccer, but the incidence of using
performance-enhancing drugs is very low in that sport, and athletes are
very cooperative.
Elsewhere, this year has seen almost unprecedented controversy over performance-enhancing
drugs, with Russia's entire track and field and weightlifting teams
banned from Olympic competition.
I'm sure we haven't seen the end of the problem. Performance-enhancing
drugs are like viruses: As soon as you get control of one, another comes
along. And some fans say openly that they
want to see athletes doping because they love the alpha male hyped up on steroids.
Fortunately, most athletes don't share that point of view. Most of
them sincerely take to heart the Olympic ethos in which participation
is more important than winning.
Just What the Doctor Ordered
These Games have struck that note over and over. I experienced the spirit
of international cooperation personally on the medical committee. Our
motto is "One world, one medical team," and our focus was on
overcoming international barriers, not creating them. Just for starters,
we spent hours making sure that all teams had defibrillators that communicated
in their native languages.
Many of us were volunteers. We all realized that we were only as strong
as our weakest link; we had to work together on every level. The first
intuitive response these doctors had was, "How can I do my part?"
That spirit shone through in the opening ceremonies. I was deeply touched
by the selection of legendary Kenyan distance runner Kipchoge Keino as
the winner of the first Olympic Laurel award and by his comments on the
importance of charity and education.
I was also very moved by the Refugee Olympic Team, who overcame impossible
odds to compete in these Games as independent athletes.
Above all, the 2016 Summer Olympics have been about coming together and
reaching across international boundaries to celebrate human achievement.
Just what the doctor ordered.
References
1.Faria NR, Azevedo Rdo, Kraemer MU, et al. Zika virus in the Americas:
early epidemiological and genetic findings. Science. 2016;352:345-349.
Abstract
2.Grills A, Morrison S, Nelson B, et al. Projected Zika virus importation
and subsequent ongoing transmission after travel to the 2016 Olympic and
Paralympic games—country-specific assessment, July 2016. MMWR Morb
Mortal Wkly Rep. 2016;65:711-715.
3.Zika virus. Centers for Disease Control and Prevention (CDC).
http://www.cdc.gov/zika/prevention/ Accessed August 15, 2016.
4.Foreign staff. Rio's dirty water claims 'first victim': star
Belgian sailor sick after racing on polluted bay. The Telegraph. August
11, 2016.
http://www.telegraph.co.uk/olympics/2016/08/11/rios-dirty-water-claims-first-victim-star-belgian-sailor-sick-af/ Accessed August 15, 2016.
Medscape Orthopedics © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily
reflect the views of WebMD or Medscape.
Cite this article: Health Risks at the Rio Olympics, by a Doctor Who Was There.
Medscape. Aug 18, 2016.