JONATHAN M. METSCH, Dr.P.H. – Tracking Emerging Public Health Challenges – June 5, 2026 – World Cup
“On June 11, the largest FIFA World Cup in history kicks off across 16 cities in the U.S. (11 cities), Canada, and Mexico. Over 5 million fans from around the globe will pack stadiums, fan zones, and city streets through mid-July.
For the emergency departments (EDs) in and around those host cities, the tournament is not a month of soccer. It is a month of sustained operational stress across nearly every category of acute illness and injury a clinician can encounter. The point is not panic. The point is preparedness.
Past mass gatherings make one thing clear: the medical burden is rarely defined by a single exotic threat. It is cumulative — trauma; heat; alcohol and drugs; cardiac events; behavioral health crises; infectious disease; and the everyday emergencies that do not pause because a tournament is underway. The same triage nurse who flags a possible measles case may also be managing heat exhaustion, chest pain, an overdose, and a trauma patient within the same hour. Effective World Cup planning is all-hazards planning.
Heat Will Be the Most Reliable Driver of Volume…..
Trauma and the Physics of Crowds…..
Alcohol, Drugs, and Behavioral Health…..
Cardiac Events and the Emotion of the Match…..
Infectious Disease: One Layer, Not the Whole Picture……
Security and Mass-Casualty Threats…..
“None of this works without baseline capacity, and the baseline is uneven. A recent Trust for America’s Health report found that fewer than half of states are adequately prepared for a public health emergency. Of the 10 states hosting matches, only five scored in the top tier, and Texas — home to the Dallas and Houston venues — scored in the lowest tier.
Federal partners are leaning in: the HHS Administration for Strategic Preparedness and Response is working with local and regional teams in every host city, and last summer ran a viral-hemorrhagic-fever transfer simulation in New York. Local readiness must extend that work through surge capacity, cross-trained staff, interpreters, laboratory pathways, pediatric and obstetric care, continuity of dialysis and specialty services, communications resilience, and plans for concurrent disasters — storms, power failures, wildfire smoke, transportation failure — that may arrive on top of everything else.
America is preparing for a sporting event unprecedented in its size and scale, and the margin for error is thin. The lesson across heat-related illness, crowd crush, cardiac emergencies, intoxication, behavioral health, security threats, and infectious disease is the same: preparedness must be layered, practiced, and operational. Critically, it must be established before the crowds arrive, not assembled during the first surge.
The World Cup will be remembered for what happens on the field. For emergency departments, success will be measured by what the public never sees: the quiet competence of systems that detect risk early, protect healthcare workers and the public, and keep hospitals functioning, allowing millions of people to gather safely.” (1)
“The scale is unlike that of the Super Bowl or even the Olympic Games, which are generally limited to one city and a shorter time frame. Soccer enthusiasts tend to travel en masse with their teams from city to city for the matches.
Inevitably, some will either arrive ill or get sick along those travels.
“… experts say the chances that Ebola would spread at World Cup games or viewing parties are extremely slim.”
A more likely virus to spread is the extremely contagious measles, which is causing several large outbreaks around the U.S.
“I would not be surprised if we saw a measles outbreak linked to the World Cup,” said Andrew Pekosz, a virologist at the Johns Hopkins Bloomberg School of Public Health. “Crowds are an ideal place for measles virus to spread.”
It takes up to 14 days for the measles rash to appear, so an outbreak before the tournament ends is possible. Because the incubation period can last up to three weeks, foreign fans could potentially be exposed while in the U.S. and bring the virus back to their home countries.
Some matches will be played in Mexico and Canada, which are also dealing with thousands of measles cases. The Pan American Health Organization is urging health officials in host cities to boost surveillance of measles outbreaks even before the games begin.
Dr. Marcus Plescia, director of the Fulton County, Georgia, Board of Health, which includes Atlanta, said his staff members have been preparing for months, making certain they have an adequate supply of vaccines and immunoglobulin injections, which can be given in some cases after an exposure. “I have specifically asked our staff to have a plan for measles if there were an outbreak,” he said.
The team has gone over a slew of scenarios: What if a visitor tests positive for measles, for example? How would or could health officials make that traveler and their friends and family stay isolated in hotel rooms, especially if they’re not U.S. citizens?”
“The Centers for Disease Control and Prevention is finalizing a dashboard geared toward local and state public health officials, with more than 30 staffers assigned to monitor wastewater levels and assist local public health authorities with tracking. About 170 others are on standby if states need help with an outbreak or other major health problem related to the games.
Separately this past week, Georgetown University and MedStar Health in Washington, D.C., launched a Health Security Operations Center to collect and analyze health data related to World Cup games nationally — including wastewater detections, electronic health record data that’s been scrubbed of personal information and real-time information from emergency personnel.”
“Rebecca Katz, director of Georgetown University’s Center for Global Health Science and Security, said the team will also monitor mobility data — watching as throngs of fans move from one city to the next — and offer regular situation reports and a daily briefing. Both will be available to the public.” (2)
“Millions of soccer fans are expected to gather in 11 U.S. cities for the World Cup, and security planners have been coordinating with state, local and federal law enforcement agencies to monitor unprecedented security threats.
“This is not just one national or one continental event,” said Andrew Giuliani, the executive director of the White House Task Force on the World Cup. “For us in the United States, these are 11 regional events. And so we rely on the expertise of law enforcement in these areas to also understand the intricacies of this and come in with federal resources.”
The expanded tournament kicking off next week will include 48 teams, 104 matches and three host nations. Giuliani spoke Thursday at a World Cup kickoff event about the security challenges of preparing for an event of this magnitude, from monitoring trends across states to heat mitigation.
“We also want to make sure that we’re not siloing off Miami from Seattle,” Giuliani said, “because if a beat cop is seeing something in Miami Beach, let’s say, or in Miami downtown, that somebody in Seattle is also seeing, we need to make sure that we are deconflicting that information if there’s more of a trend that could be threatening to our other host cities. So that’s where the complexity of this lies.”
Preparations have been ramping up for months. Giuliani and members of the task force have attended major U.S. events, including the College Football Playoff championship game in January, to observe how host cities coordinate security and logistics.” (3)
“Days out from the start of the 2026 FIFA World Cup, Houston Mayor John Whitmire and law enforcement officials alluded to the use of surveillance drones throughout the international soccer tournament.”
“”We have extra training, we have extra equipment, that’s probably as far as I’m going to go with that,” said Larry Satterwhite, director of the city’s Public Safety and Homeland Security office. “But we are definitely leaning into everything trying to ensure a safe event. You know, the world’s changing, and we have to change with it.”
The Houston Fire Department, too, said it plans to be fully staffed in order to respond both to the World Cup as well as the daily calls Houstonians make.
“All hands on deck from the fire side, along with all the stakeholders that we’ve had,” Houston Fire Chief Thomas Muñoz said Tuesday. “Covering every aspect of EMS and fire services along with, as I mentioned before, our partners that are going to be working with us side by side to ensure a safe event.”
Muñoz noted the tournament will be taking place during the early stages of hurricane season; as well as noting that Houston’s final match will take place on July 4, the same afternoon as Freedom Over Texas, the annual July 4 celebration in Houston, headlined this year by Keith Urban.
Houston will also be the base camp for the Democratic Republic of Congo’s soccer team. In their home country, an outbreak of Ebola has prompted U.S. travel restrictions and international scrutiny, but local officials say they are not concerned about the risk of Ebola in the city.
Instead, Houston Health Department Director Dr. Theresa Tran stated the biggest concerns for the World Cup are heat-related illnesses, food-borne illnesses and vaccine-preventable diseases.” (4)
“Police, the FBI and other officials held a news conference Friday morning to talk about the safety measures that are in place for the matches at Boston Stadium in Foxborough.
There were numerous officials on hand at Boston Stadium for the 11 a.m. FIFA World Cup press conference on public safety and health guidance, including FBI Boston Special Agent in Charge Ted Docks, Foxborough Police Chief Michael Grace, Boston Police Commissioner Michael Cox, Foxborough Fire Assistant Chief Thomas Kenvin, Massachusetts State Police Superintendent Colonel Geoffrey Noble, Massachusetts Emergency Management Agency Director Dawn Brantley, Boston26 Vice President and Chief of Security Officer Ryan Winmill, Kraft Sports+ Entertainment Chief Operating Officer Jim Nolan, and Kraft Sports+ Entertainment Vice President of Security Bill Christiansen.
Boston Stadium holds around 65,000 people and hundreds of thousands of visitors are expected to move through Foxborough throughout the seven World Cup matches. There will be perimeters and restrictions set out around the area which will look different than the ones set for usual events. There are already enhanced security measures at the stadium, and security barricades are up.
MEMA is working with more than 70 agencies and organizations to ensure safety for the World Cup matches. They will have daily calls to coordinate efforts in Massachusetts and also the other host cities, and are working closely with the FBI.” (5)
“As Americans worry about the risks from hantavirus and Ebola, many state and local health officials now have less power to protect the public from all kinds of disease outbreaks than during the COVID-19 pandemic.
That’s because some jurisdictions weakened their public health authorities in response to criticism of lockdowns, school closures, mask mandates, vaccine requirements and other COVID-era restrictions.
“There’s been such an enormous backlash from the COVID-19 pandemic right across America, particularly in red states,” says Lawrence Gostin, a professor of public health law at Georgetown University. “It’s become part of our national lore of overreaching government.”
The Trump administration has reined in the Centers the Centers for Disease Control and Prevention with budget cuts, staff reductions and tighter oversight by political appointees.
But most public health powers reside with the states, and more than half have made changes to their own state, city and local powers, according to the Network for Public Health Law. The changes affect their ability to respond to public health emergencies. Many watered down those authorities.
“Taken all together, we’re in a much weaker position post-COVID in handling a health emergency,” Gostin says.
At least 15 laws in 11 states, including Alabama, Virginia and Louisiana, imposed new restrictions on declaring public health emergencies — declarations necessary to do things such as muster disease fighters and clear away red tape.” (6)
“As people gather, it’s easier for infectious diseases to flourish. Los Angeles County asks providers to look out for infectious illnesses such as:
Influenza A and COVID-19
Measles, pertussis, mumps, and other vaccine-preventable illnesses
Gastrointestinal (GI) conditions (eg, norovirus)
STIs (eg, mpox, chlamydia, gonorrhea, syphilis)
Infectious diseases related to travel (eg, dengue, chikungunya, malaria)
The flu season in the Southern Hemisphere lasts from April to September, which means some fans could import and spread influenza.
The public health department reminds providers that they must report conditions on this list. Doctors and nurses should ask patients about their travel history, both international and domestic, and about their attendance at games, festivals, and other celebrations. Providers who notice patterns such as a spike in GI conditions or respiratory illness should also report them to the health department.” (7)
“The World Cup finals are jointly hosted by New York and New Jersey on July 19.
Officials have been running practice simulations to prepare for outbreaks and mass casualty events. “We plan for the worst case scenario and go through it before it actually happens,” says Dr. Alister Martin, New York City’s health commissioner.
They’ve also set up “incident command” to “divert resources from normal stuff so that we can manage any potential emergencies,” Martin says, adding that the operation will continue through much of the summer, for other big events planned in New York, including America’s 250th anniversary, Pride month and the Puerto Rican Day parade.
In Los Angeles, which is hosting eight games, including the U.S. opening match versus Paraguay, risk-assessment teams will monitor the surroundings for chemical exposures and biological threats.
In L.A., diminished federal assistance means the health department is counting on existing staff to do the extra work. “Most of our staff are not taking vacations during the month of the World Cup because they’ll need to work -– we’ll be obviously accruing overtime costs,” says Barbara Ferrer, the L.A. county health director.” (8)
1.The World Cup Is Coming. Here’s What EDs Should Prepare For. by Robert Glatter, Syra Madad, David Silvestri, https://www.medpagetoday.com/opinion/second-opinions/121617
2.Why measles and flu — not Ebola — are front of mind for doctors ahead of the World Cup, By Erika Edwards, https://www.nbcnews.com/health/health-news/world-cup-measles-flu-doctors-ebola-concerns-rcna348556
3.World Cup security: 11 U.S. cities prepare for threats, By The Associated Press | MassLive, https://www.masslive.com/sports/2026/06/world-cup-security-11-us-cities-prepare-for-threats.html
4.Houston public safety officials say they’re fully equipped for World Cup — including with drone surveillance, by Michael Adkison, https://www.houstonpublicmedia.org/articles/news/sports/world-cup/2026/06/03/553491/world-cup-houston-drones-public-safety-police-fire/
5.World Cup safety at Boston Stadium: What to know, By Jeff Saperstone and Thea DiGiammerino, https://www.nbcboston.com/news/local/world-cup-massachusetts-boston-stadium-foxborough-public-safety-health-guidance/3960564/
6.Weakened public health powers raise outbreak risks, by Rob Stein, https://www.npr.org/2026/06/04/nx-s1-5846943/public-health-mandates-limits
7.Los Angeles County health department asks providers to watch for infectious diseases during World Cup, by Meghan Holohan, https://www.cidrap.umn.edu/sexually-transmitted-infections/los-angeles-county-health-department-asks-providers-watch
8.The World Cup vs. bugs, germs and heat: Here’s the game plan, By Pien Huang, https://www.npr.org/2026/06/05/nx-s1-5846403/world-cup-mosquitoes-ebola-heat
curated by Jonathan M. Metsch, Dr.P.H.
Clinical Professor of Environmental Medicine, Icahn School of Medicine at Mount Sinai