Noah Lyles’ collapse with Covid: How not to manage health at the Olympics

Noah Lyles, a 27-year-old from Gainesville, Florida, has had himself quite an Olympics. He won a gold medal in a photo finish in the 100-meter dash on August 4. He went on to win a bronze medal in the 200-meter dash four days later, then collapsed in a heap and needed a wheelchair to get off the track, suggesting that sports officials and team doctors have put athletes’ health last, not first, during the Paris Olympics.

Lyles ran the 200-meter race knowing he had Covid. At 5 a.m. on Tuesday morning, August 6, Lyles tested himself for Covid-19 after waking up with a sore throat, an aching body, and chills. When the test came back positive, Lyles says he decided to isolate in a hotel near the Olympic Village, took Paxlovid, and tried to get as much rest and fluids as he could. But knowing he had tested positive for Covid-19 — and had asthma — put him at risk of serious complications from Covid.

The idea of not competing in the 200 was never something Lyles seriously considered. After getting a second-place finish in his semifinal heat on Wednesday, he said he “still wanted to run,” and that doctors gave him permission to try.

I am not surprised that this young track star wanted to compete. But I can’t believe that his doctors, the International Olympic Committee, or any national Olympic organization would invoke the rationale that athletes get to decide whether to compete.

It is absurd to leave the final decision to compete at the Olympics to any athlete. They will all say yes. Their focus is on winning, most are young and feel immortal, and they aren’t thinking much either about others or the long-term impact of risky competition on their health.

It’s up to the adults in the Olympic room — doctors, trainers, officials, coaches, and others — to keep the athletes as safe as they can. That is exactly what their Code of Ethics, released earlier this year, commits them to do.

The point of having health and medical expertise at any event, including the Olympics, is to ensure the health, short- and long-term, of the athletes, staff, coaches and officials. While the world has tired of Covid-19, it has not tired of harming us. Anyone with Covid in the tight confines of the Olympics should be revealing their infection, isolating, not competing depending on the intimacy required of their sport, and not mingling with others. Leaving decisions about competition up to each athlete is abnegating the duty to protect all who are participating in the games.

Anyone at high risk from complications due to Covid-19 should not be sanctioned to compete. Athletes may disagree, fans may hate it, the media broadcasting the event may object, and advertisers may threaten clawbacks, but none of this matters. Doctors must have the final say on health and who competes, whether it is swimming in polluted water, playing with a damaged knee, competing with a contagious disease, playing with a concussion, vaulting on a broken ankle, or playing with a dangerous underlying medical condition such as a serious heart arrhythmia, asthma, diabetes, Marfan’s disease, and other conditions. Doctors, not athletes, must have the final say.

It is an ethical farce for any sports organization to shrug its shoulders and leave competition decisions to young athletes who have been training for years and will ignore anything that might prevent them from fulfilling their dreams. That shows an indifference to the health and well-being of those the sports officials say they care about. It also is inconsistent with the ethics required of those working in sports medicine.

Medical paternalism has a justifiable role in sports, both to maintain public health and to prevent hypercompetitive athletes from really harming themselves. When Lyles collapsed, so did the credibility of those responsible for health at the Olympic Games.

Arthur L. Caplan is the Mitty Professor and head of the Division of Medical Ethics at the NYU Grossman School of Medicine in New York City.