"Our Games Will Be Absolutely Safe," says Rio2016's Chief Medical Officer

Dr. João Grangeiro responds to athletes and experts who fear the effects of Zika

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Fears about the threat that the Zika virus poses to this summer’s Olympic Games in Rio de Janeiro have continued to make headlines in recent weeks. NBA player Pau Gasol said that he and other members of Spain’s basketball team are considering skipping the event.

Over 200 doctors and medical experts have signed a letter addressed to the World Health Organization calling for the Games to be postponed or delayed, arguing that symptoms are more severe than previously thought and that Rio’s current outbreak is worse than predicted.

In Brazil, Zika, which is transmitted by the aedes aegypti mosquito, has led to thousands of cases of severe birth defects in babies. Zika is also suspected to cause neurological problems in adults.

Paste Magazine sat down for a one-on-one interview with Dr. João Grangeiro, Chief Medical Officer of the Rio 2016 Olympics to discuss concerns about the Zika virus and the safety of athletes and tourists.

Grangeiro is an orthopedic surgeon who has served as the team physician for Brazil’s Olympic delegations. He is also an Olympian himself—he played on the Brazilian volleyball team at the 1980 Moscow Olympics. Grangeiro spoke with Paste at the Rio 2016 Olympic headquarters in Rio de Janeiro.

What are your responsibilities as Chief Medical Officer of the Rio 2016 Games? What kind of medical facilities and resources are being made available to the athletes?

Our first responsibility is to form a team with diverse talents and knowledge—it’s as though we were forming a volleyball team. The team’s main job is to plan and deliver all the medical services for the Olympic Games, which includes caring for the health of the athletes, spectators, volunteers, and credentialed media that will all be present. We are talking about a medical structure that will be capable of treating around 2 million people during the Olympic and Paralympic Games.

I’m sure you saw the headline that NBA player Pau Gasol saying that he is considering skipping the Olympics because of the threat of Zika virus. As a former Olympic athlete yourself, what would you say to athletes who are nervous about coming to the Olympic Games?

I will respond directly to Pau Gasol. Come to the Olympic Games. First, speaking as an Olympic athlete, it is a once-in-a-lifetime opportunity. Many athletes will only have one Olympic chance, because however outstanding you are, tomorrow you could injure yourself and not have the opportunity to continue playing at the Olympic level. That’s reason enough for him to come to the Games. I am certain that he will never forget it and that it will be an unparalleled moment in his life.

From a medical perspective, particularly in relation to Zika, I want to say the following: historically, at the time of year when the Olympics will take place, August and September [winter months in Rio de Janeiro], we have extremely low indices of infestation of the aedes aegypti mosquito. I spoke with Rio’s Deputy Secretary of Epidemiological Surviellance yesterday, and he said that these numbers have already fallen a lot, even in May.

When you analyze historical data over the past ten years—and these numbers are publicly available—you can observe that in the months of August and September the number of cases is very low. It does not pose a risk to the athletes—or for anyone—coming to Rio de Janeiro during this time of year. These numbers are based on dengue, Zika, and chikungunya, which are the diseases transmitted by the aedes aegypti.  

Finally, we have preventive measures that have been in place since the summer [U.S. winter] at the peak of the epidemic. We didn’t have a single case of Zika—in either athletes or officials—during the test events which took place in the summer, which gives us a lot of peace of mind. We will continue these preventive measures—in partnership with the World Health Organization— even though we know that the level of mosquito infestation will fall absurdly low.

Can you talk more about these preventive measures that are being taken—by the local government and the Olympic committee—to protect athletes and tourists from Zika during the Games?

The preventive measures in the venues include daily identification and eradication of possible mosquito breeding sites, which is an inspection done by the city government that they already have a lot of experience in. There are also the individual preventive measures, such as using repellent and wearing appropriate clothing such as long-sleeved shirts and pants. This won’t be so difficult in the winter: in July and August we have an average temperature of 20-22 degrees celsius [68-72 degrees Fahrenheit]. Additionally, the athletes will be in the Vila Olimpica, which will have air-conditioned apartments so they can leave the windows closed. These individual preventive measures were already used in the summer at the peak of the epidemic.

(Click here for the World Health Organization’s guidelines for Zika prevention during the Olympic and Paralympic Games in Rio de Janeiro.)

You said in a January interview—and I’m translating here—that “There is no risk” and “no need for such grave concern about Zika.” Do you stand by these comments?

Yes, I defend these comments. I am absolutely convinced that in August and September in this city we will have a safe environment in relation to Zika virus. I am not saying this because I want it to be true. I am saying this because I am looking at indicators that show the decrease in mosquito infestation during that time of year and because preventive measures put in place during the test events ensured that the athletes didn’t have a single case of Zika at the peak of the epidemic. So I am very sure about this: Keeping these preventive measures in place, our Games will be absolutely safe, not only in terms of Zika transmission, but also sexually transmitted diseases.

As you know, 150 scientists and doctors recently sent a letter to the World Health Organization—copying the International Olympic Committee—calling for Rio’s Olympics to be postponed or moved. The authors write:

“Brazil’s Zika virus strain has more serious medical consequences than previously known, (ii) that Rio de Janeiro is one of the most affected parts of Brazil, and (iii) that Rio’s mosquito-killing efforts are not meeting expectations.”

How do you respond to this letter?

I have several comments. First, I would like to know how many of these 150 scientists stepped foot in Rio de Janeiro during a Zika mosquito infestation. Second, admittedly, we know that Zika virus poses a very severe risk to pregnant women. This is undeniable; it has already been scientifically proven, and we agree with this. Third, here in Rio de Janeiro we have the Oswaldo Cruz Institute (Fiocruz), which is a scientific institution of the highest international prestige. The institute has studied tropical diseases for many years and diseases transmitted by vectors such as the aedes aegypti.  I didn’t see a single scientist from the Oswaldo Cruz Institute on this list.

(Note: Professor Debora Diniz, an anthropologist and public health expert at the University of Brasilia who signed the list, is part of the Fiocruz Bioethics Program)

So I think that at a minimum, they got ahead of themselves. If these 150 scientists want to make a statement about this, they should have consulted their peers, the scientists at the Oswaldo Cruz Institute here in Rio de Janeiro, because they are actually here and know the local situation.

So you do not believe that the Games are a potential way to increase global disease transmission?

Absolutely not. I don’t expect this and have not read anything published scientifically that has convinced me to change my opinion.

Will Rio 2016 be distributing condoms for Zika prevention? Perhaps you saw the news about about the Zika-proof condoms being distributed to the Australian Olympic team?

Yes. We will be distributing condoms in diverse locations, not only for the athletes but also for tourists. But it is important to emphasize that condom distribution is already part of a prevention program against STDs, which was going to be adopted by Rio 2016 whether Zika was present or not.

I have to ask about water contamination in Guanabara Bay, where the sailing competition will take place, which is an issue that has drawn a lot of attention in the media. Are you concerned about the athletes getting sick?

We had the test events for the sailing there last year and we didn’t have a single infection with a proven relation to the water quality in Guanabara Bay. It is worth emphasizing that the sailing competition will take place not in the Marina but at the entrance of the Bay, practically in the open ocean. All the measurements taken by us during the test events and over the years show us that the sanitary conditions of the water where the competitions will take place meets the international criteria.

What about the tests being taken by the Associated Press that show the water is extremely contaminated?

The data that we have—which is the data that the International Federations had during the test events—is that the criteria meets the international standards for primary and secondary contact where the events are taking place.

What is it like to have your job during an international health crisis like Zika? I’m sure you never expected this.

I think that every major event, especially an event like the Olympics, is susceptible to a series of hard questions. The city where an event like this takes place is always subject to exposure. When Zika appeared, we had already been dealing with dengue and other diseases that are transmitted by the aedes aegypti for many years. So these preventive actions and eradication efforts are government actions that have been in place for a long time. This is not something new. Every time an event like this happens, these health policies get reviewed and reinforced, which is positive for everyone.

This interview has been translated from Portuguese. It has been condensed and edited for clarity.

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