Q&A: Dr. Michael Roshon, chief medical officer for USA Cycling

On Friday March 14, a day when the gravity of the novel coronavirus hit home for many Americans, USA Cycling (USAC) hosted a virtual Q&A entitled ‘Expert Advice on COVID-19 for the Cycling Community’ with Dr. Michael Roshon.

Now, three and a half months later, the organization has hosted half a dozen more webinars with the Colorado Springs emergency medicine physician, as well as compiled an impressive array of resources for riders, event organizers, and clubs and teams, providing invaluable guidance on how to proceed with rides and events during the pandemic.

Roshon has been involved with USAC every step of the way, and in early May he was appointed Chief Medical Officer for the organization. In addition to his specialty in emergency medicine, Roshon also holds a Ph.D. in microbiology and immunology and has worked as a team doctor for pro cycling teams like United Health Care, and Garmin since 2005. Serving as USAC’s medial consultant during the coronavirus pandemic, he says, “is a perfect storm of things I’m good at it.”

We spoke with Roshon about what the medical community has learned about the novel coronavirus since March and how that affects the ability to hold safe participatory cycling events.

How has your experience with COVID-19 changed since March?
It was very difficult early on, as patients were flooding in and it was all brand new. A lot of learning on the job for a very different sort of infection than we’re used to. It’s been an amazing scientific response with articles coming out so fast. Some of them are confusing, but some of them are very clear about what’s the best way to treat this. From the first cluster of cases in February to now, we’ve learned so much about how to treat this. We’re seeing much better results.

The other thing, from a public health standpoint, we’ve learned a lot. The classical teaching is that you can’t control the spread of a respiratory virus, i.e. it happens every year with influenza, it’s just too hard and you can’t control it. To see what’s happening in Colorado right now, it’s amazing. That some combination of stuff we’ve been doing has shut cases down to less than 200/day.

Already we’ve seen a huge increase in our knowledge about how it’s spread and how to control it. We know how to treat, how to protect people. The hope is, as time progresses, we’ll be able to dissect which of these social distancing maneuvers have really worked and which need those versus the other ones in order to maintain an economy.

I think we’ll find that we can be safe with much less stringent requirements.

Well, I imagine that knowledge translates well to the safety of cycling, no?
Cycling is a great example. Early on we didn’t know. This ridiculous Belgian-Dutch paper comes out and everyone misinterprets it, coming up with unsupported claims. Nobody actually read the paper to see that it wasn’t a study. It was a theoretical mathematical model that didn’t have to do with viruses or people.

Now, what we’re seeing is that trails are packed, and people are not getting sick.

We have established that outdoor activities, even with minimal precautions of trying to maintain some distances and not be in packs, seem to be completely safe as far as we can tell. The caveat is that there’s no such thing as zero risk these days.

It’s important to note that these epidemiological tools that health departments have to do contact tracing to figure out ‘where did this case come from, how did this person get sick,’ these are good tools. They’re not perfect, but they can go back and find out where this case came from. One study looked at a series of outbreaks in China, over 7,000 cases, and as far as they could tell, two of them happened outside. All of the rest happened inside.

In nursing homes and retirement communities, which is where half of the cases worldwide have occurred, people are only inside.

Have you been seeing a rise in cases tied to protests and demonstrations?
At the protests, people are clustered together, yelling, screaming, and getting tear-gassed, and there haven’t been a lot of cases. We should have seen that by now. There will be some cases from that, but it’s not a big blow up. I think part of the secret of that is, being outside, with wind and atmosphere dispersing it and some UV light, it just seems to be safer.

So, how are you marrying your expertise, experience treating the virus, and what you know about cycling?
My basic approach is ‘Let’s try and understand everything we can about the virus, how it gets transmitted, who it makes sick, and how we can control it.’ That’s some good science. That’s not a political viewpoint. We know a lot now. Let’s try our best to understand that. Then, let’s try and focus on the bike events we can do.

For huge events with thousands of people milling about from all over the world? That’s going to be difficult in any pandemic but especially one that’s spread by respiratory means. Maybe for some of those, we can’t do them the way we’ve done in the past.

But, maybe Colorado can do small events with locals-only. Wear masks, have wave starts. Pay attention to the off-the-bike activities so we’re not having people clustered together in big buffet dinners and at the same hotels. I’m convinced that the off-the-bike stuff is as — or more — important than what’s happening on the bike.

We don’t know everything, but we can apply what we do know to find out what type of bike racing and bike events that we can have. The same thing goes for group rides — the old school group ride where 100 people get together and try to rip each other legs off and they’ve never met before? Those days are over. You can’t do that.

But, you and your close buddies who you work with, or your family members? You’re already in their bubble, you can go on a group ride. That’s pretty safe. The bigger the group gets, the more variables you have, it gets less and less safe. 

If you’re in a place where there’s massive spread and a high level of fear, stay in your basement, ride the trainer, or ride by yourself. But what we’re seeing is how rapidly changing and how variable it is. Colorado Springs had an early outbreak; our ICUs were full. And, it totally, completely calmed down here. I haven’t had a case from our community in my hospital in weeks. 

It’s a moving target, and it’s changing.

What’s a key risk modifier that event organizers can implement to make an event safe?
If you start to strip away things, it’s about understanding how the virus works. If you have people clustered together at the top of a climb, hundreds of people who don’t know each other, from all over, standing shoulder to shoulder — that sounds dangerous. But if you strip it down to 125 pros together riding their bikes, we can test every one of those people. That’s way easier than testing 5,000 people from all over the world. If we can test them and know that they don’t have the virus, there’s not a risk of spread in the peloton.

Think about basketball. At a game, the risk is all these people sitting in the seats next to one another, screaming. It’s not the 10 guys on the court. You can test them twice a day for a week at a very low cost.

If we start to think about cycling like that, you might get it pared down so much that’s it just not fun. We could protect the riders and the community, but it’s just not worth it. So we’ll just wait. 

I think the thing to do is come from a point of understanding how the virus works, and let that science inform the kind of riding you can do rather than focusing on how you can’t do it the way you’ve done it in the past.

Is there any new information out there about the aerosolized spread of the virus?
We don’t know how much aerosolized spread there is. We do know that it doesn’t spread as easily as other viruses spread through the air. Measles, chickenpox — if you’re in a room w someone with chickenpox and you’ve never had it or been vaccinated, then you have it now. The attack rate is high. Health care workers have been seriously exposed [to the coronavirus], and the attack rate has been low in most cases. In a case where you’re not 100 percent sure, it’s a reasonable thing to be cautious, to err on the side of safety. But the risk of true aerosolized, 60 meters of spread is going to be incredibly rare. 

In terms of airline travel, which can affect cycling and races, we’ve looked at a case where someone got on a plane and was symptomatic — coughing, febrile, not wearing a mask. There were 300 people on the plane, and less than four percent of people on the plane got the virus, and those people were all sitting next to or near him. If that was measles, 90 percent would have gotten it. 

I think it’s smart to be cautious, we have to err on the side of safety, but I think the more we learn, some of those fears can be allayed. 

What about catching the virus from surfaces?
Early on, a study of surfaces was interpreted as showing that you could catch the virus from surfaces. It actually showed how long the virus survived on surfaces, not how long it’s infectious. Then, the CDC came out and said the risk is much lower than we thought. A couple of other studies have looked at surface survival and actually tried to culture the virus from a surface. They couldn’t culture the virus from surfaces. We can do PCR tests and find fragments of RNA on surfaces, but it doesn’t seem to be a growing, living virus.

Again, it comes down to ‘What’s your appetite for risk?’ We know that it certainly could be transmitted via surfaces but it doesn’t seem like it is that often.

The other great thing about this virus is that it’s incredibly weak to hand washing or hand disinfecting. Even with brief handwashing, the virus is done.

So, if you’re really really worried about surface viability and surface transmission then you need to be washing your hands.

On a bike? You’re extra careful when stopping for water and eating. Carry a little bottle of hand sanitizer in your jersey, and before you eat that bar you wash your hands. It’s not something we’ve ever done before but something that’s effective at slowing down transmission. 

So it sounds like there are safe ways to ride in a group or go to an event.
Part of the story that gets lost in the panic is that we’re getting a lot of good data about this. 

What if we wanted to do a time trial? The idea is that 100 people, start every minute, gathered together at the start line, staying in the same hotel. There’s a lot to be nervous about. So, what if we say we’re going to start people every hour? Everyone would say, ‘That’s completely safe.’ You’re just not going to get the virus that way. So, theoretically, we’ve found a safe way to do a bike race. But no one is going to do that. So the question is where are you going to put your risk meter so that it’s both safe and looks like a bike race?

We’ve seen a number of events since the moratorium on permits was up June 1. Some mountain bike events spread out on trails. A crit series in Texas with smaller heats. We haven’t made a scientific study of this but haven’t heard of clusters of cases coming from these events. 

There’s been a lot of talk about packet pickup — how would we make that part of this event safe? I think we’ll see more and more examples of that, but it will be a while before we see a mass start, clustered together type of event.

The other thing is that permitting done at the local level now involves local health departments. We [USAC] came up with a risk mitigation tool that’s a couple pages of filling out questionnaires and ‘What does your event look like.’ When I share that with local health officials, they’re really positive. Anyone who brings that to a local health official will be more likely to have their event approved. But that’s very local. If you go trying that in April in Aspen, the answer would have been no. But, as different places either cool down or heat up, then the answer to those questions will be different.

What I’m hearing from you is that people want a simple answer. They want a static ‘yes’ or ‘no’ and want to move on. We don’t have that. Many questions we don’t have a perfect answer to and we’re getting more and more info about. It’s also subject to change. 

For riders, fans, organizers — we all want this to be safe. The health of those athletes is our primary concern, it has to be. The health of the people in the community has to be a primary concern. The health of spectators. Any organization that puts on an event that’s super fun that day, but 2,000 people get sick the next day, that’s not gonna be good in the long term.

Would you participate in a race this summer?
I would definitely go to a race. I was scheduled to do The Double Triple. If they were putting it on, I would do it. It’s a rolling start, not a big drafting event, could very easily be on your own for the whole day. I would just have to come up with some strategy for how I got food. 

I’d go to an event on the trail, a small gravel event, I would do any of that. I was scheduled for the Leadville stage race. As long as they did the right things to make it safe, I would do it. A pared-down version, local-people only, no one flying in from northern Italy, maybe a hundred people instead of 500. 

I would do an event that was modified to be safe.

Would l do the Saturday morning Starbucks ride with people I didn’t know and ride for four hours? No, I wouldn’t do that.

Has USAC seen an interest in its COVID-19 resources and webinars?
Yes. Early on, we didn’t really know what to expect, and we were trying to predict, trying to understand. But, that’s the goal – if we can put together experts that can understand the situation and also understand cycling, then we can be a resource for people who want to do it. 

People who are putting on events that have been modified to be safe say that participants are really excited. Maybe not everyone because they’re seeing 10 percent less than they were expecting, but that’s still amazing in itself. It just tells you what people’s personal assessment of risk is once you’ve explained to them how you’ve modified the event. 

If you have a parent in a nursing home, maybe it’s not the year for you to do a ton of events. Everyone gets to answer those questions for themselves.