Dr Dalton's warning is contained in an article published in the latest edition of the Medical Journal of Australia, days out from a spectator-free opening ceremony.

"It's crazy to say this is going to be COVID-safe," Dr Dalton told the Newcastle Herald.

"We have got these officials saying everything is fine ... it's a country that is not really getting on top of the standard COVID-19 situation, they are going to be unable to get on top of the Delta strain."

In the article Dr Dalton argues the International Olympics Committee's (IOC) "dogged insistence" that the Games should go ahead, regardless of external realities, should be concerning.

Japan is in its fourth COVID-19 wave and third state of emergency, with more than 3000 cases being reported daily since early June, with that likely to be an underestimate, he said. To date, they have had one COVID-19 test for every 11 people, compared to Australia which is averaging one test for every 1.5 people.

The risk to athletes was real, with inevitable contact between cleaners and transport providers, as well as testing, catering and security staff.

And the proposed athlete testing strategy involves that all 11,000 athletes gather daily at a dedicated testing area in the village.

"The logistics of this testing regimen, which is more than the typical daily test peak of 10,000 in Tokyo, and the opportunity for transmission within this single location must be considerable," he said.

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Many of the proposed infection control protocols appear half-hearted by Australian standards, he said.

There was also the question of whether sick Olympians, and Paralympians would be able to access care in an overwhelmed health system if issues relating to variants of concern arise in Japan, similar to what happened in India affecting Australian cricketers.

Dr Dalton acknowledged that there were obviously many dreams and careers hanging in the balance. But there should have been a "nuanced acknowledgement" of the factors that would trigger the cancellation of the Games, and at the minimum, a thorough review of risk mitigation strategies during the planning phase, he said.

In the article Dr Dalton also questioned the pre-testing process.

The IOC requires Games attendees to have two negative tests in the 96 hours before arriving in Tokyo.

But the only tests available to many athletes from "limited resource settings" where COVID-19 is ranging are rapid antigen tests, which are much less sensitive than polymerase chain reaction tests, he said.

And the official COVID-19 test certificate is a manually completed form downloaded from the internet with no evidence of participation in a laboratory quality assurance program. The name of the signing doctor is also not required.