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Health Risks at the Rio Olympics, by a Doctor Who Was There

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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.


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). 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. 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.
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