Full format falling away: Where are the 2020 Tokyo Olympic and Paralympic Games headed due to the impact of COVID-19?

Is the purpose of simplification a measure against COVID-19, or is it to reduce the budget implementation, even a little, because there is concern that the additional costs will increase? On June 4, 2020, Yuriko Koike, the Governor of Tokyo, and Yoshiro Mori, the Chairman of the Games Organizing Committee, discussed postponing the 2020 Tokyo Olympics and Paralympic Games to the summer of 2021 due to the spread of COVID-19. These discussions resulted in a policy to consider simplification of the 2020 Tokyo Olympics and Paralympic Games (1). The Japanese government aims to hold the 2020 Tokyo Olympic and Paralympic Games as usual. On the other hand, in addition to reducing the number of spectators, plans for improving the medical system such as PCR tests for athletes, tournament officials and spectators are being considered in order to prevent infection (1). On March 16, 2020, as reported at the G7 Developed Summit Note 1, until now, the Japanese government had aimed to hold the 2020 Tokyo Olympics and Paralympic Games in its full format (2). However, the Japanese government stated, “It is very important for athletes and spectators to participate in the 2020 Tokyo Olympics and Paralympic Games safely and securely.” The Games Organizing Committee is considering reducing the size of the opening and closing ceremonies as well as the torch relay, which would also reduce the costs required for these events.

Tokyo residents and Japanese people may well say that they want to hold the 2020 Tokyo Olympics and Paralympic Games and watch it on TV. However, ignoring the importation of SARS-CoV-2 from overseas and the new risk of COVID-19, would Tokyo residents and Japanese citizens want an influx of numerous foreign visitors from overseas? Large-scale international events, such as the Olympics and Paralympics, are referred to as mass gatherings. Because many people from all over the world are concentrated at such large events, the venue and its surroundings provide an ideal environment for the outbreak of epidemics of infectious diseases. For example, an influenza outbreak occurred at the Winter Olympics held in Salt Lake City, USA, in 2002; there was an outbreak of measles at the Winter Olympics held in Vancouver, Canada, in 2010; and at the World Scout Jamboree held in Yamaguchi Prefecture, Japan, in 2015, participants from England and Sweden developed a meningococcal infection. Thus, there is proof that at large-scale international events, epidemics of measles, influenza, meningococcal infections, and other airborne and droplet-borne diseases do occur. Therefore, even before the outbreak of COVID-19, measures Note 2 had already been implemented to prevent outbreaks of infectious diseases caused by airborne and droplet-borne infections in preparation for holding the 2020 Tokyo Olympics and Paralympic Games. In addition, in accordance with Guideline Note 3 for alerting to new coronavirus infections, restrictions are placed on entry into Japan for foreign residents (as of June 8, 2020).

Measures against COVID-19 deplete Tokyo’s savings
On June 4, 2020, Governor Yuriko Koike told reporters, “In order to hold the Tokyo Olympics and Paralympic Games, the empathy and understanding of the people of Tokyo and the Japanese people are necessary.” Furthermore, it was revealed that the Games Organizing Committee was considering simplifying the Tokyo Olympics and Paralympic Games. Behind Governor Yuriko Koike’s mention of the simplification of the Tokyo Olympics and Paralympic Games, Tokyo’s financial situation is becoming increasingly severe, with expenditure on measures against COVID-19 rising to over 1 trillion JPY. The fiscal adjustment fund, which is Tokyo’s “savings box,” has a balance of over 900 billion JPY. However, it is expected this will be almost entirely depleted due to the cost of measures against COVID-19. The scale of tax revenue reduction due to the economic downturn caused by COVID-19 is expected to be 1–2 trillion JPY.

Even if the Tokyo Olympics and Paralympic Games are postponed and held at a later date, an additional cost of several hundred billion JPY will be required. The International Olympic Committee has indicated that it intends to contribute up to 650 million USD (70.9 billion JPY), but the host city, Tokyo, will bear most of the remaining costs. The Tokyo Metropolitan Government believes that holding the Tokyo Olympics and Paralympic Games will lead to economic stimulation. However, as of mid-April 2020, when COVID-19 infections continued to expand into Tokyo, the Tokyo Olympics and Paralympic Games Executive Committee suggested that the size of the Tokyo Olympics and Paralympic Games should be reduced.

There is also concern that holding the Tokyo Olympics and Paralympic Games could lead to a backlash from the residents of Tokyo in a situation where the end of the economic downturn cannot be seen. The Tokyo Metropolitan Government has received over a dozen negative opinions about the Tokyo Olympics and Paralympic Games from Tokyo’s residents, and one of the Tokyo executives in charge of preparing for the Tokyo Olympics and Paralympic Games has said that they are considering simplifying the Tokyo Olympics and Paralympic Games. Due to COVID-19, Tokyo’s financial situation is tough. Therefore, the generation of additional costs due to the Tokyo Olympics and Paralympic Games being held is a major issue of concern. Thus, people all over the world need to buy into the idea of the simplification of the Tokyo Olympics and Paralympic Games.

If we agree to host the 2020 Tokyo Olympics and Paralympics Games, various conditions will need to be met. Many people are proposing that the complete global termination of COVID-19 and the development and commercialization of therapeutic agents and vaccines against COVID-19 should be prerequisite requirements for holding the 2020 Tokyo Olympics and Paralympic Games (3,4,5). It is hard to believe that the majority of people support the 2020 Tokyo Olympics and Paralympic Games at this stage, as this assumption has not been confirmed.

The athletes are crucial parties in considering this unprecedented global issue. Due to the influence of COVID-19, ordinary people around the world have been forced to reconsider how they work and live. Additionally, the disallowance of sport may cause athletes to seriously re-examine the meaning and significance of playing sports in their lives. Governor Yuriko Koike and Chairman Yoshiro Mori must sincerely question the feelings and thoughts of these athletes. In an environment where COVID-19 persists, it is necessary to discuss whether or not to hold the 2020 Tokyo Olympics and Paralympics. Furthermore, it may be even more important for everyone to share what a sporting event should entail before the 2020 Tokyo Olympics and Paralympic Games are held.

Footnote
Attendees of the G7 Leaders Video Conference on March 16, 2020 Note 1: Japan: Prime Minister Abe, United States: President Trump, Germany: Prime Minister Merkel, Canada: Prime Minister Trudeau, Italy: Prime Minister Conte, United Kingdom: Prime Minister Johnson, France: President Macron, EU: President of the European Council of Michel Michel, European Commissioner von der Leyen Chairperson.

Measures Note 2:Information collection: Imported infectious diseases often have nonspecific symptoms. Although it is difficult for medical staff to make a differential diagnosis of infectious diseases, this is necessary to avoid suspicion of imported infectious diseases. Furthermore, it is important for medical staff to be familiar with the current epidemic global situation of infectious diseases so that fear and panic can be avoided when treating them. Thus, at the moment, it is crucial for medical staff to know which infections are prevalent and which a patient may have when considering infection control.
Principles of medical treatment for imported infectious diseases: The principle of medical treatment for imported infectious diseases is to know the origin of travel, incubation period, exposure, etc. From this information, the discrimination of imported infectious diseases can be narrowed down.

Guideline Note 3: Notice from Immigration Services Agency of Japan
Due to the spread of the new coronavirus infection, the target of foreigners who cannot enter Japan has been expanded (6). It will be as follows from midnight on May 27, 2020.
1. Foreign nationals holding a Chinese passport issued at Hubei or Zhejiang of the People's Republic of China
2. Foreigners who have stayed in the areas in listed countries* within 14 days prior their arrival in Japan
Listed countries are shown in URL https://www.narita-airport.jp/en/news/20200117

Disclosure of potential conflicts of interest
The authors declare no potential conflicts of interest. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Acknowledgments
We sincerely thank Professor Richard A. Young (Whitehead Institute for Biomedical Research, Massachusetts Institute of Technology) for his research assistance. This study was supported in part by grants from the Japan Ministry of Education, Culture, Science and Technology (No. 24592510, No. 15K1079, and No. 19K09840), The Foundation of Osaka Cancer Research, The Ichiro Kanehara Foundation for the Promotion of Medical Science and Medical Care, The Foundation for the Promotion of Cancer Research, The Kanzawa Medical Research Foundation, The Shinshu Medical Foundation, and The Takeda Foundation for Medical Science.

Author Contributions
T.H. performed most of the experiments and coordinated the project; T.H. conceived the study and wrote the manuscript. I.K. gave information on clinical medicine and oversaw the entire study.                            Kyoto@Takuma H