In March 2020, Dr Niall Elliott was planning the Summer Olympics with his colleagues from the British Olympic Association. Plans have been made on what to do if an athlete suffers a catastrophic injury or mental health crisis in the final run-up to the Games. There have been meetings about how to move some of the world’s best athletes around the world and how to resolve logistical issues.
They had plans in place for almost everything except a global pandemic, he said.
Overnight, Dr. Elliott began providing support and care to athletes who were locked out of training facilities and fearful of how this new virus might affect their athletic careers. The questions were endless and the answers few.
“We were very cautious at first because this was a new virus,” Dr Elliott said. “We just didn’t know what the impact on the body would be.”
The pressing question for athletes: How long will Covid-19 knock you out and when can you get back to training?
Olympians and weekend warriors have been asking that question ever since. And the answer continues to change as doctors learn more about the coronavirus and its variants wreak havoc on training programs.
The key is to reset expectations and rethink a timeline for a full return to play or a return to racing.
“Compared to most viral illnesses, athletes should expect it to take them on average twice as long to get back to where they were,” said Dr. Tod Olin, Director of Exercise and Performance National Jewish Health’s Breathing Center in Denver, said. “So if someone is usually back to work within a week of having seasonal flu, it can take two weeks to come back after having had Covid-19. But it also took three to four weeks for many people, and a fraction of people take much longer.
It’s a tough pill to swallow for athletes looking to come back to themselves as soon as symptoms subside. And it’s not easy to tell runners to slow down when many of their goals are to speed up.
In June 2020, Dr. Elliott published a protocol which has evolved and been adopted by other doctors as more data has become available on the virus and how it affects athletes. The initial protocol indicated a gradual return to play in six stages, beginning with a minimum rest period of 10 days and progressing to increased frequency, duration and intensity of training sessions.
Over the next two years, doctors distinguished how to direct athletes based on symptoms above the neck and symptoms below the neck. Patients with symptoms above the neck tend to recover faster and are able to return to athletics more quickly than those with symptoms below the neck who may experience fatigue, aches, pains and problems pulmonary or cardiac.
This distinction – along with patients who test positive but remain asymptomatic – helped Dr. Elliott adjust his orientation to a five-step protocol, the one that best serves athletes looking to return to training. Patients can now progress through different stages of the protocol depending on their symptoms and severity.
And in the year of post-vaccination data, doctors have found that increasing the pace or intensity of workouts can backfire significantly.
“They’re used to solving all the problems by trying harder,” said Dr. Olin, who has worked extensively with Olympic athletes. “And Covid-19 is apparently unique if you push too hard – if you train through this – there is this setback phenomenon, which is analogous to a hamstring injury, where if you improve a little bit and then you try to drop the hammer for a practice session and you’re three months behind.
I should know, it happened to me. I tested positive for Covid-19 in early May and started getting back to my running routine, albeit at a slower pace, with no real training, soon after. To my surprise, I tested positive for Covid-19 again four and a half weeks later. (Yes, really, it’s very possible.) If I was eager to start running again the first time, I was bouncing off the walls the second. This week I thought I had recovered enough to do a low speed workout. But when I hit that first interval, it’s like my body is laughing at me, “No.”
I learned that getting to the start line of a race, or the playing field, shouldn’t be a race at all.
But athletes, and arguably runners in particular, have a particular impatience when it comes to re-lacing their shoes. When we asked Running Newsletter readers to share their stories of getting back to running after Covid-19, hundreds shared their continued frustration and small victories. Many shared a sense of gratitude for their return to racing, and countless expressed dismay that their recovery was still ongoing.
Aquene Kimmel, a 26-year-old runner, said her first run after testing positive for Covid-19 last December was “a slow jog that felt tougher than it had in years”. The hills are even harder for her than she remembers, and her pace hasn’t quite returned to what it was, she said.
Dave Madigan, 52, had Covid in March, and despite returning to slow running, he said he found the effort harder than it should be. “My VO2 max isn’t much different from what I would expect, but I feel really exhausted,” Madigan wrote, referring to oxygen consumption, a way to measure aerobic fitness. “I tried some short intervals, but they were much harder than normal.”
It took a few months for Jenna Ciongoli, 38, not to feel so out of breath. “Even now, seven months later, as I’m back to running as much as I used to, I still don’t feel as fast as I used to,” she wrote.
As a pulmonologist in the still-busy city of Denver, National Jewish Health’s Dr. Vamsi Guntur is used to these responses and has begun talking to athletes about readjusting their expectations.
“What we consider recovery versus what athletes consider recovery is different,” Dr. Guntur said.
“A very early Olympian, before the vaccine, said, ‘I’m just used to pushing myself. I want to push myself,” she recalls. “I said, ‘I know you can, but I don’t want you to. “”
It’s a sentiment doctors and experts share even more widely after vaccines, warning of regression if athletes return to high-intensity training or racing before their bodies are ready.
“You will always have another competition, another race, another training session,” repeated Dr. Elliott.
“But you only have one body,” he added. “We have to deal with it.”