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- More than 300 coronavirus patients have joined a COVID-19 "bootcamp" to address their lingering symptoms.
- The virtual program involves physical activities like breathing exercises and cardio, as well as lectures, meditations, and motivational talks.
- Marissa Oliver, a 36-year-old who's had symptoms for more than five months, said the program has improved her psyche and reduced tightness in her diaphragm.
- Eventually, it could feed into a long-term treatment plan.
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Each day, Marissa Oliver logs onto her computer after work and sees the familiar face of Dr. Noah Greenspan, a physical therapist with colorful tattoos on both arms. He offers Oliver — and many other coronavirus patients with long-lasting symptoms — a daily motivation: They are not their illness. Things will get better.
Before the pandemic, Dr. Greenspan worked with elderly patients diagnosed with cardiovascular and pulmonary disease in New York City. But as the coronavirus spread, he began to hear more and more from COVID-19 patients who said they hadn't recovered. That's the case for Oliver: The 36-year-old has had difficulty breathing since March 11.
So Greenspan decided to see how these COVID-19 "long-haulers" would respond to some of the same exercises he often gave his elderly patients, even though many, like Oliver, are much younger than the people Greenspan previously treated. His initial program turned out to be too rigorous, so Greenspan launched a specialized, virtual "COVID-19 bootcamp," on August 2.
More than 300 patients have signed up, he said, and their progress is offering clues about how to treat the disease's long-term effects.
"Each week, we are seeing patients, throwing a little pebble, letting the pool ripple, seeing how things go," he said. "We're starting to be able to map out a consistent treatment plan and a consistent rehabilitation plan that will likely work for the majority of people, as long as we do it the right way."
The daily program starts with a meditation or inspirational lecture, then moves on to breathing exercises, strength training, and cardio. It's donation-based, so patients have the option to sign up for free.
"Since I started, I've actually noticed a lessening of the diaphragm tightness, which was a symptom I've had nonstop for four and a half months," Oliver, who manages an arts organization, said. "It's these exercises that I tie directly to helping relieve my pain naturally."
Rehab programs address long-term COVID-19 symptoms
Greenspan said limited hospital capacity earlier in the pandemic meant that many COVID-19 long-haulers had to deal with severe cases on their own at home — some had pneumonia, blood clots, or high fevers.
"If this were any other time in the history of the world, a huge number of the patients would have been admitted to the hospital," Greenspan said. "For all we know, had they been admitted right off the bat, maybe they wouldn't be long-haulers or maybe the severity of their symptoms would have been a lot less."
Other long-haulers never developed life-threatening symptoms, and their brain scans, chest X-rays, and blood work have since come back normal — yet they've continued to experience heart palpitations, dizziness, fatigue, and difficulty breathing for months. Some doctors suggested to these patients that their symptoms might be psychological.
"We know for sure now that that's not true," Greenspan said.
He believes there's a way for many of these patients to fully recover.
The six-week bootcamp involves recorded, virtual daily sessions — patients can tune in from anywhere at any time. The short-term goal of the lessons and exercises in the sessions is to improve patients' flexibility and balance, and to teach them how to regain control of their breath when they start to feel winded.
Sessions last around 30 minutes to start, but patients have the option to break up the exercises throughout the day or tack on more time as they grow stronger. The exercises vary each day.
At the start of the bootcamp, each patient fills out a quality-of-life survey. Greenspan said it's too early to administer a second survey to anyone, but he plans to track patients' progress once they've finished.
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The bootcamp is the US's first online rehab program for COVID-19 patients.
But it's not the first to treat long-haulers using physical therapy: The Detroit Medical Center began offering an in-person rehab program for COVID-19 patients in June. A rehabilitation clinic in Genoa, Italy, is also walking long-haulers through light, in-person exercises. And a clinic at St. Luke's Hospital in Bradford, England, has enlisted a dietitian, psychologist, and chronic-fatigue specialist to care for long-haul patients.
Greenspan's bootcamp has adopted a similarly holistic approach.
Patients do tai chi, yoga, and meditation as part of the program. They listen to relaxing music while walking in place, while gazing at serene footage from around the world on the screen. They also watch lectures from top physicians, pulmonologists, cardiologists, and neurologists, and can submit questions about their health.
"At first I thought, 'Oh, it's kind of cheesy,' but honestly, I can tell that it's improving my psyche," Oliver said, adding, "the emotional and mental impacts of the virus have been just as severe as the physical ones."
The breathing exercises are what she finds most useful, Oliver added. They often involve deep inhales through the nose and long, extended exhales through pursed lips.
In May, Oliver was diagnosed with pleurisy, or inflammation in her lung tissue. Right around the time that she started the bootcamp, her pulmonologist prescribed a steroid, which she said made her feel "really weird." Greenspan's program has made her feel like she can manage her symptoms without the steroid, she said.
Too much activity can push patients 'over the edge'
Oliver has nicknamed her lasting, fluctuating symptoms "the COVID coaster." Her health is hard to predict, she said, and it's often hard to know which types of activity will exacerbate her illness.
"One of the things about COVID is it's definitely not orderly," Greenspan said. "It's completely chaotic. There's no rhyme or reason to it."
That might be because an aggressive inflammatory response to the virus can impair the autonomic nervous system, he said, which regulates blood pressure, heart rate, and body temperature. This would explain why some patients feel dizzy or experience a racing heart after merely sitting up or walking across a room. Breathing, he said, is the portal to helping the nervous system heal and improve.
"You're only going to heal as quickly as your slowest system, and unfortunately the neurological system is one of the slower systems to heal," Greenspan said. "Until that inflammation goes away, you may not see the change."
Like patients with chronic fatigue syndrome, many COVID-19 long-haulers say their symptoms get worse after exercise.
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"You have to go extremely slow with COVID patients because sometimes they can feel perfectly fine during a treatment, or they can feel perfectly fine during an activity, but if you go that one step over the edge, then they could be knocked out for a week after that or they can have a flare in their symptoms," Greenspan said.
He encourages patients to go slower than they might think is necessary. The ultimate goal, he added, is to help them manage their recovery on their own and eventually resume normal activities.
"It's like if you were all of a sudden in a pitch-black room," Greenspan said. "Until you adjust to that darkness, you're going to tip toe around, taking slow steps, feeling things out. Eventually, as you gain confidence with that, we can start to move at a quicker pace."
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