Learning the lessons from the past Athens 2004

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Learning the lessons from the past Athens
2004 Dr Agis Tsouros Regional
Representative WHO
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OLYMPIC GAMES ATHENS 2004PUBLIC HEALTH ISSUES

• Agis Tsouros, MD, PhD, FFPH
• WHO EURO
• Chairman of Hellenic National Board of Public
  Health and Member of Executive PH Group for
  Athens 2004 Olympics
• London September 2009

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A dream becomes true
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Olympic Games 13-29 August 2004 Paralympic
Games 15-29 September
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Athens Olympics

• First summer Olympic Games after September 11
• First summer Olympic Games after SARS and Bird
  Flu epidemics

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Olympic Sites
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Athens Olympics in figures

• 6 Olympic geographic sites
• 22.000 athletes and delegation staff
• 33 venues/28 different sport activities
• 60.000 volunteers
• 25.000 accredited journalists
• 3 mil. tickets sold
• 800,000-1,000,000 visitors
• 4 billions TV viewers

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Large Mass GatheringA Planned Public Health
Crisis?

• Fluctuating populations
• Pressure on infrastructure
• Hotels, food caterers, food street vendors
• Existing public health system not reactive enough
• Need for real-time decision-making
• Challenge for control measures
• High potential for international spread
• International contact tracing
• International attention
• Media

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ATHENS 2002

• Operational Plan
• Olympic Games 2004 Health
• Established the framework of the Health Programme
• Political
• Strategic
• Operational

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Olympic Games 2004 HealthOperational Plan

• Axis 1 Hospital Care
• Axis 2 Primary Health care
• Axis 3 Emergency Health Care
• Axis 4 Public Health and Hygiene
• Axis 5 Health System Organization and
• Coordination

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Key partners

• Ministry of Health and Social Solidarity
• Health care provision, general coordination
• Athens Organizing Committee 2004-Med. Services
• Med. Services inside the fence
• Hellenic Centre for Disease Control and
  Prevention
• Surveillance, Laboratory, Bioterrorism, Training
• Hellenic Centre for Emergency Medical Care
• Pre-hospital care, Disaster med. Care, patient
  transportation
• National School of Public Health
• Environmental hygiene, cruise ships sanitation

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Hospital Care

• Capacity and preparedness to deal with
  conventional health care problems
• Designated hospitals
• Capacity and preparedness to deal with CBRN

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Primary Health Care

• Olympic Village Polyclinic
• Health Centres

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Olympic Hospitals
Prepared to deal with cases after exposure to
CBRN factors

• Decontamination Units
• Personal Protection Uniforms
• Negative Pressure Chambers

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Emergency Health Care

• Safe transportation of patients to Olympic
  Hospitals
• Pre-hospital care inside the fence, on request
• Pre-hospital medical care in mass casualty
  incidents, according to national plans

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Public Health Hygiene

• Disease Surveillance and Outbreak Response
• Environmental and Food Safety Control
• Public Information and Health Promotion

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Surveillance systems operatingin the Athens 2004
Olympic Games

• Mandatory notification system
• Laboratory reporting system
• Primary care sentinel physicians
• Syndromic surveillance from
• hospital outpatients
• Syndromic surveillance from
• athletic venues
• Syndromic surveillance from
• cruise ships

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Enhanced Surveillance System

• Notifiable disease network
• 46 communicable diseases
• Laboratory reporting
• notification of pathogens-20
• Sentinel network - primary care community
  physicians
• 50 daily system / 200 weekly
• Olympic syndromic surveillance
• 11 syndromes from EDs of Olympic hospitals and
  clinics
• Ad hoc network with forensic services in Olympic
  cities
• 13 diseases
• Cruise ship surveillance
• 8 syndromes

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Integrated Enhanced Surveillance System

• Multiple surveillance systems operating
• Daily reporting
• Zero reporting
• Standard operating procedures
• Named person responsible for surveillance in
  hospitals
• Daily analysis and review of data
• Preparation of daily report

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Syndromic Surveillance

• Respiratory infection with fever
• Bloody diarrhea
• Gastroenteritis (diarrhea, vomiting), without
  blood
• Febrile illness with rash
• Meningitis, encephalitis, or unexplained acute
  encephalopathy / delirium
• Suspected viral hepatitis (acute)
• Botulism like syndrome
• Lymphadenitis with fever
• Sepsis or unexplained shock
• Unexplained death with history of fever

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Translating statistical significanceinto public
health significance
The 3.00 pm daily surveillance meeting
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Environmental and Food Safety Control

• Air Quality/Pollution
• Heat related illness
• Food Safety
• Water quality
• Sewage / waste
• Vector control
• Border / Ports of entry control
• Cruisers

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Environmental Hygiene

• Census of premises having potential hazards
• hotels, restaurants, commercial centres, pools
• Standardized inspection methods across districts
• Standardized scoring system
• Quantitative assessment
• Triggers for action
• Effective electronic network in place
• Tried and tested system for data management
• Training seminars for public health physicians
  performing testing

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Public Information and Health Promotion

• SMOKE FREE OLYMPICS
• Exploiting the Games to promote and encourage
  physical activity
• Alcohol, drugs and safe sex

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Local Government Partners

• Local government has crucial role
• Leadership, legitimacy, enabling
• Develop and implement policies to support
  physical activity
• Settings
• Schools
• Workplaces
• Healthcare

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Health System Organisation and Coordination

• Intersectoral Cooperation
• Public Health, Medical Emergency and CBRN
  Planning, Preparedness and Response
• Standard Operating Procedures
• Unified Command

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SOTYHealth Sector Coordination Centre

• Intersectoral Committee
• Response team
• President, Executive Vice-President, President
  National Board of Public Health, President of
  Greek CDC, President Ambulance Care
• Permanent Secretariat
• Medical Team
• Representatives Civil Defence and Communications

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• SOTY organized and coordinated the operation of
  two Hospitals as Isolation Hospitals for
  extremely contagious cases.

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Major Exercises

• Flaming Glavine, October 2003
• table-top
• Olympic Guardian I, November 2003,
• table-top
• Blue Odyssey, February 2004,
• field
• Hercules Shield, March 2004
• combination of field and table top
• Olympic Guardian II, May 2004,
• table-top

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Central Public Health Lab.s
HRC
MFA
Provinces
Hospitals
BTH
EMS
EKAB
MoEnv.
OKA
SOTY
Municipalities
KEEL
Forens. Science Labs.
Major Event
Pesticide Resid. Lab. Plant Protect. Dep.
OIC
IFAB
CMC
Port Authorities
SYSOA
DOD
OSSCC
ATOC
YAOK
Olympic Air
MoH
University Of Athens
NATO
and many more
WHO
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Laboratory Response for Biological agents

• Network ARES- is supported by our center and MH
• involves 7 laboratories
• One virology lab (BSL-3)
• 6 bacteriology labs (BSL-3)
• PCR and classical methods for very high risk
  agents
• Agreements with EU labs for confirmation and
  training

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SOTY Daily Reporting

• Hospital monitoring assets - on line
• Activity reports from CDC, Ambulance Service,
  Hospitals, Food Safety Agency, National School of
  Public Health
• Reporting to the Minister and Athens 2004

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The Olympic Village
5,500 Athletes 9,000 Mission Members 10,000
Volunteers 1,500 Games Officials