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When to Return to Running After a Positive COVID-19 Test

If you’ve tested positive, or do so in the future, two leading marathon cardiologists recommend taking your time getting back into action.

As the country continues to battle with COVID-19 — making unsettling progress in some regions, but apparently losing ground in others — two leading marathon cardiologists have published an advisory for runners. Aaron Baggish and Ben Levine urge a cautious return to activity for those who have had a positive COVID-19 test. Baggish is co-medical director of the Boston Marathon; Levine, a professor of medicine and cardiology at the University of Texas Southwest Medical Center.

In fact, they’ve developed an “algorithm” that covers all runners from those who have never tested positive to those who needed to be hospitalized. Their report appeared in the June 8 edition of Circulation, from the American Heart Association.

Avoid the Icarus Complex

Baggish and Levine liken the return to running and racing after COVID-19 to the mythical story of Icarus, who died after flying too close to the sun. The sun’s heat melted his wings made of wax and feathers, and Icarus plunged to his death in the ocean below. He would have done fine if only he had flown at a moderate altitude — not too high, not too low.

Similarly, Baggish and Levine fear, runners recovering from COVID-19 might return too soon to hard training and racing, risking heart injury. They note that COVID-19 “has proven to be a highly infectious lethal disease that impacts the cardiovascular system.” Also, a recent study in Italy found a 60 percent increase in sudden cardiac deaths outside hospitals during the COVID-19 pandemic vs. the year before. Most of the afflicted were elderly, but the report “raises the disturbing possibility that sudden cardiac arrest during athletics will spike during recovery from this pandemic.”

The two endurance cardiologists note that they have long disagreed on some aspects of pre-competition “screenings” for race entrants. Nonetheless, “We collectively believe that the COVID-19 pandemic should change the nature of the discussion regarding pre-participation screening.”

The goal is to find a middle ground that Icarus missed. The authors note “the immediate positive impacts of return to the fields of play on athletes.” At the same time, they worry about “implications with respect to cardiovascular health and wellness.”

To this end, they have proposed the following four-part approach for runners and other active individuals.

If you haven’t tested positive:

There are no limitations to your exercise routine; but follow social distancing guidelines; and monitor yourself for possible symptoms.

If you test positive, but without symptoms:

Do no exercise for two weeks after your positive test; be aware that late deterioration has been seen in COVID-19 individuals; return slowly to exercise after two weeks and with doctor guidance.

If you test positive, and have mild symptoms:

Do not exercise while you are ill; monitor yourself for cardiac symptoms; do not resume exercise until two weeks post resolution of illness; consider evaluation by a cardiologist.

If you have been hospitalized with COVID-19:

Do not exercise while symptomatic, or for two weeks after cessation of symptoms; consider cardiac testing; resume exercise slowly and monitor yourself for clinical deterioration.

Baggish and Levine note that there is no current evidence regarding exercise-heart problems resulting from COVID-19, and neither is sounding the alarm. They’re simply advising caution until more is known. They conclude: “Like Icarus, we must remember that new-found freedom comes with responsibility, and that timing and strategy will be everything.”