While the Olympic games were cancelled due to the pandemic last year, Japan and host city Tokyo ironically are experiencing higher COVID-19 case numbers than last summer, with a 7-day average of about 5,000 cases.

To mitigate spread, the Olympics are ‘bubbled’ and devoid of fans. So how are precautions playing out on the ground? MedPage Today has spoken with three team doctors since the games officially began last Friday, who note that organizers have taken many other additional precautions.

The three physicians are Naresh Rao, DO, the men’s water polo team doctor; Alex Myers, DO, the rugby team doctor; and James Lally, DO, an American College of Osteopathic Family Physicians fellow who is working his 7th summer games for USA Shooting.

When the three doctors arrived in Japan, they were sequestered at the airport and tested. They needed a negative test result before they could go to their hotels.

The teams are subjected to frequent testing, mostly rapid antigen tests, they said.

Myers and Rao report to the chief medical officer of the United States Olympic & Paralympic Committee (USOPC). The USOPC bases its protocols on the assumption that nobody is vaccinated, Rao said. That includes sending daily COVID reports to Team USA doctors, said Myers, of the University of California San Diego Health. Those emails feature tips on which hospitals to go to if emergencies flare up.

The doctors are limited to going to just a few places: practice and game venues, their hotels, and dining establishments. Lally’s typical day includes eating breakfast at his hotel, being bused to the competition venue, eating lunch there, then coming back to the hotel. If he arrives after 8 p.m., he cannot get dinner because Tokyo restaurants are mandated to close by then. Dining establishments feature tables clearly marked off to ensure social distancing, separated by plexiglass, he said.

Everyone is required to wear masks when they are not eating or in their rooms — even outdoors. They can call an anonymous hotline to report noncompliance, and Rao noted Olympic Village staff are visible and around to encourage social distancing and mask wearing. Those volunteers are required to stay in hotels too, Lally noted, even if they live nearby.

“It’s reassuring to know there are people there,” Rao said. “If we stick to these measures, I think we will be fine.”

“It was very, very different to go back to masks 24-7,” Myers said.

The doctors also must carry their phones and keep them on Wi-Fi and Bluetooth, they said, to enhance contact tracing when necessary. Some athletes have already tested positive while staying in the Olympic Village, according to reports.

Apps such as OCHA are available for people who feel ill to self-report to authorities. “We are living in a nanny state, but that is appropriate,” Myers said.

Another prophylactic organizers have put in place, Lally said: Village beds are not meant to hold more than one person. Constructed using reinforced cardboard, Lally thinks they would collapse if two people jumped in bed together.

Overall “the Japanese are squared away. They’re just a little more intense than we are,” Lally said. “They have a culture that’s respectful of authority.”

The doctors have noticed some issues. When the shooting team travels, they pack 65 to 70 people onto a bus meant for 50, Lally noted. He also called the packed protests outside the opening ceremonies hypocritical — although the protest wasn’t associated with the games.

Organizers also learned that asking everyone to line up at the same time to be tested was not efficient, so they now stagger test times.

But overall the physicians, all vaccinated, said they feel safe — for themselves and the young athletes for whom they are responsible.

The doctors are not as concerned about athletes suffering from COVID as they are about an asymptomatic athlete testing positive or generating a false positive test. Positive results could lead to the team having to forfeit games for the rest of their tournament.

“I was more worried about the athletes [than myself] because this is their dream,” said Myers, who staffed the Pan American Games in 2019. “Then there’s always the risk of injury, but I’m used to that kind of worry.”

Rao also worries athletes may not keep their masks on amidst temperatures exceeding 90ºF and brutal humidity.

“Fatigue is real,” said Rao, who worked with the men’s and women’s water polo teams at the 2016 Olympic games.

But Rao’s chief worry stems from the games’ postponement, which has already hindered the performance of some athletes. Many spent more than a year training for this Olympics and had to adjust preparations on the fly when the games were pushed back.

“My biggest concern was: are we all going to have the stamina to continue this process for another year?” he said. “So far there’s been no issues with our players.”

The physicians arrived in Japan before the Games; their teams needed to adjust to the time zone change (Tokyo is 13 hours ahead of New York) and the climate.

Now having been in Tokyo for more than a week, they reflected on their experience at the games so far.

“I think things are being done the best that they can,” Rao said. “Sure, nothing is perfect.”

They believe organizers did not err in hosting the games now — despite the criticism.

“As long as we keep protocols in place and execute them and have no fans, then I think we are doing the right thing,” Rao said.

Postponing the games a year made sense, Myers said, because last spring public health officials knew far less about how to control the virus than we know now. But “I think they did make the right decision” to proceed this summer, Myers said.

“There’s no clear end to this pandemic in sight,” he said. “You either choose to live with it, or avoid anything that makes life meaningful.”

“I think it was a no-win situation. The things that drive our world are not necessarily common sense; certainly money was a big factor,” Lally said. “This was the time and they went ahead and cut bait, and the people that are here, it’s working for them.”