By Deidre McPhillips, CNN
(CNN) — The FIFA World Cup is now just a few weeks away, but Dr. Rebecca Katz has been worrying about the public health threats it poses for years.
“With any mass gathering event, there are certain disease conditions that people worry about,” said Katz, who leads Georgetown University’s Center for Global Health Science and Security. “There’s always something happening.”
There’s a well-established playbook for planning how to protect the public’s health during mass gatherings like the World Cup, experts say. But broader circumstances surrounding this year’s tournament, which is expected to bring millions of visitors to North America, are poised to test that playbook.
Right now, an Ebola outbreak in the Democratic Republic of Congo and Uganda is posing an acute global health concern. The World Health Organization has declared it to be a “public health emergency of international concern” — only the ninth such declaration since the criteria were established in 2005. And it’s happening while US and international health resources are also being directed toward responding to a rare hantavirus outbreak.
Although those rare and serious diseases are concerning, experts say that most public health preparation for the World Cup has been focused on familiar issues – but ramped up to match the scale of the event.
“We’re expecting the unexpected, but there’s this idea of ‘let’s make sure we’re also really expecting the expected,’ ” said Dr. Marcus Plescia, health director for the Fulton County (Georgia) Board of Health, which is home to the World Cup host city of Atlanta. “The common things are going to become even more common.”
Respiratory diseases are a particular concern during mass gatherings, and measles has quickly risen to the top of that list as all three World Cup host countries – the US, Mexico and Canada – face a recent surge in cases.
Other infectious diseases such as sexually transmitted infections also pose challenges, especially during celebratory times. And arboviruses — a group of viruses that spread to people through bites from infected insects, such as dengue from mosquitoes – were an early obsession for Katz and her World Cup concerns.
“We have the vectors for dengue, for chikungunya, for all of these disease challenges in the US, but what we haven’t had was enough people with those diseases to sustain the transmission,” she said. The World Cup, though, would bring in millions of people who could potentially make that chain of transmission more substantial, Katz said.
Local public health leaders have also noted concerns about high temperatures, air quality, drug overdoses, food safety and more.
Dr. Katelyn Jetelina, an epidemiologist and former senior adviser to the US Centers for Disease Control and Prevention, said heat-related illness is “probably the most reliable risk” beyond infectious diseases.
“Crowds plus sun plus summer temperatures plus physical exertion plus alcohol is a combination that sends people to emergency rooms every year,” she wrote in her public health newsletter, Your Local Epidemiologist.
Public health is always working to provide an “invisible shield” around communities, said Dr. Monika Roy, deputy health officer and director of the infectious disease and response branch with the County of Santa Clara (California) Public Health.
“We do this every day. It is the bread and butter, so we feel prepared, but having the resources to do so is very important,” she said at a briefing this month.
This year’s edition features the largest World Cup competition ever — with 48 participating teams, up from 32 — and it’s the first time games will be spread across three countries.
This unique scale makes the core elements of a public health response – clear communication, rapid surveillance and efficient coordina