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COVID-19: A Trail Running and Ultrarunning Community Guide

Working from home or a lost job altogether, extended school cancellations, large-event cancellations months into the future, no non-essential travel allowed, significant illness among our loved ones, and so much more: the COVID-19 pandemic has affected nearly every part of everyone’s life.

Not only have the lives of us runners been upended, but so has our running. At this point, races have basically been canceled or postponed globally through the end of June, with even the 2020 Summer Olympics which were scheduled for August off the calendar for now. Run training and social gatherings have been suspended. And in most places around the world there are government restrictions and recommendations on how we can exercise.

What we know about COVID-19 and how each of us should modify our behavior to decrease the risk of its spread changes on the daily. We all still need to know the answers to these crucial questions:

  • What is COVID-19 and how does it ‘work?’
  • What is our personal risk of illness from it?
  • What is our responsibility to the wider community in helping to prevent others from getting sick?

We continue to update this article with answers to these questions using the scientific community’s current knowledge.

[Editor’s Note: This article was originally published on Saturday, March 14, and last updated on Wednesday, April 15.]

What is COVID-19?

COVID-19 comes from a large family of viruses known as coronaviruses. They get their name ‘corona’ because of the crown-like spikes on their surface. Coronaviruses cause a range of respiratory illnesses from the common cold, to much more severe diseases such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) (5). Given that coronaviruses cause serious respiratory diseases, organizations like the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) monitor populations for unusual disease clusters. With COVID-19, an aggregate of viral pneumonia cases was linked to an animal market in Wuhan, China and determined to be a novel coronavirus (one not circulating in humans prior to this outbreak). What started in one market in China has quickly spread globally. This is called a spillover event and happens when the virus moves from its animal host into the human population. According to Johns Hopkins University’s COVID-19 live tracker, as of Wednesday, April 15, over 2 million cases are confirmed in 185 countries and regions.

Why Is COVID-19 Giving Us the ‘Run Around?’

COVID-19 is a serious illness. To help us understand this, we look at available data on how contagious it is, how easy it is to transmit, and the severity of its symptoms. We also compare these data to that of the seasonal flu, another virus we all know well.

COVID-19 Is Highly Contagious.

Every infectious disease has something called the R0, pronounced ‘R naught,’ which is the mathematical term indicating how contagious it is. Since the infection literally reproduces itself as it spreads to new people, sometimes this is referred to as its reproduction number. The R0 tells us the average number of people who are likely to catch a disease from one infected individual, and it varies among specific populations based on interventions taken against it. Generally speaking, if R0 falls below 1, the disease will naturally die out in the population (7).

The current R0 of COVID-19 outside of China is between 2.2 and 2.7, meaning that every infected person will likely infect 2 to 3 additional people. However, without interventions (social-distancing measures and more), the R0 is estimated to be closer to 5.7 which might explain its rapid initial spread (14). For comparison, the average R0 of the seasonal flu is 1.3 (6).

Importantly, R0 is not a set-in-stone number, and it changes over the course of a disease’s spread. For example, the R0 for COVID-19 in China is approaching 1. They’ve managed this via enormous interventions including enforced social distancing and developing testing that allowed for more than a million people to be tested each week (6). One of the best examples of a rapid and effective response is Singapore which now has a COVID-19 R0 of 0.3 largely due to their radical transparency, rapid testing, strict social distancing, and effective quarantines (6, 8).

COVID-19 Is Easy to Transmit.

One of the reasons COVID-19 is spreading so rapidly is at least partially due to the fact that you (yes, you, right now) might be carrying and actively shedding (releasing active viral particles/droplets) and not even know it (1). Most people who are infected with COVID-19 will develop symptoms 5 to 12 days after becoming infected. However, peak virus shedding happens early in COVID-19 (2 to 5 days post-infection). This means you could be actively contagious for up to 10 days before showing symptoms (1, 9). In contrast, you will show symptoms of the seasonal flu 1 to 4 days post-infection and become contagious 24 hours before your symptoms appear.

COVID-19 Causes Serious Symptoms.

There is still much that is unknown when it comes to COVID-19, some of which will not become clear until we’ve come out the other side (due to under testing, asymptomatic-but-infected individuals, and more), and this includes the virus’s ultimate mortality rate. What we know so far is that COVID-19 has very serious symptoms. The current rate of hospitalization for COVID-19 patients in China and Italy is 10 to 15% (13). There are university reports that this could be higher in the 65-and-older population, with 20 to 24% of this demographic’s COVID-19-positive patients requiring hospitalization. Again, these numbers will become more clear when this is all over due to limitations in testing. For comparison, the CDC estimates that in an average year, 1.0 to 1.8% of seasonal-flu-positive patients require hospitalization. And the hospitalization rate for the ongoing 2019-2020 flu season is estimated at 1.0 to 1.3% (12).

How Is COVID-19 Transmitted?

The coronaviruses, including COVID-19, are spread from person to person via respiratory-droplet transmission. Every time an infected individual coughs, sneezes, yells, or even breathes, they release infected droplets into the environment up to about 6 feet away–and possibly even further. This distance of 6 feet comes from standard medical precautions for any disease spread via droplets, including the common cold and other coronaviruses. We are learning that droplets may travel further than 6 feet in some situations, and so we should consider this to be truly a minimum precaution. Additionally, COVID-19 viral particles can live on some surfaces for up to 3 days (11), so even if you were not in the direct line of fire from a cough or sneeze, you can still pick up infected droplets from other surfaces they have landed upon and transport them to your face (eyes, nose, or mouth) via your hands. We should also keep in mind that a lot of virology still needs to be done (and is actively being done) to determine how virulent COVID-19 is. Virulence refers to how many viral particles are needed to get someone sick. For example, measles is highly virulent and requires a very low number of particles to infect someone, whereas the common cold or flu requires more viral particles to sufficiently infect an individual.

How COVID-19 is transmitted. Image: Otter, Jon. “Surface Contamination and Respiratory Viruses with Pandemic Potential (SARS, MERS and Influenza): an Underestimated Reservoir?” Reflections on Infection Prevention and Control, 16 Dec. 2015, reflectionsipc.com/2015/12/16/surface-contamination-and-respiratory-viruses-with-pandemic-potential-sars-mers-and-influenza-an-underestimated-reservoir/.

A comparison of COVID-19, common-cold, and seasonal-flu symptoms. Image: Baggaley, K. (2020, March 11). COVID-19 symptoms typically appear 5 days after infection. Retrieved from https://www.popsci.com/story/health/coronavirus-incubation-period-time-symptoms/

Why Should Each of Us Take Action in the COVID-19 Pandemic?

For as much panic as I’ve witnessed over the past couple months, I’ve also witnessed an equal amount of ambivalence. How much danger is each of us actually in? What it looks like right now is that if you are under the age of 50 and do not have other risk factors such as a history of smoking, a compromised immune system, cardiovascular disease, or any other chronic illness, you are much less likely to require hospitalization or intensive care (2, 6). What this means is that if you become infected, you will likely only experience mild symptoms (as in about 80% of the cases in China) or even be asymptomatic–the latter a problem all its own as we’ve explained. Symptoms can range from being down with a bad cold to “getting hit by a truck,” as was described to me by a friend. The big difference between riding this out at home versus requiring medical care has been coming down to people experiencing shortness of breath and low oxygen saturation (how well oxygenated your blood is).

There are also a lot of people reading this who are older than 50 or who have health conditions. And we all know and spend time with people who are and do. These are the people who are most vulnerable to becoming severely ill as a result of COVID-19. Thus, how each of us individually and how our whole community responds matters. I urge you to not panic, but I also urge you to take pause and reflect on how you can help the vulnerable of all our communities. Piggybacking off our climate-change conversations, I’ve been asking myself, How can I limit my COVID-19 ‘footprint?’

Because me paraphrasing will not adequately do it justice, I’ll quote Zeynep Tufekci (3) in Scientific American, “Preparing for the almost inevitable global spread of this virus… is one of the most pro-social, altruistic things you can do. We should prepare, not because we may feel personally at risk but so that we can help lessen the risk for everyone. We should prepare not because we are facing a doomsday scenario out of our control, but because we can alter every aspect of this risk we face as a society. That’s right, you should prepare because your neighbors need you to prepare–especially your elderly neighbors, your neighbors who work at hospitals, your neighbors with chronic illnesses, and your neighbors who may not have the means or the time to prepare because of lack of resources or time.”

What ‘flattening the curve’ means. Image: FlattenTheCurve.com. (2020, March 9). FlattenTheCurve: COVID19 Update & Guidance to Limit Spread. Retrieved from https://www.flattenthecurve.com/

What we need to do is to interfere with the natural flow of the COVID-19 outbreak by slowing its spread (4). This is what the scientific community calls ‘flattening the curve’ or reducing the number of active cases at any given time.

This is important because it not only decreases the overall number of people who become ill, but it can also prevent our health-care systems from being overwhelmed. Simple math tells us that no community’s health-care system is large enough to support COVID-19’s natural spread. Left to its own progression, it will create many more seriously sick people than can be properly cared for. Flattening the curve puts fewer people into the health-care system at one time, and helps allow everyone to get care that matches their illness’s severity. This will avoid unnecessary deaths.

I feel fortunate to live in California, a U.S. state that has acted aggressively and quickly to mandate social-distancing and sheltering-in-place orders. As of April 15 and despite the state having high population density in many places, the orders have been seemingly effective in flattening the curve in the San Francisco Bay Area counties.

Social Distancing Is Everyone’s Responsibility.

There is hope! We have tools that each of us can employ to help prevent COVID-19’s spread. From both past pandemics and watching countries react well and poorly to the COVID-19 pandemic, we know that social distancing is perhaps the most effective tool available to us.

Simply put, social distancing is intentionally staying away from other people in order to avoid catching and spreading a virus. This means maintaining enough distance between yourself and other people (a minimum of 6 feet) as well as limiting large, close gatherings of people. Examples of the latter include concerts, school, large offices (hello working from home!), conferences, meetings, busy restaurants and stores, and, yes, even running events. While it is thought that there is likely more risk in being inside with large groups than outside, social-distancing practices include limiting large numbers of people anywhere.

As of April 7, all but 5 U.S. states have issued shelter-in-place or safer-at-home instructions, which accounts for 95% of the U.S. population (15). The current instructions generally state that residents can leave for essential work, errands (grocery shopping and medical appointments), and exercise. The mandates are different in every state and city but have widely tried to enforce social distancing without going into more aggressive lockdowns like in many Asian and several European countries. Some states have gone further to shut down public land, closing trailheads and wild spaces, to limit both congregating and the need for remote emergency rescues stressing potentially overtaxed healthcare systems.

Large-group events, including races, are currently not permitted. On Sunday, March 15, the CDC recommended that for 8 weeks, large groups be limited to under 50 people. On the same day, Ultra-Endurance Sports Science & Medicine, a non-profit group of sports researchers and physicians, recommended that endurance sports limit large groups to under 50 people through June 15 or for 3 months, with a reassessment for extending the time period on May 15. They further recommend that if an event with under 50 people is still held during this time, participant use of public transport to the event is discouraged. On Monday, March 16, the U.S. White House recommended gathering no more than 10 people together and to practice strict social distancing in doing so.

How your actions during the COVID-19 pandemic can affect your community. Image: FlattenTheCurve.com. (2020, March 9). FlattenTheCurve: COVID19 Update & Guidance to Limit Spread. Retrieved from https://www.flattenthecurve.com/

But We’re Trail Runners and Ultrarunners!

There’s been a lot of talk about canceled and postponed races and events. There have also been plenty of jokes to the effect of, “I got into running for the social distancing!” or “Trail runners won’t get COVID-19 because no one else is out in the woods at 6 a.m.” While there is some validity to both those statements, in jest or not, do you as a trail runner need to be worried? Are these race directors crazy? Should I stop putting my hand directly into the food bowls at the aid station?

Immunologist and ultrarunner Eric Lee confirms that trail running is generally safe–we’re outside and usually away from large crowds (check, check). But he also confirms that ultrarunners aren’t exactly known for their excellent hygiene. What he means is that in a trail/ultramarathon race setting, hygiene (even outside of a pandemic) is less than ideal. Even though we are not running in the same density of people as you would in a metropolitan road race, we are given ample opportunity to unknowingly spread disease. Explains Lee, “During races, we share common food dishes, fill our water bottles from the same containers, have direct contact with many people, and share plenty of hugs and high fives.”

Also, is there inherent risk to running or racing long distances during a pandemic? While it’s true that hard training and racing causes short-term immune-system suppression, that depression is short lived and your immune system bounces back quickly. What that means, says Lee, is that there is a short window (post-exhaustive training/racing) where you are theoretically more susceptible to infection, but your immune system is robust and dynamic, and will quickly right the ship.

Yes, runners, you may keep running so long as you keep your social distance by running alone or with only one member of your household! (There are a few places in the world where running in public is currently not permitted due to quarantine rules. Please follow your local regulations.) However, the canceling and postponement of races are in the best interest of our broader community. Social distancing and limiting large numbers of people gathering, be it in shuttles to the race start or at the finish-line after party, have still been shown to be one of the most effective ways of slowing the spread of viruses like COVID-19. Plus there is the now-well-known risk of COVID-19 infection via travel (which we will talk about shortly), which racing often requires.

What Else Can We Do to Flatten the COVID-19 Infection Curve?

Here are more actions we can all take to help reduce the spread of COVID-19.

Choose Running Routes Wisely.

Please follow your local, state, and federal guidelines when it comes to getting outside responsibly. These guidelines will continue to change daily, and what might have been okay a week ago might not be okay today or tomorrow. If your trails are still open, I encourage you to go during off-peak hours, run alone, and avoid narrow trails where it’s hard to give yourself and others space. This is additionally a time to pick safe routes and to be aware of remoteness, terrain conditions, and more. They’re called accidents for a reason.

Wear Masks and Face-Coverings Responsibly.

On April 4, the CDC recommended using masks or face-coverings in public settings where social distancing is difficult to maintain. So how and when should we use masks?

First and foremost, reserve sterile (not yet opened) N95 and surgical masks for people with high exposure rates (think healthcare workers, first responders, and other essential workers including the folks working at your local grocery store). It turns out that cloth masks are fairly effective at limiting the emission of viral particles by up to 30% if you were to sneeze or cough while wearing one (16, 17). It’s not perfect, but it is a big reduction, particularly if you remember we are wearing masks to protect those around us while in close spaces.

Now, do you need to wear a mask while exercising? If you are running alone and practicing social distancing, it’s likely unnecessary. Plus, once a cloth mask gets wet (as you breathe through it, and this happens fairly quickly), it is no longer an effective barrier for respiratory particles. Another point for social distancing! However, having a covering like a buff or bandana that you wear around your neck, keep mostly dry there, and pull up temporarily as you pass other people may be the most practical, effective, and polite way we runners can currently use masks.

In general, getting into the habit of wearing a mask in public spaces is a good idea. Remember that you still need to wash your hands and practice good hygiene. This includes putting the mask on before entering a public space and refraining from adjusting the mask once it’s on. Once you are back home or in a safe space, remove your mask and sanitize your hands again.

Join the Hand-Washing Revolution.

Let’s continue to practice good hygiene. As a reminder, the CDC recommends that you wash your hands before, during, and after preparing food; before eating; before and after caring for someone who is sick; before and after treating a wound; after using the toilet; after changing diapers; after blowing your nose, coughing, or sneezing; after touching an animal, animal feed, or animal waste; and after touching garbage. Additionally, wash your hands with soap and warm water for more than 20 seconds, or the time it takes to sing “Happy Birthday” twice, or if you are feeling spicy the choruses of “Truth Hurts” by Lizzo or “Raspberry Beret” by Prince. Use hand sanitizer when you’re unable to wash your hands regularly.

Stop Touching Your Face.

The most common way a virus enters your body is through your eyes, nose, and mouth, so stop touching things that may have respiratory droplets on them and then touching your mustache, or picking your nose, or whatever else you are doing around there. If I’ve learned anything in the past two weeks, it’s that I touch my face, a lot. I’m working on this one.

Limit Touching Other People and Surfaces.

Stop shaking hands. My new personal favorite is the foot-five, but I’d take a princess wave, a bow, or a curtsey. Work on your elbow dexterity for pushing open doors, utilize those sleeves, and keep your fingertips away from light switches.

Clean Frequently Touched Surfaces.

Focus on surfaces both at work and home. Disinfect screens (like your phone!), counters, door knobs and handles, and light switches. This should also include cleaning yourself once you arrive home.

Stay Home If You Are Sick.

If you are sick, stay home. If you are sick enough to seek medical care, follow local protocol during these pandemic conditions. This may mean calling your primary-care provider or perhaps a hotline set up for your region. Limit your risk of infecting others by responsibly isolating yourself while contagious. And this should go without saying, but if you have come into contact with someone who has tested positive for COVID-19, self-quarantine for 14 days while monitoring for symptoms.

Don’t Travel Unless It’s Essential.

Travel is a significant part of how COVID-19 has so quickly spread worldwide. Given current shelter-in-place mandates, almost no travel is happening right now. As we begin to come out of peak infection rates in the coming weeks, this recommendation will likely remain important.

Be Kind, Calm, and Pliable.

Make plans to help out older family and community members, and anyone who is vulnerable. If your race has been canceled, consider donating your race-entry fee to the race director to help ease the financial burden of their last-minute cancelation. Do what you can to support the people in your community whose livelihoods are most heavily impacted by this process.

Remember to be kind to yourself and others in these tumultuous times. Stress is an immunosuppressant (10), which is why I am here yelling, “I’m trying so hard to relax right now!”

This situation is rapidly changing. As scientists learn more, recommendations may change and perhaps become more restrictive. Listen to the experts.

It’s About More Than You.

This is bigger than you; it’s bigger than any of us. We need to normalize this being ‘everybody’s problem.’ This means following local, state, national, and international guidance. Many of us runners are at low risk of getting very sick from COVID-19, but we are surrounded by people who are not. Our actions affect everyone.

A Message from Italian Trail Runner Martina Valmassoi

On March 14, Trail runner Martina Valmassoi shared what life is now like in her hometown in the Veneto region of Italy due to the COVID-19 pandemic, the country’s major loss of life and health, and government quarantines to try and slow its spread:

“More or less, here’s what has happened. This time last weekend, I was traveling to a ski-mountaineering race in Trento two hours away. At that time, we were talking about the virus and understanding that they have to prevent the spread, but none of us really understood what was going on for real. Two days later, I was ‘locked’ inside my house.

“Last Sunday, something changed. They stopped calling COVID-19 a stronger flu. We finally realized that lots of people and not just elderly people were dying for real. We [finally understood] that the request of isolation was necessary to protect the weakest. Once you understand that with the contact of other people you might infect your grandparents or parents, you definitely change your behavior. The biggest problem here besides the virus itself is the capacity of the hospitals and the number of [ventilators.] It’s super scary.

“Imagine this scenario. You go out you meet someone you don’t know is infected. You go home. You infect your parents. They visit grandma to bring her food. All now are infected. At some point, we all need to go to intensive therapy [at the hospital] because we couldn’t breathe without. There are not enough hospital places, so they give priority to the one with more chances to live. You get the spot. Your parents and grandma are dying because you didn’t stay home.

“Yes, we are staying inside as much as possible. I live in a mountain town in [the region of] Veneto, with not much people so for us it’s not as hard as it could be in the city. Also, we don’t have any contagious problem yet [in my town], but this can change at any minute. Cafes are closed, restaurants too. Supermarkets and pharmacies are still open but you have to respect the safety distance [between each person]. We can’t drive outside our village, so we must get groceries in our village. Most of the factories have closed, but a few people are still working. You can go out to walk the dog and ‘for health,’ but always close to your house and not for long. Skiing, climbing, and running are not accepted because they might be dangerous and they don’t want to rescue people. Right now, we should be isolated until the third of April, but we don’t know if this will change and we are actually fearing it. Not everyone is being respectful and responsible. Right now the most affected region is the Lombardia with Bergamo with the most cases. My region has a bronze medal [because we have fewer infections] for now. We will see.”

A Message from American Ultrarunner and Emergency-Room Nurse Scott Brockmeier

On March 19, American ultrarunner and emergency-room nurse Scott Brockmeier shares his thoughts on how the hospital at which he works in Moab, Utah has prepared for COVID-19 and what could happen if the virus moved unchecked through his rural community:

“Here’s my front-line perspective as a med-surg nurse at Moab Regional Hospital (MRH), a small, rural-access hospital in southeast Utah. My 10-plus-year nursing experience has been almost exclusively working in intensive care, but I took a position here in Moab after several years of travel nursing. It’s been a big change for me but I have to give a huge shout out to the administration at MRH. They have been proactive, excellent at communicating with and taking input from the staff, they were one of the first in the state I believe that had a triage tent set up outside the emergency department, and just in general very supportive. There are constant policy changes and it can be confusing and unnerving when it doesn’t seem like anyone knows what is going on but this is an evolving novel virus that does not act like many other viruses and this same kind of changing messaging is happening at the national level. I have 100% faith that the administration is doing the very best that they can and taking care of the staff in the very best way that they can. So, a huge shout out to everyone at the hospital for all their hard work.

“So far at MRH there has not been a confirmed case of COVID-19 and while we’ve been more or less busy it has mostly been the usual patient population though we have had a number of patients that we put on isolation while they were tested. All have been cleared. But I believe that this is the calm before the storm. I do hold out hope that with the county being shut down yesterday (bars and restaurants closed except curbside, hotels not able to hire rooms for non-essential reasons, and all public lands closed to non-resident camping) and our geographical isolation will let us escape our hospital being totally overwhelmed. But that is not a strong hope. I’ve been thinking about what it will be like when people start getting sick and requiring hospital care. We only have 17 med-surg beds, 3 ventilators, and 2 to 3 biPAP machines, so it won’t take much to fill us up. Many patients get shipped out who are gravely injured or critically ill because we are not set up to do many things that larger facilities can do. If this region is hit hard and all of the intensive-care beds fill, then we will not be able to ship them out and will just have to do the best we can with what we have. One of the things I dread most about this coming storm is having to ease the dying of those who need a ventilator but cannot get one. I’ve seen people die by slow suffocation from end-stage chronic obstructive pulmonary disease (COPD) and it is awful. I hope that can be avoided.

“As the author says, this virus is extremely contagious due to the fact that it can hang in the air for hours and on surfaces for days. Having the entire unit full of these patients will make keeping things and ourselves perfectly clean nearly impossible. Add to that the rationing of personal-protective equipment which can only increase the chance of cross-contamination of patients and staff because they need to be reused and are difficult if not impossible to clean. CDC and WHO recommend airborne isolation and gowns for any procedures done on COVID-19-positive patients that produce aerosols. I don’t know if nebulized breathing treatments will help patients with this disease but if they do then not very many patients will be able to follow guidelines because part of airborne isolation is to have the patient in a negative-pressure room and we only have two at MRH. Gowns could also be a problem as they are one-time use. I do remember my manager saying something about reusable/washable gowns, but I’m not sure how that would work. We are also rationing N-95 masks which are meant to be disposable though recommendations say that they can be worn for multiple hours safely. It’s possible that cross-contamination may end up not being something that we worry about if everyone has the same bug. Other factors that will make keeping the unit clean difficult is that we will be full, we will be short staffed with many out sick, and some of these patients may be critically ill without a critical-care bed to send them to. All this makes me think that I need to resign myself to being exposed and we are going to have to figure out how to deal with staff shortages perhaps by having people who are infected but not too ill working. I’ve seen talk of other hospitals taking certain floors and staffing them with dedicated COVID staff and only COVID patients. At MRH we only have one floor/unit, so will it become a locked-down quarantine ward? I don’t know. I don’t know how any of this is going to go down and that may be the most stressful thing right now… the uncertainty.”

Stories of Trail Runners Who Are COVID-19 Positive

On April 15, I spoke with two trail runners who tested positive for and have recovered from COVID-19.

Jon Frias is a 28-year-old runner from New Jersey who became ill in mid-March. This was before the U.S. East Coast shuttered at home, and Jon’s family had a small get-together for his father’s 70th birthday. Within a week, several family members–all young people–were sick. Jon’s symptoms came on suddenly. He can clearly remember being at a grocery store and thinking, I need to get home. I feel really terrible. He had a fever of 101 degrees Fahrenheit.

Jon quickly isolated himself from his parents, with whom he lives. Next, he contacted his primary-care provider, which had COVID-19 tests available. For 4 days, Jon says his fever ranged from 101 to 104 degrees, that he could barely get off the couch, and that he’d never been as sick before. He gradually improved and received his positive test result on day 10.

Being a young, hungry runner who was feeling better, he attempted a short run–he lives in a rural area so could be totally distanced in doing so–but his primary-care provider and coach reined him in. Jon agreed to not run for the rest of the month, which would be 3 weeks off. Jon returned to running on April 1, with short runs focusing on easy movement. Returning to running slowly has been hard with his driven mentality. He states, “It’s hard to turn back” [toward home], but after 2 weeks of easy movement, his running is in a gradual progression back toward normal.

Tracy Douglas is a 35-year-old runner from Colorado who also fell ill in mid-March. She works as a veterinarian in a busy clinic and some other staff were also becoming ill. The clinic acted quickly to protect their clients by keeping sick staff home, enforcing social distancing, and not allowing pet owners into the building. She went into quarantine at home with her fiance, and they notified the neighbors they had seen recently that they were sick. Tracy has asthma, a worrisome underlying condition.

Tracy immediately called her primary-care provider. She had a fever, but they pushed her off because she was young and at lower risk. She had to fight to get tested, and was finally able to when they agreed to test one person from their vet clinic. Tracy had the most predictable COVID-19 symptoms, so they gave her the test. Because of a testing backlog, she waited 7 days for her positive result.

After 6 days from the initial onset of symptoms, Tracy began to feel better, so much so that she thought she was coming out of it. Then on day 7 she crashed. This seems to be a classic pattern in COVID-19 patients where they turn the corner only to get worse again. For 4 days, Tracy was bedridden with a fever and shortness of breath. She called her doctor to figure out if she needed to go into the hospital. Like Jon, she had been sick before, but never like this.

Her doctor was concerned and said to go to the hospital if her symptoms got any worse. Being a “nerdy altitude runner,” Tracy was able to ride out her symptoms at home and monitor her oxygen saturation with a consumer monitor. Tracy’s fever broke, and she started to feel a little better, a day at a time. When I spoke to her 3 weeks after the end of her symptoms, she said she was feeling “pretty normal, but was still being conservative.” 

I asked Tracy about her main takeaways. She thanked her neighbors for leaving meals on their doorstep and getting to see the good in humanity. She said, “For those runners who find themselves with the dreaded COVID-19 and even for those with the quarantine blues, know that in your deepest, darkest moments, there is light at the end of the tunnel. You will run again with clear lungs. You will find flow again.”

Both Jon and Tracy did incredible jobs of adjusting quickly when they realized they were sick to protect those around them. They were cared for by their communities near and far. And they are both being patient while being hungry to get back to doing what they love, running.

News and Updates

In this section, we summarize significant updates to relevant-to-runners recommendations by governments and organizations. We’ve also made in-text updates to this article that reflect them.

  • Sunday, March 15 – The Centers for Disease Control and Prevention (CDC) have issued new nationwide guidance for large events and mass gatherings; this includes sporting events, conferences, festivals, and even weddings. The CDC is asking organizers and individuals to cancel or postpone any event of 50 people or more for the next 8 weeks (or about May 10). This new guidance is considered interim and subject to change as we learn more about COVID-19. Some of these precautions might feel over the top, and the goal of this guidance is not to keep things like schools or businesses closed indefinitely, but rather is geared toward events specifically. This is because events involve traveling and mingling between different family groups and communities and that is a considerable risk factor for spreading COVID-19. What does this mean for us, the running community? This is not a mandate (although there are state mandates that will continue to change and evolve), but it is something that race directors, running stores, groups runs, fat asses, and unofficial runs should be considering.
  • Sunday, March 15 – Ultra-Endurance Sports Science & Medicine, a non-profit group of sports researchers and physicians, published an open letter to the endurance-sports community with its recommendations. To quote, “We now recommend that all organized endurance sporting events (group training, meetings, races, etc.) of more than 50 people (including organizers, athletes, spectators, volunteers, etc.) scheduled to occur before 15 June 2020, be immediately canceled or postponed. This is consistent with guidance released earlier today by the Centers for Disease Control and Prevention (CDC, 2020), except that we are recommending that events be canceled or postponed that are in the next 3 months rather than the next 2 months. If by 15 May 2020, the pandemic continues to grow, then an additional month of cancellation is warranted. Further cancellations should be considered on a rolling monthly basis with a two-month window depending on the current control of the pandemic. If the event involves fewer than 50 people and will still be held, participation by those using public transportation should be discouraged.”
  • Monday, March 16 – Today, the U.S. White House recommended gathering no more than 10 people together and to practice strict social distancing in doing so.
  • Saturday, April 4 – The Centers for Disease Control and Prevention (CDC) have now recommended mask and face-covering use in public.

Call for Comments (from Meghan)

This is a sensitive topic. We welcome you to constructively talk with each other in the comments section of this article, but please do so according to iRunFar’s comment policy. We additionally ask you to focus your comments on public health rather than politics. Comments not adhering to these requests are subject to redaction or removal. Thank you.

  • Would you like to share a story about the COVID-19 pandemic in your local community and actions that are being taken to reduce its spread?
  • If you are in a country where social-distancing and/or quarantine measures have been recommended or regulated, can you share how the experience is going?

[Editor’s Note: Thank you to Olivia Rissland and Eric Lee for advising in the development of this article.]

Resources

References

  1. Branswell, H. (2020, March 9). People ‘shed’ coronavirus early, but most likely not infectious after recovery. Retrieved from https://www.statnews.com/2020/03/09/people-shed-high-levels-of-coronavirus-study-finds-but-most-are-likely-not-infectious-after-recovery-begins/
  2. Riou, J., Hauser, A., Counotte, M. J., & Althaus, C. L. (2020). Adjusted age-specific case fatality ratio during the COVID-19 epidemic in Hubei, China, January and February 2020. doi: 10.1101/2020.03.04.20031104
  3. Tufekci, Z. (2020, February 27). Preparing for Coronavirus to Strike the U.S. Retrieved from https://blogs.scientificamerican.com/observations/preparing-for-coronavirus-to-strike-the-u-s/
  4. FlattenTheCurve.com. (2020, March 9). FlattenTheCurve: COVID19 Update & Guidance to Limit Spread. Retrieved from https://www.flattenthecurve.com/
  5. Coronavirus. (n.d.). Retrieved from https://www.who.int/health-topics/coronavirus
  6. Thomas, R. (n.d.). Covid-19, your community, and you – a data science perspective. Retrieved from https://www.fast.ai/2020/03/09/coronavirus/?fbclid=IwAR1PS-KLf74YFn_Tq8NyefndjEMfBS8ACnsgf2rBqMDVA8RlvHu7YpuDPkI
  7. Cascella, M., Rajinik, M., Cuomo, A., Dulebohn, S., & Di Napoli, R. (2020). Features, Evaluation and Treatment Coronavirus (COVID-19). StatsPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554776/
  8. Firth, S. (2020, March 5). Singapore: The Model for COVID-19 Response? Retrieved from https://www.medpagetoday.com/infectiousdisease/covid19/85254
  9. Baggaley, K. (2020, March 11). COVID-19 symptoms typically appear 5 days after infection. Retrieved from https://www.popsci.com/story/health/coronavirus-incubation-period-time-symptoms/
  10. Cool, J, and D Zappetti. “The Physiology of Stress.” Medical Student Well-Being, 5 Jan. 2019, pp. 1–15., doi: https://doi.org/10.1007/978-3-030-16558-1_.
  11. Van Doremalen, N, et al. “ Aerosol and Surface Stability of HCoV-19 (SARS-CoV-2) Compared to SARS-CoV-1.” NEJM Original Article, doi: https://doi.org/10.1101/2020.03.09.20033217.
  12. “2019-2020 U.S. Flu Season: Preliminary Burden Estimates.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 13 Mar. 2020, www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm.
  13. Specht, Liz, and Ronald Katz. Simple Math Offers Alarming Answers about Covid-19, Health Care. 10 Mar. 2020, www.statnews.com/2020/03/10/simple-math-alarming-answers-covid-19/.
  14. Sanche, Steven, et al. “Early Release – High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2 – Volume 26, Number 7-July 2020 – Emerging Infectious Diseases Journal – CDC.”Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, wwwnc.cdc.gov/eid/article/26/7/20-0282_article.
  15. Mervosh, Sarah, et al. “See Which States and Cities Have Told Residents to Stay at Home.” The New York Times, The New York Times, 24 Mar. 2020, www.nytimes.com/interactive/2020/us/coronavirus-stay-at-home-order.html.
  16. Greenhalgh, Trisha, et al. “Face Masks for the Public during the Covid-19 Crisis.” The BMJ, British Medical Journal Publishing Group, 9 Apr. 2020, www.bmj.com/content/369/bmj.m1435/li>
  17. Kushner, T. “SARS-CoV-2: Masks and Running.” Google, Google, docs.google.com/document/u/0/d/106lUZEmqbdToLVCD7BU-XkcCPvzIl8DgbrlNTZV3fo0/mobilebasic.

Image: iRunFar/Meghan Hicks

Corrine Malcolm: is a self-proclaimed ultra nerd running for Adidas Terrex as well as a coach.

View Comments (86)

  • Can we train if we are recovering from a flu like this or a normal flu?

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    • First: amazing article, Corrine - thanks for the thorough (and fast) production!

      Second: per early research out of Wuhan, the covid19 - like it's "relatives" (SARS and MERS) - is beginning to show signs of both significant lung capacity decreases (20-30%, in acute post-recovery) and potential for long-term lung damage:

      https://www.ajronline.org/doi/10.2214/AJR.20.22969

      Runners, themselves, need to be concerned.

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      • Hi Joe,
        Thanks for bringing up the potential long term effects of other coronaviruses. The patients that are having significant lung capacity decreases are the ones who develop something called ARDS (Acute Respiratory Distress Syndrome), these are the patients that are going to end up on ventilators in the ICU. The ones who recover from the ICU end up having their lung function significantly reduced for several months up to two years even, but do generally recover their lung function after that time. We won't know until this is all said and done, and what percent of patients requiring intensive care (~5%) die (hopefully no more than ~1% but potentially up to 4% in the total infected population). From the data coming out of China currently the majority of the patients requiring intensive care is coming from the elderly population, though people with underlying comorbidities are at risk as well.
        We'll do our best to keep this article updated as things progress!

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    • As with any illness, training hard while your body tries to recover is detrimental to the healing process. Unlikely to do long term damage, but maybe just take it easy and let your body do it's job combating the infection.
      Eric

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    • Well, the coronavirus isn't the flu, so there's that.

      As for running during and after the flu, here's an article from a few year's back. You can scroll to the end for concise "Recommendations for Training and Racing After the Flu." https://www.irunfar.com/2014/02/down-with-the-sickness-guidelines-for-running-during-and-after-the-flu.html

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  • Superb article.
    As a doctor I have been trying to get the seriousness of this outbreak across to people ever since China announced its emergence and mortality rate.
    I live in France where the government has reacted promptly, given good advice, and mobilised all the services to be prepared.
    My elderly parents live in the UK where the story is completely the opposite.
    I will be sending your article to everyone I know, most of them not runners, because it is the best description of what to do and what not to do, and more imortantly why, that I have read so far.
    Well done and thank you.
    Tim
    PS: there are a few details you could add if you wanted to regarding rates of mutation and reinfection but you may well cosnider these as information overload.

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    • Tim thanks so much for your response, it has been fascinating to follow other countries responses (large and small). ie the smaller countries in Asia who were prepped for SARS and came out strong for COVID-19 vs Western countries being on the back foot it seems. I'll be thinking of your parents in the UK! Stay safe and keep spreading the most the word about what we can do to help!

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    • Tim can I ask where in France you are? I am in chambery with my husband who is hospitalized and I don’t speak French. Would never dream of asking normally but these are not normal times.

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      • Monica, I sent you an email.

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  • Really informative article. Thanks so much.

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    • Thanks Rob!

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  • Superb article, I have read literally dozens of summaries and this one is the most concise and approachable one I've read. Great job, thanks Corrine!

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    • Thanks John!
      We will do our best to keep this article updated as new information emerges and things change and progress. We've included a time stamp at the bottom of the article so that everyone will know when it was last updated which I hope aids in all our understandings on how quickly things can change on the ground.

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    • Well said, John. And super well said, Corrine. As a health care worker, runner, Irunfar patron/fan, and erstwhile ski/run/ACSM-presenting buddy of Corrine, I believe this piece should be spread beyond our ultra community. Sorry Bryon and Meghan, but you and Corrine have simply nailed it here, and it seems this piece could be a life-saving PSA for outdoor athletes of all types. Would you consider sharing with other media? Runner's World has a decent practical advice piece right now, and I think this article would stand nicely by it, given its approachable science AND personal runner story from Italy. This article is a concise distillation of a complicated and world-changing event. We all need to read and understand this!

      PS I am no longer on the health advisory board of RW, but I assume Bryon and Meghan have connections there. I would be happy to approach those editors/writers I do know if that could be of help (including FasterSkier...I think Topher would be quite interested). Sorry if I am sticking my nose in (figuratively) where is does not belong. I simply think you ahead of some other endurance media outlets here, and you words could save lives. Thank you.

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      • Thank you, Nikki. Please feel free to let as many people know about the article as possible. The more eyes, the more lives we save.

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  • Corrine is the Bomb

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    • Thanks Chris! We'll share some trail time safely in the (hopefully) not too distant future!

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  • Really nicely done. I'm forwarding to non-runner friends just because the science and public health aspects are so clearly put.

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    • Thanks Alex! We'll try to keep this as up to date as possible as well as things change and progress.

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  • Thank you Corinne and other contributors to this article. Some running organizations are continuing to conduct events with such statements as, "the run has a limited number of people participating", and, " this event is only open to local runners", etc. The Tokyo Olympics have not been postponed with the hope that, "This pandemic will probably be over by July". Let's be clear. This is a serious disease. "Social distancing" is an important component of slowing its progress through our population. If Apple can close its stores, we need to at least indefinitely postpone our cherished events. The miles we may want to run are still there. The trails we may want to explore await us. Let's stop fooling around with this and deal with it, as individuals and as organizations.

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    • Thank you Richard for your incredibly thoughtful comment. I do think more events will get cancelled as both state-level and national-level social distancing likely becomes mandated for a period of time. We can also as a community voice our concerns directly to RD's to encourage them to cancel or postpone races with the plans to reevaluate in a month. That does mean doing what we can to support those RD's as well, publicly support them in their decision, donate your entry fee for the costs they might not be able to recoup, etc. We can support and encourage them with our voices and our actions. The Olympics is an interesting situation, and I honestly am not sure what they will do, run it without any spectators (potentially?), postpone (likely), and they could even postpone it for 1-2 years if they needed too. I think they have time yet to make that decision, and hopefully they make the right one as the time approaches.

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      • Corrine,
        Great idea regarding donating to RDs/organizations who cancel events. Even though I was still on the waitlist (and, therefore, not yet charged), I just emailed the White Mountains 100 team to let them know that they shouldn't hesitate to reach out to anyone who entered to help offset all the out-of-pocket costs. I know I'd contribute.

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  • I have been concerned that the Georgia Death Race is pushing ahead--I've been wondering if Hoka is on board with that decision, and if they'll still allow the event to hand out Golden Tickets to Western States this year or in the future. It seems risky and irresponsible to not look for a different solution. The race is two weeks away and things are just going to worsen in Georgia before then. I'm not going to include my name because I still haven't decided if I'm racing.

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    • I feel the same way, how can we make sure this is being addressed and taken seriously?

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      • Hey Rather not Say & Concerned (and I understand!)
        As I mentioned above to Richard, I do think we as a running community can use both our voices and our feet to effect change. Emailing and reaching out to your RD's and respectfully (which is hard when we are stressed and worried) expressing our concerns is really important, we can also chose to personally not go to events that we think aught to be cancelled (which is also hard, because FOMO or the feeling of "am I just overreacting???"). And importantly if they do decide to cancel or postpone publicly support them for making the call, positive reinforcement! Some of these RD's are potentially risking their permits for upcoming years by pushing the limits right now, particularly races that are say, through the end of April. It's going to mean most of us are training in the unknown, and so maybe that means making the best decision you can for yourself. ie "if by this date the RD does or does not cancel the race I will make my own decision to attend or not" Give yourself time and space to sit with your decision and then we'll continue to move forward together.

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        • The comments on the GDR FB page from some runners, as well as the RD (now and historically)*, make me almost as sad as the brilliance, accuracy, and compassionate public health information of Corinne and Eric give me hope. I'm still hopeful for the community overall, based on the comments here, but ashamed of anyone who thinks that any of our silly runs through the woods or mountains are that important (or, actually "hard" compared to real-life stuff) in the big picture.

          * WSER should not be affiliated/giving Golden Tickets for GDR. Full stop.

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          • I completely agree. His behavior is reprehensible. It's time to pick a new east coast Golden Ticket race. Is this event sponsored by Hoka? Are there other sponsors?

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  • Somehow I’m off your email list
    Could you put me back on- I was wondering why hadn’t seen any come thru

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    • Hi Kathy,
      You unsubscribed on December 1st last year. I've just sent a new subscription email to your inbox (I think), that you should confirm. Welcome back!

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  • Thank you for posting this! Very important and very timely. Kudos.

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  • This is an excellent article. Corrine, Thank you so much for putting this together.

    “It’s about more than you” pretty much captures my line of thinking when I had to make the very tough call to cancel the Grasslands Trail Run for the first time in 22 years yesterday morning. Even though the reported cases in North Texas have remained relatively low, I felt like we needed to do our part to help flatten the curve and buy time for science to catch up. I personally was not concerned about my own well being, but more about our volunteers, participants and their loved ones that are in higher risk groups.

    Making the call to cancel a race is one of the toughest decisions an RD faces. The fear and anxiety of economic loss is is very real. Being the second time in two years I’ve had to cancel one of our larger events, I understand this all too well. Believe me, It’s a punch to the gut!

    On the surface it does seem to be an extreme measure, but if we pay attention to what's going on in the world and put our trust in experts we'll get through this quickly. It's not exactly like there isn't a precedent for this.

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    • Hey Chris,

      Thank you so much for sharing this. I actually had an athlete who was going to run Grasslands Trail Run, and I've been really impressed with the general understanding I've seen in our community - supportive and understanding. I do think we need to publicly support the hard decisions you and many other RD's are having to make! Thank you for thinking about your community, their loved ones, and beyond.

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  • Thank you, I really appreciate the clear concise information. That stuff is hard to come by these days.

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  • Anyone who has run in cold weather has seen the cloud of water vapor exhaled with each breath. In warm weather, the vapor is still there, even though it can't be seen. Am I correct in assuming these droplets, small as they may be, may contain the virus if a person is contagious? If so, running with a group, regardless of its size, could potentially spread the virus if any runner in the group is infected. Over the years, I'm pretty sure I have caught a number of colds via this route of transmission.

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    • Rick,
      You are correct that this particular virus (Covid-19) is shed in respiratory droplets by breathing, coughing, sneezing. It can stay suspended in the air for a short amount of time and then land on surfaces and remain there for up to many hours (there have been a few studies looking at this).
      In regards to running in a group there is definitely a small amount of risk involved, though due to the constantly exchanging air in your personal bubble (you're moving) the potential for infection is greatly reduced. It's more likely that you'll transfer infections by hand shakes, hugs, shared food/water. So just be aware of how you interact with people, definitely best to avoid big group runs (dozens-hundreds) but definitely keep on running for your personal sanity and overall health.

      Eric

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  • Excellent article, Corrine.

    I also express concern how the GDR's RD is communicating to his followers about COVID-19. It's one thing to decide moving forward with an event at the RD's risk; it's quite another to mock what's going on. I would not feel comfortable contacting an RD posting "we fully plan to quarantine dickheads." I hope the WSER board will reach out to this RD and consider pulling the Golden Ticket if this behavior continues.

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    • Also Concerned / Rather Not Say

      Thanks for sharing your concerns. I, too, and very disappointed in Sean Blanton's attitude about the covid19 threat.

      That said:

      FIRST: so many people are ill- (or un-)informed. The extremely delayed (/lack of) cerntral leadership and communication on this issue has lulled people into varying degrees of complacency to downright denial.

      Thus, it's up to ANYONE with a voice and an education (on the subject) to inform our micro communities.

      I have been "on" this issue for weeks. Here are some resources that are being constantly updated and contain a variety of resources from the very smartest and most informed in the world:

      This Covid19 Twitter List, complied by Naval Ravikant (who I consider one of the most intelligent - and pragmatic - people out there): https://mobile.twitter.com/i/lists/1221004646656835585

      Here are my personal sites. For the past two weeks, I've been creating my own resources to share with my friends/family (again, to fill the vacuum of leadership and guidelines):

      FB: https://www.facebook.com/joe.uhan
      Twitter: https://twitter.com/00joeuhan

      SECOND: ***People are going to remember the businesses*** (which most RDs are, including Blanton) that either protect their customers (at a potential huge financial expense), or those that try to make money on the sole risk-taking of the customer. People will remember, once this is over.

      For us business owners, we all have to do the right thing - even if it hurts. Like in an ultra, we're all in this together, and ultimately, we'll all share that burden and emerge from it, OK.

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      • Also interesting - and sad:

        Runners that have to post *legitimate concerns* (without attitude or demands) anonymously are operating in fear or reprisals from race directors. That's far more pervasive that it should be.

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        • This particular race director has a history of using public embarrassment and harassment to intimidate anyone that criticizes him or his events.

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    • Honestly the GDR RD is an [name calling redacted by the editors as it is not in line with iRunFar's comment policy] and the race really shouldn't even be associated with WS 100. Boycott that crap. If people want to support that kind of behavior and ignorance...then let them. But, don't buy a bib from that guy. I hope the people wake up and just avoid his races all together. The dude is an [name calling redacted by the editors]. Blanton was considered a La Sportiva Athlete for a few years while accomplishing absolutely nothing...the guy is a class-A manipulator and is only concerned with his own social status and profit. The guy point blank cares 0% about the community.

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    • Hi all,
      I'd like to chime in here to stop the pile on regarding the Georgia Death Race, not because I think it or any other race in the near term should be held, but because the point has been well made that the race probably shouldn't be held and this thread has started devolving toward personal insults and attacks in contrast to the positive tone of the article and the other comments on it.

      If you're in an upcoming race and don't think it should happen, consider contacting the race director and letting them know your viewpoint. More broadly, we're all empowered to make decisions on which races we want to take part in now and in the future. At the moment, let's celebrate the race organizations make the difficult and correct call to cancel events after countless hours of work and investment.

      Respectfully,
      Bryon

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      • Bryon-

        I'm going to "counter-chime":

        The criticism for Sean Blanton is NOT about his resistance to canceling the event. Prudence in such decisions is logical (and also logical: it's much easier to cancel, then to "un-cancel" -- so there's no harm at the moment in holding off on that decision).

        The criticism is for the negative, insulting and bullying way in which he is interacting with those runners who are (overwhelmingly) calmly stating that they are concerned about the race, or are simply not racing.

        His unprofessionalism in this regard is wholly worth the criticism.

        But more importantly - and generally - runners are consumers and all of us need to remember the businesses that:

        * looked out for our best interests (even when the individual isn't)
        * make prudent and mutually sacraficial decisions
        * act in a supportive, professional manner

        and we also will remember those who do not.

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        • (Addendum: I DO agree we shouldn't hurl (baseless) personal attacks in this forum.)

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        • I'm very much aware of those other issues, there's just probably a better time and place than an informative/instructional COVID-19 article to discuss those. ;-)

          And three cheers to supporting businesses and organizations, including races, that act well on what each of us feels its important to act well upon. :-)

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        • What Joe said....

          Run Bum has gotten a pass for too long with his behavior and lack of respect. Hopefully one day WS100 will realize this as they are helping to provide a platform for him and his behavior.The current situation is a whole other level as this impacts peoples safety and health.

          The trail running community should be working as one to help lessen the impact and spread. Bullying and name calling is never the answer.

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          • I hoped to be able to refrain from commenting on the GDR/Blanton comments but wanted to quickly follow up with Joe's sentiments, and why this is a place to discuss this. His actions do impact the greater trail running community. RD's forge people's opinions and actions regarding decisions and behaviors at and within trail/ultra racing. Unfortunately Blanton has a history of dividing people. There is 100% evidence that he deletes comments that go against him or brings up concerns over his beliefs. If he is a public figure in the sport, which he is because of the popularity of some of his races, he needs to have a certain level of professionalism. It is okay, and possible, to carry out a certain brand, but it is not okay to discriminate, name call, and bully those that don't agree, or counter that brand.

            However, like Joe said, we have the choice as consumers to remember those businesses that act acertain way to make informed buying decisions. I hope this comment does not come across as hurling baseless attacks, but rather with overwhelming evidence and facts.

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      • In a respect, I have to agree that all of us piling onto Blanton over this in the comment section is ultimately useless. You, however, as the editor here, are in a unique position to call him out on this kind of behavior (which as others have pointed out, is not new for him). I don't have any influence in the community. If people who actually did have an influence in the community had the courage to call him out, firmly and publicly, he might change his behavior.

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  • Corrine,
    As an emergency room doctor, I thank you for taking the time to write this in a meaningful way. I am seeing the impact of COVID19 grow every day in our region both personally and clinically, as more and more patients begin to show up at our hospital system. I am not an alarmist, but I am worried. Worried that the demand could outpace our resources similar to current situation in Italy, and where some regions in the US may soon be. What Martina wrote about Italy is not hypothetical--my colleagues there tell us that critical care, ventilators, etc. are being rationed. I hope people understand that pandemics like this are not stopped by the healthcare system. They can only be stopped by a unified effort amongst us all. People will get sick. People will die. But more people will die if we all get sick at once. And not just from COVID. If our healthcare (including trauma) resources are tapped dry fighting COVID, then mortality from things we treat everyday will also go up. So everyone please, don't panic but do your part. Get your information from reliable sources and follow your local guidelines. Your individual action will save lives. Please don't make me decide who gets intubated and who gets left to die. This is an opportunity for us all to come together and do what we can. I believe in us. And in the meantime, keep running if you can. I know I am.

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    • Hi John,

      Thank you so much for the work that you are doing and the calm and reasoned voice you have on this crazy evolving topic! My partner is an MS3 on his internal medicine rotation, and my parents practice as an ER doctor in MN and family practice doctor in WI, so I feel like I'm perched on the edge watching this all unfold. The burden this could (this will) have on our health care system, on valuable critical and trauma resources is real, and I do fear what could be coming. It's so important for folks to realize these seemingly small and individual actions will have real value in saving lives. Thank you again, we will be thinking about you and your patients.

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  • Corrine,

    Like most others on here, I've combed through tons articles the past 72 hours and this is hands-down the most concise and helpful write-up I've read. Thank you and onward!

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    • Thank you Tyler!
      We will do what we can to keep this article as up to date as possible as things evolve. Stay safe!

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  • Holding a race right now is sheer selfishness. Complaining about a race being cancelled right now is sheer selfishness. If you are an RD and you are still holding races after all this data, you are merely a profiteer only concerned with your pocket and not with the health of the ultrarunning community and the world at large. I've read a lot of selfish commentary by way of runners on social media in the past week and it blows my mind. Your training, your running, and your goal race is insignificant when it comes to a global health crisis like this one.

    Thank you Corrine for putting in the time to summarize the facts and science behind this pandemic. I hope this resonates with the ones who only think about themselves in great times of need. Most people commenting above are the ones already acting responsibly and I applaud all of you.

    Selfishness is the scourge of humanity. I hope people can really see this is not only a test in human resiliency, but in human empathy and our ability to feel and think outside of our own minds and bodies.

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  • Hi all we are in Ireland where schools closed last Thuraday evening and will remain closed until March 29th. Universities and colleges followed suit. Realistically everyone feels that this is a first step and that it is unlikely schools will reopen in the interim week between March 29th and our 2 week Easter break. There are many rumours and lots of statistics but as yet the feeling is one of an abstract problem that we know is very real but have not yet experienced. The government has taken huge steps and sacrificed much to prepare the country for an onslaught of cases if we are to follow the trajectory as seen in Italy but we are perhaps a little more prepared and one step ahead. We know how to kill the virus from our hands and surfaces and we now have an appreciation (perhaps not yet a full one) of how to contain the spread. However today March 15th, pubs and hotels have started to close their doors..no gatherings over 100 indoors or 500 outdoors are permitted. We are 2 days to St. PATRICKS Day and our nations greatest festival and all has been cancelled. But ours, like so many other healthcare systems is to theboun of their collar and will succumb to an onslaught of people all getting very sick at the same time. The object of this exercise is to space out the cases over a longer period of time so that as many as possible can be treated when needed and to minimise the number if fatalities. The Irish like the Italians are very social beings so many are frequenting our lakes, forest walks, beaches and public areas where being outdoors speaks to our mental health but inevitably that is bringing small crowds into shops etc..a situation we feel will change very soon and perhaps within days we will find ourselves also in enforced lockdown. New police recruits and army cadets have been called up or sworn in early and those due to retire have been asked to stay on. There is some stockpiling and panic buying but more so in the cities. We intend to home school our children and speak often to elderly neighbours and family. Local politicians and businesses are coordinating efforts to bring supplies to those who cannot leave their homes. So it is the calm before the storm we feel and there is fear and trepidation but also a sense of pulling together to get through this in the hope that normal life will resume sooner rather than later. Right now the sun is shining and families are taking advantage of being outdoors..we pray they will still be able to do so when all of this is over. On the running front our club has ceased its activities together with all football, rugby, swimming, irish dancing, gymnastics..all sport! Dentists and florists and small businesses are closing to try to protect themselves, their customers and their staff. A group of about 12 of us ran 11 miles this morning..we maintained a social distancing before and after and wondered when we might be able to do so again..nobody knows for sure...

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  • Thank you Corrine for this concise summary.. and to gel it into trail running.. what a set of talents you have between scientific writing and running!

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  • Thank you Corrine for this well written article which parallels my views on COVID-19.....we need more solid information. To add to it I am going to paste a comment on a thread in FB I wrote regarding the homeless in LA as they relate to the spread of COVID-19 (i.e. it is NOT spreading through this group like one would think given the lack of hygiene) : "Based on the media hyperbole the rate of infection of COVID-19 in the LA Basin Homeless should be spreading like a Santa Ana Wind fanned Wildfire throughout the LA Basin Tent cities.....however, based on the disease progression maps, so far it hasn't. So I am willing to be wrong and say I doubt it will because the science is already suggesting the virus persists in cold moist climates and doesn't do well in warm dry climates like LA...add to that the UV exposure from the sun and the virus persistence in the environment is almost nil.....and the maps indicate this....northern latitude metropolitan centers are much more impacted....as one moves south not to much.....LAX, LAS, PHX and even MIA have as much global and even Asian air traffic coming through their ports as JFK, BOS, DIA or SEA but their cases are a fraction... check it out here:

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