I live in Charleston, South Carolina. One of the biggest sporting events here is the annual Cooper River Bridge Run, the third most popular 10-K in the United States. As every major sporting event in the country did, race officials postponed the race due to fears of spreading the new coronavirus. By moving the event until August, though, participants now must face running 6.2 miles in our August heat and humidity. I discussed the reasons for preparation and how to do it in my latest newspaper column.

Coronavirus forces postponement of the Cooper River Bridge Run until August 1

Last week, organizers of the Cooper River Bridge Run postponed the annual 10-K race until August 1 due to the threat of the new coronavirus. Now runners face an equally daunting threat – the heat.

Many years ago, I assisted with the race medical coverage. Even in early April, we treated a number of athletes exhibiting heat illness who felt dizzy, light-headed or even nauseated. I expect there will be far more cases of heat illness – and possibly heat stroke – this August.

Heat illness and exertional heat stroke

Heat stroke represents the most serious condition in a spectrum of heat-related illnesses. Milder forms of heat illness resolve with rest, fluids and cooling the athlete’s body. But it can quickly progress to heat exhaustion, with nausea, vomiting and dizziness, or eventually heat stroke, with confusion, disorientation, or loss of consciousness. The excessive core body temperature in heat stroke can quickly cause multi-system organ failure. 

Fatalities due to exertional heat stroke

Unfortunately, some athletes die, like University of Maryland football player Jordan McNair did in 2018.

A 20-year study of fatalities in high school and college football found 38 deaths related to heat. On the days of those deaths, the average temperature was 79.8° F.

Average temperatures in August in Charleston

Using data from timeanddate.com, I calculated the average temperature and humidity on August 1 in Charleston over the last 10 years. At 8:56 AM, a time when non-competitive participants start crossing the finish line in downtown Charleston, the average humidity was 83.6%. The average temperature was 79.2° F. 

Fortunately, these heat stroke fatalities are almost completely preventable.

Event and participant preparation to prevent heat stroke

Cooper River Bridge Run director Irv Batten emphasized that race officials will be ready. “We understand the concern about the heat, but we considered that and we will be prepared.” Hopefully there will be extra medical providers at the finish line and along the course prepared to treat cases of heat illness and heat stroke on site should they occur.

Also read: Exertional heat stroke – treatment

People considering running in this year’s event need to understand one simple fact. Responsibility to avoid heat stroke falls squarely on your shoulders. You must prepare for the race and the inevitable August heat now.

The challenge facing new or occasional runners

One of the great aspects of the Bridge Run, but also one of its biggest risks in terms of the heat, is that many average people participate. People who normally run very little have friends in town who plan to run or they want to enjoy the bar scene after the race. They decide to start training a few weeks before the race. 

Every year, I see a huge number of overuse injuries as people ramp up their training from essentially nothing to four- or five-mile runs in a week or two. They aren’t ready to run 6.2 miles in cool conditions, let alone 80° sunny days.

Young athlete exhausted from the heat

Acclimatization to heat

With gyms closed due to the coronavirus, start running now. Improve your fitness slowly over the next few months so you can easily run a 10-K by July. Then put your body through an acclimatization process.

This is a process in which your body “learns” to increase its sweat rate and decrease electrolyte loss. Athletes generally require 7 to 10 days to adjust to hot and humid conditions. We use an acclimatization process at the beginning of summer high school and college football practices, gradually increasing players’ physical activity and heat exposure and slowly adding full uniforms and equipment.

Once you’re in running shape, start preparing your body for the August heat and humidity. While your early training might be indoors on a treadmill or outside in cooler weather, eventually add short runs in the heat. Gradually increase your distance and speed in hotter conditions.

If you prepare for the distance and the heat, your risk of suffering heat stroke drops dramatically. If you don’t prepare, don’t run. Walk the course or run it next April.

Also read: Exertional heat stroke – prevention 

Korey Stringer’s death due to exertional heat stroke

One NFL player has died of exertional heat stroke. Korey Stringer, a Vikings offensive lineman, went into a coma after a practice in full pads during training camp in Mankato, Minnesota. The 2020 Cooper River Bridge Run will take place on the 19th anniversary of Stringer’s death – August 1, 2001.

Douglas Casa describes his experience with heat stroke

Douglas Casa, Ph. D., ATC, CEO of the Korey Stringer Institute, is a leading expert on heat stroke. He once told me about his own experience as a high school athlete competing in the 10-K of the Empire State Games in Buffalo – in August. That event led him to his current career studying heat stroke and sudden death in sports.

“On the 25th lap, I was vying for a medal. I collapsed at 200 meters to go, got back up, and then collapsed again with about 50 meters to go and was in a coma for most of the afternoon. Very luckily, I had amazing care at Millard Fillmore Hospital in Buffalo and had a physician there who knew about aggressively bringing someone’s temperature down. From that day…that’s all I’ve been interested in.”

Dr. Casa was an elite athlete, not someone barely in shape to simply complete 6.2 miles. If heat stroke could happen to him, it can happen to anyone.

Note: A modified version of this article appears as my sports medicine column in the March 23, 2020 issue of The Post and Courier.