this is "nightline." >> tonight, pandemic games. tokyo 2020. not like any olympics before. >> i'm waiting for the results of a coronavirus test which i just took. >> arenas empty and a host nation worried about the virus spreading. >> this seems like they're putting everyone at risk. >> the games with a record number of women competing. why one country's gymnasts are covering up. plus, preventable spread. the delta variant fueling a surge in new cases. >> out of all our covid patients, 99.9% are unvaccinated. >> several states with low vaccine numbers the worst hit. >> we just thought we were young

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unlike past games, virtually no fans have been allowed to travel to cheer on the athletes. there's constant testing and strict health protocols. the long shadow of covid always present. abc's james longman has our report tonight from behind the scenes in japan. >> reporter: it's an olympics like no other. from the empty stands to the covid testing to the masks and social distancing. >> united states of america! >> reporter: but for those athletes who've made it to tokyo and to the opening ceremony, nothing beats competing on the world's largest stage. and winning feels just as sweet. >> and taylor dressel has another olympic gold. >> reporter: take the american men swimming to gold in the 4x100 freestyle relay, for example. or this australian coach dancing uncontrollably when swimmer ariarne titmus won gold. >> he's going crazy. oh, my goodness. >> reporter: titmus narrowly

beat american and three-time olympian katie ledecky in a nail-biting race. >> this is an olympics unlike any other. holding the olympics in the middle of a pandemic it's so difficult. it just looks so different and so weird. and yet sports can save these olympics. even with all the issues at the olympic games it still is the greatest thing going. when it's good, it's great. >> reporter: this already unprecedented olympics continues to make history with athletes like anastasija zoltic becoming first american woman to win a gold medal in taekwondo. >> i felt like everything was lining up. my training before-hand, my warm-up and everything was going perfectly and i had no doubt in my mind i was going to win the olympics yesterday. >> before each match the colorado native always releases a primal scream. >> i do it to calm nerves and then i kind of see it intimidates people. so i was like maybe if i scream even louder it will intimidate them a little bit. >> reporter: these games breaking all kinds of records, especially in lgbtq representation. in rio there were just 56 out athletes. now there are at least 160.

and one of them is british diver tom daly, who won gold for the first time at this, his fourth olympics. and he spoke through tears to a new generation. >> i hope that any young lgbt person out there can see that no matter how alone you feel right now you are not alone and that you can achieve anything. >> reporter: all of these athletes are facing their biggest moments without their friends and family there to support them in person due to strict covid protocols. the tokyo olympics continue to see athletes test positive for covid-19 as infection rates rise in japan. already there have been at least 153 confirmed covid cases related to the olympics. 19 of them athletes. a dutch rower recently tested positive after competing. he's now self-isolating. >> when you're holding an olympics in the middle of a pandemic and bringing athletes from the world together, many of them unvaccinated, this is what you're going to get. i don't think it's a surprise at all. the hope is it doesn't become a super spreader event. >> reporter: to prevent the

spread of the virus both athletes and journalists like me have to undergo rigorous testing that began as soon as we arrived. >> the amount of paperwork you need to get into japan is unbelievable. and now i'm waiting for the results of a coronavirus test which i just took. that would appear here. and then i'll be summoned to a window. and then i've got to go through imigration. >> reporter: at the olympic village officials have implemented rules to try to keep athletes safe. this is the olympic village, a series of high-rise blocks here in the center of tokyo where all the athletes from around the world are staying. but they're only allowed to leave here to go to their events or to train. >> reporter: once at an event even in the midst of olympic glory athletes are urged to keep their masks on. officials warned athletes after u.s. gold medalist chase kalisz celebrated with his teammate silver medalist jay litherland on the podium. but the olympic committee did ease up a little allowing medalists to take their masks off for just 30 seconds for a few photos. after two weeks on the ground here in tokyo and multiple tests i dropped off one last pcr test. >> i'm officially past the

14-day quarantine period. my app says i have cleared. still going to put in my temperature every day. >> reporter: outside the village those who call tokyo home have mixed feelings about the games occurring in their city at this moment in the pandemic sxwlp japan has been in a state of emergency for a long time. it just doesn't really make any sense to me. it just seems like they're putting everyone at risk. >> i'm so glad to held the olympics in japan. and i watched ceremony and i think it's -- it was beautiful. >> reporter: that ceremony opening up the games dazzled those watching on tv. but outside protesters made their voices heard. >> listen to that. that's the sound of police shouting at protesters. there are quite large crowds of them on this street down below. we're not allowed to go because we're in the olympic bubble. >> reporter: the university professor koichi nakano, the discontent over the games is something he warned about. >> a lot of us in japan are in

disbelief this is happening. >> reporter: covid cases here are low compared to other countries, about 5,000 a day at the moment but japan has a serious issue, a poor vaccination rate, only around 24%. so a ruined olympics could be coy ahodid they get to this poi? >> i think the japanese people themselves are quite surprised and shocked. the japanese people have been rather trusting of the state and have been rather conformist. but in the past decades there have been cases of the vaccination programs gone wrong. there's been a rather persistent vaccine hesitancy in japan. >> reporter: the controversy and uniqueness of these games leaving even the marquee athletes feeling the pressure. the u.s. women's gymnastics team had an unusually rough start, stumbling at qualifiers. the squad performing lower than expected for a team anticipated to dominate. inside the arena the world's most decorated gymnast simone biles going out of bounds during her floor routine and again on her first vault. biles shook off her shaky performance by taking to instagram writing "it wasn't an

easy day or my best but i got through it. i truly do feel like i have the weight of the world on my shoulders at times. the olympics is no joke." >> this is a hallmark moment for usa gymnastics. of course this is the first olympics for these athletes since the larry nassar sex abuse scandal, which we found out about in 2016. >> reporter: former usa gymnastics national team doctor dr. larry nassar was sentenced to 176 years in prison. >> you do not deserve to walk outside of a prison ever again. >> reporter: for sexually abusing hundreds of women and girls. and one of those survivors, superstar simone biles. >> the survivor of the larry nassar scandal now having finally the ability to go on the grandest stage of all, the olympic games. all the changes in usa gymnastics who's been leading the way? vimown biles. >> reporter: attention now being paid to the athletes' uniforms. the german women's gymnastics team choosing to wear a unitard that covers them from their legs to their ankles instead of the typically bikini cut leotard. the german gymnastics federaton

branding the unitard a statement against sexualization. >> you can tell that it's 2021 and you have women athletes speaking out and saying enough, about all of the sexist outfits and the way that they're treated. these people athletes at the olympics are not here for the male gaze, to appeal to men. they're here to compete. >> reporter: there are more women than ever competing at the olympics this year, in part because of two new sports, surfing and skateboarding. two 13-year-old girls took home gold and silver in skateboarding. some of the youngest olympic medalists ever. >> there is full gender equality across all of those new sports and new events. >> reporter: this is the centerpiece of the tokyo games, a $1.5 billion stadium. but take a look at all the security around it. this is about as close as most japanese are going to get to their own olympic games. >> my name is kiyoko ishikawa. >> reporter: and you're a huge olympic fan. >> yes. i have attended all summer olympic games since the barcelona olympic games in 1992.

>> reporter: kiyoko ishikawa is known as miss five rings. she is a massive olympics fan but she understands the need for restrictions and believes the government and the ioc when they say the games can be kept safe. >> it is unfortunate but it is the way it is. it should be. the way it should be. because this is unusual situation in a covid environment. and then don't forget, the enemy is not the government or committee but the enemy is the covid virus. >> reporter: a philosophical view perhaps. but for fans like ishikawa and the athletes she watches olympic glory will prevail no matter what. >> our thanks to james. up next, a plea from the unvaccinated. truthfully, it's frustrating to see how fast dust reappears. but dusting with a cloth is a pain.

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the numbers are going in the wrong direction. covid cases nationwide up over 300% since mid june. the highly contagious delta variant fueling the rise. and the unvaccinated paying the highest price. for kay cobb the decision to not get the covid-19 vaccine is something she says she now regrets. >> you know, just being in the hospital, you know, having to go through a lot of things. the treatment and everything. and not knowing if i was going to end up on a ventilator. you know, it's just scary. >> reporter: she survived her battle with eph couldid,

fighting for life at memorial hospital miramar in florida. >> i'm a believer now that we need to make sure that everyone is vaccinated. >> reporter: cobb's home state of florida has one of the highest rates of new covid cases in the country. arkansas and louisiana also among the hardest-hit states. florida alone averaging more than 10,000 new cases per day, accounting for one in five new cases in the u.s. dr. michelle aquino, a physician in florida, says she's been seeing an uptick in covid patients coming through her doors. >> the unvaccinated percentage of our patients, right now in our hospitals of all our covid patients 99.9% are unvaccinated. when you see someone under 40 die because of covid when there's a vaccine they could breaks your heart. >> reporter: 60% of u.s. adults are fully vaccinated, but in arkansas only 36% of the population is fully vaccinated. leading some hospitals in the

state pleading with the public. >> he with really need your help to help us. >> reporter: this video gaining national attention this week. dr. michael bolding of washington regional medical center has been working in the covid unit for the past 16 months. >> what i really wish you could see is to look into the eyes of a young father or a gentleman who knows that they may be short for this world because they didn't get their vaccine. >> reporter: tate and christine easy of little rock, arkansas are grappling with the devastating loss because of covid. christine was pregnant and suffered a miscarriage while battling covid-19 in the icu. >> we lost the baby at some point between when she was on the vent and went on the ecmo machine. all we know is the oxygen just dropped too low at some point. >> reporter: they hope other

unvaccinated americans consider the risk they're taking. >> i do want to just tell my story because it could happen to me, it could happen to anybody. >> earlier i spoke to our chief medical correspondent dr. jen ashton. thank you so much for joining us, doc. first question, we just saw that florida, arkansas and louisiana are struggling with some of the highest covid case rates in america. what do we know about what's driving these infections? >> well, byron, i think according to public health officials if you had to say one word it's the unvaccinated. the majority of the people being admitted now to the hospital and unfortunately dying of covid-19 disease are unvaccinated. but i think we need to think about this in terms of two types of behavior, the way the virus behaves and the way humans behave. the humans, a lot of people unvaccinated, that's driving the human aspect of it. the way the virus is behaving, delta variant, much more transmissible than the original prototype virus. >> so talking about the delta

variant, how big do we think this next wave is going to be? >> well, no one has a crystal ball. so when they look at these models, it's only as good as the data that's being put in. so that means how many people are being tested. and remember, this is still a virus that we think in up to 50% of cases potentially causes no symptoms. so when you know that a variant is more infectious, more transmissible and we know that a significant portion of the population is not fully vaccinated there is a major concern based on the rise in cases that we've seen over the last several weeks in this country that this next wave could be a significant one. >> we've seen mask guidelines change and evolve in parts of the country recently. what do people need to know to keep themselves safe? and should we be masking up again? >> i think we're seeing a lot of back and forth and deliberation on the part of senior public health officials on that issue. i think the short answer is if you're unvaccinated you should be wearing a mask.

but even if you are vaccinated, if you are amongst the vulnerable populations, 65 years of age or older or someone with a weakened immune system or going into an environment where it's densely crowded, people are unmasked, in an area of the country where there's a low vaccination rate, then we've heard cdc director dr. rochelle walensky say that a mask is an individual choice and that may offer some additional degree of protection. >> we've seen some high-profile breakthrough cases among vaccinated people like at the olympic games recently. what do we know about how prevalent these breakthrough cases are and how concerned should people be at home? >> well, i think when we hear these cases we should expect it. right? no vaccine is 100% effective. so when you hear about breakthrough cases, what we think right now is that if someone is infected with covid after having been vaccinated they are less likely to transmit that virus to someone else and they are less likely to develop

severe disease. that doesn't mean no symptoms. it means they are unlikely to need to be admitted to a hospital. but i think we still need to prepare for these. we need to expect them. and that is a reminder that we need to take this virus very seriously. >> and doc, final question. for all our parents who are watching and people who are responsible for children, federal regulators are now asking pfizer and moderna to expand the size of their studies in children ages 5 to 11. why is that? and how could this impact the timeline to vaccinate children? >> well, we heard just today, byron, that the timeline is going to be driven by science and not anything else. it's not going to be based on a school year calendar or anyone's convenience. and there's a saying in pediatrics, kids are not little adults. we need to see safety and efficacy data in different age groups to see if different doses are needed based on weight or size and how children of different ages respond to these before they get emergency use

authorization or full fda approval. >> doc, thank you so much. always grateful for your wisdom and your insight and your comfort. we'll see you. >> great to be with you, byron. thank you. up next, celebrating the olympics. these kids could be america's future stars. i've got moderate to severe plaque psoriasis. now, there's skyrizi. ♪ things are getting clearer. ♪ ♪ i feel free to bare my skin yeah, that's all me. ♪ ♪ nothing and me go hand in hand nothing on my skin, ♪ ♪ that's my new plan. ♪ ♪ nothing is everything. ♪ achieve clearer skin with skyrizi. 3 out of 4 people achieved 90% clearer skin at 4 months. of those, nearly 9 out of 10 sustained it through 1 year. and skyrizi is 4 doses a year, after 2 starter doses. ♪ i see nothing in a different way it's my moment ♪ ♪ so i just gotta say... ♪ ♪ nothing is everything. ♪ skyrizi may increase your risk of infections and lower your ability to fight them. before treatment, your doctor should check you

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and finally tonight, nurses in missouri really got into the olympic spirit. holding a mini opening ceremony featuring the hospitals newborns and their parents. the handmade olympic outfits for the tiny babies representing various sports including swimming. notice the goggles and swim cap. weightlifting, tennis and of course basketball. the kids got to keep their outfits. and the parents got to be judges. there was at least one perfect 10. nurses even held their own opening ceremony, complete with torch relay. good for them. that's "nightline" for this evening. catch our full episodes on hulu. we'll see you right back here same time tomorrow. thanks for the company, america. good night.