An internal U.S. Olympic Committee document obtained by ESPN.com shows that by the fall of 2015, the organization was clearly convinced that athletes competing in water sports will be at risk of illness at the Rio Summer Games.
The 14-page document spells out the USOC's recognition that Rio de Janeiro's overall water quality likely will not improve before the Olympics begin on Aug. 5, and emphasizes the importance of refining preventive protocols and advice for athletes.
The unsigned Oct. 20, 2015, memo titled "USOC Rio Water Quality Planning" was generated after a meeting with the International Olympic Committee Medical Commission and other experts in Lausanne, Switzerland. The document specified that the information was not to be distributed beyond the USOC and national governing bodies for Olympic sports.
"Water improvement plans that were projected to take place by the host organizers will not happen for the largest part," the memo read. "The initial agreement with the Rio organizers was to create multiple water treatment facilities in Rio to improve the water quality of the competition venues. These processing facilities were not built and will not be built in the immediate future to impact water quality at the Games.
"Construction is underway to create a new sewer line that will cut off several sources of water contamination before this untreated water reaches the competition venues. The actual impact on the water quality of this project is unknown at this time, however it may help especially if there is rain during the Games.
"There are also ongoing improvements to repair and upgrade lift stations and waste water pipelines to better allow for the movement of the effluent discharges. A recent mechanical failure of a lift station pump resulted in a spike in waterborne pathogens during a competition and these mechanical concerns are being addressed.
"The IOC and Rio Organizing Committee recognize that the water quality in and around Rio is for the most part not at an acceptable level and there [are] significant fluctuations in the bacterial and viral contaminants at the competition venues," the memo said. "The levels of pathogens will fluctuate depending upon environmental impacts and especially with significant rains. The IOC is tracking the weather impact using historical data. Additionally the IOC and Rio organizers are studying the current flows in and around the competition venues."
The USOC document also details various medical opinions on use of antibiotics. Many experts believe that using those medications to try to prevent infection beforehand is unwise, both because they can cause an stomach upset and could unnecessarily increase resistance at a later date.
"The USOC as well as the Rio organizing committee will have appropriate medications to manage bacterial or viral infections," the document says.
Also mentioned in the document is the possibility of preparing informed consent documents for athletes planning to compete in water sports in Rio. A USOC spokesman said athletes customarily sign some version of a waiver and release form, and it is possible the language will be altered to reflect specific conditions expected this summer.
Questioned about the document last week by ESPN.com, USOC CEO Scott Blackmun said the organization does not have the authority to prevent qualified athletes from competing, whether because of water quality concerns or the Zika virus epidemic.
"If they've been fully informed and they want to go compete at the Olympic Games, how can we not support them in their efforts?" Blackmun said. "That's why we exist. If the WHO [World Health Organization] or some other body with oversight says nobody should travel to Rio, then it becomes a different question. But right now, nobody's saying that.
"I think we started talking about [water-quality issues] a couple of years ago, honestly. This is a challenge. I think it's important for the Olympic movement to go to new places and to bring the Olympic Games to continents and countries that haven't had the opportunity to host it.
"When you go to less developed countries, one of the outcomes is that you're going to have different conditions. Unfortunately, I think we all thought the Olympic Games could be a catalyst for improvements in Rio, and then all hell broke loose with the economy. I wish we could do something to change it. At this point in time, we can't."
He said he has not been informed of any significant changes in water quality or infrastructure improvements since the USOC's October 2015 memo was written.
Although not mentioned in the October 2015 document, independent water testing at competition venues was done by a private company at the USOC's behest in 2014-15 and yielded data similar to what the Brazilian authorities have published, according to two sources who requested anonymity. Testing was also performed on water at training facilities, but results were not made available to ESPN.com.
Among the general and specific recommendations being fine-tuned for athletes and staff in water sports are: receiving a variety of vaccinations, including hepatitis A; careful cleaning and covering of any cuts and abrasions; and refraining from shaving at least 12 hours before contact with water to avoid the risk of infection. One common-sense directive -- to shower no more than 30 minutes after contact with water at a competition -- could be hard to achieve, given post-event logistics including drug testing and award ceremonies.
Blackmun told ESPN.com that an ongoing Associated Press investigation, whose major installments were published in July and December 2015, "shined a pretty bright light" on substandard water quality in Rio, but that planning on how to protect the health of the U.S. delegation already was underway.
The USOC is in what might be termed an awkward diplomatic situation regarding water quality and other issues in Rio. Chicago's bid to host the 2016 Games lost to Rio -- creating a potential sore-loser perception around American objections -- and the United States has another active bid in Los Angeles for 2024. A prolonged period of tension and feuding with the IOC over television and marketing revenue ended with a revenue-sharing deal in 2012. But Blackmun said the USOC hasn't and won't let those dynamics affect aggressive preparations or the information it disseminates to its delegation.
"Our [risk-] mitigation strategy is going to be the same whether there's any political background or not, because our job is to make sure that our athletes are as informed and safe as possible," Blackmun said.
He added that he is confident the water quality in Los Angeles will "conform to the highest standards" if that city wins the 2024 bid.