Covid is coming: how to ride out the expected winter surge
Most of us are by now familiar with the experience of having our training or racing interrupted by a bout of Covid-19. The UK has seen three major Covid waves in 2022 alone and more are forecast. Prof Karl Friston, a virus modeler at University College London (UCL), predicts there will be a spike by the end of November that’s bigger than any we’ve seen so far, with up to 8 per cent of the UK population infected then yet another wave next March. As cyclists, what do we need to know to minimize the impact on our riding this fall and winter?
The World Health Organization also predicts a challenging autumn and winter for Europe. A high number of cases increases the likelihood of new variants, which are likely to be more easily transferrable; whether they would cause more or less severe diseases than the currently dominant Omicron variant remains unclear.
In the UK, only those over 50 and those who are clinically vulnerable are being offered a booster shot, which it is hoped will keep infections and hospitalizations lower in high-risk groups. Younger age groups who were last vaccinated in late 2021 or early 2022 will find their protection against infection has diminished, although they should still be well protected against serious illness.
Whether or not you get another booster shot, it is possible to take preventive measures to reduce your risk of contracting Covid-19. On group rides, keep spitting and snot rockets to a minimum and be sure to wash or sanitize your hands if you can, while cafe stops for coffee and cake are best taken outside. If you’re feeling down, skip this week’s group ride and do a lateral flow test, even if it’s just to rule out the worst-case scenario.
(Image credit: Future)
In the UK, ONS figures show that 95-96 per cent of the adult population of the four home countries already have antibodies from previous infections or vaccinations, while one in 36 people has reported symptoms of long-Covid – where symptoms of the disease, such as fatigue, shortness of breath and Brain fog that lasts 12 weeks or more after initial infection. While a study published in June showed the latter to be more common in people in poor health, it can and has affected even super-fit athletes.
Long way back
“Even in the snow, I rode my mountain bike out to collect my winter miles,” says Charlotte Broughton. The 24-year-old recounts her early winter of 2020 as she prepared for her first season on a full-fledged UCI Continental team, AWOL O’Shea. Broughton, who juggles 15 hours of training a week with a full-time job, was excited for what 2021 would bring. But just after Christmas 2020, she began to feel uneasy. “I have a pretty sensitive digestive system, so I thought I ate something bad because I was throwing up all the time,” she explains. But what followed was two weeks of pain so bad she would wake up crying at night.
“I had no energy,” she recalls. “I was living in this little cottage at the time and it was pretty overwhelming to walk up the really steep stairs. I knew that as a fit 20-year-old, my body wasn’t supposed to feel the way it did.” The pain subsided, but the shortness of breath persisted even with light activity. “I couldn’t imagine how my body could go from being so powerful to a situation where little kids could run faster than me.”
After four weeks, Broughton returned to the saddle and slowly began to build her form back up, but still couldn’t manage intervals. “I was fine on long endurance-paced rides,” she recalls, “but when it came to intensity, my body just couldn’t respond.”
Broughton also suffered from palpitations and underwent precautionary echocardiograms. “I remember being at the Tour Series in August 2021. I wasn’t nervous because I knew I wasn’t able to fight for a solid position,” she says. “But then I looked at my heart rate and it was 180 just as I was standing on the starting line. My resting heart rate is usually around 45.”
The ambitious rider is now back on track to victory, most notably at the Santini Women’s Otley Grand Prix in June, but it’s been a long road – including a full three-month hiatus in late 2021 on the advice of her trainer – and the impact could last even longer. “I feel like Covid may have ruined my hopes of turning pro,” she admits. “Nobody wants a mid-20s sprinter from England – if you don’t have the results, you’re not for them.”
positive signs
(Image credit: Future)
While Broughton’s situation shows only part of the devastation caused by Covid-19 over the past three years, there are some silver linings. Vaccination offers good protection against serious illnesses, which means you are unlikely to become seriously ill if you do get it. There’s also now better-informed advice on how to recover and how to safely return to cardiovascular exercise like cycling.
“The biggest concern for athletes who train when they are unwell with a viral infection, but particularly with Covid-19, has been the risk of heart problems, a condition called myocarditis or pericarditis,” says Professor James Hull, consultant respiratory specialist at das Institute of Physical Education and Health, UCL. “At the start of the pandemic, there was concern that the prevalence of myocardial damage or inflammation was very high – papers have emerged suggesting that up to a third of elite or competitive athletes were showing signs of inflammation,” he adds. “Over time, with larger and larger studies, this number has been regulated down to 1 to 1.5 percent.”
However, the threat is real. EF Education-Tibco-SVB’s Lizzy Banks was sidelined earlier this year with pericarditis – swelling and irritation of the tissue around the heart – while Quick Step Alpha Vinyl’s Tim Declerq also missed the start of the Classics with the same complication.
Another concern early on was that people would develop long-term scarring of the lungs (‘fibrosis’) after Covid-19, but Hull says this is ‘vanishingly rare’ in athletes. Being fit and active is thought to offer some protection, with data suggesting a lower risk of serious complications. “Even the regular goal of 10,000 steps per day is protective,” adds Hull.
Clearer guidelines
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Although the risk of developing heart complications when returning to cycling after a Covid-19 infection is relatively low, it still affects one in 100 people. Fortunately, it’s possible to decrease your chances even further. A Washington University observational study published in the British Journal of Sports Medicine in 2021 found that the nature and severity of Covid-19 symptoms tend to warn of the risk of developing heart problems. “Most athletes who later develop heart problems have had some type of cardiac symptom — chest pain, palpitations, a problem with shortness of breath — when they were acutely unwell,” Hull explains.
This research has fed into the British Medical Journal’s latest Graduated Return to Play guidelines, which allow you to tailor your recovery to the severity of your infection.
(Image credit: British Medical Journal)
“If your symptoms are limited to the upper part of your airway — loss of smell, a runny nose, or flu-like symptoms just above the throat — you’re unlikely to develop heart problems and you’ll be able to return to full exercise fairly quickly,” says Hull. “If you have chest or under-throat symptoms, or have been systemically unwell with a high fever, you need to be a lot more cautious. If you have cardiac symptoms – chest pain or palpitations – you need a cardiovascular evaluation before you return to sport.”
The respiratory specialist warns against returning to high-intensity training too quickly. “It’s about being realistic about what you can do,” he says. “The recovery timeline needs to be managed appropriately. If you come back seven days later and think, “I’m done, I can’t do this,” that’s an unrealistic schedule. It takes four to eight weeks for people with symptoms below the neck to feel better.”
Even if you’ve had an asymptomatic case of Covid-19, guidelines recommend taking a few days away from high-intensity exertion. This is because the immune system is still fighting an infection even though there is no obvious disease.
tests at the tour
As the Banks and Declerq cases above show, the professional peloton is not immune to Covid-19. The most prominent examples of this type were the positive cases at this year’s Tour de France, which accounted for 17 out of 40 retirements from the race – including four-time Tour de France winner Chris Froome and stage winners Simon Clarke and Magnus Cort Nielsen – For Cort positive changes in heart rate and respiratory rate in Covid-19 were uncovered by Whoop.
There was also controversy, with some riders posting positive results but allowed to continue, most notably stage ninth winner Bob Jungles (Ag2r-Citroën) and UAE Team Emirates’ Rafał Majka.
“The decisions for the athletes at the Tour were made by a triumvirate of the team doctor, a doctor from the UCI and another independent expert, not named, who made a decision about the risk and weighed these things up,” explains Hull, who advises a number of professional teams. One of the main factors determining whether or not a driver was able to continue driving was their Cycle Threshold (CT). A special PCR machine runs cycles to find the virus in a test sample. The number of cycles it has to go through before it finds the virus can determine whether the person is currently positive or contagious. A CT score greater than 33 cycles meant a driver was no longer a risk to themselves or others.
Hull explains that this review was conducted on a case-by-case basis, stressing that there is a difference between an asymptomatic positive case of SARSCov-2 and Covid-19 – the latter being the clinical condition caused by the infection. “There are many different things and reasons why someone can test positive and actually have no clinical consequences [after effects],” he adds. “People can still test positive for a PCR test many months after the disease.”
However, for amateurs who test positive, Hull urges caution, even if they are asymptomatic. “That could mean taking a full five-day off the bike before gradually building up the training, or simply dodging high-intensity training for a few days just to be on the safe side.”