An Open Letter to the Endurance Sporting Community Regarding COVID-19

15 March 2020

Dear Endurance Sporting Community,

The rapid spread of the COVID-19 to 114 countries with over 4,000 deaths, led the World Health Organization (WHO) to declare a global pandemic. Around the world, government officials are undertaking unprecedented actions to respond to and mitigate the spread of this virus and manage the hospitalization of those severely affected.

As athletes and event organizers participating in a voluntary activity, it is our responsibility to do our part to control the spread of this illness. We must also unselfishly limit our impact on the health systems and healthcare workers who will take care of us, our families, and our friends. We should be taking a leadership role during these times.

The racing season is just getting started in the northern hemisphere, with millions of athletes in various stages of training. Events have been scheduled, fees have been paid, many hours have been spent to prepare. We do not underestimate the personal impact of our recommendation, which is also unprecedented.

Although there were limited data on the effect of viral infections in the endurance sports community, we will be affected by it. The median time from onset of COVID-19 illness to hospital discharge is 22 days, with about two weeks of shortness of breath and coughing (Zhou et al., 2020). This is longer than previously reported viral infections amongst athletes (Heir et al., 1995).

We now recommend that all organized endurance sporting events (group training, meetings, races, etc.) of more than 50 people (including organizers, athletes, spectators, volunteers, etc.) scheduled to occur before 15 June 2020, be immediately canceled or postponed. This is consistent with guidance released earlier today by the Centers for Disease Control and Prevention (CDC, 2020), except that we are recommending that events be canceled or postponed that are in the next 3 months rather than the next 2 months. If by 15 May 2020, the pandemic continues to grow, then an additional month of cancellation is warranted. Further cancellations should be considered on a rolling monthly basis with a two-month window depending on the current control of the pandemic. If the event involves fewer than 50 people and will still be held, participation by those using public transportation should be discouraged.

Lastly, this is an evolving situation, and today’s circumstances may not reflect tomorrow’s reality. Our recommendation is not intended to supersede any government mandates. We strongly invite you to follow any local policy mandated by the State or Federal public health entities.


Nikiah G. Nudell, MS, NRP, FACPE
Chief Data Officer, The Paramedic Foundation, a 501(c)3 non-profit charity
President, American Paramedic Association
Board Member, National EMS Management Association
Board Member, Colorado Chapter of NAEMSP

Guido Ferrari, MD
Associate Professor of Surgery
Associate Research Professor in Molecular Genetics and Microbiology
Duke University
Medical Director, Umstead 100, 2010-2020

Robert H. Weiss, MD, FASN
Professor of Medicine, Emeritus, Division of Nephrology and Cancer Center
University of California Davis
Medical Director, Western States Endurance Run, 2013-2019

Timothy Durkin, DO, FAAEM, CAQSM
Medical Director,
Durango Sports Medicine, PLLC.

Martin D. Hoffman MD, FACSM
Chief of PM&R, VA Northern California Health Care System
Professor of PM&R, University of California Davis
Founder, Ultra-Endurance Sports Science & Medicine
Research Director, Western States Endurance Run, 2006-2016



Centers for Disease Control and Prevention. Interim Guidance for Coronavirus Disease 2019 (COVID-19). Guidance as of 3/15/2020. Accessed 15 March 2020.

Heir T, Aanestad G, Carlsen KH, Larsen S. Respiratory tract infection and bronchial responsiveness in elite athletes and sedentary control subjects. Scand J Med Sci Sports. 1995;5(2):94-9.

Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. doi: 10.1016/S0140-6736(20)30566-3. [Epub ahead of print]