Long Covid – Distance Remaining: Unknown.

Hayley France ran short distances for fun: usually two to five miles at what she describes as a “pretty slow” pace. Hayley had arthritis but was usually able to ignore or push through the pain. While she may not have been as fit as professional runners, she was very fit compared with the average person – hiking an average of 10 miles a day, visiting the gym for three to six hours a week, and often swimming 10 miles a week. The last time she ran her favourite run – the Cinder Track between Scarborough and Whitby – she could never have imagined that just a few short months later, she would need to use a wheelchair.

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The Piece of String Fun Run is the brainchild of race director James Adams, a British ultra-runner who once ran across America. In this unique event (dubbed by Adams “The World’s Most Pointless Race”), carefully selected runners are given a date and start time – but no indication of the distance they will cover. Worse still, the mileage is cut into chunks: the first distance and destination are announced on the start line; once participants have completed that, they are given the next leg – or a train ticket to the next starting point – and so on. The race could last an hour, or it could last 150 miles. And if you thought that was unfair, just wait until you hear about Adams’ new event, Bingo: The World’s Most Unfair Race.

The difficulty in any race is to pace yourself, to find that delicate mental and physical balance between the moments you push through and the times you take it easier. But if distance was removed from the equation, if you were faced with the unknown, how would you plan for the event? What would you pack? How would you manage your food intake, your pace, your hydration – and most of all, how would you fare mentally?

This little digression is the best analogy I found for the illness now called Long Covid (LC), or Post-Covid Syndrome. Those suffering with LC tend to experience the ups and downs of a marathon: they hit the wall, but find a second wind with a bit of sugar; they wonder whether their legs will start twitching, or whether the stitch will pass. An even better example would be the unknowns of that first ultra: how will my stomach hold up? Should I eat now, just before the steep ascent? When will sleepiness hit? Should I stop or can I keep pushing?

The disciplines of training and racing may mean that runners are perhaps more used to reading their bodily cues, but those impacted by LC are hit with the biggest hurdle of all: no one can tell them how long it is going to last.

Long Covid: the start line

Hayley’s initial bout of Covid-19, in November 2020, didn’t require hospitalisation – although she was bedbound for more than a week. When she felt a little bit better, she went for a slow jog one morning. “It came on fast: I felt a little ‘off’ and only managed two miles before I had to go home,” she remembers. “Then, that afternoon, I was planning a seven-mile hike but, one mile in, I very suddenly started to feel really poorly and dragged myself home. I went to bed and haven’t really been able to get up since.”

Nine months on, Hayley hasn’t recovered. It was about a month after the initial infection that she first read about LC: “I wondered if that might be why I hadn’t recovered. About two months later, I accepted that this probably was what was happening to me. Physically, I feel terrible. My heart always beats too fast; I’m constantly dizzy and fatigued; I have to use a wheelchair to get about. I blame Long Covid for that.”

But it’s not only the physical symptoms that are debilitating: the illness’s neurological and cognitive symptoms have dramatically impacted Hayley’s ability to work as a writer. “Mentally, I’m not sleeping much at all and am depressed that I’m not being helped or taken seriously,” she explains. “I also get confused easily and am not able to read or write as well as I could before.”

I myself caught Covid-19 in March 2020, on a short flight where I was the only one wearing a mask. It took 11 days for my first symptoms to appear, and I tested positive on the 14th day after my flight. Since I didn’t need to go to hospital, my initial illness is qualified as mild – but I got served with five days of 40°C fever, coughed up blood clots, experienced two weeks of laboured breathing and the terror of worrying that I might fall asleep and not wake up. It didn’t help that I experienced this horrible illness alone in a caravan (after the flight, I was in quarantine). After 14 days I was able to go for a short walk but became out of breath after a few steps. Then I graduated to a few hundred metres, though my heart was pounding way too fast, too quickly.

By September – six months later – I was able to go for gentle five-mile walks. And in December (nine months after my positive test), when winter hit, I traded trail shoes for snow shoes and extended my hikes up to 25km. My heart was still pounding. I felt an unnatural breathlessness. My lungs randomly burned. I felt sharp, sudden pain in various parts of my lungs – but I hiked on. It felt amazing to be able to reconnect with my body, to tame the residual Covid-19 symptoms and feel them fade away.

Then in January, strange things started happening: I developed rashes and food allergies; I started coughing again; half of my face felt tingly, then numb. I had a stabbing pain in the left side of my chest. My throat would swell up and my whole lymph system felt like hot lava was running through it, yet my glands were not swollen. Twice I went to Accident & Emergency, where I was checked for lung and cardiac issues, inflammation and infection – I even got a brain scan and a follow-up MRI. All the tests came back normal.

The hardest miles

Long Covid has now firmly established itself as a multi-organ post-viral affliction that can manifest itself in multiple systems of the body, sometimes all at once. A study published in The Lancet* found that patients report prolonged, multi-system involvement and significant disability. For 91% of the 3,762 Covid-19 longhaulers taking part in the study, the time to recovery exceeded 35 weeks. The report also states that during their illness, participants experienced an average of 55 symptoms across an average of 9.1 organ systems.

Viral debris left behind in the body can trick the immune system into thinking that it’s still fighting the initial infection, causing it to keep up its heightened response – sometimes resulting in auto-immune issues, such as new allergies or dermatological problems. The inflammatory response to the initial disease causes microvascular blood vessel damage, which can lead to neurological problems including headaches, delirium, cognitive dysfunction, dizziness, fatigue and loss of the sense of smell or other neuropathologies.

The autonomic nervous system, which regulates bodily functions such as digestion, breathing and heartbeat, is shocked out of tune by the initial infection – and can fail to return to its natural state months after the illness, resulting in dysautonomia (the umbrella term for autonomic system issues such as breathing pattern dysfunction, hyperventilation, low oxygen saturation, breathlessness, tachycardia or gastrointestinal issues).

More than 200 respiratory, digestive, musculoskeletal and neurological issues have been reported as part of LC, making the scientific community’s attempts to create a predictive model of the illness even more complicated.

Almost two years into the pandemic, while the research has progressed at an academic level, and Long Covid specialist clinics have opened, the practical implications are only just starting to trickle through to mainstream medicine. Often, the only recourse for local general practitioners is to refer patients to an LC clinic.

For Gez Medinger, the path to understanding Long Covid before such clinics were open was to get involved in patient-led research. A film director by trade, Gez used to run 90-100km a week. “I started running cross-country at 11 because my older brother Jos was good at it, but I realised I didn’t like it. I’d always come second or third. I switched to football until my mid-thirties, and when parkrun started, I fell back in love with running and have run numerous marathons.”

Gez fell ill at the very beginning of the first Covid-19 wave of 2020, although he only experienced mild chills and a flu-like feeling for a few days. The second week, he went for little runs, and built up to 6km at an easy pace. Within six weeks, a disproportional fatigue set in, alongside an inability to recover – not just from runs, but from any moderate activity. “This was such a huge loss for me. Running was part of my routine, part of my identity, and helped me keep my mental balance. I’ve had running injuries in the past, but this is the worst [injury], as it’s got no prognosis.”

Gez started using his YouTube account to communicate the findings of his own research. His first video, where he demonstrates the link between his own LC symptoms and Post Viral Fatigue Syndrome (PVFS), struck a chord. Hundreds of sufferers used the comments to let out a collective sigh of relief: suddenly, they were not alone, their symptoms were not in their heads.

Fitness fatigue

Sports respiratory physician Dr James Hull authored a study of 147 elite athletes on behalf of the British Association of Sport Rehabilitators and Trainers. While around 13.3% of the general population didn’t get better after 28 days, the number among the athletes was 14% – which shows that fitness doesn’t protect from LC. But much more importantly, of those considered “recovered” before 28 days, one in four (25%) had not yet been able to fully resume their sporting practice. This contrasts markedly with the numbers usually seen with other acute respiratory illnesses, in which around one in 20 aren’t able to resume activity within a month. What’s more, the study found that presenting lower respiratory symptoms during Covid-19 (for example, breathlessness) had a strong correlation to LC, as opposed to upper respiratory tract symptoms or a loss of smell.

For Ruth Ainley, a clinical specialist in respiratory physiotherapy who spent the first Covid-19 wave at the front line of acute patient care and who now mostly treats LC patients, the mental strength that is often associated with endurance sports can prove to be a negative asset for the patient. “A big barrier to recovery is guilt,” she says. “Previously fit people are struggling with the concept of rest, and feel like they need to apologise for suddenly not being their active selves. But if you had a broken foot, you and everyone else would know that you wouldn’t be able to get off the couch.”

Chasing a Long Covid diagnosis

It may be easier now to get referred to a Long Covid clinic, but it is still a long road to get a clear diagnosis, because gold-standard tools such as scans, MRIs, blood tests or cardiac assessment tend to return a clean result. This was what I initially experienced with my local doctor.

As I turned up with yet another new symptom, my GP sat me down and calmly told me that there was nothing wrong with me. “All your vital signs are OK. Your lungs are not scarred. Your heart is normal. The symptoms you have do not amount to an illness, therefore I cannot treat you.” When I broke down in tears, he proposed that, “You’ve suffered a lot of stress. Your symptoms are, in all probability, psychosomatic.” Defeated, I accepted the anti-anxiety medication he recommended and walked away, my trust in him shattered.

It was only when I met a consultant at the Long Covid clinic at the Geneva University Hospitals that I got a clear answer: my breathing was dysfunctional, my autonomic nervous system was out of whack. I finally understood that the hardware was not broken – it was the software that was malfunctioning and misfiring.

For Luke Hanson, a 2h40m marathon runner, who caught Covid-19 while skitouring in Chamonix, the initial illness in January 2020 was mild. “I felt rough, but nothing too bad. But in the week I came home, one afternoon I went for a walk on the beach and just fell asleep – which was very unusual for me. I continued exercising, but each day was more difficult than the previous one, and I’d just be knackered for the rest of the day. In May, I struggled through a run but had to walk home. Energy-wise, things got worse. I had moments of paralysis, where I couldn’t lift my own weight out of the bath. By June I couldn’t do anything for myself – just feeding myself took an immense amount of energy. I couldn’t look after the kids (I was supposed to be homeschooling while my wife went to work), let alone look after the household. One summer day I tried going for a walk along the coastal path, but after 700m, I had to lie down on the floor for 40 minutes.

“My GP proceeded to diagnose me by elimination – until he finally said: ‘It must be ME.’ My ground zero day was when my wife called an ambulance after she found me seemingly paralysed at the bottom of the stairs, yet paramedics told me there was nothing wrong with me other than ‘being depressed’.”

Debbie Reece, a 50 year-old marketing manager, caught the virus in October 2020 as she was running the virtual London Marathon with a friend who didn’t realise she had Covid-19. “After my illness, after months of pacing myself off the couch, I managed to go back to work – however, I was still unwell.”

But what really knocked Debbie’s confidence was her doctor’s advice to just rest and take anti-inflammatories: “Eventually, after three months of being given pain medication by my doctor, I self-referred for private physio, which helped a bit. But it’s respiratory physio that really helped. I can now breathe normally in my day-to-day life, and am gradually getting back into exercise (gentle intervals for two miles), but that didn’t go well as it’s more difficult to manage my breathing while running. I manage, but I need to nap for two hours the following day.”

For fashion designer and Los Angeles-based triathlete Cesar Villalba, 35, LC symptoms were not just felt – they were tracked. “I was ill very early on, in December 2019, followed by a second pneumonia-like illness early January.” As reported in the Washington Times, just before Christmas 2019, Los Angeles county registered 50% more respiratory hospital emergencies than forecasted, which seems to point to the presence of Covid-19 much earlier than was thought. Although his illness was explained much later by a positive Covid-19 antibodies test, Cesar explains that at the onset of the illness, “my wearable device, a WHOOP band, immediately picked up on my autonomic nervous system issues. My heart rate variability (or HRT, a measure of autonomic system balance) was shot, and my heart rate was elevated beyond recognition.”

According to neurobiologist Emily Capodilupo, vice-president of data science and research at WHOOP, wearables have shown to be an important piece of the puzzle, with data such as respiratory rate (number of breaths in a minute, measured during sleep), heart rate variability (the number of milliseconds between heartbeats) or heart rate (number of heartbeats per minute) providing crucial insights. “Covid-19 is a lower respiratory tract infection. The infected cells are the alveoli, the point of contact in your lungs to your blood. As they get damaged, your ability to get oxygen into the blood and get carbon dioxide out becomes less efficient. In order to compensate, you have to take more breaths.”

After a user with Covid-19 reported an elevated respiratory rate, WHOOP fast-tracked the launch of respiratory rate tracking on its app and added in a way for users to signal a Covid-19 infection. “In just a couple of weeks we had almost 300 WHOOP users report positive Covid-19 tests, and we noticed a pattern of elevated respiratory rate, in many cases prior to the onset of symptoms.” This led to a peer-reviewed study* published in collaboration with the Central Queensland University (CQU) in Australia. According to the findings, respiratory rate may deviate from the baseline before we start to feel ill, which could tell infected people they might be capable of spreading Covid-19 – in a non-invasive way. “We’re not a medical device, we don’t believe that this is a replacement for a PCR test,” Capodilupo explains, “but I do think that there’s a lot of room for wearables and for these other types of approaches to try and catch some of the cases [where] the infrastructure doesn’t exist for the gold standard to be used in every single person every day.”

Long Covid: No clear path to recovery

Quantitative workout data, coupled with qualitative measures such as exertion perception, might also indicate recovery issues – which in turn might point to Long Covid. Enter stage left: Post-Exertional Malaise (PEM). Borrowing from myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) terminology, PEM is the worsening of symptoms following exertion, with symptoms typically worsening 12 to 48 hours after activity and lasting for days or weeks. This can be brought on by minor physical activity, such as taking a shower or making the bed – and by mental exertion, which can be as minor as checking one’s text messages or watching TV.

For Luke, after a lot of ups and downs, recovery finally seemed within reach. “I’m very lucky that my wife is a psychologist. I learned a lot about my illness from her, not least that I think that every pathology is part of a bio-psycho-social system, where all three components can trigger an illness, but can also help solve an issue. For me, getting counselling, while looking after my body with pacing, and having the support of my wife and friends, all contributed to the fact that I’m getting better. I got to the point where after hitting rock bottom and starting a pacing therapy (starting with two weeks of doing absolutely nothing), I was back running by December, one kilometre at a time, adding one kilometre every two days. By February I was running 20km three times a week. It felt incredible, and I had no PEM. I started working again, which distracted me from being ill and helped to give me a sense of purpose again. By April I felt fully recovered. It felt incredible.

“In May I raced in the Bristol Three Peaks (a 28km trail race) and felt brilliant. Following that, I went silly – six days later I ran the 55km trail Peaks Pilgrimage, followed by the Bob Graham Round crewing for a mate, where I ran the whole 110km. Then I got offered a place in the Serpent Trail, which in hindsight I shouldn’t have been running. Throughout those six weeks, I felt pretty fatigued – and I haven’t fully recovered. I can still run five times per week, but I’ve upped my meditation and rest practice. I feel like I now have certain triggers where my body relapses – such as running, or looking after the kids. But I feel that after the good times and bad times, it will get better over time.”

George Brill, 25, from Surrey in the UK, had been planning to start his PhD researching indigenous tribes and human performance. As a runner and free-diver, George knows a thing or two about breathing – yet he can’t seem to get better. “After Covid-19, I was out of breath but my lungs had no functional issues. My GP offered Cognitive Behavioural Therapy [a type of talking treatment that focuses on how thoughts affect feelings and behaviours], which didn’t help at all. The only thing that works is breathing exercises, specifically from the Stasis* programme, and acupuncture.”

For John (name changed), the initial illness in January 2020 was followed by two weeks of dizziness and fainting spells. “Nothing was picked up on ECG or scans. I felt that it was difficult to be believed by health professionals. I was told that my results for POTS [a dysautonomic syndrome that results in rapid heart rate changes] were inconclusive, as my heart didn’t go up by 30 beats per minute [in the Active Stand Test*], only by 20. But the problem is that their scale measures ‘normal’ people – who have a resting heart rate of 80. For fit people like me who practice endurance sports, going from a 45bpm resting heart rate to 65bpm should be a significant enough increase to qualify for POTS.” This prompted John to create an endurance-sports specific LC discussion forum* to compare notes.

According to Ruth Ainley, “As respiratory physios, we are seeing symptoms that are unlike anything we have seen before, and GPs often are not equipped to respond.” For Ruth, standard medical diagnostic tools are required initially to rule out serious conditions such as cardiac myopathy, lung scarring or autoimmune issues. However, provided that those are clear, suspected long-haulers can – and should – ask for more. A lot can be done with less standard tests, such as the Nijmegen Questionnaire, available online as a self-evaluation tool*, to identify dysfunctional breathing patterns. “I always tell my patients to bring a partner or a friend to their doctor. That way, if the doctor refuses to consider more options, or if the patient feels intimidated or lose their train of thoughts because of brain fog, they have the support of someone who can advocate on their behalf. There are standard ways to diagnose dysautonomia or fatigue, and it is OK to ask your GP to be tested for that.” The Lancet study showed that post-exertional malaise was the second-most common symptom of Long Covid. PEM results in a wave-like pattern of symptoms betterment, followed by bouts of more severe symptoms.

For John, the ups and downs are still there 18 months on. “On Saturday I looked disabled, I couldn’t go upstairs. Today I feel OK, I could cycle 50 miles if I wanted to. But if I do it and I push too hard, it would ‘store’ the issues I have and serve them back to me for two weeks. With LC you become scared of exercise – it’s not worth the price. It’s not like DOMS.”

Chris Silver is a competitive triathlete with a master’s degree in psychology who represented Great Britain at the 2018 Commonwealth Games. Throughout his LC illness (since April 2020), he went through the typical ups and downs of a long recovery. “Initially I radically changed my nutrition and took lots of supplements,” he says. “I also did a lot of breathwork, which improved my respiratory symptoms. But for me the most important part of my recovery was to start thinking myself out of the illness this year. Like most Covid-suffering athletes, I had created a lot of negative associations between exercise and LC, and it took a lot of time to retrain my brain that it was safe to exercise again. Health-wise, I feel similar to where I was pre-Covid – minus the year and a half of deconditioning, which means I’m not performing as well. I’ve retired from competitive sport and started my own practice* supporting athletes with mental strength coaching.”

For Cesar, the best source of information was John’s support group for athletes. “People were really knowledgeable, and as athletes we could exchange specific tips. I tried a lot of the techniques proposed in the group. Supplements have really helped, and what I also found useful so far is hyperbaric chamber treatment, which I do together with EMF (electromagnetic field) therapy. That has really helped with breathlessness right after the sessions. As a recovering triathlete, I find that cycling is easier on the body, and running is the one that I’m struggling the most with, as it gets your heart rate up much quicker. My resting heart rate previously was 38-39; right now, 18 months in, it’s going down slowly but still at 45. And it still suddenly goes up to weird peaks even when I’m not moving. My HRV was always in the 150s, but since my illness it’s never been back higher than 90. Will I ever go back to those numbers? I don’t know.”

Is that the finish line I see?

Through patient-led experimentation, small-scale studies and a growing collection of LC clinic strategies, it is possible to find an array of tools to find a way out of the condition. In one of Gez Medinger’s excellent videos*, Darren Brown, a physiotherapist who himself suffered from LC, explains the idea behind “pacing” in the context of fatigue: “Long Covid is unpredictable – the goalposts are moving, it’s episodic. Aim to find a balance between activity and rest. For example, avoid taking the stairs for a while, until you are better. And realise that an activity could also be reading – reading is not rest, it’s using energy as it’s a cognitive activity. So is television.” Ruth Ainley concurs: “Stop everything, and see what your baseline is. Strip all the non-essential (just like an elimination diet). Having a shower, getting dressed, having breakfast – those are all activities that can cost you energy. Start adding back one by one, balancing with scheduled and spontaneous rest.”

It’s OK to refuse Graded Exercise Therapy or psychotherapy if it’s offered. Ruth says that: “while strategies like meditation do help relieve the anxiety often associated with LC, the illness is definitely not psychosomatic. There are real physiological symptoms that were caused by the initial viral infection. Unfortunately, a lot of medical professionals still reach for the old tools for this brand new illness, for example to prescribe Graded Exercise Therapy – which we know is detrimental for people with Post Exertion Malaise.”

Breathwork is also key to recover from any form of dysautonomia. Various online programmes offer individual breathing coaching, but there are numerous exercises available online for free. Stasis, which is used at Mt Sinai hospital and has shown promising results, has an excellent breathing tutorial* specific to LC sufferers, with a mobile app in the works.

There are also promising nutrition protocols coming through. Some propose cocktails of over-the-counter vitamins and minerals; others suggest an anti-histamine diet to lighten the load on the immune system; some use short fasts or intermittent fasting to promote autophagy, which might be beneficial for LC. Also, some LC clinics prescribe anti-inflammatories, antihistamines and various receptor blockers – but this is still largely experimental and very much down to individual doctors or specific clinics.

After all the discussions he witnessed in his support group, John says: “My advice to previously fit people with LC is to know that the normal playbook does not work. Put it in the box, and re-think everything you do. LC typically shows high levels of inflammation, and we know that running is inflammatory. Don’t run, don’t throw petrol on it. Stop means stop. We’ve seen among our members that even gentle walking can do damage. If you had broken an ankle and been told to rest for six weeks, you wouldn’t run on it after two weeks. Somehow a lot of previously fit runners feel that this doesn’t apply in the context of LC.”

For John, there are a lot of transferrable skills between endurance sports and LC: “Take what you know from an endurance event, such as a marathon – things like hydration, fuelling often, listening to your body or pacing yourself. Those are super-useful for your day-to-day LC recovery strategy.”

As runners, we are used to having the ability to train hard and push through discomfort. But racing is not like being ill. For one thing, training and racing are choices we make; being sick isn’t. And while the races James Adams dreams up – with no set distance – are a closer analogy, competitors in these events can still stop whenever they want.

With Long Covid, it is becoming clear that taking a runner’s approach to the illness – trying to push through the discomfort or resting for the minimum viable amount of time – is at least unhelpful and at worst damaging. The stories that we have heard make it clear that LC is a serious issue affecting a large population – including thousands of runners – around the world. And that just like in racing, pacing is key to LC recovery.

We can only hope that the science and the medical profession will start to understand more about LC and the best way to treat it. And in the meantime, we must all stay vigilant and take steps to protect ourselves and others from this disease, so that in the long run there will be no more stories of runners being forced out of the race through no fault of their own.

* Find the studies and resources mentioned in this article at bit.ly/ltw-covid-resources

Julie Freeman is the co-founder and art director of Like the Wind magazine. A March 2020 Long Covid veteran, she is working towards getting back to mountain running. IG: @sistak

Alex Murphy is the co-creative director of Like the Wind. He likes to run uphill. IG: @alexrunstrails

Long Covid: Runners tell us about their own story

Nikki Rees
Female, 43, UK
Covid-19 illness: November 2020

It has taken more than seven months to feel any sense of normality. The first two months were spent with constant muscle aches and sudden bouts of extreme fatigue that I couldn’t fight. It was like drowning.

My fitness before Covid-19 was above average – I had finished in the top 10 ladies at the Stour Valley Path 50km. But Covid-19 saw me bed-bound for more than a week.

Foolishly, I tried going for a run the week my quarantine ended. Afterwards, I passed out for two hours and tried to accept that my body really had been hit hard. I’d been on course for hitting 2,000 miles for the year and was gutted to miss that, as well as all of my races.

In mid-December, when I was just randomly passing out, still couldn’t smell or taste and had crushing fatigue pretty much all the time, someone on Twitter mentioned how nice it must be to have Long Covid because you could nap whenever you like and it really upset me that people might view it like that.

Bradley Freeman
Male 21, UK
Covid-19 illness: August 2929

I was above average fitness before I contracted Covid-19 in August 2020 – I ran 2m01s for 800m at the British University Championships. I didn’t feel much at the time; it was more like a seasonal flu. I actually ran during my illness, fearful of losing fitness (my biggest regret). I didn’t want to lose all those 70-mile weeks of training I’d banked.

I tried to run and build back my lost fitness but my health was declining, heart rate ridiculously high for paces that had previously been easy. I then had bad Post-Exertional Malaise after every run so I had to rest for around six weeks.

It’s affected me tremendously. I used to run six or seven days per week, three session days and some days were double days. I’ve not been able to run more than three times per week and have only done two sessions in the past 11 months. I have gone through dark moments where I’ve felt like everything was just falling apart and I wanted it to end. But I exerted myself elsewhere – in my studies.

Kent Wagenschutz
Male, USA
Covid-19 illness: January 2020
Do you ever not feel well and think you might be able to shake it with running? I have taken that gamble often. Sometimes you win big and feel incredible. Sometimes your body and its pathogen invaders have other ideas.

I am an above average runner, usually in the top 10% of a race, who loves an unstructured run in the woods more than most things. I contracted Covid-19 in January 2020 but realised I had long Covid that summer, when the air had warmed up to normal highs but my breathing hadn’t improved. I’ve been prescribed an inhaler which helps a little, but hardly fixes things. I have also been referred to have a lung function test performed, but that is yet to come.

Now, I am trying to run as often as I can, but my endurance is shot and running at any pace is overly stressful. What I am really struggling with is that I can’t simply work my way out of this particular physiological problem. It’s an incredible strain on every aspect of my life.

Rick Stahl
Male, 46, USA
Covid-19 illness: December 2020

When I contracted Covid-19 during December 2020, I suffered hard for a few days, but was much better in a week. I was able to resume light activities after my 10-day isolation period, but quickly noticed that my heart rate was elevated when doing easy-paced runs. I didn’t necessarily feel out of breath or distressed, but since I monitor my heart rate with most runs, I picked up on this immediately. I can’t say that this peculiarity got better in the first few months. I’m not convinced it’s better now.

Now I can run any distance or effort level I want; however, my performance cannot match where I was pre-Covid. My spiking heart rate eventually limits my workouts and racing.

I’m in above average physical and mental health but annoyed that I can’t match my running times from late fall 2020. I try to take running a little less seriously given that no PRs appear to be around the corner. Sometimes that approach works, other times it does not.

Abigail Johnson
Female, 22, USA
Covid-19 illness: November 2020

Prior to contracting Covid-19 in November 2020, I was above average fitness, with above average tolerance to effort and no pre-existing conditions. I suffered hard for a few days, but was much better in a week. I wasn’t aware I had Covid-19 at first so I did a hill workout and I remember it just going awful. I felt like I couldn’t get my body moving and I was just trying to finish the workout without stopping to catch my breath.

After contracting Covid-19 my energy was wiped; I went from 50 miles a week to about 25. I also contracted Mono (glandular fever) right after getting Covid-19 so I was extra sick and tired.

I feel like currently I feel pretty good physically and running has been going a lot better for me lately because I have stepped back from doing so many workouts and speed training and tried to just enjoy the miles and getting out the door because I’m not currently training for anything.

Anonymous
Female, 43, UK
Covid-19 illness: April 2020

I was part of a team of five who did a test event for a 100-mile race across the mountains and plateaus around Falls Creek in Australia. It was an incredible experience.

I contracted Covid-19 in April 2020. I didn’t feel that ill; I was really tired for about four days, but other than that didn’t feel unwell as such. I was hit really hard about eight weeks later, when I stopped exercising altogether, then deteriorated over a month or two to the point where I couldn’t work. I was suffering from shortness of breath, extremely heavy periods, brain fog, memory loss, my hair was falling out, I had aches and pains in my ribs, stomach and belly. I was sensitive to sound, had phantom smells, was nauseous, had weird food aversions.

I can run now, but only for about 10-15 minutes, and very slowly, which doesn’t compare with pre-Covid fitness. My health is improving, and seeing that improvement keeps my mental health in check. Not being able to run, and run with friends is really frustrating.

Anonymous
Female, 44, Canada
Covid-19 illness: March 2020

After the 2008 New York City Marathon I realised I had qualified for Boston. It felt like the crowning glory of my running life. My initial illness in March 2020 was very mild. I instinctively felt something was wrong, but didn’t have any of the classic symptoms and generally felt almost well. As the weeks went on, I developed more symptoms: my lungs started to feel sticky and that they were filling with fluid. I had no appetite.

I have not been able to run again. I mentally feel like I am just hanging on. Running was a way for me to process and I cannot do that. Plus I generally felt great afterwards. Physically I am tired a lot. My body doesn’t feel like my own. My lungs aren’t right. I have POTS-like symptoms.

I gauge every activity – vaccuuming, taking out the garbage, loading the dishwasher, work etc – to see how I might do with a short walk or if that will be too much for me and make me feel so fatigued that I cannot even hold my body up sitting for a couple of hours.

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