I’ve been enthralled watching the Winter Olympics! The physical feats seem impossible, and the mental strength required is impressive.

From a medical perspective, the likelihood of injuries is high, including serious injuries. And bringing people from all over the world together in close proximity for a few weeks in the winter is an infectious disease nightmare! So, of course, I began thinking about the medical planning that had to happen long before the Games began.

Italy has spent over €50 million on an upgraded medical network for the Olympics. They launched a recruitment drive for health personnel for the Olympics and Paralympics, seeking hundreds of doctors, nurses, physiotherapists, radiology technicians, podiatrists, social-health operators, pharmacists, psychologists, and more. The events are spread out in several locations, so there are 4 different hubs with dedicated care for the Olympics: in Milan, the Olympic Village, Cortina, and Valtellina. They have everything from specialized facilities for major trauma and head injuries, advanced medical transport (as we saw when Lindsey Vonn had a crash), a dedicated emergency room for athletes and staff, and dental and medical clinics for minor illnesses. There are rescue teams at all venues, including physicians and nurses experienced in advanced life support. They have created an innovative Olympic Operations Center in Milan using telemedicine to coordinate all health activities related to the Games. They even had 5 mass casualty simulation drills during 2025, to test their widely flung system, requiring coordination of rescue teams, ambulances, helicopters, and hospitals. It all sounds highly organized.

In addition to Italy’s staff, a typical Winter Olympic team brings approximately 90 medical professionals from their country to manage the specific needs of winter sports. The US, for example, sent a 150-person medical team, including doctors, nurses, trainers, chiropractors, physical therapists, and psychologists. In addition, many athletes bring their own. With 90+ countries competing, the total number of medical personnel from all countries combined is likely in the thousands.

It wasn’t always this way. In the 1896 Athens Olympics, the first modern Olympics, a few doctors traveled in carts behind the runners, and there was a shed set up near the swimming venue for doctors to await athletes who needed help. By 1908 a doctor’s certificate of fitness was required for marathon runners, and there were doctors patrolling the marathon course. By 1912 there were 7 doctors on staff. That, however, was the year of the first Olympic athlete death. Francesco Lazzaro, from Portugal, collapsed and died during the marathon, despite prompt medical attention. By the 1920 Antwerp Olympics, the Red Cross (which came out of WWI with a great reputation for organized healthcare) ran the medical program, which included nearly 50 doctors and 200 nurses and ambulance personnel. Few injuries were documented that year; some broken bones, three testicular traumas (?) and an arm with a javelin through it.

The 1928 Winter Olympics in St. Moritz saw the founding of the International Association of Sports Medicine. 1932 (Los Angeles) was notable for the first ever Olympic Village for the athletes, with a dedicated Olympic hospital, including 24-hour staff, radiology, and a laboratory.

The 1936 Olympics is remembered mostly for the shadow of WWII and the drama of Hitler and Jesse Owens. Medically, it is remembered for its large hospital with 171 doctors and 200 staff, many from the German armed forces. There was a modern telephone network for medical emergencies, and medical translation services, for the first time.

The 1948 Olympics in London, just after WWII, was called the Austerity Olympics. It still had a large polyclinic, ambulance services, and many medical volunteers. For the first time, two hospital beds were dedicated for psychiatric cases although “It (was) of course understood that if any competitor became dangerously insane that he could not be accommodated at this most respectable hospital.”

By the 1952 Helsinki Games, medical support looked a lot like what we are used to now, with mini clinics at the Olympic Village, and an extensive network for first aid and emergency posts at the venues. Military support was phased out in favor of civilian volunteers, and private companies sponsored or donated supplies and financial medical support.

How about illness during the Winter Olympics? Almost 3000 athletes (along with their support people) come from all over the world to compete. There are 18,000 volunteers. About 2 million visitors will come during the games. They are all moving around, in close contact with each other. It could be a perfect storm, from the germ perspective!

Well, it certainly has happened. During the 2018 winter Olympics in South Korea, over 260 people were sickened with norovirus and over 1000 people were quarantined. Two swimmers  got sick after swimming in the Seine in the 2024 Paris Olympics and had to withdraw from further events. The 2020 and 2022 Olympics saw several athletes sidelined with Covid.

This year in Milan, Norovirus (a particularly nasty intestinal infection) has been spreading through the Olympic Village. It’s highly contagious, and resilient. This virus can survive on surfaces like countertops for days, can withstand freezing temperatures and is not killed by hand sanitizer. An Olympic Village, with close living quarters, communal dining facilities, lots of shared spaces, and group bus travel, is the perfect environment for Norovirus. Early in the Olympics, one player on Switzerland’s women’s hockey team tested positive, so the entire team entered precautionary isolation and missed the opening ceremony. A norovirus cluster among the Finland women’s hockey team forced the postponement of their opening game against Canada, as more than a dozen players were either ill or quarantined. A couple of Finnish biathletes withdrew due to stomach issues. Interviewed athletes have said, “I’ve never washed my hands so many times!”  

It’s not just Norovirus. The Olympic period coincides with peak Influenza and Covid activity. Transmission of these illnesses is enhanced in indoor, high-density settings such as athlete villages, transportation systems, competition venues, and social gatherings (Have you seen videos of those parties at the Dutch House??). This year, there are no formal Covid restrictions, so teams are all using their best judgement. The US and Swedish cross-country teams are staying in private hotels instead of the Olympic village. Some athletes are wearing masks. Some teams had their athletes stay in their rooms for 48 hours after arrival to monitor for symptoms. But Covid can crop up anywhere. At least two Australian support staff members tested positive for Covid just prior to the start of the games.

Measles has gotten a lot of press lately, with several outbreaks in the US. During the 2010 Vancouver Winter Olympics, there were at least 3 different cases of Measles in visitors, which spread rapidly, leading to a total of 82 cases of measles (largely in unvaccinated people). Could this happen in Milan? With 2 million international visitors, frequent mixing of people, indoor venues and the extreme contagiousness of Measles, an outbreak is certainly a possibility. Vaccines were not mandated for people attending the Olympics, but Measles, Influenza and Covid vaccines were strongly recommended.

Sexually transmitted diseases are also on the list of common infections at any Olympic Games. 10,000 condoms were distributed to the Olympic athletes at the beginning of the Games. That sounds like a lot but there are almost 3000 athletes, so that’s only about 3 condoms per person. “Shows that Valentine’s Day is in full swing in the village, and I don’t think I can add very much more to that,” IOC spokesperson Mark Adams told reporters on Saturday, Feb. 14. I just read that condoms have been restocked in the Olympic Village, so everyone can breathe a sigh of relief!

And there you have it, insight into all the behind-the-scenes medical issues at the Winter Olympics!