Tuesday, March 10, 2020

Coronavirus and the Boston Marathon

Today, the New York Road Runners (NYRR) announced that its half marathon, which was scheduled to be held on Sunday, March 15, is now canceled. The New Bedford Half Marathon in Massachusetts was also canceled due to fears of spreading the novel coronavirus. Meanwhile, the Los Angeles marathon was held as planned last weekend.

Nearly all large races occurring in March and April have announced that they are closely monitoring the coronavirus situation and are working with health officials on the appropriate course of action. The Road Runners Club of America (RRCA) has provided guidelines for communications regarding race cancelations due to the fear of spreading the virus. New developments and cancelations are occurring daily as the fear of COVID-19 rises.

I've ready plenty of articles and seen loads of data regarding the coronavirus. To me, it seems like we should be concerned, but we shouldn't be taking such drastic measures to contain the virus and it shouldn't be causing the state of panic that we are now in. Just look at what's happening:

  • Schools are sending their students and teachers home
  • Major events (concerts, South by Southwest, conferences, races, and more) have been canceled
  • The stock market crashed
  • Schools of all levels are being shut down; college students are being sent home.
  • There are major shortages of hand sanitizer, medical masks, and even toilet paper in some places
  • Travel bans are in place and people are canceling their trips
  • Businesses are telling employees to work from home
  • If you sneeze in public you will be treated like you have the plague
To me, the virus doesn't seem so deadly that its worth sacrificing our economy, our freedom, and the things that bring us joy. We have 709 known cases of the virus so far in the U.S. and 25 deaths. The flu kills way more people. Yes, I know the percentage of people who die from coronavirus is much higher than that of the flu, and there are likely many more infections that we do not yet know about. However, there is no (published) evidence that COVID-19 will kill more people than the flu, and there is no evidence that it can be contained. And at what point will enough be enough? When will it be okay to start living our normal lives again?

I spent my wedding anniversary sick with mono
If you've been following my blog for awhile, you know that I have immune system issues. I have gotten mono three times in the past 8 years, and I have been sick for months at a time. Greg is worried that if I catch the coronavirus I could die, given my immune system. That's possible, but I could also die in a car accident. Because of my immune system issues, I wash my hands about 5-10 times per day. I don't touch anything in a public place-- I use my sleeve or my knuckles instead of my fingertips. If I have to shake someone's hand, I immediately go to the bathroom and wash my hands. I don't use hand sanitizer; I use soap and water because you don't necessarily want to kill the germs; you want them off your hands. I sometimes hold my breath in elevators. I do not like people breathing near me. When the barista hands me my coffee, I make sure she's not touching near the part where my mouth would go.

I like that the general public is now taking these same precautions and that I won't be forced to shake hands, or looked at oddly for not touching door handles. And yet I still think this virus is over hyped. I have not done anything differently and I don't intend to.

I'm registered for the Cherry Blossom 10-miler and the Boston Marathon, both of which are now at risk for cancelation. I had hoped that the LA marathon set a precedent for NOT canceling races, but now that NYRR has canceled its half marathon, that could be the new precedent. I strongly disagree with the decision to cancel races because:
  • It should be an individual's choice whether or not to "risk" getting sick
  • The virus cannot be contained
  • People are going to run in groups no matter what
  • Some runners will still run the planned race route, which is very dangerous without road closures
  • It contributes to the mass hysteria and panic
  • We cannot live in fear; life must go on
If I were advising the Boston Marathon officials on whether or not to cancel their race, I would not use any of the above arguments because they are mostly my opinion and there's room for disagreement. I would tell them to analyze the population of runners and spectators of the Los Angeles marathon. 

The virus has an incubation period of up to 2 weeks. So, wait two weeks (until March 22) and then determine how many of the LA marathon participants and spectators contracted the virus. If the percentage of that population has a higher than normal rate of infection, then it would make sense to correlate it to the marathon. If not, then there is no evidence that large marathons perpetuate the spread of the illness any more than living one's daily life.

Since the spread of this virus is being extremely closely monitored, it should be apparent in two weeks if LA marathon participants represent a larger-than-normal contingent of infected people. I'm not a medical professional or a public health professional but to me, it seems like this would be the only data-driven way to determine if a cancelation would help prevent the spread of the virus. 

Let's take it a step further and say that yes, LA marathon participants and spectators contracted the virus at a higher rate than the rest of the US population. Should Boston be canceled? They would have a data-driven case for doing so, but I still think that it should be left up to individual choice. Cars are dangerous but they aren't banned. Jumping off a bridge is dangerous but bridges exist. Furthermore, Boston Marathon runners are fanatics. They will still run the course on April 20, with or without the support of volunteers and medical professionals. That could pose a far more dangerous situation. 

It will be interesting to see what happens in the coming weeks. The number of daily reported infections in the US has declined over the past few days according to several sources, and if that trend continues, maybe we can all stop panicking and get back to living. . . but still not shaking hands.

Edited to add:
I am not a medical professional and this post is not meant to be a medical one. It's about how our society is collapsing under the fear. Let's all take precautions but not create one disaster after another, after another.

25 comments:

  1. You just voiced everything I've been thinking. I truly do not understand the level of panic surrounding this virus. I am currently registered to run my first Cherry Blossom and to make my first serious attempt at a BQ in Toledo. I will be heartbroken if I don't get to do either.

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  2. Right there with you on all of this. I am immunosuppressed because of the medication I take for RA. My rheumatologist tells me I shouldn't be worried. My medical background also is reassuring. I'm going to Florida in 2 days to visit my parents and run a 25k in the Everglades. Come run with me! :p

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  3. I understand the disappointment but in this instance the individual choices and the good of public health conflict. You can spread it to other vulnerable people before you even know you are sick. It’s the same concept as why it’s good to get a flu shot. Here’s the former FDA commissioner’s take https://www.usatoday.com/story/opinion/2020/03/09/coronavirus-past-containment-but-usa-can-limit-epidemic-scott-gottlieb/5007417002/

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  4. Also that this virus has a much larger incubation period and spreads much easier/faster than the flu. Which brings us to an important issue regarding containment measures (which I do agree should weigh in cost-benefit): it's really undesirable to let everyone get sick at the same (Italy, Wuhan, Iran), as those healthcare systems got overwhelmed to the point of affecting all patients and healthcare providers, to the point of people being let to die with literally no respiratory assistance in some cases (shortage not only of ventilators, but simple o2). That also doesn't happen with the flu, which much more rarely causes those severe pneumonias.

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  5. Some great points. The challenge with the larger marathons such as Boston and London is the high number of foreign nationals who will travel to those races. And that's one of the problems - risking further transportation of the virus around the world. With that in mind, I wouldn't be surprised if Boston was postponed. Not saying I agree if that's the direction but maybe having lots of people from, for example Italy, coming across may be too high a risk given there are so many unknowns.

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  6. Wow Elizabeth, I knew that you had mono, I didn't know you've had it 3 times. I've only had it once and I just can't imagine going through that 3 times. It's really tough to have the possibility of these races being canceled hanging over your head. I don't know what the answer is but I wish that people would put one tenth of the energy they spend panicking into, you know, just washing their hands.

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  7. Elizabeth - I have been a long time reader of this blog and your running journey and enjoy that content, but this is one time where you should “stay in your lane” and listen to experts.

    The *facts* about this virus are:
    1. Reported infections in the US are increasing. Your post is simply incorrect when you say “the number of daily reported infections in the US has declined over the past few days.” The opposite is true, any news sources will tell you that and this incorrect information is dangerous.
    2. We do not know how many total Americans have the virus because there have not been enough tests available (you can’t find something until you look). As more tests get released we will likely see even more cases.
    3. Most healthy people who get the virus will be ok (they won’t die), but *importantly* they can spread the disease to vulnerable people. They can spread the disease *before they know they are sick* so it isn’t as simple as an “individual’s choice whether or not to ‘risk’ getting sick.” This is a situation where the actions of each individual greatly impact society as a whole.
    4. If you research #flattenthecurve you will see that the problem with everyone getting sick at once from this virus is that it will overwhelm hospitals and ICU capacity. Northern Italy has more hospital beds and more doctors per capital than the US, and their hospital system is overwhelmed. This can happen in the US, too. It doesn’t just mean that coronavirus patients may not be treated (very bad), it also means that people visiting the ICU / ER for other reasons (injure yourself running? have a heart attack?) may not be able to be treated.
    5. The virus *can* absolutely be contained (contrary to what you said in your post), but only if people take action. It can be done by taking the steps you are actively arguing against, such as minimizing large group activities.

    I would encourage you to think deeply and self-reflect on why you believe your own opinions are correct in the scenario. Why do you feel the need to promulgate your own opinions in this forum and on this topic rather than deferring to and echoing the advice of the trained experts?

    The medical community in the US (consisting of formally trained doctors, public health officials, epidemiologists, etc.) has issued guidance on the importance of responding to coronavirus with active measures, and fortunately the organizers of large events are heeding the advice of experts rather than the opinions of the uneducated. These experts are specifically trained for this, and they pull from both the history of what has and hasn’t worked in similar scenarios (look at the Spanish Flu and response of St Louis) and the best practices of the medical community.

    I understand it will be personally disappointing to you if the races that you have trained so hard for do end up getting canceled. But please understand that the organizers of the events in question are not making arbitrary decisions. They are listening to the advice of experts trained in this topic. We should all follow that example.

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    1. I am not a doctor or a medical professional. What I see is our society collapsing. What I am feeling is not about a race cancelation- it's about how easily we can all be paralyzed by fear. We have allowed this virus to completely destroy our economy and our way of life with no end in sight. We must take precautious to prevent the spread of a deadly virus, but we cannot be paralyzed. It's about WAY more than my personal disappointment about a race. This is so much bigger than that.

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    2. Also, I appreciate your perspective; I am aware that this is a controversial topic. I'm curious what the long-term solution is, with a vaccine not being available likely until 2021? How many people will lose their jobs and their homes because of businesses shutting down? This is a downward spiral that isn't simply about hospital beds; it's about our whole infrastructure.

      I do not appreciate being told to "stay in my lane" as this is a personal blog and I am free to write about whatever topic I choose to.

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  8. You are right. The "lane" comment was purely in reference to medical advice and opinions, not broader topics. Though even that is your prerogative on this blog.

    Yes, this downward spiral is very bad for the economy and infrastructure and goes well beyond hospital beds. But that is not a reason to ignore the medical advice.

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    1. I don't think we should ignore the advice of medical professionals. But are the medical professionals consulting with economists and other experts that have a "big picture view" on this situation and our infrastructure? Not saying I trust politicians either!

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  9. I agree 100% with your stance Elizabeth. We should definitely be cautious but I think a lot of these cancellations are overkill.

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  10. I agree with so much of this! When I heard about the stock market earlier this week, I inwardly rolled my eyes. I think it's crazy how out of hand the media has made this virus out to be, and that people are stockpiling their pantries and closets like it's about to be the end of civilization as we know it. A small part of me understands that it's a tough decision on how to handle this virus since people can spread it before they show symptoms - so those who have a lot of close contact with elderly or low-immunity family members and friends makes it risky. But I don't think essentially forcing our society and economy to shut down and asking people to stay at home is the solution (especially when a vaccine wouldn't be available until sometime next year!). It's frustrating for sure.

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    1. It doesn't seem like anyone is weighing the risks of these drastic measures with the benefit of "flattening the curve". We are choosing a long drawn out flood over a quick tornado, and that might be the way to go, but is anyone even looking at that?

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  11. I work with two particularly vulnerable populations - transplant and oncology patients, both of whom are immunosuppressed - and we are taking certain precautions with them (mainly the same things they are already told to do, just reiterated, plus a recommendation to delay travel. Normally we only tell new transplants, who are especially high risk, to avoid travel). However, as we do not have firm information on how the virus is spread, its incubation period, and who is at most risk (we have some info on risk of infection and characteristics correlated with death, but both are small sample size), we're simply encouraging common sense hygiene for other patients. I do not agree with race cancellations at this time unless they require overseas travel from highly affected areas. We just don't have evidence to justify doing so. We might in the future, but you're right that many people are panicking right now. I can understand the concern for sure, and I also understand the intent of containment policies, but at the moment we are blindly reactive. I expect we will see the CDC issue guidelines once we roll testing out and have a better idea of how widespread the infections are. A race is a fairly low-risk event since it is held outdoors; it would be reasonable to move packet pickup outdoors to lower risk of indoor crowds, which can be petri dishes.

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    1. I completely agree. Panic mode is not the way to operate. We have no real evidence that these cancelations are slowing the spread of the illness and our economy is collapsing. Many will lose jobs and I fear we are headed towards another Depression- not a recession. The entertainment, hospitality, and manufacturing industries are getting hit so hard that I think we may be causing more problems than we are solving.

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  12. I really enjoy reading your posts and look forward to continuing to do so, but as a physician I’m very concerned about the misinformation in this post. The WHO has declared this a pandemic, and we have good enough evidence from Europe and China to determine that this is much, much worse than the flu. Epidemiological models predict that without implementing widespread social distancing measures, many additional people will die and our healthcare system will be overwhelmed (as Italy’s is now—to the great detriment of their economy).

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  13. Another risk factor that is unique to amateur distance runners is the toll that intense physical conditioning has on an individual's immune system. When our bodies are maxed out we are more susceptible to illness. The worst flu I ever experienced was during peak mileage training for Vermont City Marathon. I was down and out for 2 weeks in spite of being in peak physical shape! So I consider marathoners (amateur ones) a vulnerable population for sure... and the goal is to slow the spread... MA has already declared a state of emergency. The St. Patrick's Day parade thru Southie was cancelled, too.

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    1. also i really admire your writing and dedication to the sport, Elizabeth. Boston Bound is an amazing read! I'm so glad you wrote it. Everyone trying for that BQ should read it. Keep going!

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  14. Well Zebra you certainly invoked some interest in your blog with your comments on the COVID-19 scare! I partly many of your views on the whole hoopla, if not fiasco about this matter and the way it is dragging normal life and the global economy and markets down. Canceling major races and all that those regional economies depend upon, only adds fuel to the fire for market scare and decline.

    Conversely, I recognize what they doing and trying to slow the rate of its progression. Too late to stop its spread...because it managed to get here and more and more getting it. That is the way of the virus and once it here...it will increase. You cannot prevent a virus and once a new variation has evolved...it spreads until it either gets beat back by our immune systems, or we have vaccine to resort to. The vaccine most likely a year away, so whatever actions taken slow its progression may have an effect at keeping it a low-key infection in the population as opposed to full-blown pandemic.

    The problem with major marathon races like LA, Boston, NY, Chicago and others is a lot of others from the world come to run them. And any virus likes that as it increases the likelihood of its spread not only within our country, but globally by 10, 100, 1000 times or more.

    I never seen this magnitude of scare about a pandemic for a virus that is not all that lethal compared to other viral based diseases in past. Like my investment funds that took 15k downturn and no sight of stability and rebuild anytime soon, we have to be patient and let it ebb and flow, then we back to normal....if anything is normal in this crazy world!

    I think you will fare fine, even if you contract it, so help Greg loose his worries or concerns. We already know you cognizant and do your thing to minimize your susceptibility to anything can put the stress on your immune system. Stay strong, run strong!

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    1. Thank you for the support. It's difficult to know if these drastic measures are needed or not. I wish someone was actually analyzing the impact of all these closings and cancelations on our economy and infrastructure and weighing the self-inflicted damage against the potential damage of the virus. Prevention of the spread is the #1 priority, without regard for anything else.

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  15. Hi Elizabeth, apart from the health considerations, organisers are cancelling races because their insurances do not cover them for harm arising from potential or actual pandemics. It's sad and frustrating especially for those who have trained so hard for races. Stay positive and keep training as we all need to believe there will be other races for us, once this pandemic is under control.

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    1. Good point. Races do not want to be held liable for spreading the virus.

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  16. Love your passion my friend. I think as we learn more, there will be greater understanding that these measures, while they seem insane, will be wiser in the end even if we don't understand it all. I saw plenty of areas where you said you're not a medical or public health official so no worries. It's your blog and you're allowed to state your opinion and it's ok for others to disagree.

    It is what makes life and the world go round. You sharing your thoughts is good for all of us that read your blog and are seeing a little something different from you. As I see it has brought in conversation from some who don't post and we see other's perspectives.

    As for the economic damage. It is what it is and yes it sucks. We're all getting crushed in our retirement accounts and all but for the most part, this is not a financial issue like 2007-8 nor is it an excessive inventory issue (outside of Saudi Arabia flooding the oil market is a price war with Russia) like we saw with semiconductor companies during the dot com crash.

    It may not be a V-shaped recovery but we will recover fairly quickly. We can't trust what China says but South Korea took these drastic measures are are seeing a decline. It's painful and psychologically exhausting and consuming us like there's nothing else in the world but we'll get past this and YOU WILL TOO!!! Thanks though for sharing your thoughts and it's good to get the viewpoints of others. Anyone who posted and comes back to this, thank you for the conversation. I think everyone gets more educated by sharing thoughts and ideas and putting them all together (if only the politicians actually did this instead of wasting our money)

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