blame it on RIO

POLLUTION, VIOLENCE, DISEASE: A CALL TO CANCEL THE GAMES.

ive your passion,” the motto for the summer’s Olympic Games in Rio de Janeiro, is too vague and anodyne to remind anyone of the host city. But that’s probably for the best. A focus group given the job of devising a slogan that more accurately describes Rio these days might have picked something along the lines of “Sicker! Stinkier! More corrupt!”

To be sure, fre tting about whether a host city will have everything ready in time is a familiar pre-Olympics ritual — especially when the games are to be held somewhere other than northwest Europe, North America, or a few highly developed Asian countries.

Delays are blamed on corruption or the inherent laziness of the host populace or both. Concerns about human rights and the environment are sprinkled on to these stories for altruistic flavouring. Then, the games open and run more or less smoothly. Everyone marvels at how plucky those Greeks or South Africans are for pulling it off. The athletes go home. The media lose interest. Stadiums fall into weed-covered disrepair. And the pattern repeats itself four years later.

But the problems afflicting Rio are sufficiently severe and unique that some question whether the games should even go ahead as planned.

The city’s waterways are full of raw sewage and, from time to time, dead fish. Victorious rowers might want to forgo the traditional celebratory post-race jump into the water. Open-air swimmers will be in a tighter spot.

A corruption scandal implicating dozens of senior current and former politicians and business executives has triggered massive street protests. The Senate has suspended president Dilma Rousseff, pending an investigation into allegations she violated budgetary laws to conceal a deficit. Former vice-president Michel Temer has taken her place on an interim basis.

All this is happening as Brazilians suffer through the worst recession in living memory.

“This is a triple-whammy,” says Matthew Taylor, an associate professor at the American University’s School of International Service in Washington, D.C. “Put together, those three things are unprecedented, certainly in the last 30 years of democracy.”

On top of the economic and political turmoil, Brazil is facing a public health crisis because of the spread of the Zika virus, a sickness that can cause microcephaly, involving a shrunk skull and brain anomalies, in babies born to infected mothers. The virus is transmitted by mosquitoes, or sexually from men to women or from men to other men. Almost 100,000 cases have been reported in Brazil.

On Friday, 150 prominent physicians, bioethicists and scientists from around the globe published a letter urging World Health Organization Director-General Margaret Chan to exert pressure on Olympic authorities to move the Olympics from Rio or delay them because of the Zika threat.

Amir Attaran, a professor of public health and law at the University of Ottawa and one of the four authors of the letter, also made the case in a widely circulated essay this month in the Harvard Public Health Review.

Exposing visitors from around the world to the virus will inevitably accelerate its global spread, he says, infecting especially poor populations in the developing world where insufficient sanitation, densely populated cities and the presence of the same type of mosquitoes make them vulnerable.

“If Brazil is unable to get this thing under control, how are you going to do it in Congo? How are you gong to do it in Nigeria?” he says.

Laurie Garrett, for global health at the Council on Foreign Relations in New York, disagrees with Attaran only in that she thinks his focus is too narrow.

“I’m less concerned about this biological entity, this Zika virus and the mosquitoes that carry it, than I am about the ability of this chaotic, disastrous mess that is called the government of Brazil to ... muddle through,” she says.

Brazil has had four health ministers in the past eight months. The current one doesn’t have a medical background.

“I’m worried about the entire picture,” Garrett adds. “There are just so many tiers to this that seem utterly chaotic and crazy. It’s many factors beyond what we’ve seen in past Olympics. It makes the challenges South Africa faced look trivial.”

People infected by Zika generally suffer at worst a rash, fever and minor aches and pains. The most serious symptom, microcephaly, affects only pregnant women and their babies, a small subset of any population.

“But that does not mean that actions that exacerbate a low base- line risk are prudent,” says Attaran. “The risk of nuclear reactors melting down is almost nothing. But what you have when it occurs is a very bad outcome. We’re in a similar paradigm.

“The most prudent public health advice is, when you’ve got a fire burning, don’t pour gasoline on it. That’s what I worry is happening.”

Attaran says the games could easily be postponed or held elsewhere — perhaps in a city that recently hosted the Olympics. He thinks Olympic officials won’t consider doing what’s right because of all the money, time and planning that have been invested in holding the games in Rio.

“We just have to be willing to accept that the Olympics are not too big to fail, that they are subject to the laws of gravity and public health,” he says.

The threat from Zika, Garrett believes, is but one danger that could derail the Olympics. She isn’t convinced the Brazilian government can handle the logistical and transportation challenges posed by welcoming about 500,000 visitors and athletes. She has concerns about public safety. And she thinks Zika is not even the most serious health with which Brazil must grapple.

“Brazil is facing a far larger dengue fever epidemic, a massive chikungunya epidemic. It has been struggling with all kinds of vectorborne diseases,” she says, referring to two viruses that are transmitted by the same species of mosquito that carries Zika.

“So from the point of view of, say, a team physician, I’m worried about the amalgam, the totality of this enormous burden of vectorborne diseases and whether I can provide to my athletes, particularly those who will be in outdoor venues, sufficient protection to ensure that they’re not going to get bit by a mosquito that may given them dengue, may give them chikungunya, may give them Zika.”

Garrett says there are several mosquito-control and other protective measures authorities in Brazil could carry out to sufficiently reduce these risks. She simply doesn’t have faith in their ability to do so.

“If I were deciding based on what I know right now, as opposed to two months from now, I would say, wow, better have a Plan B for the Olympics — somewhere else.”

For Brian McCloskey, who advises the International Olympic Committee’s medical director, talk of postponing or moving the games is overblown and alarmist.

McCloskey, director of Global Health for Public Health England, worked on public health services for the 2012 Olympics in London. He says he and his colleagues then prepared for outbreaks similar to the H1N1 flu or severe acute respiratory syndrome (SARS), which caused hundreds of deaths around the world in 2003.

“Those would have been serious challenges to us, but I don’t think either of those would have resulted in the games being cancelled, because you can put in place mitigation effects to try to manage the consequences,” he says.

Brazilian authorities, he says, are doing what they must. Hundreds of thousands of soldiers have hit the streets searching for standing water where mosquitoes might breed and telling residents how to protect themselves. Venue sites have been thoroughly doused with insecticide.

Besides, McCloskey says, the risk of exporting the disease to new locales is low. Most visitors to the games will come from Brazil and elsewhere in South America where Zika is already present.

He notes Brazil hosted the soccer World Cup in 2014, and has already held its annual Carnival this year — both events that attracted visitors from all over the world and didn’t result in a notable spread of Zika. “It seems to me that the residual risk of accelerating Zika is not that substantial, and history suggests that it doesn’t really happen,” he says.

Citing another mass gathering, McCloskey points out that dengue fever is present in Saudi Arabia, which receives millions of hajj pilgrims every year who return to their homes without triggering a public health crisis. “So you just have to keep the risk in context,” he says.

Joe Foweraker, an emeritus fellow the University of Oxford’s St. Antony’s College, says Brazil’s response to the Zika outbreak has been “as comprehensive as a government under siege can make it.”

He says Rio’s municipal government runs relatively well, which may protect the games from any disorder in the federal government. But he notes that Zika’s presence in Rio and elsewhere in Brazil has been made worse by the poor living conditions for millions of urban favela (slum) residents successive local and national administrations have been unable to improve much.

“If you’ve got very poor areas that have no sanitation, no running water, and people have to travel a distance to lug water to their homes, then of course you’re going to get a lot of standing water around the home, because they keep it there. And that is a perfect breeding ground for Zika, dengue fever and all those other things,” he says.

This persistent poverty, perhaps more than the Zika outbreak itself, reflects some of the disappointments in Brazil that the Olympics will shine a spotlight on.

“These games were supposed to be a showcase for the Brazil that basically existed eight years ago, which was very successful, growing rapidly, with an expanding middle class and reduced rates of poverty,” says Harold Trinkunas, director of the Latin America Initiative at the Brookings Institution’s Foreign Policy Program in Washington, D.C.

“That Brazil is not really available to showcase anymore.”

Instead, the country is struggling to convince prospective visitors it is a safe place. For most, it probably is (although the risks to pregnant women are particularly worrisome). And it is difficult to imagine those who do make the trip to Rio won’t enjoy themselves. But this isn’t shaping up to be the coming-out party for the country Brazilians might have hoped for when they bid on the games almost a decade ago. “L A ‘TRIPLE-WHAMMY’ OF CONCERNS: WHY RIO’S OLYMPIC TORCH SHOULD BE SNUFFED