Saturday, May 2, 2020

Pandemic Papers special: Interview with ultrarunner and ER doc Jay Friedman


Our athletes – current and former – are certainly familiar with the world-class running over in New Paltz and the New Paltz area of Ulster County. Minnewaska, which is about 15 minutes outside of the village, during preseason XC; Wallkill Valley Rail Trail for memorable and vitally important workouts throughout the late summer and fall. There are many other trails and preserves on which you can run for miles and miles and miles. In fact, Rock The Ridge is a 50-mile race that was supposed to be this weekend and that was, of course, postponed till later in the year.

It’s no surprise, then, that the New Paltz area is a haven for national-caliber runners of all ages. I’ve pointed out to our men and women, numerous times, some of the age-group champion athletes who have trained on the rail trail around the same time as us. Jason “Jay” Friedman is among the many great runners in the New Paltz area. Jay is a national-caliber trail and ultra guy -- a blogger, a podcaster and a coach. Most importantly now, he’s on the frontlines of the Coronavirus pandemic as an ER doc at Northern Dutchess Hospital in Rhinebeck (fun fact: my three children were born at Northern Dutchess!). Last week, I reached out to Jay via Facebook to see how he was doing. Then, I emailed him some questions for use in my weekly running column in the Poughkeepsie Journal. Jay gave me excellent, detailed responses, which I will have to parse considerably for my upcoming Journal column (usually, I’m constrained to a word count of 750-800). Back in the day, the newspaper vernacular for this was “newshole” (which sounds like something the president would say with a sneering look on his face?), the limited amount of space in print that you have for your copy. But alas, here in the blogosphere, we are not constrained to such newshole issues. As such, I felt it would be neat – not to mention quite informative -- to include the email interview I did with Jay here, in a special weekend edition of the Pandemic Papers. Other than being a local runner and a “friend to the program,” he has no direct ties to Marist Running. Still, I felt his thoughts and comments would be extremely relevant during this unique time in our country’s history. I hope you agree.  

How has the Covid-19 pandemic impacted you on a professional and personal level? Are you working more, less, different? What percentage of your patient work is now with Covid-19?

It's changed the way I interact with patients, the way I approach my job ... when you've been doing this for a very long time like I have (I graduated med school almost 20 years ago!!), you have certain assumptions you can make based on your previous experience, and patterns that you can recognize that help guide your practice.  So many of those are now out the window.  In many ways I feel like an intern again, constantly second-guessing, flying blind in a way I haven't needed to do in a very long time.  Treatments that we use every day for common, critical illnesses like asthma, emphysema and congestive heart failure are either not available to us or available in limited circumstances.  Other treatments are fraught with danger to both patients and medical staff.  I'm working the same amount as before, seeing fewer patients (some people avoiding the ED due to COVID fears, some decreased patient volume because people aren't out and about and getting injured or going to bars or driving as much or seeing other people), but the stress level is much higher.  

Based on your experience working with Coronavirus, what lessons have you learned about the disease? In your opinion, what's working and what's not working in terms of public health decisions?

We know very little for certain about this virus, how it works or how best to treat patients -- but we're learning more every day. What's interesting is that many of the assumptions we made early on based on what we were hearing out of other countries and how patients initially presented were either incomplete or just plain wrong. It seems like we're starting to recognize the role that abnormal blood clotting plays in this disease, which is not something we were not aware of or prepared for early on. But at least that is a complication that we can treat with a fair degree of success, if that is in fact proven to be one of the underlying causes of morbidity and mortality.

In terms of public health -- physical distancing is working. That's about it. New York did a poor job (like most states) of recognizing or anticipating the problem and so we lost a lot of time early on; but since then I think the state has in general done I think an admirable job in ramping up its response quickly. In our area, local health systems have responded well in setting up remote testing sites and increasing access to tests.  But testing is still woefully inadequate in terms of getting the data we need to safely start to reopen our state and our country, and unfortunately while I think state leadership recognizes this, the federal government does not.  We need millions and millions of tests to get the data we need and we need a centralized, coordinated analysis of and response to that data ... but it doesn't seem like that's coming anytime soon, which is incredibly frustrating and frightening.

Looking into a crystal ball, what factors need to improve in order for us to return to normalcy? Massive testing and contact tracing? An effective drug? A vaccine? What is a realistic timeline ... for all of that? 

Without a vaccine or a reliable treatment (or both), we're not returning to normalcy.  Period.  We've already shown in various parts of this country that we're not going to keep up social distancing for an extended period of time, so we're going to see another wave of this, and another, and another, until that changes or we have a vaccine. Massive testing/contact tracing will tell us how and when we can reopen various aspects of society, but if we do that safely, it will not be in a way most of us would recognize as "normal."  

Timeline?  On testing, I wouldn't hold my breath.  If the president would invoke the DPA to produce and distribute hundreds of millions of tests, I would be optimistic.  Why that wasn't done a month ago is beyond me.  If it had been, and we were in the position to test a million people a day right now, we might actually be able to safely reopen.  But he seems to think we can reopen without that, so I'm not sure it will ever happen.  I have no hope at all for contact tracing.  There is no way people are agreeing to that.

Treatment-wise, who knows?  Like I said, we learn more about this almost every day.  If blood clotting plays a huge role in pathology, and blood thinners are useful ... well, we have lots and lots of blood thinners already.  Beyond that, we're still figuring out how this thing even works.  Until we figure that out, I couldn't say how long for a treatment.  Maybe it'll wind up being something simple, but I doubt it. Serum antibodies from recovered patients seems promising as well.  Maybe a month from now we'll find out that's a magic bullet of sorts. 

We still don't know if antibodies from previous infection confer any real immunity.  Once we figure that out, that will help immensely in terms of developing treatment or figuring out how best to manage our response.

A vaccine is actually the avenue I'm most optimistic about.  It sounds like there are research teams both here and in the UK that are starting human trials on a vaccine very soon, if they haven't already started. I've seen estimates that a vaccine could be in production by September.  I'm skeptical that we'll have widespread vaccination any time this fall (partly from a scientific perspective as these things rarely go smoothly, and partly because even if there actually is a vaccine available I'm very confident that the federal government will botch the roll out), but I wouldn't be shocked if we have one in early 2021.

In terms of the running and racing scene: First, what are some dos and don'ts for local runners: Should we be wearing a mask (gosh, I hope not)? Should we be running solo? If we can run in groups, how and where can we do that? What other precautions do we need to take?

Again, recommendations change frequently.  Masks aren't necessary if you're able to distance from others (at least 6-10 feet).  I've started carrying one if I'm running in a high-traffic area like the rail trail or the River to Ridge trail in New Paltz, and I put it on when I pass people, even though I give them plenty of space ... mostly just to make other folks feel comfortable.  Yes, if we're running and breathing more forcefully, we're probably releasing more virus particles if we are infectious, but we're also releasing them in larger droplets that will fall to the ground faster.  I've seen the "garden hose study" and I'm not sure we're putting anyone else at any additional risk by running as long as we're still doing the 6-10 feet thing, but it seems to make people more comfortable.

I'd recommend running early or late when trails/routes are less crowded.  In terms of running with others, I think groups of two or three are OK, again, as long as you can maintain that 6-10-foot distance.  Seems like running abreast with space in between or "offset" is better than running single file.  Groups larger than three get unwieldy in terms of maintaining appropriate distance and I think should be avoided.

Unfortunately, on my side of the river, the closure of the Mohonk Preserve has forced runners, walkers, and cyclists into a much smaller area with many fewer routes and therefore has had the opposite of its intended effect.  I understand the instinct and what they are concerned about, and I understand the concern for the health of their rangers.  But I do wish they had just closed the Preserve for climbing and left the trails open for recreational use, even if they had to do so with the parking lots closed or restricted.  It's led to greatly increased congestion elsewhere.

Part 2: Realistically, what are the chances of organized races returning anytime soon and if so how would it happen? How long before "big" races like NYC and Boston come back?

I could see limited-field races at New York or Boston like they did with Tokyo earlier this year -- like, just elites.  NYC, Boston, and Chicago as 30,000-plus events are not happening this year, in my opinion, unless the most optimistic projections for an effective vaccine are met.

I could see smaller races coming on line this summer, like 100-200 people or less.  I actually think the Escarpment Trail Run has a good setup for the COVID era -- about 150 runners, waves of 15-20 runners starting every few minutes on a remote trail and spreading out quickly.  

What are YOU doing in terms of your running and fitness? How has the pandemic altered your training and racing plans? Did you have any races coming up? What's "next" for you, whenever we return to some semblance of normal? Any "virtual" races in your plans?

I've been training as usual, though running a lot more roads than I'd like ... but still doing my 60-70 miles per week, still doing 1-2 hard workouts weekly.  Actually, I've been feeling really strong recently ... all this fitness and nowhere to go!  I was registered for Rock the Ridge, which was scheduled for this weekend.  It's been postponed until September, so we'll see if that happens.  I'm registered for Leadville, which I'm still holding out hope could happen in late August.

I'm not into virtual races, but like many trail and ultrarunners, I'm into the Fastest Known Time (FKT) scene.  If you're not familiar with that, it's basically creating a route or finding a well-known route and trying to establish the fastest time on it.  You need to document your attempt with GPS data, photos, etc.  There are routes all over the world; some famous routes like the Presidential Traverse in the White Mountains, or Rim to Rim to Rim (R2R2R) in the Grand Canyon have had many world-class runners taking shots at them over the years.  This was a growing aspect of the sport in the past few years, Ultrarunning Magazine has started including a "FKT of the Year" section in its year-end issue; but as you can imagine its really taken off in the past few months.  Last month, I put up an FKT on the Wallkill Valley Rail Trail from Gardiner to Kingston, and Phil Vondra set an out-and-back FKT (Kingston-Gardiner-Kingston) on the same day.  We've got a couple of well-established routes we've got our eye on -- one pretty long one later this month, and one very long one either in the summer (if races are still cancelled) or in October if we somehow get to race in August/September.  I'm not gonna name them yet though ... don't want other people going for them first!  Gamesmanship is fair play in the FKT world. 

Anything else you'd like to add ... including a little background in your running -- how long have you been running, number of marathons, ultras, PRs, career highlights, etc.

Running for 30 years.  Don't know how many marathons.  Almost 50 ultras.  Top 10 overall at national championships for 50K, 50M, 100K, 100M, and 24 hours, including an age group national championship at 100K in 2018.  Also an exercise physiologist for the Heart Center and coach with Boundless Coaching and Guiding (boundless10200.com). Hope this helps. Stay safe my friend.

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