Si: COVID-19 is a complicated disease with many different symptoms and unfortunately, outcomes.
Over the last year though, as more and more data is generated, a slightly clearer picture has
emerged including some possible serious effects on fit, healthy, and active people like cyclists.
In this video, we are going to look into that and also try and answer the question of how you can
best get back to riding after you've had COVID-19. [music]
Before we start, let's have a quick recap as to what COVID-19 actually is so that we're
all on the same page. It is an illness that is caused by a type of coronavirus of which there
are many. This one though is called SARS-CoV-2. It's increasingly thought of as a vascular disease
that's spread through respiratory pathways. What that means is that it's not just your nose,
your throat, and your lungs, but also your blood vessels, your heart, and other organs besides.
Now, you don't need me to tell you how serious it can potentially be but even milder cases of
coronavirus can have symptoms that go on many months after the initial infection.
Some patients are reporting chest pain and heart arrhythmias,
and shortness of breath, and debilitating fatigue many months after they initially got COVID-19.
There are also other potential effects from even milder COVID-19,
that would have serious consequences for active people particularly, like cyclists. Although
rarer, COVID-19 can sometimes affect your heart in various different ways. Myocarditis being one,
which is inflammation of the heart itself, pericarditis, which is inflammation of the
sac surrounding your heart, and then also heart arrhythmias like atrial fibrillation.
One early study suggested that as many as a quarter of all athletes who'd had COVID-19 showed
signs of myocarditis afterwards. Subsequently, a piece of research from Vanderbilt University
Medical Center that tested a much larger cohort of people including non-athletes as well as athletes
that hadn't had COVID-19 fortunately showed that the incidence was much lower although in part
that's because 24% of all athletes that hadn't had COVID-19 that they tested, showed signs of
myocarditis anyway, but it increased to 27% when they were testing athletes that had had COVID-19.
Still, 3% is significant. Particularly, when you consider that 107 million people have already
had COVID-19, so it would be really good to get some specific guidance. In the first instance,
I reached out to Dr. John Greenwell who works with team EF because I wanted to find out
what protocols a world tour team would put in place in the case of a rider who had COVID-19.
Now clearly from his response, it seems like cardiac issues are a real concern with them too.
He said in the first instance, they would check cardiac enzyme blood tests so that
effectively will tell you if the heart has been under stress. Then, complete rest for 10 days
after the symptoms have settled. That seems like a long time in the world of a professional athlete.
Then once past this window, we check a resting ECG, then an exercise ECG, then an echocardiogram
to look at cardiac function. He then says if those tests are normal, we would allow the rider
to restart training. If abnormal, then we would do a cardiac MRI. If this was abnormal, then they'd
have to rest for a much longer period of time. Now I don't think there've been any cases in
professional cycling of that, but Dr. Greenwell does work in other sports other than cycling.
He said he's had a couple of endurance athletes that have been off training for 10 and 8 months
respectively following presumed initial infection. We say presumed
because it actually was so early in the pandemic that actually they didn't test for it back then.
Now that level of investigation that's available to pro athletes just isn't going
to be for the majority of us I wouldn't have thought. Healthcare systems are stretched to
breaking point as it is without me then walking in there asking for an ECG
just so that I can start racing on Zwift again. To give us the right information for the rest of us,
we are going to speak to Dr. Alex Heim. He's actually an ex-professional cyclist. He's also
a GP here in the UK, with as you can imagine, a special interest in sports medicine. Alex,
thank you very much for joining us. Firstly, can I start with an easy one? What do you do if you've
had symptoms and a positive diagnosis of Covid? Dr. Alex Heim: The first thing, the most important
thing, is to self-isolate. The current British government guidance is to self-isolate for 10
days. Then, if you're symptom-free at that point, you can head back out. If you're still symptomatic
you need to wait until you're symptom-free before you leave isolation. From a cyclist perspective,
the evidence is clearer from the BMJ advice which is 10 days from the onset of symptoms, and at
least 7 days after your symptoms have settled down then you can start thinking about resuming
or starting the process of resuming exercise. Si: What kind of symptoms are we talking about
here because some people report things like taste that doesn't come back for a long time. Is that a
symptom that you've got to count for your 10 days, or is it just more serious ones, the acute ones?
Dr. Heim: You're talking more serious ones. Fever, being the primary one. Shortness of breath, cough,
although the cough is a difficult one because a lot of people do have a cough for a prolonged
period of time. If you've got a severe worsting cough which is productive, then that's something
which you should be more concerned about. Diarrhea is a common one. Gastrointestinal disturbances,
vomiting. Those sort of things you should definitely be considering as the major symptoms.
Si: Then what about long Covid then? Is 10 days long enough do you think to kind of mitigate
the risks of going into long Covid, or is it not clear actually what's causing it at the moment?
Dr. Heim: I think it's really unclear at the moment as to exactly what the factors are.
There's some nice studies which are in place at the moment, but we don't have any data from,
looking at whether there is a subset of symptoms which people are more likely to
present with initially, and then go on to have long Covid, but the data from it isn't clear.
Reference your initial question, is 10 days long enough? Probably in most people, 10 days is long
enough. As long as you do rest really well and then listen to your body when you're coming back.
It's that difficult one with people who generally perform best, want to
drive things forward, and get back onto exercise sooner rather than later.
I think if you can hold back and you're not feeling 100%, give it a little bit longer,
but 10 days should be adequate. Si: Then what about the cardiac
risks? What symptoms should we look out for, everyone, but specifically for people
that are looking to get back into exercise? Dr. Heim: I think there's a big overlap between
cardiac and respiratory. The overlapping symptom of the two is shortness of breath,
and if you've got excessive shortness of breath for your relative perception of exertion, say
walking up the stairs, you're going to get short of breath but if it is much more than you'd expect
normally, then that's not a great sign. Chest pain is the classical one. The thing with cardiac chest
pain is it tends to be a dull ache but it can be sharp and in some of the symptoms associated
with Covid, it can be more of a sharp pain. One of the differentials would be pericarditis,
and that's worse when you're lying down or leaning forward,
but any chest pain is probably worthwhile chatting to your family doctor or GP about
whether it's something which you need to run some further tests for.
Si: If that doesn't settle down, then that is something that would
definitely keep you off the bike, right? Dr. Heim: Yes, I'd definitely say stay
off the bike until you've had it checked out by your family doctor or a physician.
Si: Now one thing that I'm struggling with, I think I've been diagnosed as medical-student-itis
because basically all the research I've been doing. Any kind of ache, or pain, or twinge or
whatever I'm immediately thinking like, "Oh, maybe I've already had Covid and didn't know, and now
I've got myocarditis or pericarditis, or anything like that." For people like me, idiots like me,
how serious is it? If I was wearing a heart rate monitor or a wearable device, could you see signs
in data basically, if you're monitoring yourself? Dr. Heim: Yes, I think if you're talking
specifically about myocarditis, one of the most common things we see is arrhythmias generated by
that. If you're getting periods with a WHOOP or another device that you're wearing, where your
heart rate goes up quickly and is much higher than would be expected, then that's an indicator that
something's going on. I think it's always very difficult with patients presenting to me
with symptoms. I think if you've got persistent symptoms lasting longer than two or three days,
that are causing you concern, discuss it with your doctor because it is difficult to differentiate.
Si: The overriding thing then is to actually take this 10 days off after your symptoms resolve
basically. That seems to be the gold standard. Dr. Heim: Yes, that's what we've got from the
data so far, is 10 days seems to be a gold standard, but I think the real thing is learning
to listen to your body. In my experience, you can get a double-dip, so improve initially,
and then two-three weeks later, start to go backwards as you try to ramp up
what you do. I think learning to understand that the feedback from your body is really important,
and if you're feeling tired, take more time off. Si: Alex, that's been brilliant.
Super helpful. Thank you very much. Dr. Heim: No worries, Si.
[music] Si:
I've got to say I do feel quite reassured having spoken to Dr. Heim. I had got myself
worked up into a little bit of a stew, but it does sound like as long as you don't bury your
head in the sand, as long as you give yourself adequate rest, and you listen to your body,
and if there are any symptoms that linger on, particularly ones that get worse on exertion,
then you go and you speak to your local doctor. Getting adequate rest isn't necessarily that
easy though. Ten days off the bike could be pretty brutal, and I say that as someone that
can barely take three off the bike, but this is really, really serious and it's worth doing.
Actually, I was reading an article on training peaks,
and a quote jumped out at me. It was written by a guy called Adam Mills. He said
basically, "The traits that can make a cyclist successful, can also be the ones that
betray us," and this bit was a really important bit. Basically, if you have a few days off at the
front end, then it can mean many, many, many, more happy days of training in the midterm and the long
term. Is 10 days of mild torture worth a lifetime of having to hold yourself back? Yes. 100%, yes.
Lastly, one point on vaccinations. Our mates at WHOOP who have that wearable device
that generates heart rate data 24/7, and then unlocks all sorts of insights like
sleep data, and recovery data, and strain data, have some really interesting insights
from WHOOP users who have had the vaccine. They showed that actually more than double
the number of users had a red recovery score on the day after they'd had that vaccine,
but unlike the data that WHOOP users see when they get Covid, actually that red
recovery score bounces back on the day after. If you are lucky enough to have the vaccine,
have an easy day after, and then sounds like you can just crack on as per normal.
As time goes on, a clearer picture of the effects of COVID-19 will undoubtedly
emerge. There are some big studies going on at the moment that may well tell us
whether or not it is worse than other viruses for cardiac effects, or whether or not the
prevalence at the moment is more effective just how many people have become infected with it,
in such a short space of time. Still, undoubtedly the single biggest thing you can do
is just not get COVID-19 in the first place. For the benefit of humanity,
the fewer the people are infected, the better. Also for you as an individual, it reduces your
risks of any possible long-term complications and of course, it means you don't have to take 10 days
off your bike and indeed get stuck in your house. Hopefully, that's not too late for many of you
out there who I guess statistically will have already had COVID-19. Make sure you let us know
in the comments actually if you have had it, and also how you found your recovery from it.
Not exactly scientific research, but it'd be interesting anecdotal research and I look forward
to reading those comments. Before we leave, I just want to say a huge thank you to Dr. Alex Heim
for his time talking to us today. Also Dr. Jon Greenman as well and many other contributors
actually, who've been helping out with research behind the scenes. If you have found this video
useful, please give it a big thumbs up. [00:13:46] [END OF AUDIO]