LISTEN: How have public health and public safety departments been preparing for the global event? GPB's Sofi Gratas gets the story.
Walking through downtown Atlanta’s Centennial Olympic Park a couple weeks before the city hosts its first soccer game, preparations for the FIFA World Cup are on full display.
Thousands of fans will flock to this park for what the city is branding as a weeks-long “Fan Festival,” which officially got started this week.
Decades ago, an estimated 2 million visitors came through here for the 1996 Summer Olympics.
Epidemiologist Jodie Guest saw this firsthand.
“It was exciting, it was busy,” she said.
Atlanta will be hosting eight soccer matches during the cup, including the semifinal.
And while far fewer visitors are expected to come for the FIFA games, Guest, a professor at Emory University’s Rollins School of Public Health, says local public health departments will have just as much responsibility this time around, if not slightly more, because of changes to public health infrastructure.
"So, this is a classic mass mixing event," Guest said, "meaning we've got a lot of people coming into the city, and they're coming from a lot of different places and then they will go back to many different places."
The challenge for public health, and the city’s hospitals, becomes how well they can respond to possible outbreaks of diseases. That takes a coordinated effort involving surveillance, communication between agencies and treatment.
“How are you going look at people as they're coming in, and then what are you going to do ... if anyone becomes ill or you start to see signals of an outbreak happening,” Guest said.
Right now, a series of public health emergencies are straining healthcare workers in the U.S. and globally. An outbreak of Ebola in eastern Africa could become the deadliest to date, and hantavirus infections this year, while not categorized as a widespread threat, have tested the public’s trust in state and federal agencies that have had to scramble in a coordinated response.
And of course, highly contagious diseases once eradicated in the U.S., like measles, are back, a result of falling vaccination rates nationwide. That’s pushed the Fulton County Public Health Department to make plans for possible outbreaks.
Georgia has had five cases of measles this year so far – two on the coast, and three in metro Atlanta. The state Department of Public Health has asked that people check their vaccination status, while also promoting the availability of the measles vaccine at county public health offices.
At a recent public health meeting, Sasha Smith, chief epidemiologist for the Fulton County Board of Health, reminded staff that with all of the visitors crossing domestic and international borders, the city will be doubling down on surveillance.
"Time is of the essence, timely notifications," she told the room. "And DPH has done an excellent job in the 'three I's' — that's identify, isolate, inform.'"
If any Fulton County residents get measles during the World Cup, their staff would be responsible for the case investigation, contact tracing and followup.
Responsibility falls on the state to notify the health system about an outbreak if a measles case falls outside of county lines, and on the federal government if an infection occurs outside of the state.
"But we're still all working together during this event," Smith said.
A single measles case can require contact tracing hundreds of people. That’s only possible with enough money, staff and time.
If there was an outbreak during the FIFA World Cup, local public health departments should be able to rely on their national public health agency — the Centers for Disease Control and Prevention.
But one estimate from a federal employee union said the CDC has lost nearly a quarter of its staff because they were fired or they resigned. This comes after public health departments were pushed to their limits during the COVID-19 pandemic.
"That's what actually keeps me up at night, is the loss of the public health workforce," said Elizabeth Soda, an infectious disease physician who resigned from the CDC last year.
And measles isn’t the only preventable disease of concern. Georgia ranks among states with the highest prevalence of sexually transmitted diseases. There’s also the risk of injury from hot outdoor temperatures.
More crowds raise risks across the board. Soda said she’s not entirely confident that local public health departments like Atlanta’s will have all of the support they need.
"We're talking about 16 cities, three countries," Soda said. "This is the stress test."
She describes the CDC like an air traffic controller at a busy airport.
"State and local health departments, they're the airplanes, they can fly on their own," Soda said. "But you really need that person overseeing the big picture, right, and helping to coordinate."
In May, Fulton County Public Health Director Marcus Plescia told reporters during a meeting of the Big Cities Health Coalition that CDC staff have been on "numerous" calls with the city in its planning process.
He said they’ll rely on national surveillance monitoring systems and CDC experts in the case of any disease spread.
"I've found them to be responsive and also forward thinking and quite helpful as we prepare," Plescia said.
For months, and up to a couple years, city officials including the Atlanta Police Department, the mayor's office and major hospital systems have been running drills for weather emergencies, public safety threats and mass casualty events.
These tabletop exercises have also spanned across seemingly smaller threats, said Shane Smith, manager for Grady Hospital EMS Special Events and Operations, because emergency services could be the first to notice clusters of certain diseases.
"Viral infections, bacterial infections, even down to just some bad food poisoning," he said. "We have actually looked at those and trained on those."
Smith said the hospital will have extra staff on site, as well as at the Fan Festival and near Mercedes-Benz Stadium. The key is to be prepared if enough people get sick, since even outbreaks of common diseases could cause a strain on the health care system large enough to back up emergency rooms.
Atlanta's first FIFA game will be between Spain and Cabo Verde on Monday, June 15.
An earlier version of this story read:
A decade ago, an estimated 2 million visitors came through here, for the 1996 Summer Olympics.
