Post-acute SARS-CoV-2 (Long Covid) has presented as a multisystem disease, where approximately 10% of people experience prolonged illness and sometimes occurring after a relatively mild acute illness. This blog unfolds the experiences of a few avid and competitive runners who have been on a prolonged and unpredictable recovery journey since contracting coronavirus.

Although the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has seen such unprecedented scale of morbidity and mortality at the initial and acute phase of infections, post-acute SARS-CoV-2 (Long Covid) has presented as a multisystem disease, where approximately 10% of people experience prolonged illness months later, extrapolate this to the current global burden of covid-19, there are more than five million current “long haulers” (Altmann and Boyton, 2021). Long covid is also a frequent occurrence in those with a relatively mild initial illness (Greenhalgh, Knight, Buxton and Husain, 2020). This causes a level of naivety when a runner catches covid, thinking “this hasn’t affected me badly because I’m fit, I’ll brush it off easily enough”… Then weeks and months pass, wondering how it was possible to get it so wrong…  A scary finding is that 70% of "low-risk" individuals have impairments in one or more organs four months after initial symptoms of covid infection (Dennis et al, 2020). It is indeed important to take some findings with a pinch of salt though, for example; 73 of the 201 subjects used in the study above did not have PCR or antibody confirmation of SARS-CoV2 infection (but on the other hand neither did I, my dad did though and we have been on a similar journey, in some ways slightly worse for me with the effect it has had on my running and studies).

Before I get into this blog, I’d like to leave a little analogy that strongly resonates with me. Imagine two people are in a car wreck, one person completely paralyzed in the accident, the other isn’t as damaged and looks at the mangled person confusingly and says, “I was in the same car accident… and I’m fine… What’s wrong with you?”. I indeed know of a handful of runners who have brushed off covid, no issues as they engage in their old training routines as though nothing happened. However, this does not resemble long covid (to be clear). Long covid is when those infected are left stuck and feeling broken. It is sometimes as though things won’t ever improve; it can be debilitating and incredibly frustrating. Those who are unlucky enough will be able to resonate with the little glimmers of hope that things are sometimes improving before relapses; at times, it can feel like a seemingly endless game of snakes and ladders.

In this blog, I’ll briefly express my long covid journey and from other runners on their own recovery journeys. Including what we can learn from their experiences!

My journey started back in August 2020, to now where I am at 13 months post covid. Things have improved for me with time, self-treatment and endless GP visits. I did have a multitude of struggles from post-exertional malaise, breathlessness, fatigue, brain fog etc. To now, where I’m living with only a few deficits. Lung issues are the prime one influencing my running- recently, I received a bronchodilator (an inhaler) to help with this, in addition to reteaching myself how to breathe correctly as it appears that I no longer economically do so, even as a competitive runner. My biggest struggle is that I constantly have to adjust what I expect from myself- being a runner is quite hard when you’re not running much. Although I struggle today with a various few symptoms, the biggest difficulties I face have begun to escalate to become mental to a large degree, my identity is constantly compromised by how I feel (tired, unproductive etc.) and my usual mechanism to reduce stress (through exercise) is not being fulfilled enough. Although I have other outlets to turn to-its just not the same, especially 13 months later. I am slowly improving though and being back studying at University is a good distraction, the summer was a difficult one; it is so easy to get caught up in a negative cycle with nothing else happening. So having this balance where I can switch off and focus on other means has been great.

Key message- If you are struggling with breathlessness I urge you to see your GP about this, I managed to get a chest clinic appointment, they did various lung function tests (albeit at rest, unfortunately). I was provided with the inhaler which is a help when running as one diagnosis was prolonged post covid breathlessness. It’s also worth mentioning my breathing pattern struggles when running. During exercise, breathing pattern issues can cause dynamic hyperinflation- this is when incomplete exhalation can result in residual air adding to the volume of the next inhalation (breath stacking) with eventual over-inflation of the lungs. Airflow can become limited and the amount of O2 reaching the alveoli decreases as dead space volume increases. Inefficient ventilation and dyspnea are the end result (Clifton Smith and Rowley, 2011).

The crazy side to breathing pattern disorders is that due to the vital function which breathing has, the implications are multisystem. It can cause brain fog, muscle pain, fatigue and many other symptoms. The positive to this is that breathing is habitual and can be retrained. I’m currently retraining this with simple 4 seconds in, 4 seconds out breathing exercises for 10 minutes daily. The diagnosis from the chest clinic appointment has concluded that I have long covid induced bronchial asthma (various chronic inflammatory diseases of the respiratory tract). For this reason, please look at the diagram below if you are experiencing similar (Bradley and Clifton-Smith, 2013).




Andrew Sumner // Athlete from Torpenhow (Lake district) // Road and sometimes trail & fell runner. Has done 9 marathons.

“I succumbed to covid in February 2021, I was out on one of my usual running route’s and despite feeling like I was putting more effort in, my mile times were dropping off a cliff and by the end of the run, I felt awful. Covid positive test followed and very quickly on top of that came pneumonia (inflammation of the tissue in the lungs) and pericarditis (inflammation of the heart lining). More recently I have been in and out of hospital for scans and tests. As I write this (19/09/2021) I am hooked up to a 5-day heart monitor. I didn’t run for 3 months and initially when I did start again my performance times whilst slower were not as bad as I expected and then…. BANG, a couple of weeks later extreme fatigue hit, legs felt like I had fallen in a nettle bush, the chest was tight, sweating was extremely excessive and not normal for me and I was producing enough phlegm to sink a battleship. I stopped running for the second time but even short walks became too much and I needed sleep during the day to get through – fortunately I work from home for now so a nap could be accommodated into my schedule for the day.”

“I was beginning to think I would never run again and having Skye Half Marathon and Langdale Marathon looming I was feeling pretty down. I stumbled upon an article by Brad and quickly made contact to discuss how he had managed to recover from covid/ long covid – I took his advice, spoke to my doctor (who was completely unaware of the benefits of the prescription Brad suggested) and began a course of Famotidine and several other vitamins. Slowly but surely I began running and training for the Skye Half, to be honest, it was hard work, slow and frustrating but last weekend I successfully completed the Skye Half – it wasn’t my best time but it certainly wasn’t my worst and I was extremely pleased and proud to have finished the race. I have cancelled the full marathon and will now continue to slowly build up my stamina and pace whilst taking the prescription for famotidine. It’s certainly helping me slowly recover and I have combined it with probiotics and this has been a big plus. I am probably 50% down the road to recovery but with help and advice I am getting there – never give up / keep positive and keep searching until you find something that works for you. Long covid is an unknown and everyone is different but there are common symptoms that we can identify with and start to address.”

Key takes

Georgia Yearby // Athlete from Leeds City/Leeds Beckett Uni/Sheffield & Dearne. 200m pb- 24.8s, 400m pb- 55.40, 800m pb- 2.05

“I contracted covid middle of March this year (I’m sure it was from working in a school), initially my symptoms were very mild… I lost my smell and taste and had hay fever symptoms. One day during the initial infection (the second day) I had a strong headache but other than that was ok. At 6 days in I felt fine so I thought it would be a good idea to go on my cross trainer fairly gently. (In a way sometimes you sweat out a cold … I was wrong!) The next day I had a really tight chest and was anxious going to sleep at night. Had to sleep in certain positions or I’d have shortness of breath. It was a vicious circle of panicking also! It took 3 weeks to see improvement and then began to train and work again. At first, I felt ok but as the weeks went by I felt weaker and weaker. My legs felt like they were trudging through treacle, I felt fatigued and would go to sleep for hours after work and just didn’t have a second gear!”

“I tried some competitions (assuming that I wouldn’t be affected as much doing short events) that was a bad idea also! My 400m was 4 seconds slower than my best and it felt very hard work! I came home and felt awful/ my self-esteem was hurt! At this point, I realised that my recovery was starting to suffer as a result of trying to get back fit too soon. I’d go for a 20 min run (trying to consume energy) and feel tired days later and my muscles would feel like they’d done a lactic session! When you can’t do anything which is part of your life it just makes you feel helpless. I had to make the hard decision to step away from training and competing and focus on rest! So I rested for 3 weeks solid doing nothing but walking/ being at work. I started to feel an improvement. It was noticeable that the real improvement was when having the summer holidays, this allowed me to smartly plan runs and recovery. It is now mid-September and I’ve only just started to feel like my normal self! I am so thankful and I have built back up to doing several runs/ sessions and gym a week. I still have to be careful not to do anything too hard too soon and to be progressive slowly! I can still have mini relapses when I can tell I’ve pushed it too hard too soon. It’s all about really listening to my body now!”

Key takes

Sophie Troth // Doncaster AC and Loughborough Students // 10k pb-38.45. HM pb- 84:47

“I tested positive for covid in October 2020 and was very unwell for 2 weeks to the point where I couldn’t even stand up long enough to make a coffee due to nausea and severe eye pain/ headache. After 3 weeks I tried an easy jog but felt like I couldn’t breathe (not the type you get from being unfit or after the flu). It was a genuine struggle to put one foot in front of the other and I could genuinely not run under 5:20/km which really upset me because I used to do 20+ KM long runs at 4:30-4:40 pace.”

“I rested and in a few weeks, tried again but still no luck. Didn’t really train then until after my university exams at the end of January. From Feb-April things were finally getting better, I never resumed to how I felt pre-covid, however it was an improvement. I was doing 5k tempos back under 19 mins and felt ok. Annoyingly I was still extremely fatigued and after doing one run in a day I would struggle to do any uni work and be reliant on napping, something which I really struggled with as a go-go-go type of person prior to Covid. At the end of April, I decided to do a 5k race where I actually ran 18:12 and was happy given the past 6 months, however like I’ve said I never felt like I did before. This is when all of my problems started. During my shakeout the day prior to the race I was unable to finish my 20min jog due to stabbing rib/stomach pain in my right side but didn’t think much of it. Luckily I was ok during the race but the pain came back during my cool down to the point where I was struggling to walk to the car.”

“Ever since that day I’ve been plagued with such bad chest/rib/upper back pain which has resulted in 3 hospital trips due to suspected heart attacks. I’ve had a high temperature every day for the past 6 months and started getting heart palpitations and panic attacks (most likely due to the pain). After being dismissed from A&E several times with being told I had a pulled stomach muscle and costochondritis was very disheartening as I knew there was something wrong. I spent £400 on acupuncture and chiropractic treatment with minimal relief. Resting wasn’t helping and I was on such high doses of naproxen that I was struggling to drive and felt generally very unwell. I’ve not completed a proper week of training since that week in April and have struggled to do any physical activity without flare-ups to the point where I’m bedbound due to the pain, meaning I’ve done nothing for 2 months which obviously affects your mental health when you’ve gone from running 70-90km a week. I also had shingles and severe stomach problems indicating my immune system is messed up. Struggled to breathe due to severe stabbing pain for 6 months and 500mg naproxen twice a day was starting to lose its effect, resulting in worse chest pain. I have had a nightmare with GPs etc- there has been times where they’ve forgotten appointments, been rude and not taken it seriously, because I’m a runner I ‘should just rest’, having to ring 300 times to get through on the phone and they would rather give you a cortisone injection and some anti-depressants and send you on your way without addressing the problem.”

“The frustrating thing is all long-covid tests have come back clear apart from a slightly higher serum protein level (inflammatory marker), including an ECG and chest X-ray. There’s nothing worse than feeling like nobody even your family can understand that you’re in constant pain because ‘no one has found anything’ and accuse you of complaining all the time making my mental health even worse. I’m now on anxiety medication to stop the heart palpitations and constant fight or flight mode I was in for months, giving me the worst panic attacks to the point where I couldn’t function doing daily things without adrenaline rushes and constantly waking up with twitches (I honestly think this is due to not being taken seriously by any medical professionals, apart from one GP I saw in August after many months of despair, not receiving any help or proper diagnosis for my issues and being told to suck it up and just rest when I knew resting wasn’t helping). After connecting the dots together myself due to previous medical history I might have a rare condition called thoracic endometriosis….. “

Key takes


It is also important to mention that although the mortality from acute COVID-19 accounts for approximately 70% of deaths being male, females are more prone to long covid, this is because females distinctive immune responses are stronger than in males (Dennis et al, 2020). It has been suggested that “the more active female immune system may be an advantage in clearing the virus, but this could be a double-edged sword if the female immune activation produces a lingering syndrome” (Walsh-Messinger et al, 2021). I have been contacted frequently particularly by female athletes who are distraught, they usually state that "I've been told that I have anxiety etc..." Unfortunately, this leads to an issue that has been ongoing for a long time within healthcare; treating females struggles as though they are hysterical. please read the following article to find out more, although a slight tangent, this is very important. The female problem: how male bias in medical trials ruined women's health | Women | The Guardian

For Andrew, Georgia, Sophie, myself and many others post-acute covid has been quite an unpredictable journey. I decided to write this blog to show how diverse everyone’s experiences are, yet there are common themes to take away. I urge anyone reading this, whether a long hauler, health practitioner or someone interested in the area to read the research “Long Covid in Primary Care” by Greenhalgh, Knight, Buxton and Husain (2020) Management of post-acute covid-19 in primary care

Thanks for reading!

References

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Bradley Freeman

Sport and Exercise Scientist. Currently studying MSc Sport & Exercise Physiology from Manchester

Age group: U23
Club: Stockport Harriers
Coach: Self coached

My Disciplines
10 KM Track & field Trail run

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