Dealing with Covid during Marathon Training

There is never a good time to get covid (period!). Even though we’re 2.5 years into this pandemic, there is little known about return to sport guidelines for athletes post-covid since every case is variable. Fortunately, Omicron is mostly mild these days and the percentage of hospitalization is much lower, nonetheless, there is still fear and stress involved regarding long covid. This blog is not intended to provide medical advice, you should always consult your primary care physician first. I hope this blog provides guidance on how to handle covid and return to running.

I got covid in September 2022 likely from patient exposure in clinic. Unfortunately, at the same time I was recovering from a posterior tibial tendon injury. My return to run was going somewhat well and after my first workout back, I developed a scratch in my throat that felt similar to post nasal drip. I went home and tested negative and thought maybe there’s pollen in the air? This went on for about 3 days without my symptoms changing (which was a little odd).The next day, I waited for my symptoms to progress. I’ve heard horror stories of body aches, night sweats, awful bed ridden days so I always thought if I had covid, that is how it would present itself. I still had a mild sore throat on Friday and tested negative. Ran 8 miles and it felt fine, not totally great, but ok. That Saturday, I covid tested again before going on a long run with a friend and saw the ever so faint line on my covid test. It was so faint, I almost threw it away.

(Photo is my covid test on day 3 of having a mild sore throat.)

Fortunately, my running friend is also a sports cardiologist and helped me classify the severity of my covid case. There are updated CDC guidelines now differentiating between severity and return to sport. Fortunately, my covid case was more mild than a typical cold. My symptoms were: sore throat days 1-3, mild congestion & phlegm days 4-5, lethargy & fatigue day 6-8). I did have a cough throughout that lasted for about 3-4 weeks total. My average sleep during covid was 10 hours/night. While my initial covid test was faint early on, the T line did get darker and indicated more viral load by day 5.

I ran the first 2 days I was symptomatic, but only because I tested negative and didn’t know it was covid. I continued to walk for exercise to get some fresh air. I never felt bed ridden. I tried to run on day 5, 30 minutes (very easy 9:15 pace) and my heart rate was almost 150. Normally, my heart rate is in the low 130’s at that pace so I knew it was out of the norm. I called my coach Mario and we both decided I would scratch out of Berlin Marathon and focus my efforts into getting healthy for CIM at the end of the year. It was a hard pill to swallow. Perhaps if it was just covid, I would still do it. Coming off a post tib injury made it complicated. Even then, I was scared at how taxing running a marathon (even an easy one for me) would be on my immune and cardiovascular system. It was logical to skip it.

That being said, my return to run started about 9 days of complete rest. I took an extra 2 days since I wasn’t racing Berlin anymore. I gradually returned to running once I tested negative. Coach Mario had me doing 3 miles the first day, and adding a mile each day after that for about 5 days. The following week, we started doing very light workouts again but still keeping volume low. My heart rate was still elevated by 5-10 bpm, which could be normal due to not running for 9 days. All in all, it took me about 4 weeks to feel normal during running. I fortunately never experienced shortness of breath or chest pain, but I did have difficulty with running anything faster than threshold pace. It took about 6 weeks total for me to feel 100% normal with running and hitting paces I normally would.

My best advice for someone dealing with covid is be patient the first 7 days. We often get blindsided when we have a race coming up and it’s hard to think logically, but listen to your body to avoid getting long covid. When in doubt, go see your doctor! I didn’t make my training decisions alone (thanks to my coach and sports cardiologist) and neither should you. I am immensely grateful for the vaccine and boosters available to us that getting covid is the norm these days and the rate of hospitalization is very low.

I also really enjoyed this podcast and found it super informative for runners with covid: Rambling Runner Ep. #459 - Monica Verduzco-Gutierrez, MD: Returning to Running Post-Covid/Long Covid