Tokyo health risks

Osterholm strongly disagrees. In Minnesota, for example, a peak in case numbers in April was partially fueled by high school and grade school sporting events. Another recent case report identified a gymnastics facility in Oklahoma as the root of an outbreak fueled by the Delta variant. Declaring that sports present a low risk of transmission also ignores the risks outside of the competitions themselves, Osterholm says. In response, McCloskey says that the evidence cited only shows an association between sports activity and transmission and not proof that transmission occurred during play.

The official Olympic guidebook contains recommendations for social interactions in the Olympic and Paralympic villages and measures in place to impede viral transmission. According to experts, some of these measures are more effective than others. Osterholm likens aerosol transmission to smelling cigarette smoke: If someone is smoking in an enclosed room, others will be able to smell the smoke even if they are behind plexiglass barriers or if the smoker has already left the room.

All attendees are allowed to remove their mask when speaking to Paralympians or others who rely on lipreading—with the suggestion that they stay two meters from the athletes. According to predictions from the IOC, more than 85 percent of athletes and officials in the Olympic and Paralympic villages—and more than 70 percent of media staff in attendance—will be fully vaccinated. These percentages, however, do not extend to support staff, including groundskeepers, food preparation workers or cleaners.

Unlike the NBA when it restarted its — season last year, the Olympics have not been placed in a so-called bubble, Fauver says. The NBA and NFL also performed real-time genomic sequencing, Sparrow says: public health experts were able to trace the spread of the virus from person to person and to pinpoint specific high-risk interactions and environments. But the IOC opted not to include this technique in its testing program. The IOC maintains that the mitigation measures in the official guidebook will be enough.

The variations in doses obtained by ingesting each food from the same area in the same week at the same daily rate of consumption were considered to indicate variations in the radionuclide concentrations. Daily consumption of foods and the radionuclide concentrations in foods were assumed to follow a log-normal distribution. The variations in the dose from each food were estimated from the input data for the Monte Carlo simulation, namely, the variation in daily consumption, the distribution of arrival shares, and the variation in doses received by ingesting the foods in the same areas.

The simulation was performed 10 times for drinking water and for each food. The lifetime attributable risks LARs of cancer incidences up to the age of 89 y were estimated in accordance with the method described in a WHO report [48] and Harada et al.

We estimated those due only to the ingestion of I, Cs, and Cs for citizens in each city and those due to three pathways—ingestion, inhalation in the radioactive cloud, and external exposure to material deposited on the ground and in the cloud—for citizens in Fukushima City.

Estimation of doses due to inhalation and external exposure followed previous references [15] , [50] as described in the Supporting Information. The risk models were based on data from survivors of the atomic bombing in Japan; the validity of the thyroid cancer incidence was also confirmed by a cohort study performed after the Chernobyl accident [51] in the WHO report [48].

A linear-quadratic dose-response model was used for leukemia [52] , and linear non-threshold LNT models were used for all solid cancers, breast cancer, and thyroid cancer [53]. Doses in the second and subsequent years were calculated from the doses of Cs and Cs in March and from the physical decay of Cs and Cs half-lives of 2. The cancer-free survival rates of males and females were derived from the age- and sex-stratified all-cause mortality in Japan in [54] plus the difference between the all-cancer incidence in Japan in [55] , [56] and the all-cancer mortality in Japan in [54].

Cancer incidences in Japan in [55] , [56] were used as baseline incidence rates for all solid cancers, leukemia, breast cancer, and thyroid cancer. The minimum latency period was set at 2 y for leukemia, 3 y for thyroid cancer, and 5 y for breast and all solid cancers.

The details of the EAR and ERR models and their parameters for leukemia, all solid cancers, breast cancer, and thyroid cancer are described in the Supporting Information. The relationship between cancer risk and dose is still uncertain [57]. However, for the same dose, the risks at low dose rates are known to be lower than those at high dose rates [58]. In particular, coordination of DNA repair processes plays a critical role in allowing proper development and survival of organisms [59]. This study included sources of uncertainty: Cs and Cs concentrations in tap water in Fukushima City, limited data on foods in the early stages, data that were less than detection limits, individual behaviors such as purchasing of bottled water or not purchasing products from Fukushima Prefecture , and assessment of doses in the second and subsequent years for cancer estimation.

The deposition ratios are known to be similar in the two cities [62] , and drinking water treatment plants in both cities use sedimentation and rapid sand filtration, which are effective for removing Cs and Cs [63]. In the early stages of monitoring, data were not available for some foods in some prefectures in the Kanto region, but these contributions were judged to be small see Supporting Information.

The number of samples was limited for some foods in the early stages even in Fukushima Prefecture. We therefore used a Monte Carlo simulation and show the variations in dose e. We regarded radionuclide concentrations that were less than detection limits as nil. There were differences in detection limits among periods and institutions surveyed. We therefore confirmed the results through validation against observations in market basket, food-duplicate, and whole-body-counter surveys.

Differences in individual behaviors, such as not purchasing products from Fukushima Prefecture, could have influenced the variation in estimates. However, as the volume of major crops shipped from Fukushima Prefecture did not decrease after the accident [64] , [65] , we ignored differences in behaviors. We ignored the consumption of bottled water and soft drinks: the assumption that people drank only tap water would conservatively overestimate the dose from drinking water.

The doses due to ingestion in the second and subsequent years for cancer estimation were calculated from the physical decay, although the actual doses might be lower because of tighter regulations. The doses due to external exposure from September were also calculated from the physical decay. These assumptions can be regarded as conservative. The effective doses due to ingestion of Cs and Cs in the diet in Fukushima City Case 1 , Tokyo, and Osaka agreed within a factor of 2, in general, with those calculated in the market basket [1] and food-duplicate surveys [1] , [13] , [67] in five periods from July to March Table 1.

The market basket survey includes drinking water as well as foods. This good agreement supports the accuracy and reliability of our results. The doses in the diet in Fukushima City Case 2 were higher than those in the market basket and food-duplicate surveys. This result is reasonable because Case 2 is conservative. Validation for the period from March to June, including for the thyroid equivalent doses due to I, was not done, because no data from market basket and food-duplicate surveys were available.

The average effective doses due to total radionuclides were 62, , 25, and 2. The dose due to ingestion of I in Case 2 was 3 times that in Case 1 and the dose due to Cs and Cs was 6 times that in Case 1. Regional trade in foods was considered in this study, whereas the WHO preliminary assessment and UNSCEAR report assumed that consumers consumed mainly food produced in Fukushima and neighboring prefectures. Inclusion of regional trade in foods is a key to accurate dose assessment.

In both doses, Fukushima City had the highest values and Osaka the lowest. This was consistent with the distances from the nuclear power plant i. The contribution of effective dose from I to total radionuclides was higher than that from Cs and Cs in Fukushima City and Tokyo, and lower in Osaka. Except in Case 2, drinking water contributed the highest thyroid equivalent dose due to ingestion of I in Fukushima City and Tokyo, followed by vegetables Figures 1 , S5 , and S6.

These results indicate that local contamination of drinking water caused higher intake of I by citizens in Fukushima City and Tokyo than in Osaka, and that regional trade in foods played an important role in the intake of Cs and Cs by citizens in Osaka.

CM, countermeasures; M, male; F, female. Case 1, citizens consumed vegetables bought from markets. The effects of differences in monitoring time were small, because our average effective dose due to Cs and Cs in November 1. Note that the whole-body-counter surveys had sampling bias and may have underestimated the doses received by the general population [11].

These values were much lower than the annual effective dose due to other natural radionuclides in the diet; e. The 95th percentile doses due to ingestion of individual and total radionuclides in Fukushima City Cases 1 and 2 and Tokyo were greater than or equal to 1 order of magnitude lower than the provisional limits and also lower than the new limits. Those in Osaka were greater than 2 orders of magnitude lower.

The thyroid equivalent dose due to ingestion of I in Fukushima City Case 1 decreased with increasing age from 1 y Figure 1 , Tables S5 , S7 , although the daily consumption of drinking water and most foods increases with age Table S2.

This discrepancy between dose and daily consumption is attributable to the thyroid ingestion dose coefficient, which depends largely on age. In contrast, the effective doses due to Cs and Cs increased with age. The difference in dose between sexes was small. Because the dose coefficients are the same for males and females Table S1 , the differences in doses can be attributed to differences in consumption patterns. Similar results were found in Case 2, Tokyo and Osaka, with the exception that there were no large differences in effective dose due to total radionuclides among ages in Osaka Figures S5 — S7 , Tables S9 — S This was consistent with our previous result [19] and is attributable to the short half-life of I and the absence of new serious releases from the nuclear power plant to the atmosphere.

The intake of I was dominant within the first 2 weeks: rapid countermeasures are therefore important in reducing intake. The longer-term intake of Cs and Cs is due to the longer half-lives. In particular, the intake via consumption of vegetables and fisheries products was continuous.

The LARs of cancer from ingestion are summarized in Table 3. These values do not include risks from external exposure and inhalation. The LARs of all the solid cancer risks were 8. The risk of all solid cancers combined together with leukemia is intended to provide an overall indication of the lifetime risk of cancer; however, in circumstances where the tissue doses are highly heterogeneous, such as with doses of I to the thyroid, the risk of all solid cancers underestimates the cancer risk in specific tissues [48].

The LARs of all solid cancers estimated from the colon dose are not suitable in the case of ingestion, although they may be still useful as indicators of the risk of deadly cancers. The LARs of thyroid cancers were 2.

These values were calculated from the average doses. Because of the variation of doses, a factor of at least 2—3 could be applied to the 95th percentiles of LARs. In addition, these values cannot be directly compared with the ongoing results of diagnosis of thyroid cancers in Fukushima Prefecture because of the screening effects of diagnosis and the use of advanced ultrasound techniques [18]. As described above, most of the I was taken up within the first 2 weeks.

The LARs of thyroid cancers were attributed mainly to I in the first 2 weeks, highlighting again the fact that rapid implementation of countermeasures after a nuclear accident is important. Cancer risks from ingestion—especially in the case of the thyroid cancer risk in young females in Fukushima City—might not be negligible, but they are 1 to 2 orders of magnitude lower than the cancer risks from ubiquitous carcinogens in the daily diet.

The total effective doses due to ingestion, inhalation, and external exposure in the first year and over a lifetime up to 89 y for Fukushima City are summarized in Table S Vaccines for disease Recommendations Clinical Guidance for Healthcare providers Routine vaccines Make sure you are up-to-date on all routine vaccines before every trip. Hepatitis B CDC Yellow Book Dosing info Japanese Encephalitis Recommended for travelers who Are moving to an area with Japanese encephalitis to live Spend long periods of time, such as a month or more, in areas with Japanese encephalitis Frequently travel to areas with Japanese encephalitis Consider vaccination for travelers Spending less than a month in areas with Japanese encephalitis but will be doing activities that increase risk of infection, such as visiting rural areas, hiking or camping, or staying in places without air conditioning, screens, or bed nets Going to areas with Japanese encephalitis who are uncertain of their activities or how long they will be there Not recommended for travelers planning short-term travel to urban areas or travel to areas with no clear Japanese encephalitis season.

Routine vaccines Recommendations Make sure you are up-to-date on all routine vaccines before every trip. Immunization schedules. Hepatitis A Recommendations Consider for most travelers; recommended for travelers at higher risk e. Hepatitis B Recommendations Recommended for unvaccinated travelers of all ages to Japan. Japanese Encephalitis Recommendations Recommended for travelers who Are moving to an area with Japanese encephalitis to live Spend long periods of time, such as a month or more, in areas with Japanese encephalitis Frequently travel to areas with Japanese encephalitis Consider vaccination for travelers Spending less than a month in areas with Japanese encephalitis but will be doing activities that increase risk of infection, such as visiting rural areas, hiking or camping, or staying in places without air conditioning, screens, or bed nets Going to areas with Japanese encephalitis who are uncertain of their activities or how long they will be there Not recommended for travelers planning short-term travel to urban areas or travel to areas with no clear Japanese encephalitis season.

Measles Recommendations Infants 6 to 11 months old traveling internationally should get 1 dose of measles-mumps-rubella MMR vaccine before travel. Hide Non-Vaccine-Preventable Diseases.

Avoid sick people Tuberculosis TB Avoid contaminated water. Leptospirosis How most people get sick most common modes of transmission Touching urine or other body fluids from an animal infected with leptospirosis Swimming or wading in urine-contaminated fresh water, or contact with urine-contaminated mud Drinking water or eating food contaminated with animal urine.

Tickborne Encephalitis How most people get sick most common modes of transmission Tick bite. Avoid Bug Bites. Hantavirus How most people get sick most common modes of transmission Breathing in air or accidentally eating food contaminated with the urine, droppings, or saliva of infected rodents Bite from an infected rodent Less commonly, being around someone sick with hantavirus only occurs with Andes virus.

Avoid rodents and areas where they live Avoid sick people. Tuberculosis TB How most people get sick most common modes of transmission Breathe in TB bacteria that is in the air from an infected and contagious person coughing, speaking, or singing. Hide Stay Healthy and Safe. Eat and drink safely. Prevent bug bites. What can I do to prevent bug bites? Cover exposed skin by wearing long-sleeved shirts, long pants, and hats. Use an appropriate insect repellent see below. Consider using permethrin-treated clothing and gear if spending a lot of time outside.

Do not use permethrin directly on skin. What type of insect repellent should I use? Higher percentages of active ingredient provide longer protection. What should I do if I am bitten by bugs? Avoid scratching bug bites, and apply hydrocortisone cream or calamine lotion to reduce the itching. Check your entire body for ticks after outdoor activity.

Be sure to remove ticks properly. What can I do to avoid bed bugs? Stay safe outdoors. If your travel plans in Japan include outdoor activities, take these steps to stay safe and healthy during your trip: Stay alert to changing weather conditions and adjust your plans if conditions become unsafe.

Prepare for activities by wearing the right clothes and packing protective items, such as bug spray, sunscreen, and a basic first aid kit. Consider learning basic first aid and CPR before travel. Bring a travel health kit with items appropriate for your activities. Heat-related illness, such as heat stroke, can be deadly. Eat and drink regularly, wear loose and lightweight clothing, and limit physical activity in the heat of the day.

If you are outside for many hours in the heat, eat salty snacks and drink water to stay hydrated and replace salt lost through sweating. Protect yourself from UV radiation : use sunscreen with an SPF of at least 15, wear protective clothing, and seek shade during the hottest time of day 10 a. Be especially careful during summer months and at high elevation.

Because sunlight reflects off snow, sand, and water, sun exposure may be increased during activities like skiing, swimming, and sailing. Very cold temperatures can be dangerous. Dress in layers and cover heads, hands, and feet properly if you are visiting a cold location.

Stay safe around water Swim only in designated swimming areas. Obey lifeguards and warning flags on beaches. Do not dive into shallow water. Avoid swallowing water when swimming. Untreated water can carry germs that make you sick.

Practice safe boating—follow all boating safety laws, do not drink alcohol if you are driving a boat, and always wear a life jacket. Keep away from animals. Olympic Games typically involve a large population influx from various countries to a city, in this case, Tokyo, already one of the largest cities in the world. How will this work in a COVID world, where physical distancing is set to be recommended for a long time?

While multiple vaccines are currently undergoing development and trials, it remains unclear whether they will be viable by the postposed games date, and how COVID might be circulating within the region and across the globe.

By design, the games bring together participants and spectators from around the world, so considering the local and global landscapes will be key. A recent government survey showed only 0.

Questions around the safety of the public and athletes remain, and with this uncertainty in mind, organisers have set a self-imposed deadline of April on the viability of the event. If the games go ahead, expect measures such as reduced spectator capacity, temperature checks, long lines and masks, as well as changes to athlete schedules to ensure they can quarantine and prepare for the events.

This may require entire new risk assessments and large-scale re-planning to take place as existing plans were designed in a pre-COVID world. There are other people risks to consider. Ever since the Munich Olympics, where terrorists kidnapped and killed Israeli athletes, crowded spaces like sporting and entertainment venues have become attractive targets for international and domestic terrorists alike.

Japanese authorities have made substantial anti-terrorism preparations for the event. Whether the threat arises from domestic or imported vectors, the multiple layers of security including police, military and private security will rely heavily on technology, not least to coordinate their activities.

Alongside anti-terrorism drills at major venues, technology is also being used to fight back; these will be the first Olympics to make use of facial recognition technology to assist with risk management and identification. With a well-developed reputation for innovation and embracing new technology, Japan looks set to provide one of the most technologically advanced sporting events in history.. Spectators will interact with human support robots and complete streamlined security checks using the latest facial recognition technology.

With such a high-profile event though, security must be ultra-tight, and cybersecurity in particular is a major concern. Due to their operational requirements, scale and scope, Olympics events have potential to trigger complex second order effects, and cyber-attackers have grown increasingly ambitious as organisers have embraced digitalisation. At the Pyeongchang Winter Olympics 8 , suspected state-sponsored hackers carried out extensive campaigns with TV signals disrupted, the games website crashing, and ticket sales disrupted.

Japan has been developing and strengthening its strategy around cyber security for a long time. It has been crafting a specific plan for Tokyo since just after those Games. Emergency cybersecurity measures 10 , focussing on local-level government training and transparency on reporting attacks to help support coordinated responses, were launched.

The Rugby World Cup in provided in many ways the perfect test environment to vet some of those plans. Further time will allow more identification of vulnerabilities across the cyber landscape. Think of Tokyo and for many earthquake risk is top of the list of concerns. Given the structural dynamics, megathrust earthquakes along these boundaries are a common driver of risk discussions for the region.