Training Intelligently in the Time of COVID-19 with Dr. Jeff Sankoff

Training Intelligently in the Time of COVID-19 with Dr. Jeff Sankoff

Listen as Endurance Coach and Emergency Room Physician, Doctor Jeff Sankoff discusses the current status and future of racing in the time of COVID-19.

If there ever was someone with true expertise in endurance training through a pandemic, it would be Jeff Sankoff. As a doctor of 21 years, with a specialty in critical care, he has deep insight into the physiology behind triathlon training and racing, in addition to a well-informed perspective on the current status of race safety in the time of COVID-19.

Jeff is also a triathlete with many Ironman and Half-Ironman race finishes under his belt. Listen as Dirk and Jeff explore the future of safe racing as well as discussing the infectivity to COVID-19 among training athletes. 

Stand-out Quotes

  • “I say that triathlon changed my life and it really did… and especially now throughout this period of quarantine and everything else we’ve been going through, even without races training has been a huge, huge boon to my mental health.”
  • “Indoor transmission, restaurants and bars are so dangerous, because it’s restricted airflow and the air tends to be recirculated. It’s really dangerous in those small spaces, but outdoors, you have continual air movement. You also have changes in humidity and you have direct ultraviolet light from the sun. So all of those things together just seem to make outdoor transmission of this virus much, much less.”
  • “Other kinds of viruses, influenza viruses, we have an excellent immune response to it and we actually retain this immune memory. And if you get re-exposed you, your response is very, very strong and you tend not to get reinfected. With coronavirus, it tends not to be quite as good.”
  • “You asked a question about how many viral particles you need to be exposed to and that’s really the crux of this to be infected. It requires both exposure, it requires time and it requires viral load as you’re running along and you’re passing by people. You simply do not have the time or the exposure to get a sufficient viral load to be infected, especially when you’re outdoors.”
  • “I’ve talked to a couple of local race directors here in town and the issue for them is volunteers on the water. They’ve got to get permitting. They have to have enough people out on the course to watch traffic. And there’s just a certain number of participants they need to make it viable. And the question is what’s that magic number?”
  • “I came to the realization that I don’t just train to race. Training for me has become so much more a part of my life. And it’s so important to me for so many other reasons.”

Resources

Jeff Sankoff’s Instagram

Jeff Sankoff’s Podcast: The TriDoc Podcast on iTunes

Jeff Sankoff’s Podcast: The TriDoc Podcast on Spotify

Jeff Sankoff’s Website

Episode Transcript

Dirk Friel:

In this episode, I interviewed Doctor Jeff Sankoff, who is an emergency physician, longtime triathlete and Ironman University Certified Coach. As a doctor of 21 years with a specialty in critical care, he has deep insight into the physiology behind triathlon training and racing, in addition to a well-informed perspective on the current status of race safety in the time of COVID-19. He has completed six Ironman races, including Kona and more than 50 races at the 70.3 distance, including five world championships.

He is a medical contributor to Triathlete Magazine and produces the TriDoc podcast as well as being owner of TriDoc Coaching.

Hey, Doctor Sankoff, thank you so much for joining me today. 

Jeff Sankoff:

It’s my pleasure. I’m glad to be here. 

Dirk Friel:

You know, if people look you up through our search at TrainingPeaks, you‘ve got several articles written on our blog. And I think the last one was in March of this year. You certainly wrote about COVID – gave some guidelines around training what we can expect to see around racing, but things have certainly evolved a lot in the last few months. So I think it’s a good time to catch up and give some people some good, sound advice. 

Jeff Sankoff:

Yeah, it’s been quite a ride, both as a physician and of course, as a triathlete as so many others experiencing really the loss and the grief that we’re all going through as a result of this pandemic. But as a physician, that’s been an incredibly humbling experience.

This disease has been something we’ve been learning about on the fly, and it is really an incredible illness. One that has caught us off guard and that we still know a lot less about than we think we do. 

Dirk Friel:

Well, tell us more about your experience in the medical field. What your day job is and where you’re kind of gaining all this knowledge. 

Jeff Sankoff:

Yeah. So I am an emergency physician at a level one trauma center in Denver, Colorado. We are an outreach facility for three or four different states that surround us that refer a lot of trauma. But we’re also the urban safety-net hospital for the city of Denver. So we take care of a lot of the inner-city population, the indigent community, as well as minority communities who unfortunately have been really hard hit by this disease. 

And I actually was one of the physicians who saw one of the first patients to hit the United States. Although at the time we weren’t able to be sure of that, I saw a gentleman who had flown back. He was a pilot for one of the shipping companies and he had flown back from Wuhan and was manifesting all of the symptoms of what we now call the coronavirus, novel coronavirus. And we just had no way of confirming that he had that, but you know, and at the time he was a fairly younger gentleman, he wasn’t terribly ill and did not presage what was coming. The spectrum of illness and severity of illness that we’ve seen has just been really, really incredible. And as I mentioned humbling, just because patients can present looking really well and have the most remarkable chest x-rays and within a very short period of time deteriorate very, very quickly.

Dirk Friel:

Wow. Well, we’ll dig into more of those details to come. Another part of your experience, is certainly triathlon, and that has a lot to do with this conversation we’re having today, giving advice to not only triathletes, but any endurance athlete listening. So tell us a little more about your triathlon experience. 

Jeff Sankoff:

Yeah. I came to the sport, well, about 20 years ago now. I was finishing up my medical training. I was a critical care fellow, found myself very much out of shape, very much overweight and had one of those moments that I think a lot of people have, I call it an Andy Dufresne moment, (sorta from the Shawshank Redemption movie) where it was, you know, get busy living or get busy dying, and just made a decision that I needed to change something because my family has a history of heart disease and a premature death, and discovered triathlon pretty soon after that. 

And for a long time, I was pretty content just getting in shape and doing the sport. But about eight years ago now, [I] got a lot more serious about it. My kids were a little bit older. I had more time to dedicate to the sport, I’d been in the sport at that point for quite a while and just with applying myself and really with a newfound kind of desire to do well was able to move up to the, you know, top five in my age group and qualified for 70.3 World Championships, many times and Kona one time. And yeah, it’s been a journey that I’ve really enjoyed and I say that triathlon changed my life and it really did. And it’s become such a huge part of my life now. And especially now throughout this period of quarantine and everything else we’ve been going through, even without races training has been a huge, huge boon to my mental health.

Dirk Friel:

Right. And coaching as well, is that correct?

Jeff Sankoff:

So I had been a medical contributor for several triathlon publications for a long time. And it just kind of, you know, seemed like a natural evolution to take what I’ve learned in the sport and try and help others. As you know, with the perspective of someone who has not only been in the sport for so long and had so many experiences, but also someone with a medical career. And I got certified as a coach two years ago. And I’ve been coaching, this is my second year of coaching now and I’ve really enjoyed it. It’s been a fantastic experience with my athletes. I know that they appreciate my perspective and I certainly learn from them just as much as I hope they’re learning from me.

Dirk Friel:

Yeah. Well, I assume you’ve had some of these conversations already with your athletes. So thank you for sharing this advice with the world through the TrainingPeaks CoachCast today. I’d like to start off with some of the more basics of COVID-19. I think a lot of people may have heard, but it has maybe evolved. So if we kinda level set on a few things and understandings and there’s still question marks out there. And then from there we can go into more of the advice around actual training. 

But so if we can kinda back up and talk about this virus and what we know of it so far, can it be transferred through surfaces or just air transmission, or how are we seeing it being transmitted within the population? 

Jeff Sankoff:

Yeah, so much of that is still up for debate. And, you know, speculative, what we do know is this is a coronavirus, and we know a lot about the family of coronaviruses, because there are something like two-to-three hundred varieties of coronavirus and each one of them causes, for the most part, the common cold, or different varieties of the common cold. And it’s only been in the last, I want to say, 20 to 25 years that new novel coronaviruses have emerged that have caused much more serious disease. And the ones that people have heard of are SARS, which was an Asian coronavirus that came out back in 2003 and was responsible for a very high mortality. That was a novel coronavirus. Mers is another one which is Middle Eastern Respiratory Syndrome. And now this new novel coronavirus, which is known as SARS-2, or COVID-19 but they’re all coronaviruses, and coronavirus share a certain amount of characteristics.

And then this COVID-19 has been remarkably different from other coronaviruses in a lot of important ways, but we can infer certain things about this virus based on what we know about other coronaviruses. And all coronaviruses are through what’s called droplet infectivity. 

So when we think about the way that viruses can be spread, the worst or the most infectious way would be airborne. And that would mean that every time you took a breath, viral particles would be expelled as part of your exhaled air. Droplet infectivity refers to viruses that are spread on or within respiratory droplets. So whenever you exhale, especially if you sneeze or cough, you expel these tiny little droplets of respiratory secretions and within them and coating them are just, you know, millions and billions of these viral particles and influenza is spread that way and almost all coronaviruses are spread that way as well. 

Now, the thing about respiratory spread, by this fashion, droplet spread, is that droplets tend not to linger in the air. They tend to fall to the ground because those droplets don’t get suspended. And so usually as long as you’re a certain distance away from somebody who’s coughing or sneezing, those droplets will fall to the ground and not have the infectivity to a person who’s more than, you know, six feet away. That’s where this whole social distancing thing comes from is this notion that respiratory droplets won’t go further than that. 

But then there’s the question of what happens to those droplets when they hit a surface and that has been a cause of great speculation. Early on, there were laboratory studies that showed well, if I placed some coronavirus on a surface and then pick it up, an hour or two later, it still would be infective. It will infect cells. And so this led to speculation that coronavirus does remain infective if it’s on a surface. 

And again, comparing to other coronaviruses that cause the common cold, you know, there’s been studies in the past—it showed that the most common way that the common cold was spread was through contact. So a person would cough in their hand and then touch something and then someone immediately after would touch that and then touch their nose. So we know that coronavirus can spread that way. But the question is, and I think the question you’re asking is, how long is the virus infective on any specific surface? So if I have coronavirus, I cough on my hand, I touch a desk, I walk away and you were to come along half an hour later, touch the same desk. Are you likely to get infected?

And the answer to that is honestly, we just don’t know. We do think, however, based on what we’re seeing, now that we have, you know, eight months of experience, that it probably does not last on surfaces for very long at all. So yes, if you were to touch a door handle immediately after someone infected with a door handle, you could get infected. But if you were to touch that same door handle, say 15 minutes later, less likely. How much less likely, I can’t tell you for sure, but certainly less likely. 

Dirk Friel:

Okay. So if that door handle is now, one is indoors and one is outdoors in direct light, sunlight. Might that make a difference? 

Jeff Sankoff:

Yeah, absolutely. I mean, it’s an excellent question. We’re seeing tremendous variabilities in the infectivity rates indoors versus outdoors. So outdoor infectivity seems to be incredibly low compared to indoors, but whether or not that has anything to do with surfaces is unclear. It stands to reason that outdoor surfaces are going to be much safer than indoor surfaces, but again, there’s no real great data on this.

Dirk Friel:

And then not just droplets, but through your breath, being outdoors, obviously sunlight, but now you have you know, wind, greater airflow, that I’ve heard, that reduces risk as well as that. Yeah. Is that a good statement?

Jeff Sankoff:

The things that seem to play into outdoor transmission being so low are, as you said, sunlight and wind, no question airflow is the absolute number one predictor. And that’s why indoor transmission, restaurants and bars are so dangerous, because it’s restricted airflow and the air tends to be recirculated. It’s really dangerous in those small spaces, but outdoors, you have continual air movement. You also have changes in humidity and you have direct ultraviolet light from the sun. So all of those things together just seem to make outdoor transmission of this virus much, much less.

Dirk Friel:

Okay. Now what about the actual amount of exposure? Is it equal, no matter how much? It hits you, you breathe it in, do you automatically…? Or does it matter the amount that you might breathe in or you…?

Jeff Sankoff:

Absolutely. You have to be exposed to a certain amount. So, I mean, while theoretically, one viral particle would be enough to cause an infection, practically, that just is not the case. Nobody knows exactly how many viral particles you have to get on the susceptible membranes in the respiratory system to actually get infected, but it’s going to be greater than one and probably less than several thousand, but when you consider how tiny these viral particles are. You know, a pinhead can contain millions of them. So it doesn’t require a very large volume, but the number of viral particles within that volume can be very high, but again, that diminishes with distance from the infected person.

Dirk Friel:

All right. So if we now start to dig in and look at age, the spectrum of, you know, kids up to obviously aging adults. Obviously it’s affected the older generation more, they have higher risk of actual death I’d assume. But have we seen that migrate to younger ages through the last three, four months?

Jeff Sankoff:

Well, there’s a number of things that predict mortality, age is by far the strongest association and that’s the one that everybody knows about. If you’re greater than 70 years old, your likelihood of succumbing to this disease is as high as 50%. If you’re younger than 20 years old your likelihood of dying from the disease is quite low, less than 1%. So definitely age is a very important predictor of outcomes. However, amongst those who survive, this is not a benign illness. Consider for example, people in the 40 to 50 range, they have a very low mortality rate. It’s only about 5 to 7% of people, and already 5 to 7% is very high, but you know, 5 to 7% will die, but as many as 20 to 25% will require hospitalization. And in that group, about 20% of those are going to end up in the intensive care unit.

So these are really, really sick people. And when they recover from the illness, they’re often left with very profound morbidity afterwards. This disease causes terrible vascular problems, it causes strokes, it causes heart problems. They can be left with terrible respiratory illness. So yeah, maybe they didn’t die, but they’re left with really, really bad after-effects from this disease. 

Now, there are other things that predict outcomes as well. So while children for the most part are not likely to die, there are going to be groups of children who are. So any child who has known cancer or known associated comorbid illnesses, such as diabetes or any kind of pre-existing heart conditions, and we see those congenital heart conditions in kids, that does predict poor outcomes.

Dirk Friel:

Huh! And the after-effects of the infection, that’s independent of age as well?

Jeff Sankoff:

That we don’t know, but that does appear to be independent of age now, right now, because the number of survivors is higher in younger people. We’re seeing that the after-effects of illness are skewing to younger people. Does that make sense? Because if you have more people who survive the illness, who are younger, you’re going to have, you’re going to see more frequency of those after-effects in younger people.

Dirk Friel:

Okay, but yeah. So my point is young people still get these after-effects.

Jeff Sankoff:

Absolutely. 

Dirk Friel:

So brushing it off and saying, “I don’t really care, cause I’m in college.” Doesn’t really do us any good.

Jeff Sankoff: 

Right! And I don’t want to…people forget young people are dying from this. Young people are ending up in intensive care on ventilators for a very long time. So while it may be less likely that they’re going to die, it’s not zero. And it’s certainly significantly higher rates than with the flu, which is what everybody seems to like to compare this to.

Dirk Friel:

How about treatments and how has that evolved? 

Jeff Sankoff:

Yeah. Unfortunately, viruses are incredibly difficult to treat and for a number of reasons. Viruses are inert and that is to say they are not alive on their own. So bacteria are distinguishable from viruses in that bacteria are living organisms. They multiply on their own. They don’t require a haman host. Bacteria, which causes things like pneumonia for example, when bacteria get into the lungs, the way we treat them is we give antibiotics and those antibiotics interfere with the bacterial life cycle without interfering with any of our mammalian cell life cycles.

So the antibiotics are very specific to the bacteria themselves. Now because viruses aren’t alive on their own, what viruses have done is they get into a cell and they just harness our own cells’ machinery to replicate themselves. As a result of that, any drug that would work against a virus necessarily has to work against our own cells to stop the reproduction of the viral particles. So it’s really, really hard to interfere with viral replication. 

So instead, drugs that work against viruses have to operate against things that are very specific to the virus itself. So for example, coronavirus has this spike protein, which latches on to a specific receptor on the surface of cells and that’s how it gets in. And so a lot of work has been on trying to identify a drug that can block that spike protein, but it’s really hard because as I said, there’s already a receptor on human cells for that protein.

Well, if you block that spike protein, and you’re probably going to block whatever that receptor is needed for in the first place. And therefore you’re going to interfere with normal cellular function. Now there is one drug that’s come out, it’s called Remdesivir. It came out to a lot of hype a few months ago. It was originally designed for something completely different, when it didn’t work for that, it was kind of dusted off and tried out for COVID. You know, it was one of these things where we had nothing. And when Remdesivir seemed to show a tiny glimmer of hope, everybody kind of latched onto it. Like this is it. We got something. The reality is, is that Remdesivir is really not that big of a deal. It’s effects are very specific to a very small subset of patients with this disease and doesn’t really change mortality.

It may change morbidity for some patients. So right now we really don’t have any specific therapy for this drug. What we have learned, however, is we have learned how to treat these patients with our conventional therapy. So for example, we used to intubate these patients right away, and now we try very hard not to, because we’ve learned that putting these patients on mechanical ventilation can actually, in many cases, be harmful. So we try as best we can to keep these patients off the ventilator as long as possible and ventilate them only at the last instance when they absolutely must be. So we’ve really learned how to manage these patients with conventional therapies, as opposed to having any new therapy,

Dirk Friel:

And then any progress around the vaccine side of things? What have you been hearing lately? 

Jeff Sankoff:

Well, there’s a lot of, a lot of hope around that because that’s going to be honestly, probably the only way we’re ever going to see this go away. And there’s some, there’s several hundred different candidates out there. One of the issues with a vaccine for this virus is that there’s never really been an effective virus against coronaviruses before. Now they did have a potential candidate for SARS that was the Asian virus from about 20 years ago. And because SARS just kind of went away, they never really pursued that vaccine all the way through to clinical trials, but they were able to bring that one back because this new coronavirus is pretty similar to SARS in a lot of ways. So that gave them a head start and that’s actually one of the vaccine candidates. 

That’s sort of the furthest ahead and is actually in clinical trials right now in England. Moderna, which is a company here in the United States, has a candidate as well that just got approval to go into the next stage of clinical trials. And we’ll be testing thousands of patients across the country with their next step. So I’m optimistic that we will get a vaccine for this. 

The question is always when vaccine research is just one of these things that takes time. You have to inoculate a lot of people to show that it actually works. And more importantly to show that it’s safe.

Dirk Friel:

Right. So the soonest might be?

Jeff Sankoff:

I mean, they’ve been on a really accelerated timeline and because this is such a huge problem for the entire world you know, people are saying optimistically that by the beginning of 2021, we could actually see a successful vaccine. That would be the fastest ever from beginning to end of a vaccine trials, as long as they can show that the vaccine is safe, I would be willing to accept that. But that’s the key is they have to show that they’ve tried it on enough patients to not have significant side effects and that’s going to be the crux of the matter.

Dirk Friel:

Got it. And now I’ve been hearing recently about how antibodies actually don’t last all that long and may not be like…if you did have COVID-19 got the antibodies early on, it felt like, “Oh great, I’m protected.” And now some of the research is showing that’s not the case.

Jeff Sankoff:

Yeah. We kind of know that from other coronaviruses like when you get a cold you can be reinfected by the same coronavirus, usually about six months later. And that’s just because the immune response to the coronavirus is not one of those that our body remembers. Other kinds of viruses, influenza viruses, we have an excellent immune response to it and we actually retain this immune memory. And if you get re-exposed you, your response is very, very strong and you tend not to get reinfected. With coronavirus, it tends not to be quite as good. And nobody really understands why that is, but it unfortunately is just the way it is. So we don’t know for sure. Again, it’s too early, we’ve tested a lot of people, we can see who has antibodies, but we’re still following them to see if they get, re-exposed and if they get reinfected. If they do get reinfected, there’s some hopes that they will not be at as much risk. But again, it’s going to be one of those things where time will tell.

Dirk Friel:

Okay, well, let’s get into the day-to-day application here, advice. People are still training, they’re wanting to race, they can’t race except virtually. But let’s dig into swim, bike, run, and some advice around training for athletes. So if we look at the run, certainly we go out on the trails outside, sounds like, a first good step instead of in a health club on a treadmill, which health clubs for the most part are closed, but that’s not the case around the entire world or in the United States. There are health clubs open, I believe. 

Jeff Sankoff:

Yeah. Gyms started to open. They’re opening with a reduced capacity, but they are still open. I haven’t gone to my own. I don’t think it’s particularly safe. I think that training indoors by yourself is fine. Training in a place where there’s going to be other people around… there’s no great science to this. This is just a gestalt. I know that they’re socially distancing things like treadmills. So like, they won’t have people on treadmills next to each other. They’ll space them out and that might be just fine. My personal feeling is, I can run outside where I know my risk is significantly less. I know that a lot of people like to do weights and a lot of people like to, do strength work at a gym cause they don’t have any options or alternatives. And I don’t really have any great advice for that. I think that it’s a risk. I think that if you practice great hand hygiene and your gym is washing things down continuously, you can mitigate that risk, but you’re never going to be able to reduce it to zero. I would definitely say wear a mask because that’s going to help.

Dirk Friel:

And if I’m outside on a trail and I am more than six feet away from somebody, do I need that mask on? Can I be okay, kind of having it drop down below my chin and only pull it up when I am going to get within six feet? 

Jeff Sankoff:

Yeah. This is a question I get asked a lot and this goes back to a couple of studies that came out back in February and Belgian sports medicine journals that looked at computer modeling of respiratory secretions of runners and bikers. And they got a lot of press at the time. And the authors of those two papers were mortified when they saw how their computer modeling was being used to extrapolate to real world scenarios. And we have to be really careful with that because computer models are great, but they’re not reality. 

And I think I had a conversation with one of my infectious disease colleagues on my own podcast where we discuss this very topic and it comes down to this. You mentioned before you asked a question about how many viral particles you need to be exposed to and that’s really the crux of this to be infected. It requires both exposure, it requires time and it requires viral load as you’re running along and you’re passing by people. You simply do not have the time or the exposure to get a sufficient viral load to be infected, especially when you’re outdoors, there’s wind and all the other things going on. If you want to be super safe and you want to run with a mask on, I would never tell you not to, because I think that’s totally fine. But I do think that it’s probably not necessary. I just go back to my own real world experience with coronaviruses of other types. I have never once caught a cold, just going out for a run or a bike ride. I just think that COVID-19 is probably the same way. 

Dirk Friel:

And if, now however, I’m in a group, let’s say I’m in a four person running group and I’m behind two or three of them, that exposure and time can certainly go up. Because you are now in their draft. You know, four or five feet behind them.

Jeff Sankoff:

Yeah, so everything I’m talking about is when you’re running on your own, maybe if you’re running with one other person side by side, but as soon as you get into a group dynamic, then yes, I agree. That’s a whole different situation. If I was going to be riding in a group, I would wear a buff. If I was going to be running with more than one person, I would wear some kind of mask.

Dirk Friel:

Right. Right. So obviously that’s the same with cycling, even maybe more so, because the trail of that draft is longer because of the speeds of cycling?

Jeff Sankoff:

Again, that goes back to that computer modeling. And we don’t know how much of that turns into reality, just because of cross winds and stuff like that. I think that, if you’re riding on your own, you’re fine. If you’re going to ride with somebody else and you’re not going to be riding side by side, if you want to be safest, yes, you should wear a buff. I think it’s probably okay not to, but again, I can’t say a hundred percent and therefore I think to be safest to then yes, wear a buff if you’re going to ride with someone else. Personally, I’m just riding by myself all the time or else I’m riding gravel where I can ride side by side.

Dirk Friel:

Yeah. Yeah. That’s kinda what I’ve been doing as well. And if we talk about swimming now, what about water? Does that reduce the risk?

Jeff Sankoff:

So there’s no evidence at all that his virus is transmitted or survives in water. So swimming itself is fine. The issue is where are you swimming. If you’re swimming in an indoor pool, I would think that that’s not a great idea because again, you’re indoors. If you’re swimming in an outdoor pool, probably fine. 

But the question is how did you get to that pool? I know for myself, my pool is at my gym, which means I have to walk through the gym. There’s a lot of surfaces. I have come into contact with. There’s the locker room. There’s just endless amounts of places where I could get in touch with someone who’s infected. And then if I’m in the pool, I would hope that they’re only allowing one person per lane. And if that’s the case, then I think outdoor swimming is going to be fine. The best of all worlds is going to be open water swimming,

Dirk Friel:

Right. With no locker room.

Jeff Sankoff:

No locker room, just go dressed to swim. Haul on your wetsuit, on the beach. Jump in, do your swim, come out, get the wetsuit off, dry off. Don’t change. Just go home, change at home.

Dirk Friel:

Yeah. Yeah. And how about the immune system? Obviously during these stay-at-home times, people working from home, there’s the Everesting challenges. There’s the 24 hours. You’re just really pushing the limits. A lot of people are, or at least on social media, you see a lot of this pushing the limits. And it would just seem like that’s not a great idea because that would compromise your immune system, possibly make you more susceptible.

Jeff Sankoff

So there’s a lot of research on this and I’ve covered it a few times, cause this is another one of those questions I get asked a lot. Exercise and training on the whole has been shown repeatedly to actually strengthen your immune system. Now, the question becomes, what you’re pointing at, which is like pushing the limits. And we know that when you do something, like an Ironman, when you are at a very high level of exertion for a very prolonged period of time, that it is true, it seems to have a transient immunosuppression effect specifically as it relates to respiratory viruses.

But that is really specific to those very long, high exertion type of efforts. It’s not specific to say pushing yourself hard everyday for a week. It’s really specific to a one-day, sort of like 10 hours really hard, or it doesn’t have to be 10 hours, but it could be. It’s those very high intensity, long efforts that can suppress the immune system transiently on the whole. 

I haven’t really modified my own training and I haven’t modified that of my athletes because I’m not sending them on any of these 8-10 hour days. I have them doing intense training sessions, but they’re doing so for no more than two hours right now. Maybe I think I might’ve had somebody do three hours once because there was an Ironman still on the calendar. 

But especially during quarantine, where during lockdowns anyways, where you were doing all your training indoors, or you were doing all your training without really having much interaction with anybody, then it’s even less of an issue. Because again, if your immune system is slightly depressed, but you’re not exposed to anybody, then it doesn’t matter cause you have to be exposed to something in order to catch it. So I really don’t think it’s that much of a… I think it’s overblown as a significant concern. I think that as long as you’re training at a reasonable level, you’re not overdoing it in terms of significantly long efforts at significantly high intensity. You don’t need to worry about that.

Dirk Friel:

Yeah. Okay. So now if we jump over to the racing side of things USA triathlon put out a three-phased return to racing kind of guidelines.  And I believe we’re obviously still in this phase one, which is not allowing racing. I can’t remember all the details of it, but do you know what I’m referring to?

Jeff Sankoff:

I do. I actually reviewed them on the Coach’s Blog. 

Dirk Friel:

Okay. Yeah. And so that’s correct. Right? We’re in phase one. What might get us out of phase one and into phase two? Or what, what does phase two allow? What does phase three allow?

Jeff Sankoff:

No, I mean the first question is really the most important one and that’s going to be a significant decrease in infections. And I just don’t see that happening. I mean we don’t have a great coordinated response in this country to help infections go down. So unfortunately, as long as the infection rate continues to rise, as long as we continue to see across the country that, you know, hospitals are being overwhelmed, we’re not going to be able to have mass gatherings, even gatherings of 100- 200 people. 

If we get to a point where they’ve gotten in Europe and in Australia, New Zealand and Canada, where numbers have come precipitously downward, and they’re having just tiny numbers of infections, then you can start considering moving to a phase two. Phase two is where they start encouraging group activities. It’s where they start saying that we can start thinking about having camps.

Phase three is when they actually started talking about having races again, but I think we are a long way from that. I do not think you’re going to see any races for the remainder of 2020 except for maybe small local things, but certainly nothing big. And then in 2021, we can hope if there’s a vaccine or if we really get on top of this… and I worry what the Fall is going to bring, but optimistically, if we can get on top of this, then maybe we can start thinking about phase three coming to pass in 2021 at some point. But right now phase two is a bit of a dream.

Dirk Friel:

Right. And so, you said we might have small local… that meaning wave starts? Like, how might that even happen if you’re allowed to have 200 people in a race? 

Jeff Sankoff:

I honestly don’t know. I mean, so I participated in a gravel bike race, which was exceptionally well done. I was very impressed.

Dirk Friel:

And how long ago was that?

Jeff Sankoff:

It was like three weeks ago. And I was very, very impressed. They limited it to 150 people. No, they limited it to 100 people and I think they had about 75 and we were mandated to wear masks at the start. We had to socially distance. They had a very big open space for us there was no mass start. It was, instead of having everybody rollout together, they rolled us out in small groups and in a very wide sort of area. And then you had to wear your mask for the first couple of miles until we got all spread out and then you could drop your mask. And then you had to get your mask back on when you got back to the finish. They did have some food at the end, but you had to take the food with you and go, and there were no awards or anything like that.

So it was really well done. I was very impressed. It was a gravel ride, so obviously didn’t need a whole lot of support. Didn’t need a whole lot of stuff going on. And for the organizers, they didn’t have to think about things like a swim and a run course. So in that sense, [it was] much easier for them to do.

For triathlon, I honestly don’t know. I mean, I think duathlons are going to be a lot easier to do than triathlons simply because it’s easier to keep people spaced out. It’s easier to send people off on the course. On a time trial type start, swims are going to be problematic just because people tend to congregate around the swim start and you really just can’t have that. I have read of some small races going off in some parts of the country, small local events with very small fields. Pictures I’ve seen look like transitions were really nicely thinned out. But I did not see how they managed the swim start. Once people get in the water, it’s fine because then things tend to spread out on their own and they tend to stay fairly spread out through the rest of the race.

Dirk Friel:

Yeah. I could see almost a time trial start at the swim, one by one, not mass gathering, so possibly there, but certainly on the very small size. 

Jeff Sankoff:

Yeah. And in my conversation, I’ve talked to a couple of local race directors here in town and the issue for them is volunteers on the water. They’ve got to get permitting. They have to have enough people out on the course to watch traffic. And there’s just a certain number of participants they need to make it viable. And the question is what’s that magic number? And are they going to be able to get it for a gravel race? It’s super easy. You don’t need anybody. You don’t need anybody monitoring traffic. You really didn’t need much. So I think once you start talking about triathlons, it starts getting more complicated.

Dirk Friel:

Yeah, certainly. Lastly here, with your coaching, how are you helping your athletes through this, without races on the calendar. How are you setting goals for them or where’s their motivation coming from?

Jeff Sankoff:

You know, we’ve talked a lot about that and I think it’s been, listen, I’m an athlete too. So I’ve gone through exactly what I think they’ve gone through and what everybody else is going through. As my races started falling off the calendar, I had my own struggles with motivation and my own struggles with, why am I putting in these hard efforts and everything else? And I came to the realization that I don’t just train to race. Training for me has become so much more a part of my life. And it’s so important to me for so many other reasons. As I mentioned before, it helps with my mental health, especially with all the stress I deal with at work. But also I’m realizing that I can get so much more out of my training now by exploring different things.

Like I was never a huge gravel rider. And this year I’m riding gravel like a lot more and enjoying it, I’ve gotten my mountain bike out and then doing a bit of that. And so I’ve explored those things with my athletes and I’m always checking in to make sure they still feel motivated to keep themselves going. And we look for alternative goals. So, maybe the goal is to become a better bike climber. Maybe the goal is to improve their best mile running. But we can always find something to keep them encouraged and the feedback and the response that I’ve received from my athletes is that having the training scheduled for them and having the training and seeing their fitness continually build has been something that has just given them a sense of positiveness that otherwise does not exist right now. And so they’ve been really, really grateful for them.

Dirk Friel:

Yeah, I’m much the same way. I’ve certainly done a lot more gravel. I’ve always wanted to do a four day bike packing trip, which I actually did do a few weeks ago. I also think, being an athlete, isn’t three months a year. You can be an athlete 12 months a year. You progress year-to-year. And if you think like these Olympians. These Olympians now have this whole entire year to become better and they’re focused a year out from now. So can we have that Olympic, Olympian mentality, that we can be stronger and better next year? 

Jeff Sankoff:

Yeah, and one of the things that I’ve really found is watching my CTL on TrainingPeaks – comparing it to previous years where, I’d have several races throughout the summer, and I would see the CTL climb, climb, climb, and then drop as I tapered and then, you know, spike for the race, but then drop a little bit as I recovered and then start to climb again. Whereas this year it’s just been a consistent climb, you know? So my fitness is actually… despite the fact, you know, I would have been right now ramping up towards Ironman Canada. So my hours would have been significantly more than what I’m putting in, but my fitness is actually not that far off, I think, from what it would’ve been, just because I’ve been consistent.

Dirk Friel:

Yeah. That’s a great point. I’m the same. I’m about 20 points higher now today, versus the same day last year. Yeah. Thank you so much, Dr. Jeff Sankoff. Thank you so much. I’ve learned a lot. I hope all the listeners have. Unfortunately this is not going away tomorrow. Hopefully we don’t have to revisit this [but] we might have you on again, though in the future. 

Jeff Sakoff:

Well, it’s really been my pleasure. I’m always available to anybody out there who has questions. They can reach me through the website and yeah, I know it’s tough times for everybody. And like you said, I hope we can be talking about this in the past tense sooner than later.

Dirk Friel:

Yeah. And what was your podcast link again? 

Jeff Sankoff:

So it’s the TriDoc Podcast and that is on all of the different platforms. It’s hosted on Captivate, but you could find it on iTunes, Spotify, Stitcher, Google, the works.

Dirk Friel:

Super. Thank you again.

Jeff Sankoff

Thanks so much, sir.

TrainingPeaks

The staff at TrainingPeaks includes passionate athletes, coaches, and data enthusiasts. We're here to help you reach your goals!