Extreme heat and health at Tokyo-2020ne: The need for scientific coalition across sectors

The Summer Olympic and Paralympic Games are rightfully one of the world’s largest athletic competitions to showcase and praise excellence, respect, and friendship through sport. While athletes are striving to meet the hendiatris of the Olympics, Citius (faster), Altius (higher), and Fortius (stronger), experts from varying disciplines (Figure 1) have been working to build resilience against extreme heat through integrated heat preparedness plans for identifying, tracking, mitigating, and responding to the negative health impacts of extreme heat in Tokyo. Such preparedness efforts across a coalition of individuals are groups will help to not only maximize athletic performance but also ensure that the health and safety of all stakeholders involved in the games are protected.

Figure 1.

Depiction of lines of communication across various sectors involved in integrated heat preparedness plans that can identify and track the physical nature of extreme heat across scales, mitigate physiological impacts, and respond to the negative health impacts. Such preparedness efforts help to not only maximize athletic performance but also ensure that the health and safety of all stakeholders involved in the games are protected. We thank Graphic Designers in the Global Futures Laboratory at Arizona State University for helping design the graphic.

Extreme heat may cause declines in the performance and health of athletes, potentially forcing the postponement of events, attrition in races, and/or result in serious exertional heat illnesses. In the context of the Tokyo 2020 Summer Olympic and Paralympic Games, there will be a total of 15,490 athletes, along with over ten million spectators, volunteers, staff, and workers involved in the events, whose health and safety are top priorities for successful games. The risk of extreme heat is a well-known and accepted fact for the Summer Olympic and Paralympic Games. In anticipation of the Tokyo Games, Temperature presents its second Special Issue from the international scientific community, which highlights specific heat-health risks to athletes, such as hypervolemia [1] and potential performance impacts of pre-cooling [2], and further provides guidance on acclimation for safety and reduced fatigue [3]. Integrated heat management to prepare for heat-health risks requires adaptable approaches at various temporal and spatial scales. For example, advanced predicted of the planetary and local weather patterns of heat exposure in Tokyo provide advanced and actionable weather information for preparedness [4].

Ideally, weather and climate data should be integrated into the decision-making process for event schedules and venue locations [5,6]. Multi-scalar environmental heat risk assessment by climatologists and biometeorologists can undoubtedly set the stage for what to expect, and provide valuable data for physiologists, sports medicine doctors, and athletic trainers to support the health and performance of those exposed to heat during their metabolically demanding events. For example, the decision to relocate the marathon and race walk competitions from Tokyo to Hokkaido for the Tokyo 2020 was a data-driven decision [7], although in future events, such analysis should be done much earlier in the decision-making process to not interfere with athletes’ training plans. Furthermore, vulnerability to heat stress may be amplified in spectators, volunteers, staff, and workers who are unlikely to be heat acclimatized. Spectators from overseas may also face additional barriers due to the lack of familiarity with the area and language. Therefore, comprehensive heat risk assessments are needed that address the risks unique to populations, which can avoid over-stressing the medical response teams in the city.

Successful heat mitigation strategies must also consist of both tangible and intangible resources to cope with heat stress and strain at the individual and public response levels [8]. Appropriate public health responses also require coordination between local stakeholders in emergency medicine, public health, and events/operations––which can further benefit from climatological risk assessments as outlined above–to ensure that localized preparedness plans (e.g. in “hot spots”, expected crowded areas, midday events) systematically provide adequate support among athletic and social activities alike. Researchers and practitioners who study extreme heat have a robust history of research to implement evidence-based strategies to combat the adverse effects of heat. Yet for success, appropriate delegation of tasks among respective experts is essential to coordinate in advance of and during the Games. These integrated efforts heighten event safety and importantly support performance while also respecting the danger of heat.

Postponement of Tokyo 2020 brings an unexpected opportunity for a coalition of researchers, practitioners, and operations to further optimize strategies to mitigate extreme heat risk, yet now with additional considerations to manage potential COVID-related issues. Such precautions could further increase heat vulnerability. Through coordinated efforts, Tokyo 2020 can instill a legacy for future mass-participation events that may face the multi-faceted challenges of extreme heat.