TOKYO – The Tokyo Paralympics will begin Tuesday night following a one-year postponement due to the coronavirus pandemic, with unanswered questions over the safety of participants and the Japanese public during the world’s largest event for athletes with disabilities.

Tokyo will become the first city to host the Paralympics twice, having staged the 1964 edition. But this time, the games will be held under conditions that nobody had imagined before the virus took hold, with safety measures preventing fans from attending, as was the case during the Olympics.

About 4,400 athletes from about 160 countries will take center stage through Sept. 5 at venues without spectators in Tokyo and three nearby prefectures, all now reeling from record numbers of daily COVID-19 cases and under a state of emergency.

While the 17-day Tokyo Olympics ended without a major outbreak of infections among athletes and officials, some Paralympians may have a higher risk of suffering more serious symptoms due to their underlying health conditions.

Tokyo’s daily infection figures have been repeatedly over 5,000, which are roughly three times higher than those reported before the start of the Olympics on July 23.

Tokyo Gov. Yuriko Koike said last week the situation is a “disaster-level” emergency.

Japan’s medical system is under immense pressure, while the number of people recuperating at home has been rising at a fast pace amid a shortage of hospital beds.

Due to the impact of the pandemic, athletes from Samoa, Kiribati, Tonga and Vanuatu, were unable to travel to Japan, making the total participating nations and regions less than the record of 164 at the 2012 London Games.

Under the COVID-19 “playbook” that must be followed by athletes, they are required to be tested on a daily basis, in principle, and they must wear face masks and maintain social distancing including when they are in the athletes’ village.

The Tokyo Games organizing committee said it will strengthen its anti-virus measures to address the current situation.

As he did for the Olympics, Japanese Emperor Naruhito is expected to declare the opening at the National Stadium, with the 68,000-capacity main venue expected to have a sea of empty seats because only VIPs will be allowed to attend as a precaution against the spread of the virus.

The number of performers was largely reduced and the content of the ceremony was reviewed. Still, the opening event, to be held under the concept of “We have wings,” will see athletes parading into the stadium first by members of the refugee team.

The Paralympic flame, created by unifying flames lit across Japan and in Britain’s Stoke Mandeville, the birthplace of the games, will light the cauldron.

The Paralympics will consist of 539 medal events over 22 sports. Taekwondo and badminton have been added to the program for the first time, while other competitions include swimming, athletics, boccia and wheelchair tennis.

Organizers have hoped that the Tokyo Paralympics will contribute to building a more inclusive society that embraces people’s differences.

International Paralympic Committee chief Andrew Parsons has stressed that the games are the “most important” in their history, believing they will help the voices of people with disabilities to be heard as they have largely been “left behind” during the pandemic.

But the Paralympics have become mostly a TV-only event, after the Japanese organizers and the IPC decided earlier this month to stage them behind closed doors at all venues, except for students involved in a government-supported educational initiative.

Up to about 172,000 students, mainly from schools in Tokyo, plan to watch competitions at venues.