What Athletes Should do About Coronavirus COVID-19

By Jason Koop with Jim Rutberg,
Co-authors of “Training Essentials for Ultrarunning”

This week I will be jet hopping across the eastern seaboard as well as over in Europe to record a few podcasts and support athletes racing at Transgrancanaria. With the ongoing COVID-19 (formerly known as the Coronavirus) outbreak, I did not take this travel lightly. International travel has been touch and go and I have had several athletes with domestic and international travel who are rightfully concerned. Several sporting events have already been altered or cancelled, including the Tokyo Marathon, which paired down its event to elites only in an attempt to limit a mass gathering of people. Even the French have had to issue a warning advising citizens to forgo their customary greeting la bise (kisses on both cheeks) in an attempt to halt the spread of the virus. Sacré bleu!

COVID-19 will continue to affect athletic events in the US and abroad.  And many athletes are wondering if the races they are registered for are going to take place at all. There’s even been discussion around this summer’s Olympic Games being impacted. Furthermore, there’s a real chance that the virus could spread into our communities, impacting day to day life and your training.

So what should athletes do? Pack up and head home? Run on a sanitized treadmill or ride the indoor trainer for the next 9 months? Build a fortress, dig a moat, pull up the drawbridge and live off of canned beans and MREs for the next 12 months? I am not a doctor or epidemiologist, but from a coaching standpoint I have got some sane, rational and at times boring advice for you to stay healthy and sane during this outbreak.

Rule #1- (as always) don’t panic

Outbreaks like this tend to bring out the worst of our fears. It’s difficult to count how many cases there are, the future spread of the virus is unknown and tuning into more than a few minutes of the 24-hour cable news cycle will make you think the COVID-19 outbreak is going to be next level apocalyptic. Be careful about where you are getting your information. If you want reasonable, rational information about the virus and up to date advice on travel and precautions go to the World Health Organization or the Center for Disease Control. This is not a time for ‘news by Facebook’.

Also, I would be willing to bet the vast majority of people reading this article are not in one of the high risk categories, such as the elderly or people with compromised immune systems. This being the case, realize that if you do get sick, your job is to not infect other people who may be more vulnerable. Your life will likely be miserable for a period of time, and you should take the illness seriously, but recognize that it is likely more dangerous for others. Although we have already seen deaths in the US from COVID-19, consequences are unlikely to be that extreme among this readership.

If you have immediate travel, don’t be afraid

If you have an immediate travel planned (bear in mind this article is coming out March 3^rd) keep it, so long as it is not to one of the areas with widespread transmissions. There’s no need to cancel immediate plans for either domestic or international at this point. Keep an eye on the CDC’s Information for Travel page.

If you have travel in the future, plan cautiously

If you have races that you have to travel for on the calendar in the May-September months, do yourself a favor and look for refundable travel and accommodations, or hold off on booking flights and hotels until the outbreak plays out. Despite what you might hear from friends and family members, we don’t know quite yet what the impact of COVID-19 will be on races and travel. So, just like your pacing plan for your next 100 miler, be patient, don’t get ahead of the game and take it one mile (or day) at a time.

Look into travel insurance if you need to make flight and lodging reservations for the spring and summer. Read the policy information carefully, however, because not all travel insurance policies cover cancellations based on personal preference (e.g. concern about potential illness risk). You need a policy that will cover “I don’t want to go.” rather than just “I can’t go.”

Don’t forget to train

You’d be surprised how many runners are looking at this situation and saying ‘UTMB, Western States, Dirty Kanza, etc., are going to be cancelled anyway, so why should I even train?’ This is a fool’s guessing game and a surefire way to get caught behind the eight ball with your training. Train as if the race is going to happen. If it doesn’t, all you will have is better fitness and that is not a bad consolation prize. While it’s not quite the same thing, when the Camp Fire resulted in the cancellation of The North Face 50 Mile Championship in 2018, athletes parlayed their fitness into wins at other events.

So what can I do to prevent getting sick?

This is the best question to ask. The COVID-19 virus is just that, a virus. Meaning, protecting yourself from contracting the virus is similar to preventing yourself from getting sick from similar viruses. Fortunately, we have good blueprints for that from the common cold and flu.

(Author’s note- My colleague and co-author of Training Essentials for Ultrarunning, Jim Rutberg, has maintained a fantastic resource for athletes managing cold and flu season for the last several years. We adapted the advice that follows specifically for the COVID-19 outbreak.)

Take Standard Precautions 

What were the last 5 objects or surfaces you touched? When was the last time you touched your face or put something in your mouth? How long has it been since you washed your hands? See where we’re going with this? If you’re like a lot of people, you don’t spend a lot of time thinking about what you’re touching from moment to moment, but during cold and flu season these habits can make a big difference in your ability to stay healthy.

You have an immune system for a reason, and it generally works well. That said, COVID-19 will still attack your immune system, so a bit more vigilance is a good idea. As an athlete, training sessions can suppress your immune system, making you more susceptible to infection for a day after training or up to 3 days following harder, more stressful training sessions. Hard training blocks can have the same impact, even if the individual workouts are relatively short (1-2hrs each).

Here’s a list of day-to-day precautions you should take

• Wash your hands frequently, especially before eating. Regular soap and water work wonders.
• Use hand sanitizer if you can’t wash with soap and water.
• Minimize time spent in crowds, especially indoors and in small spaces. Be especially careful around gym equipment and group training classes.
• Try not to touch your face or put your fingers in your mouth or nose.
• Don’t share food or drinks with friends, and avoid communal foods (chips, dips, nuts, candy, etc.)
• Stay hydrated. Mucus membranes in the nose and throat don’t work as well when they’re dry, so staying hydrated helps your natural defenses work better.
• Sleep more! Even if you can add one more hour of sleep to your normal routine, the added recovery makes you less susceptible to infection.
• Reduce lifestyle stress. All stress (training, lifestyle, nutrition, etc.) takes a toll on immune function, so if you’re training hard make an extra effort to reduce stress in other areas.

Pro-level precautions

There’s an additional list of precautions we give elite athletes, especially during high-stress periods of training or in the final weeks leading up to an important event (like a once-a-year championships or once-every-four-years Olympic Games). If you have a major competition coming up, these might be worth incorporating in the final 14 days beforehand. Note, these are just cold/flu/COVID-19 precautions. There are additional recommendations for avoiding food-borne illnesses before major events.

• Don’t shake hands. If you need to physically greet someone, use a fist bump to restrict contact with another person to the backside of your hand. Or avoid contact.
• Always have your own pen. Whether it’s for autographs or signing a credit card receipt, at least you know where your pen has been.
• Carry your own flatware: Those disposable, packaged flatware sets from take-out restaurants are a great option.
• Drink bottled beverages you can open yourself, which can include a reusable bottle of your own. Drink straight from the bottle to minimize contact with reusable glassware.

What about nutrition?

Nutrition plays a role in protecting you from getting sick, but mostly from the standpoint of supporting your activity level so that you’re not energy deficient. Athletes who are proactively trying to lose weight can be at particular risk because they are often training hard and restricting calories, which can negatively impact immune system function.

How about supplementation?

A lot of athletes swear by Vitamin C. The science around consuming a large quantity (Emergen-C contains 1000mg ascorbic acid) of vitamin C has been debated since Linus Pauling first suggested it should be used to prevent and reduce the severity of the common cold. Review studies that aggregate the results of previous research indicate it might work, but that it’s more likely to work in children and populations under higher amounts of stress… like athletes in training!

Vitamin D has also been linked to immune function. A review study in 2018 found there’s no simple yes/no answer to whether Vitamin D levels affect a person’s risk of developing respiratory infections and the flu, or whether Vitamin D supplementation reduces the risk. They did conclude, however, that the available research does not exclude the possibility it is effective. Vitamin D is produced by the body from exposure to the sun. In winter, people spend less time outside and have less exposed skin when outside. Sunscreen use can further diminish the production of Vitamin D. This is not as much of a concern in the summer when overall sun exposure is higher, but may have a meaningful effect in the winter.

So, should you supplement with mega-doses of Vitamin C and Vitamin D? In principal (and for the reasons discussed below) I would rather athletes increase their intake of vitamin-rich foods. Consuming more foods rich in Vitamin C – including citrus, peppers, kiwi, strawberries, and dark green leafy vegetables like kale – also mean an increase in your fruit and vegetable intake. Vitamin D is primarily found in seafood, particularly salmon, sardines, cod liver oil, and oysters. Eggs and fortified dairy products are a good source for lacto-ovo vegetarians, and vegans can consume Vitamin D in fortified foods as well as mushrooms. A 2018 review study showed exposing mushrooms to UV-B radiation – including sunlight – can generate a nutritionally useful amount of Vitamin D. Some brands of store-bought mushrooms may also be irradiated to increase Vitamin D content.

But since we’re talking about supplements…

A word of caution

Supplements, over-the-counter cold and flu medications, and prescription medications for cold and flu may contain substances on the WADA Prohibited Substances List. USA Cycling, USA Triathlon, and other sports’ governing bodies are stepping up testing of amateur and age group athletes. This is a great step forward in the fight against doping, but for a lot of amateur athletes anti-doping regulations aren’t top-of-mind when buying herbal supplements, cold medication, or filling a doctor’s prescription. If you’re going to participate in competitions, even in ultrarunning where there is no common set of rules and regulations and even if you’re not subject to doping control, you should be following both the spirit and the letter of the rules. The safest route is not to take any supplements (they are unregulated, may be contaminated, and may not contain what is listed on the label), consult the USADA Athlete Guide, and check any medication you plan on taking – even the ingredients in over-the-counter cold and flu medications – against the prohibited list and the Global DRO (drug reference online). If you really want to take supplements, consult USADA’s Supplement 411 resources and consider supplements that are NSF Certified for Sport®.

If you do get sick

In light of the warnings above, the best things an athlete can do to combat the common cold and COVID-19 are get more rest, stay well hydrated, avoid contact with other people, and wait it out. In light of the COVID-19 outbreak, the CDC recommends calling ahead before going to see your doctor or hospital. If you have a fever or are ill enough to consider taking cold medication, rest is going to do you more good than training. Return to light training once you’re asymptomatic for at least a full day, and in the days following that don’t try to make up for lost time by piling on extra training volume or intensity. Too much workload too soon after an illness puts stress on an already overworked immune system and you’re more likely to get sick again.