Illness at Tokyo 2020, archery included: Derman 2022

This is the illness surveillance at the Tokyo 2020 Paralympic Games, the first held during the pandemic: 4,403 athletes (1,853 women and 2,550 men) from 162 countries and 23 sports, followed for the fifteen days of the Games, a total of 66,045 athlete days. There were 280 illnesses in 261 athletes, 5.9% of the total, or 4.2 per thousand athlete days: the lowest figure yet seen at any Paralympic Games, summer or winter (London 2012 had 12.8 and Rio 2016 had 10.0). Skin conditions were the most frequent (1.1 per thousand athlete days), followed by respiratory illness (0.8), and there were 13 cases of COVID-19. Women fell ill more often than men (5.1 against 3.6), and the three days before competition had twice the rate of the twelve competition days (7.0 against 3.5). Of all the illnesses, 77.1% cost no days of training or competition.

Archery appears as one of the 23 sports. The 139 para-archers (60 women and 79 men, 82 of them aged between 35 and 75) had 10 illnesses, one each: 7.2% of the archers, 4.8 per thousand athlete days, with a confidence interval from 2.6 to 8.7. That puts archery mid-table, level with judo; wheelchair tennis was highest (7.1), followed by shooting (6.1).

The data came through two channels. Teams with their own medical staff (81 countries, 3,836 athletes, 87%) logged illnesses every day on a dedicated web system, WEB-IISS; for teams without a doctor (another 81 countries, 567 athletes) the count came from visits to the Games polyclinic and to the medical posts at the venues. After the Games the two records were merged and cleaned of duplicates, leaving out items such as physiotherapy, bracing, optometry, routine dentistry and radiology. Illness was defined as in the IOC consensus statement; for COVID-19 there was a daily saliva antigen test, followed by PCR if positive.

The denominator is an estimate: each team's size from the Paralympic Committee's official list, multiplied by 15 days (3 before competition and 12 of competition). For archery that is 139 times 15, or 2,085 athlete days. Days lost were forecast by the physician when the illness was logged, and illness burden is given as days lost per thousand athlete days. The analyses are univariate Poisson models, so each factor is looked at on its own without allowing for the others; athletes entered in more than one sport were counted under their main one.

The authors themselves point to the weakest spot: under the COVID-19 rules arrivals and departures were staggered, yet athlete days are calculated as if everyone had been present for all 15 days. Athlete days may therefore be overestimated by up to about 10,000 and incidence underestimated by up to 18%, or by up to about one illness per thousand athlete days. Impairment type is missing for athletes seen at the polyclinic, and the compulsory 10-day isolation for every COVID-19 case, even without symptoms, inflates the days lost.

For archery the margins are tighter still. Ten cases give a wide interval, from 2.6 to 8.7, and the archers' rate is not broken down by body system, impairment or days lost: the study does not say what the archers had or how much it affected their competition. It is also a single event, in a Tokyo summer and under exceptionally strict COVID-19 measures. In the manuscript read here, Table 3 swaps the numbers of athletes and athlete days between women and men; the rates match the figures in the text.

For archers the study has little that is specific, and what it has concerns a particular group: Paralympic archers, most of them over 35, during the fifteen days of a Games. In that setting archery does not stand out from the other sports: roughly one illness for every fourteen archers, and with ten cases no difference from the overall average that can be read into the data. The figure is of more use to whoever plans medical cover for a Paralympic team abroad than to the individual archer.

Two findings apply to every sport, archery included. The three days before competition had twice as many illnesses as the competition days: it is the first time this has happened in this series of studies, and the authors report it without explaining it. Skin conditions also overtook respiratory illness for the first time. The authors credit the overall drop to the COVID-19 measures (masks, hygiene, daily testing, restricted movement), but with no comparison group this remains a plausible reading rather than a measure of what each measure achieved.