COVID-19: THE DAY AFTER IN RECOVERY AND RUNNING

Illustration: Shyam G Menon

For a while now, the world has been grappling with a pandemic necessitating lockdown, use of masks, physical distancing and other health protocols. Runners were among those affected by COVID-19. Experiences have varied. Some had a robust engagement with the virus; some others had a brush with it.

The general observation is that the recovery phase has to be dealt with carefully so as not to trigger any further health complications. Resumption of running or any sort of heavy training post COVID-19 has to be slow and cautious, doctors said. Runners have also been advised by their coaches to recommence training gradually, keeping in mind the varying degrees to which the virus has impacted people.

We spoke to a few runners who contracted COVID-19 about their journey through the infection and their return to physical activity. We also spoke to a couple of coaches for their suggestions on how runners, who recovered from COVID-19, may manage their return to running. For a complete overview, please read this article in conjunction with the piece by doctors Arati and Pravin Gaikwad, available on this blog.

Dhruv Dubey (Photo: courtesy Dhruv)

July 3, 2020 – Dhruv Dubey remembers that date well. A recreational runner from Kolkata, he had set a personal mileage target of 3000 kilometers for 2020. In 2019, he had covered a distance of 2100 km. He felt the urge to increase the distance this year.

But the lockdown caused by the COVID-19 pandemic forced change of plans. Once the initial stringent lockdown was over, Dhruv explored running outdoors and managed to cover fairly good mileage during the months of May and June. But in early July, a setback occurred. On July 3 he got a fever. He waited for a couple of days but the fever did not subside. He began to lose his sense of smell. A test proved that he was COVID-19 positive. He was allowed home quarantine.

“ I had fever for about nine days. After my fever subsided, I had some lung issues. My lungs were affected. My VO2 max came down to 40 from my peak of 47 ml / kg/ min,” he said. Despite recovering from the infection, Dhruv continued to experience weakness. “ On July 26, I started my fitness regimen but felt very tired,” he said. He gave it some more days. By the time he was able to get back to some level of activity, almost a month had passed since the first onset of fever. “ I started with the home gym and then I slowly started running, attempting very short distances with many walk-breaks in between,” Dhruv said.

Slowly, he began inching up his running mileage. He also resorted to pranayama (practice of breath control in yoga). He felt the improvement with every passing day. “ My lung exhalation capacity improved,” he said. A vegetarian, Dhruv paid attention to his food intake and also took supplements, which aided the recovery. August was mostly focused on stepping out of the house, walking and light jogging. September was a better month in terms of his fitness workouts. His improving health has helped him get back to a training plan devised by his coach Ashok Nath.

“ I did an easy 21 kilometer-run last weekend. I was able to complete it without taking a walk-break,” Dhruv said, late September. He was able to complete the run in two hours, 32 minutes compared to his personal best of 1:58 for the half marathon distance. He believes his sustained focus on fitness, nutrition and overall health over the past few years helped him tide over COVID-19 and get back to running.

Kamalaksha Rao (This photo was downloaded from the Facebook page of Hennur Bamboo Ultra)

During the initial days of the lockdown in Mumbai, Kamalaksha Rao, 73, stayed indoors but kept up his workout regimen, including running inside his apartment. When the lockdown norms began to ease, he stepped out to run.

On the morning of July 11, 2020, he ran a distance of 21 kilometers. That evening he came down with fever and body ache. “ I took a pill but the body ache persisted for the next two days. I also began experiencing loss of smell. I went to a doctor, who suggested that I do a COVID-19 test,” Kamalaksha said. He tested positive.

Although the civic authorities suggested home quarantine for him, he decided to get admitted to a hospital as his granddaughter lives with him. “ I was in Vivanta Hospital, Malad, for six days. From there, I shifted to a COVID care center where I stayed for three days. I then shifted to my neighbour’s apartment, which was vacant. I stayed there alone for 11 days,” he said. Following this long stretch of time, he tested negative for COVID-19.

He commenced his physical activities with walking and slow jogging. “ COVID affects joints and muscles. I was told by doctors to keep moving. When I was at the COVID care center, the people managing it would ask everyone to keep walking,” he said. Kamalaksha also consulted a cardiologist as he wanted to get back to running. Following that he resumed running but at a very slow pace. Every Sunday he would increase the distance he was running. He also had a small goal he was gravitating to – he hoped to run 42.2 kilometers during the Virtual London Marathon of October 4, 2020. He planned to run close to his residence in Malad. On race day, Kamalaksha started his run at 4.40 AM. The septuagenarian ran the first half of the marathon and walked the next 21 kilometers. He had a target of finishing in eight hours. He finished in 7:20 hours. “ It was a self-supported run. I had carried a bag. During the run, I had two gels and two nutrition bars,” he said. He planned to do recovery walks over the next few days.

Rachna Bhatnagar (Photo: courtesy Rachna)

Rachna Bhatnagar, a resident of Kharghar in Navi Mumbai, took to recreational running about a year and a half ago. She joined LifePacers, a Navi Mumbai-based marathon training group and in the ensuing period ran many 10-kilometer-races. Through the lockdown period, Rachna kept up her home fitness regimen, which included a series of workouts. She contracted COVID-19 in the fourth week of June.

“ My husband got fever first. Then I got throat ache and headache. My son also got fever and experienced loss of taste and some breathing issues,” she said. All three of them tested positive and were admitted to a hospital. While at hospital, Rachna did suryanamaskar (yoga), starting with two sets a day. She increased the counts daily. She also walked for ten minutes daily and did some stretches. Ten days later, Rachna tested negative. “ After I came home, I did another test, which was again negative,” she said.

In the initial days, post-COVID-19, she experienced tiredness. “ In the early phase after recovering from the disease, if I did housework for ten minutes I needed to take 20 minutes rest. That’s when I increased fluids intake. In one week I recovered,” she said. She commenced walking and took to slow running interspersed with walk-breaks. “ I have slowly increased my distance. Now, I walk-jog for about 10 kilometers and jog-run for up to seven kilometers,” she said. According to her, managing recovery is the crucial element in the stage following disease and the body’s battle with the virus. “ It is essential to stay positive. I kept away from negative people and negative news. The whole recovery process is a mind game,” she said.

Arun Waghukar (Photo: courtesy Arun)

As of early October, Arun Waghukar, a runner from Kamothe, Navi Mumbai, was back at work. When we spoke to him for this article, he was still in the recovery phase after contracting COVID-19. “ I had a toothache and kept avoiding going to a dentist. But I finally had to visit the dentist as the toothache got severe. I had four sittings with the dentist. Three days later, after my last dentist session, I developed symptoms – body ache and fever,” Arun said.

With some pills prescribed by a doctor, his fever disappeared but the body ache persisted. He tested positive for COVID-19. An employee of Jawaharlal Nehru Port Trust (JNPT), he was admitted to the JNPT Hospital.

After he recovered, he started doing yoga and pranayama. “ I plan to recommence my running from October 20 by which time I would have finished one month after recovering from the coronavirus,” Arun said. He resumed work at JNPT on September 30, 2020. Early October, he was still doing an hour of yoga in the morning including sun salutations and various types of pranayama.

Arun commenced recreational running in 2015 and has been running half marathons mostly. In January 2020, he ran his maiden marathon at the annual Tata Mumbai Marathon (TMM).

A doctor with the Indian Army and a longstanding runner, Colonel Muthukrishnan Jayaraman combines interest in the sport with a background in medicine. Following the outbreak of COVID-19 in India, his daily work in Delhi – where he is based – included treating defence personnel who had contracted the infection. This was on since April-May. In September, he was doing a recovery run in Delhi after a virtual marathon when he sensed an element of tiredness that was more than what he normally felt after running 42.2 kilometers. “ I initially thought it may be because of the weather,’’ he said. A COVID-19 test showed that he was positive for the virus.

Col Muthukrishnan Jayaraman (Photo: courtesy Muthukrishnan)

Asked how an otherwise healthy individual like him contracted the virus, Muthukrishnan pointed out that the general benefits attached to running shouldn’t be brought into the frame as presumed layer of defence. “ The chances of getting the virus are probably the same for all now given it is there in the community. Further in my case, being a doctor I deal with COVID-19 patients. So the source could have been from anywhere, from travel to life in the community to work at the hospital,’’ he said. Soon after he tested positive, Muthukrishnan commenced ten days of quarantine. He was asymptomatic. In the initial phase of the quarantine period he took complete rest. To stay happy, towards the concluding portion of the quarantine, he did some mild indoor exercises; he also walked indoors. In the post quarantine test for the virus, he tested negative.

Muthukrishnan now wanted to get back to running. He started the process with an ECG to get an idea of heart rate and heart condition; he also did tests for inflammation markers. When this blog spoke to him in early October, roughly a week had gone by since completion of quarantine. In that while he had moved through days of only walking to a mix of walk-jog to about an hour of slow running. “ The initial days were trying. The disease leaves you a bit tired,’’ he said, adding, “ you cannot see COVID-19 as just another viral disease because first, we are still learning about it and second, studies show that it is capable of impacting the body’s organs including the heart. That makes it important to revisit the fundamentals of your health before you restart physical activity.’’

As he put it, given the still evolving knowledge about the disease, the return to running would be largely based on runner’s ability to listen to his / her body. Plus, through the period of illness, recovery and return to running, nutrition is critical. “ As runners, we have this tendency to eat such that we don’t put on weight. When you are enduring COVID-19, recovering from it and slowly getting back to running, that old logic can be counterproductive. You have to eat well, have a balanced diet,’’ Muthukrishnan said.       

Sanjay Motling (Photo: courtesy Sanjay)

Dr Sanjay Motling started running during his days as a research scholar in engineering, at Jadavpur University. According to him, in 2014, he participated in his first running event (a half marathon); in January 2020 he did his first full marathon – the Tata Mumbai Marathon. Currently a resident of Panvel near Mumbai, in September 2020, after the lockdown caused by COVID-19 was eased; he and his friend drove to a village at the base of the hills not far from Panvel, for a weekend run. During the rains and just after it, the place is pretty; it is a spot runners like to visit for their long runs. That night, back in Panvel, he developed a mild fever. Following intake of paracetamol, he felt fine. But next night the fever returned. The subsequent three days went by without any symptoms. On Friday, he reported for work. But that night, the fever came back. “ It was a mild fever, it never exceeded 100 degrees Fahrenheit, it was always below that,’’ Sanjay said. On Saturday however, he developed a minor cough. “ I felt something wasn’t good and decided to go for testing. On Monday, the test result showed that I was COVID-19 positive,’’ he said.

That day itself, he was admitted to a hospital. A day earlier, the friend with whom he had gone for the weekend run, was also admitted to a hospital having tested positive for the virus. Sanjay spent eight days in hospital. The first night there, he developed shivering. But the remaining days felt quite normal although he was on medication. For 4-5 days during this period he did yoga and breathing exercises. Upon discharge from hospital, he was advised to continue taking his medicines but a week into it, tests showed that his sugar levels were up considerably. The doctor recommended that the medicines be stopped. “ Aside from the first couple of days since discharge from hospital, I haven’t felt tired,’’ Sanjay said. When he could find the time for it, he did yoga; he also started going for walks. Early October he told this blog that he felt ready to restart his old training sessions in running. Sanjay’s friend has also recovered.             

Rahul Sangoi (Photo: courtesy Rahul)

A runner from Pune, Rahul Sangoi tested positive for COVID-19 but remained asymptomatic throughout. At his home, Rahul’s uncle tested positive prompting the rest of the family to test for COVID-19. “ I did not move out of the house for 15 days but I continued my home workouts,” Rahul said. He was prescribed a five-day course of antibiotics as a precautionary measure by his doctor. Rahul has been running for the past six years; he has participated in a few half marathons and full marathons. This year, he also ran 50 kilometers at Tata Ultra, as a means to prepare for Comrades, the ultra-marathon held every year in South Africa. The 2020 Comrades was cancelled but stayed alive in the form of a virtual run.

In India, barring a few fortunate to be in the hills (or some such location away from cities) and those determined to run no matter what, most runners were housebound during the pandemic. The initial phase of the lockdown was strict and major sporting events were cancelled. Stuck at home, many introspected. “ The lockdown helped me acquire a clean diet. My job entails a lot of travel. In the days before the pandemic my food intake used to be improper due to the frequent traveling. During lockdown my diet improved. I also did workouts for six days a week,” Rahul said. In the process, he managed to knock off eight kilograms from his body weight.

Doctors Bindu and Vivek Nair have been dentists in Thiruvananthapuram (Trivandrum) for a long time. Bindu got into running about two years ago thanks to Trivandrum Runners Club (TRaCs). A resident of Vazhuthacaud in the city, her first run was approximately five kilometers long, from Kowdiar to LMS Junction and back. Three months later, she did a run of ten kilometers. Since then, Bindu has been running four days a week; she leaves home at 4.30AM and returns by around 5.30AM having covered the distance from home to Kowdiar to the local museum, botanical garden and zoo (a popular haunt for those into morning walks and jogs) and back.

Dr Bindu Nair (Photo: courtesy Bindu)

When COVID-19 reached India and the lockdown of March commenced, Bindu who wished to be utterly careful, stopped her running. She followed a routine of online exercises and Zumba, which she stuck to even after the lockdown eased. The regimen helped her shed 12 kilos from her body weight during the lockdown period. On September 22, a friend who wished to speak to her in person, visited briefly. Unknown to Bindu, the visitor had been experiencing mild symptoms. By evening, the friend came down with fever and chills. Three days later, on September 25, Bindu – she is normally healthy and free of ailments – experienced a mild headache. On September 26, she got a mild fever (below 100 degrees Fahrenheit) along with the chills. Realizing that it was perhaps time for comprehensive precaution, she took paracetamol and consulted her daughter Ambica, also a doctor. Bindu isolated herself. She had her rapid antigen test on September 28; it showed up positive for COVID-19 and she was admitted to the Medical College Hospital in Thiruvananthapuram.

The doctors advised complete rest. “ The first two days were okay,’’ Bindu said. She was administered hydroxychloroquine. The medicine can cause gastritis as side effect in some patients; Bindu had her share of it. Probably due to COVID-19, she also had lower back pain, fever and a clouded mind. This was a tough phase, lasting three days. “ Given we are both doctors, my husband used to send me reading material on the disease. But I couldn’t read it. My brain felt clouded,’’ Bindu said. The doctors treating her told her not to worry. They knew there would be such a phase. On the fifth day of her hospitalization, she had fever touching 101 degrees Fahrenheit. She was given paracetamol. That night she slept well. The next morning, she woke up drenched in sweat but feeling well otherwise and with the distinct feeling that the infection had been overcome. Subsequent tests for the virus proved negative. On October 7, roughly ten days after she was admitted to hospital, Bindu was discharged. She was told not to venture outside her house for the next seven days.

“ I didn’t have any lingering sense of fatigue,’’ Bindu said. The day after she got home, she commenced mild activity; cooking and cleaning in small doses. Pretty soon, a doctor also called recommending mild exercise to prevent clotting of blood. Clot formation has occurred in some individuals after COVID-19 infection. Taking that into consideration, the doctor wanted her to do mild exercise.“ I feel perfectly normal now,’’ Bindu said mid-October. In the recovery plan, she has been advised mild to moderate physical activity for the first month, more intense activity for the second and a return to running and whatever else she likes to do, by the third.    

Samson Sequeira (Photo: courtesy Samson)

Coaches speak

` Asymptomatic’ has been around in medical parlance for long. But it was COVID-19 that made it a household term. Samson Sequeira, coach at Run India Run, a Mumbai-based marathon training group, contracted the infection but showed no symptoms at all. He was asymptomatic. “ After our neighbor tested positive for COVID-19, we decided to test for coronavirus,” he said. That was how he learnt of being positive.

Although he confined himself indoors, Samson did not stop doing his workouts. As a coach, he has been advising his wards to be cautious in stepping up mileage as the threat of the virus is far from over. “ There should be no high intensity workout. I have been pushing for low intensity workout. Walk, talk, jog, run is my mantra,” he said. According to him, in these times, it is essential to keep fit, eat well and sleep well.

Dnyaneshwar Tidke (Photo: courtesy Don)

Ashok Nath (Photo: courtesy Ashok Nath)

Ashok Nath, Bengaluru-based coach and mentor, highlighted the importance of apprising the affected amateur athletes of what they are dealing with. As a disease with no vaccine yet, it is only natural for people to be scared of COVID-19. What they must be reassured of is that serious cases are a small percentage of the total number of people infected. The vast majority recovers. For the duration of full recovery, runners should assign top priority to their health and keep their competitive mindset parked at a safe distance. Once they get the green signal to resume training, they should ease into it with full awareness and respect for feedback from the body. He felt that in the interest of timely withdrawal should there be any discomfort, it would be best to avoid rigidly structured training programs. Be mindful. Only after a fortnight of such cautious approach and assessment thereon, should you think of resuming training. Even then, Ashok’s emphasis is on proceeding with “ feel’’ as opposed to “ paces,’’ till such time as the disease becomes a memory.

Caution was the watchword for Dnyaneshwar (Don) Tidke too; he is coach at LifePacers, Navi Mumbai. He felt that after adequate rest (two to four weeks) as required by the severity of infection, small modules of walk-jog for a couple of weeks followed by the same in slightly longer duration maybe the right way to revive one’s association with running. Further progress should depend on the runner’s fitness levels and response to recovery, he said.

(The authors, Latha Venkatraman and Shyam G Menon, are independent journalists based in Mumbai. For the article by doctors Arati and Pravin Gaikwad, please click on this link:  https://shyamgopan.com/2020/10/09/recovered-from-covid-19-and-planning-to-restart-running-keep-this-in-mind/)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s