Tuesday COVID meeting Cochin 25 October
❤️Special topic: Death during marathons, Thread👇
COVID hospitalisation declines further
Patients requiring ICU, O2 continue to fall after recent Onam surge
Inpatients mostly 80+ age, multiple co morbidities
Testing rates low
1/9
❤️Special topic: Death during marathons, Thread👇
COVID hospitalisation declines further
Patients requiring ICU, O2 continue to fall after recent Onam surge
Inpatients mostly 80+ age, multiple co morbidities
Testing rates low
1/9
We discussed a special topic:
Are marathons or half-marathons safe?
Premise: recent deaths during such events in Delhi (16 October) Kolhapur Maharashtra (18 September) and elsewhere
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timesofindia.indiatimes.com/city/kolhapur/…
Are marathons or half-marathons safe?
Premise: recent deaths during such events in Delhi (16 October) Kolhapur Maharashtra (18 September) and elsewhere
2/
timesofindia.indiatimes.com/city/kolhapur/…
Our panel included several marathon runners among doctors, multiple specialists and doctors who organise marathons. Our special guest was Dr Dhananjay Shukla from Gwalior, a veteran marathon runner.
Our consensus:
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Our consensus:
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1. Marathons and half marathon are “extreme sports” events, compared to walking, cycling or swimming.
They require a certain level of fitness, sustained training towards such levels of exertion.
They are not recommended for individuals without prior training.
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They require a certain level of fitness, sustained training towards such levels of exertion.
They are not recommended for individuals without prior training.
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2. Deaths during marathons are nothing new. In fact the first marathon runner, Pheidippides, collapsed and died.
Although deaths are reported, the numerator of death is tiny against a large denominator comprising tens of thousands of people who participate in such events.
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Although deaths are reported, the numerator of death is tiny against a large denominator comprising tens of thousands of people who participate in such events.
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3. Participation in extreme sports during the pandemic:
2 considerations:
1) if the person had a moderate bout of Covid recently, it is best that they do light exercises when cleared by his doctor, and avoid extreme sports events.
2) Never do this while ill with COVID
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2 considerations:
1) if the person had a moderate bout of Covid recently, it is best that they do light exercises when cleared by his doctor, and avoid extreme sports events.
2) Never do this while ill with COVID
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4) Our own IMA Branch in Cochin, one of the largest, has held multiple 1/2 marathons over past decade, no deaths occurred. None have occurred in the combined memory of all those who attended today. Deaths are rare.
However we haven’t held a similar event after the pandemic.
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However we haven’t held a similar event after the pandemic.
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5) We don’t endorse or recommend “blanket check ups for everyone”. The preventive value of such an approach will be low, and will not justify the cost and effort.
However, at an individual level, based on risk stratification, people can check with their own doctor.
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However, at an individual level, based on risk stratification, people can check with their own doctor.
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6) Older people are more likely to have heart disease, which is often silent. Unfortunately, we don’t have a perfect test to pick up heart disease. They have high false negative rates as well as false positive rates.
Those with risk factors, check with their family doctors.
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Those with risk factors, check with their family doctors.
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7) Although there are several seniors (70+) who have been running marathons for decades (Note: they are seasoned athletes), we do not recommend anyone to *start* participating in marathons at a later age. There is no age cut-off to start (maybe 55), esp.those with high risk.
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8) We reviewed pertinent medical literature and the following facts were noted:
a) it is common to have elevated cardiac enzymes after marathon, *without* having a heart attack.
This means that we are putting our hearts under extreme stress with such events.
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a) it is common to have elevated cardiac enzymes after marathon, *without* having a heart attack.
This means that we are putting our hearts under extreme stress with such events.
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B) A negative cardiac evaluation before a marathon, is no guarantee that a death will not occur.
Why? Deaths have many causes. A sudden death can occur from electrical failures of the heart (arrhythmia from conduction defect), which need not be picked up during check ups.
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Why? Deaths have many causes. A sudden death can occur from electrical failures of the heart (arrhythmia from conduction defect), which need not be picked up during check ups.
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9. “Runners don’t quit” rhetoric may sound ambitious during sports. But this might not be the best option for health.
In other words, if a runner feels tired, breathless or has chest pain during a race it’s better to stop and get medical attention.
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In other words, if a runner feels tired, breathless or has chest pain during a race it’s better to stop and get medical attention.
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10. The death in Delhi apparently occurred in spite of having all the advanced cardiac resuscitation devices available.
We still recommend holding marathons *only* after adequate defibrillators and medical care points are posted at regular intervals.
Be well-prepared.
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We still recommend holding marathons *only* after adequate defibrillators and medical care points are posted at regular intervals.
Be well-prepared.
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11) For any sports, it is important to start training slowly, build up gradually - preferably under professional supervision and also know and respect our individual limits.
Excessive comparisons to other people at the gym can be dangerous.
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Excessive comparisons to other people at the gym can be dangerous.
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12) We recognise that long Covid is a problem particularly in people who had required COVID hospitalisation. Such individuals must be more careful. Those with long Covid symptoms should not be participating in marathons or extreme sports events.
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13) One practical problem with the pandemic is that some people who had been running half marathons earlier might have taken a long break.
Such people must be careful while participating, after long breaks.
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Such people must be careful while participating, after long breaks.
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In summary, deaths occurring during marathon or half marathons are extremely rare events.
But for the person who died, it is clear that the death would not have occurred in the absence of the event. There is no easy solution here. Discretion is the better part of valour.
16/16
But for the person who died, it is clear that the death would not have occurred in the absence of the event. There is no easy solution here. Discretion is the better part of valour.
16/16
Linking my article on sudden deaths in young adults, it has links to several of my prior works, especially the one about CPR, cardiac testing and its limitations.
17/17
(See thread above 👆 for context)
17/17
(See thread above 👆 for context)
https://twitter.com/rajeevjayadevan/status/1496767407955714050
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