Clinicians working with patients suffering from Long Covid are exploring whether “Breathwork could be the missing piece of the puzzle” in relieving long term symptoms of coronavirus, in an article published in The Atlantic.

The fascinating article cites the figure of 10 to 30 percent of those infected with the novel coronavirus have long-term symptoms, quoting Craig Spencer, the director of global health in emergency medicine at New York–Presbyterian/Columbia University Irving Medical Center, as stating “What people need to know is the pandemic’s toll is likely much higher than we are imagining. It is an area that merits urgent attention. There will be people living with the impact of COVID long after the pandemic is over. This is not made up or in the minds of people who are sickly. This is real.” This is precisely why we here at The Minded Institute are committed to a rigorous exploration and fostering discussions as to how the therapeutic application of yoga can help address the health crisis exacerbated by COVID-19, Long-COVID, and Social Isolation.


This particular article is well worth reading as it interviews clinicians on the frontline of treatment and research who are advocating that their experience with patients suggests that Long Covid is related to the functioning of the autonomic nervous system – and in the yoga therapy and yoga community, we know well the scientifically proven role that yoga, pranayama and meditation can play in nervous system regulation.


The article includes an interview with David Putrino, the director of rehabilitation innovation for the Mount Sinai Health System. He spends his time on questions that many doctors don’t think about, including “measuring things that are hard to measure”


When Putrino looked at the data around Long Covid patients and their sypmtoms “ it looked like those of patients who suffer from a poorly understood and often misdiagnosed condition, one that he happens to know a lot about because his wife lives with it: dysautonomia, or impairment of the usual functioning of the autonomic nervous system, which controls blood pressure, temperature regulation, and digestion


Dysautonomia is the term for a host of different conditions in which the autonomic nervous system has trouble regulating the heart’s response to exertion, changes in posture, or variations in temperature, sending the body into an inappropriate fight-or-flight response. As a result, patients can experience some blend of fatigue, headaches, digestive problems, heart palpitations, difficulty breathing, and cognitive issues such as brain fog.


By chance, Putrino had been working on a project for dysautonomia patients with Amy Kontorovich, a genetic cardiologist at Mount Sinai who studies the condition and had a wealth of experience. After they spoke, she had a sinking feeling: “If this is something that happens to a lot of people, we’re in trouble,” she remembers thinking, “because most doctors don’t recognize dysautonomia as a real entity.”


Now this is where some of you might start thinking….’what about yoga?’.  Putrino and Kontorovich developed a broad hypothesis: In a group of patients, they theorized, either the virus or the immune system’s reaction to it had caused dramatic dysregulation of the autonomic nervous system. Patients with cardiac or pulmonary problems typically react well to rehab that pushes them physically (“if you can take a little more, we’ll push you a little more,” as Putrino put it). But that push-through-it model can dramatically exacerbate dysautonomia patients’ symptoms, causing exhaustion and a racing heart. So standard rehab usually doesn’t work. So….Yoga anybody?

They pulled together a team of other clinicians and specialists that included a physical therapist, a sports-medicine physician, a respiratory specialist, and a nutritionist—all of whom had been trained to work holistically to treat conditions for which clear-cut medical protocols don’t exist.


However, in the meantime, the Mount Sinai teams struggled to find treatment protocols that worked for everyone to whom the new label seemed to apply. Some of their patients were so sick that even gentle rehab worsened their symptoms. In others, rehab worked, but only up to a point, or patients overexerted themselves and relapsed.

And then, according to the Atlantic: ” the missing piece of the puzzle, the Mount Sinai teams soon found, was right in front of them: breathing”

“What the researchers and doctors at Mount Sinai hadn’t realized was that even mild cases might be affecting respiration after the acute phase of the disease. Evidence began to accrue that long-COVID patients were breathing shallowly through their mouths and into their upper chest. By contrast, a proper breath happens in the nose and goes deep into the diaphragm; it stimulates the vagus nerve along the way, helping regulate heart rate and the nervous system. Many of us breathe through our mouths, slightly compromising our respiration, but in patients with post-acute COVID syndrome, lung inflammation or another trigger appeared to have profoundly affected the process. In these cases, patients’ breathing “is just completely off,” McCarthy told The Atlantic.


This led them to introduce a science-based breathwork program, to try to restore normal breathing patterns in the sickest patients. As far as we can tell, this protocol was very similar to the most basic coherent breathing technique.


Similar symptoms (fatigue, shortness of breath, racing heart) occur in people who have low carbon-dioxide levels in their blood—a condition known as hypocapnia, which can be triggered by hyperventilation, or shallow, rapid breathing through the mouth. The creator of the specific breathing protocol used here, Josh Duntz, wondered if perhaps these long-COVID patients, so many of whom suffered from dizziness and tachycardia, were also breathing shallowly, because of either lung inflammation even in mild cases or viral damage to the vagus nerve.” The theory seemed plausible to Putrino: Oxygen is key to our health, but carbon dioxide plays an equally crucial role, by balancing the blood’s pH level. Mount Sinai was able to launch a breathwork pilot program swiftly because of “how desperate people were—the hospital was so overwhelmed,” Duntz said. The program also didn’t have to pass FDA clearance.

And according to the Atlantic: “After a week, everyone in the pilot program reported improvement in symptoms like shortness of breath and fatigue. (No double-blind randomized controlled trial has yet been conducted, so it is not possible to know what percentage of the improvement was due to the placebo effect.)”

And according to Putrino , “The patients’ responses – to the breathwork – were game-changing”

Dayna McCarthy at the Center for Post-COVID Care explains why the treatment is so helpful. “Through breathwork, patients can consciously control their heart rate, she noted. In addition, modulating the nervous system’s fight-or-flight response may help regulate the immune system. (Studies have shown that elevated stress hormones can lead to chronic inflammation.) And proper breathing is crucial to circulation in the lymphatic system, often described as the body’s highway for immune cells, which plays a role in eliminating toxins and waste.

It’s a fascinating outcome and one area we’re watching closely!  As of today, preliminary observations were yielding more data to support the theories about the role that breathing issues and autonomic dysfunction played for some patients, and more studies and research is emerging. But clearly, the early signs show that breathwork and pranayama, alongside gentler forms of yoga, could very well have an important role to play in how we treat the long term symptoms of Covid19.

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