The 2020 Tokyo Paralympic Games are underway, almost two weeks of action featuring over 4,000 athletes from around the world competing to be recognized as the best in their sports. In some ways the landscape is familiar, with many of the venues from the 2020 Tokyo Olympics being repurposed to handle Paralympic competition in the city where the term “Paralympic” was first used back in 1964. The athletes’ attitudes are the same too.

“It’s a joy and a responsibility to compete in a Paralympics in my own country, and with people all around the world suffering from the pandemic I want to be ready to do my absolute best, from the bottom of my heart,” said Yukako Hata, sixth in paratriathlon in Rio.

But there’s no escaping a couple of crucial differences. Post-Olympic polls by major Japanese news organizations almost universally showed public support for having held the Olympics at over 60%, a stark contrast to the pre-Games numbers reported by most international media, and these support levels have continued for the Paralympic Games. Compared to the months before the Olympics it’s even been hard to find much negative press in the lead-up to the Paralympics. This is despite Tokyo’s COVID-19 situation being at an entirely new level of direness compared to where it was at the start of the Olympics.

On the opening day of the Tokyo Paralympics, Aug. 24, Tokyo had 4,220 new cases and nine COVID-related deaths reported, with 1,900 people across Japan hospitalized in serious condition and about 42% of the national population fully vaccinated. By comparison, the first day of the Olympics, July 23, Tokyo’s numbers were 1,359 new cases and zero deaths, with 431 people in serious condition nationwide and a roughly 25% vaccination rate.

Yet, while there were cases of people testing positive after arriving for the Olympics from abroad, the containment bubble in the Olympic Village and among international media and staff appears to have worked. Japanese government coronavirus response committee head Shigeru Omi told a House meeting, “I don’t think there’s a direct relationship between cases inside the bubble and the rapid spread outside the bubble at all.” The numbers in Tokyo were already on the way up at the start of the Olympics, following the same kind of time frame as previous waves after the cancelation of their preceding state of emergency.

Unlike previous states of emergency, though, this time the numbers have not come back down. And in that you can see an indirect impact of the Olympics on the situation. Japan’s states of emergency have been relatively toothless, mostly requests for people to behave responsibly and stay home except when absolutely necessary, and for restaurants not to serve alcohol and to close by 8 p.m. But holding a major international sports event in the midst of a state of emergency blunted people’s willingness to listen. Omi commented, “The fact that the Olympics took place has had an impact on people’s attitudes getting complacent. The message from leaders has also not been unified, clear, or strong.” That mixed messaging was exacerbated when IOC president Thomas Bach took a sightseeing trip through the high-end Ginza shopping district on Aug. 9, posing for selfie after selfie with people on the street—caught in the lens of the national media. Olympic minister Tamayo Marukawa shrugged it off at a press conference the next day, saying, “The judgment of whether something is absolutely necessary is one that must be made by the individual,” but the damage to the government’s COVID messaging was profound. If the top leadership can’t be bothered to exert the bare minimum of self-restraint in the interest of the common good, why should the average person?

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While the Olympics proved the isolation bubble sound, the overall situation leaves the Paralympics in a precarious position. Athletes and support personnel have to go through even tighter restrictions and procedures regarding testing, tracking, and tracing than those at the Olympics. With only about 40% as many athletes scheduled to compete and personnel limited to essential staff only, you might think the situation would be more workable. But Paralympians require more support, from wheelchair mechanics and prosthetics experts to guide staff for blind athletes and 24-hour care people for boccia athletes in electric wheelchairs. Exact numbers are confidential, but the greater support staff needs bring the overall number of people involved up significantly. Some para-athletes like American swimmer Becca Meyers found themselves unable to have their usual support crews along due to the restrictions. In Meyers’ case this led to her withdrawal from the Games.

With a range of disability classifications covered by the International Paralympics Committee, everything from intellectual impairments to severe muscle impairments, the logistics of dealing with para-athletes who test positive presents major problems as well. Noel Thatcher, a five-time Paralympics gold medalist who served as an advisor and liaison to Paralympics Great Britain for Tokyo 2020, commented, “Intellectually-challenged athletes and those unable to care for themselves can’t simply be quarantined in a hotel room like Olympic athletes. The isolation presents significant issues with regard to mental health, and co-morbidities are a serious worry.”

Many Paralympians would need to be quarantined where they can get assistance, typically in hospitals. But with the worsened COVID-19 situation in Tokyo, major hospitals and ICU facilities are already at close to capacity, and some contracted to provide Paralympians with basic treatment, like Tokyo Metropolitan Bokuto Hospital not far from the Olympic Village, have said they cannot accommodate athletes needing emergency care. Where they would be taken, and who would treat them, remains to be seen. If all goes well there won’t be any issues, but it’s an extremely fragile situation that has everyone holding their breath and wincing every time a new positive case is reported within the bubble. While it may not be likely, any kind of significant cluster infection in the Olympic Village could prove disastrous. “We’re all very nervous about what might happen,” said Thatcher.

It might seem contradictory that both public support and COVID numbers are up, but most people in Tokyo seem to understand that the Olympics didn’t bring the virus. With new cases hitting record-high levels in the 5000s for days on end and ambulance sirens having become an almost constant wail in the background hum of the city in the week before the Paralympic opening ceremony, for the first time during the pandemic there’s a real sense of unease.

One big question remaining is how much the people of Tokyo will hold back in trying to be a part of it. As at the Olympics the public has been barred from attending events, although there is a still a scaled-back plan in place to put tens of thousands of area schoolchildren in the stands. At the Olympics, the few events on the city streets—the triathlon, road cycling, and the opening and closing ceremonies—brought thousands out in close contact. The extremely popular marathons and race walks brought even more to Sapporo 500 miles away. Against the backdrop of much higher COVID-19 numbers and the worries they bring, will the same kinds of crowds turn out at the triathlon, marathon, and other events held in public at the Tokyo Paralympics?