More than 6.5 million people are expected to attend the World Cup this summer at stadiums across Canada, the U.S. and Mexico. One of the largest sporting events in world history, the tournament is presenting unique infectious disease challenges for public health officials. To help, spatial epidemiologist Professor Will Goedel has developed an interactive map to track the movements of World Cup teams and their fans. He explains how his live-updated tracking map is helping health departments, and how it might be able to prevent a disease outbreak before one starts.

This summer, one of the world's biggest sporting events is coming to North America. The World Cup is kicking off on June 11th.

[Crowd noise enters]

48 teams from around the world, as well their fans, will criss-cross the continent. They'll play soccer matches in 16 cities across the U.S., Mexico and Canada.

More than 6.5 million people are expected to attend the matches.

For soccer fans, getting to host the World Cup is a dream. But public health fans might be getting a little nervous…

[Crowd noise out]

[00:01:10] Megan Hall: This is Will Goedel. He's an associate professor of epidemiology at Brown's School of Public Health. And he's helping public health officials prepare for the World Cup.

[00:01:45] Megan Hall: So to help, Will made an interactive map of the World Cup. It shows where every game is being played. Which hotels teams are staying in, and where they’re training. And it also shows the big fan fests that are happening around the country.

It’s fun to look at, but it’s also designed to help public health officials in case they need to track a disease outbreak.

[00:02:24] Megan Hall: This kind of work, making maps to help public health officials prepare, is not a one off for the World Cup, it's part of a whole field of epidemiology.

I like to think of myself as a public health jack of all trades. I go where the maps are needed, and so I've- I sort of say everything from asthma to Zika is kind of in my wheelhouse.

[00:03:23] Will Goedel: And I was talking to my colleagues in our, in their Center for Emergency Preparedness and Response, where they were saying, "Well, we know we have to get a lot ready for the World Cup."

And my colleagues at the health department were feeling like it was really hard to keep track of where every- everybody was gonna be throughout these games, understanding that this is a kind of a special World Cup in the way that it's being hosted. Most of the time all of the matches are played in one place. This time, the World Cup is being hosted jointly by three different countries in 16 different cities, with 48 teams from all over the world who all have training camps and hotels. And so knowing that a team is starting in Rhode Island and then playing a game at Gillette and then moving to LA or whatever, it makes the public health challenge that much more complicated.

My colleagues at the health department were looking through the FIFA website to try and keep track of all of this, and it's mostly in long lists and tables of, like, who's playing when, when the games are, where they are, which team is staying where, and it just wasn't a particularly intuitive interface.

And I thought, "Well, I know a thing or two about making clickable map-based interfaces to help people find information." And so that is where we sort of started, was just trying to be helpful, for health department folks who needed to be able to track how the games were gonna unfold.

[00:04:36] Will Goedel: Yes. Every large mass gathering usually has a public health response that is working behind the scenes to keep fans, athletes, and related sort of personnel as safe as possible.

Think about a Summer Olympics: Usually it's in a place that's quite hot. You put a lot of people in a stadium celebrating something really exciting like the Olympics, you're gonna get people who are dehydrated and get heat-related illnesses. And with that many people all in an Olympic-sized stadium, the local health system needs to be ready to handle that increased volume of people. And so they're usually doing preparedness drills or increasing staffing and increasing monitoring to make sure that they're ready to handle these kinds of public health challenges as they emerge.

[00:05:32] Will Goedel: Now, luckily, it was a Summer Olympics in the Southern Hemisphere. That's their winter, where- and mosquitoes are a lot less active. and so that turned out not to be a public health threat that materialized in a really substantial way, but it's something we want to be prepared for nonetheless.

[00:05:59] Will Goedel: So normally when there's these large events, there's usually at least a year's worth of preparation and planning that leads up to the large event, coordinated by a local health department and usually by federal partners. Our local health departments are doing everything that they can to be ready for these games.

There's, again, I've mentioned there's 16 host cities. 11 of them are in the US, so most of the local health departments are all preparing for these things. But usually you've got the CDC and FEMA as the kind of coordinating hub in between.

We had a government shutdown earlier this year. That meant that there were several weeks, where funds couldn't get out the door, where work couldn't be performed, and so that was going to put us on a delay. But over these last several years, the mass departures we've seen from the CDC, the gutting of CDC budgets, have meant that there are fewer people centrally at the national level who are able to help coordinate these kinds of responses.

And so as allies to our partners in local health departments, academics like myself have been trying to step up and fill whatever gaps that we can. So, I made a tracker that our local health department really needed, and it turns out it's been quite helpful for lots of other health departments who had a similar sort of need to be able to track what was going on.

We've been able to really disseminate and circulate that through both the STAT Network that's based out of the School of Public Health that brings together state health officers, as well as our Tracking Report that comes out of the Pandemic Center every week, that keeps track of kind of new and emerging infectious disease threats.

We're all partnered with a health security operations center that's operating out of Georgetown Center for Global Health Science and Security, that's really trying to bring together private sector, academic and government partners to be able to make sure that information is being shared as quickly as it needs to at an event that is as complicated as this one.

[00:07:57 Will Goedel: Our local health departments are working really, really hard around the clock to deal with public health challenges in their jurisdictions. They're doing this without additional funds. As far as we know, additional funds were allocated for security at all of these locations through the Department of Homeland Security. But no direct public health funding has come to health departments, so they're doing this all with their u- routine sort of public health preparedness dollars. because it's the right thing to do, and it's the thing that they know that they need to do to be able to support these kinds of mass gatherings.

And so, while it does present a risk, it's not that every partner is asleep at the wheel. Our local health departments are working really, really hard, to make these games happen.

Last month the WHO confirmed an outbreak of Ebola in the Democratic Republic of Congo. And before that, an outbreak of Hantavirus on a cruise ship caught people's attention.

So what diseases is Will worried about for the World Cup? Are Ebola and Hantavirus big concerns?

They do not transmit particularly efficiently. Ebola really requires close contact with bodily fluids, and so the chances that those viruses are going to be really big challenges during the World Cup are relatively low. really the three things that come to mind when I think about the World Cup: Canada and the US have both had larger than previously seen outbreaks of measles over the last year.

The U.S. is at risk of losing its measles elimination status, and so that is probably at the top of my list. There are several measles outbreaks. We've seen them in Texas, Florida, which are all places where games are being played or where teams are being hosted, where measles really is probably the most significant sort of infectious disease threat. Thankfully, that is one that we can prevent through vaccination. Measles vaccination is highly, highly effective. and in a place like Rhode Island where we have very, very high uptake of that vaccine, that's one of the sort of lower, there's a lower risk locally of that particular infection.

COVID tends to spike over the summers, and so that is another infectious disease threat we want to be paying attention to. And then, anytime you get people in large gatherings with food and beverage happening, you have to worry about foodborne illness, things like norovirus. So making sure you're washing your hands, you're carrying hand sanitizer when you go to all of these events, paying attention if you've got some sniffles, and avoiding those kinds of large events, I think are gonna be your main ways to avoid those last two.

Um, but those are probably the three most likely things. It's measles, COVID, and gastrointestinal illnesses like norovirus.

[00:10:55] Will Goedel: You know, the irony of all of this is that I am not a particularly big sports fan. My friends and family always like to joke that I sort of save up all of my sports watching every two years, and then I watch nothing but the Olympics every two years. But I think now that I've been getting involved in so many of the preparedness activities, I have to watch at least one game.

[00:11:14] Will Goedel: Oh, probably not. Crowds are not my thing. So I will be watching from the comfort of my own home.

[00:11:26] Will Goedel: Yeah. Crowds in the summer is just a recipe for people getting dehydrated and way too hot and a little too angry.

[00:11:49] Will Goedel: The main advice I would give to people attending any of these World Cup events is that your risk of getting any sort of infectious disease at one of these things is relatively low. The main things you want to watch out for are any of the things you would be paying attention to if you are going to be outside in the sun, or out drinking , um, and celebrating, where you want to make sure that you are staying hydrated, using sun protection, you're aware of your surroundings, and that you're staying home if you're not feeling well.

I probably cannot emphasize that enough. But you're doing a service to the whole games and to everyone around you by staying home if you're not feeling great.

[00:12:38] Will Goedel: Yeah. I'm happy to do it. And thank you for having me.

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the podcast studio at CIC Providence.

I'm Megan Hall. Talk to you next month!