On Tuesday, soon after the U.S. CDC shortened its recommended isolation period for asymptomatic people with COVID-19 from 10 days to five, Beijing Olympic organizers stood by a policy that could bar athletes from the upcoming Winter Games long after they’ve cleared infections.
A day later, an International Olympic Committee spokesperson said that exceptions to the policy could be considered, but indicated that final decisions would lie with “the Chinese authorities.”
Protocols for the 2022 Winter Olympics, outlined in published “playbooks” and supplementary documents, require all participants to submit two negative PCR tests shortly before entering China. They do not include exceptions for athletes who’ve recently recovered from COVID-19, despite widespread evidence that PCR tests can continue to detect insignificant traces of the virus weeks after the contagious phase of a person’s illness.
The U.S. CDC, under pressure to keep American healthcare systems and economic sectors operational amid record-breaking virus surges, cited “science demonstrating that the majority of SARS-CoV-2 transmission occurs early in the course of illness, generally in the 1-2 days prior to onset of symptoms and the 2-3 days after.” Acting on that science and similar pressure, multiple U.S. sports leagues have refined their return-to-play protocols. The NBA on Monday agreed to allow vaccinated players to return six days after initial positive tests if follow-up tests show that the player is no longer infectious. The NFL announced a similar policy earlier this month.
Even prior to the amendments, most leagues allowed asymptomatic players to return after 10 days, even if they continued to test positive. This was because, as Vanderbilt infectious disease specialist Bill Schaffner explained Tuesday, “after 10 days, if your PCR [test] is positive, that is just detecting dead soldiers — remnants of the virus that have persisted in your system. It does not mean that you are infectious.” Athletes could, therefore, return to competition confident that they were no longer capable of transmitting the virus to others.
PCR testing after the 10-day mark is not only unnecessary, Schaffner said. “It's actively discouraged. Just because it leads to confusion.”
The Olympic protocols, however, rely solely on nasal PCR tests. In an FAQ document distributed to media earlier this month, in response to a question specifically about “the high likelihood of false positive tests from post-infection viral shedding,” organizers reiterated that two negative PCR tests within 96 hours of departure would be necessary, even for individuals who’ve recently recovered from COVID-19.
When asked if there was any scientific rationale for the requirement, Schaffner said: “Only that they're being over-careful. … You're going to disqualify some people for no good reason.”
On Wednesday, a day after the initial publication of this story, the IOC spokesperson said that, “In case of recent infection, if there are persistent positive PCR tests, then cases could be assessed and considered by the Medical Expert Panel,” a group comprising members of China’s CDC, members of Beijing’s CDC, and five international experts representing the IOC and international sports federations.
“If the MEP makes a recommendation that the person is fully recovered and no longer infectious, this would be forwarded to the Chinese authorities for consideration as an exception,” the IOC spokesperson said. They did not immediately respond to follow-up questions about how Chinese authorities would consider those cases, and about any protocols that would guide decision-making.
The spokesperson also said that a negative PCR test “is the basic requirement of the Chinese authorities for entry into the country.”
‘I’m a little worried about what will happen’
Athlete testimony has highlighted just how precarious the requirement is. Summer Britcher, a U.S. luger, said that upon arrival in China for a pre-Olympic competition in November, she was “pulled off” a bus, “not really told anything,” taken “to a separate building,” and told she had COVID. Her test at the airport had come back positive. Follow-up tests proved that it was a false positive — “it was, I think, remnants of when I previously had COVID in August,” Britcher said. Nonetheless, “even after several negatives, I was kept in isolation, missed a few training sessions, kept separate from my team entirely,” Britcher said. “Not able to go to the gym, anything.”
“I'm a little worried about what will happen when we go back [to China for the Olympics],” she continued. She wonders “if athletes unfortunately will have their experience cut short due to a non-confirmed positive test.”
In the FAQ document, in response to a question about a scenario where one of two pre-departure tests comes back positive and the other negative, organizers wrote, unequivocally: “Any positive PCR test of COVID-19 within 96 hours of the departure of your flight to China will prevent you from traveling to China.”
The policy would put any athlete who contracts the virus between now and Feb. 4, the start of the Games, at risk of essentially being disqualified — even if, by late January, they feel uninhibited by COVID and aren’t capable of spreading it. Schaffner estimated that the likelihood of “persistently positive tests” was 10%, and said that “sometimes those tests can be persistently positive for several weeks.” Jonathan Finnoff, the U.S. Olympic and Paralympic Committee’s chief medical officer, recently acknowledged to the Wall Street Journal that athletes who test positive in the coming weeks might not be able to clear the negative test hurdle.
Just days after that acknowledgement, on Monday, skier Mikaela Shiffrin, one of Team USA’s biggest stars, tested positive for COVID. The International Ski Federation’s protocols could allow Shiffrin to return to World Cup races after 10 days and a negative test, or after 14 days and “an individual assessment” of her case if she continues to test positive.
It’s unclear if there will be Olympic rules providing similar leeway. Published protocols suggest there aren’t. The IOC did not immediately respond to questions about whether the possibility of an exception mentioned in Wednesday’s statement is codified in spelled-out guidelines or official protocols.
The rigidity of Beijing Olympic protocols
Some experts, to be clear, have questioned the U.S. CDC’s five-day recommendation, and its interpretation of the science upon which the updated guidance relies. Michael Mina, an epidemiologist at Harvard, called it “reckless.” He and others clarified that, although most transmission occurs in the five days immediately following a positive test, it can still occur later in the infection cycle.
Many experts — and even those who find the updated guidance “pretty reasonable” — would prefer that end-of-isolation protocols include a negative test requirement. But they don’t recommend PCR tests. They recommend antigen tests, which are less sensitive, less likely to detect insignificant traces of the virus, and therefore a better measure of contagiousness.
“PCR [tests] can stay positive for months after recovery, while antigen tests are a good balance,” Erin Bromage, an immunology professor at UMass Dartmouth, said Monday. “Recent data shows that if you are antigen-test negative (with a good quality test), then the likelihood of being able to transmit [the virus] to others is very low.”
The NBA and NFL, meanwhile, have taken a more advanced approach. Updated protocols detail how those leagues analyze each sample’s “Cycle Threshold,” or CT value, a measure of viral load. Once that value clears a certain threshold (35), and indicates that a player is no longer infectious, he’ll be cleared to return.
The Beijing Olympic protocols, on the other hand, are rigid with respect to testing: “Nasopharyngeal PCR tests are the only accepted option,” the FAQ document states. It’s unclear how medical authorities will analyze test results.
The Tokyo Olympics allowed for flexibility in their return-to-play protocols this past summer. Their “playbooks” vowed to consider “relevant medical information,” including positive test history, “to help assess potential complex COVID-19 cases” after an athlete tested positive.
The Beijing protocols, which align with China’s uber-strict “zero-COVID” approach to the pandemic, instead seem to require two rounds of back-to-back negative tests. A Beijing organizing committee spokesperson, in response to questions about that requirement and the possibility of post-infection positives, pointed to a section of the countermeasure “playbooks” that spells out how an athlete who recovers from COVID within 30 days of the Games must, “at least eight working days before planned departure,” submit two negative PCR test results, among other documents. Those tests are “in addition to the tests required within 96 hours of departure to China,” the playbooks state.
It’s unclear whether the IOC’s Wednesday statement will allow for flexibility similar to Tokyo’s.
The apparent rigidity has left athletes taking extreme precautions to avoid the virus. Some, though, feel a degree of helplessness. They know, especially with the highly contagious Omicron variant pushing U.S. case counts to record highs, that some Olympic dreams will inevitably be spoiled.
“We're all vaccinated, we're all safe, we wear our masks, sanitize, every hour,” U.S. luger Tucker West said last week, shortly before Christmas. “But you can only do so much. You never know when you're gonna catch it or if you're gonna catch it. And the stark reality of it is, if you get it two, three weeks out from the Games, you will not compete in the Games.
“So at this point, we're just doing everything we can to be as safe as possible. Half of my teammates stayed in Europe [over the holidays] to be safer, rather than taking the trip home. I came home just to see family. But we just have to be as safe as possible. Because the risk of getting COVID is not competing in the Olympics, and it's a very real risk.”