How Opera Singing Is Helping Long-Haul Covid-19 Patients Recover

Developed in the United Kingdom, ENO Breathe is a virtual program that rehabilitates patients through the art of song

ENO Breathe class
Covid-19 patients during their weekly vocal lessons as part of ENO Breathe. Courtesy of English National Opera

Early in the pandemic, Sheeba began exhibiting Covid-19 symptoms. At first she had chills, a slight headache and general malaise. A week later, the 43-year-old United Kingdom-based charity worker and mother of two, whose last name has been withheld upon request, lost her senses of taste and smell and had difficulty breathing.

“It felt like I had a ton of bricks on my chest,” she says. “I had to call an ambulance.”

After several days in the hospital, Sheeba finally tested negative for Covid-19 and doctors discharged her, even though she still felt ill.

“I told [the medical staff] that I didn’t feel confident about going back home,” she says. “They told me that they couldn’t do anything more for me, and that they needed the bed for other patients.”

More than a year later, Sheeba still faces bouts of breathlessness, fatigue and anxiety, things she rarely experienced prior to her Covid-19 diagnosis. And she’s not alone.

Most Covid-19 patients recover and return to normal health two to six weeks after initial diagnosis, according to the World Health Organization. But the global medical community is finding that lingering symptoms are quite common, and some conditions can last weeks or even months after a negative Covid-19 test. Symptoms can include fatigue and anxiety, similar to what Sheeba is experiencing, as well as shortness of breath, muscle pain, headaches, rashes and persistent coughs.

According to the United Kingdom's Office for National Statistics, one out of ten respondents in a national survey reported they were “still exhibiting symptoms for a period of 12 weeks or longer” after testing positive for Covid-19. A study published by the Journal of the American Medical Association in February found about one-third of patients still had persistent symptoms nine months after a Covid-19 diagnosis.

Frustrated that she wasn’t getting better, Sheeba turned to the internet for answers and stumbled upon ENO Breathe. Launched in June, ENO Breathe began as a pilot program in partnership with the English National Opera (ENO) and the Imperial College Healthcare NHS Trust, part of one of the largest healthcare networks in the United Kingdom. Working together, a team of doctors, therapists and vocal coaches developed a breathing and well-being program for people like Sheeba who were recovering from Covid-19 but still suffering from breathlessness and anxiety. Their idea was simple: Take the same vocal techniques and breathing exercises used by opera singers and apply them to Covid-19 patients in a group setting. The program is structured into hour-long sessions that take place via Zoom once a week over the course of six weeks. (It’s also entirely free.)

“The program mirrors the training of opera singers, but in a more accessible way,” says Jenny Mollica, director of ENO Baylis, ENO’s learning and participation program. “Patients don’t need a background in singing to participate.”

A Lesson in Sirening for the Female Voice

The practice of singing—in particular operatic singing, which involves hitting different ranges and holding notes for extended periods of time—is rooted in breathing and involves engaging the diaphragm, a muscular respiratory structure that contracts and expands when a person inhales and exhales.

“We found that people with Covid tend to breathe using only the top portion of their lungs, or they’ll breathe too fast and start hyperventilating,” says Sarah Elkin, ENO Breathe's lead doctor and a respiratory consultant at Imperial NHS Trust. “[With this program] we teach them to slow down their breathing and to become more aware of diaphragmatic breathing and the pattern of their breaths.”

With ENO Breathe, vocal training goes beyond the simple “do-re-mi” scale many of us learned as children. One category of singing the program focuses on in particular are lullabies, such as “Summertime” from the 1935 opera Porgy and Bess. Lullabies seem to help soothe patients in the class, many of whom are dealing with anxiety on top of their breathing issues.

“The song offers the message that there’s a light at the end of the tunnel,” Mollica says. “It gives a sense of hope.”

Students learn a range of exercises during sessions, such as blowing bubbles in a glass of water using a straw, singing the shape of their names if written in the air in cursive and gently stretching their neck.

Because the program is working so well, that sense of hope seems to be contagious, with healthcare organizations from around the globe reaching out to ENO Breathe to create similar programs at their own facilities.

According to data provided by ENO Breathe, 90 percent of students in the pilot program reported positive improvement in their breathlessness, while 91 percent felt that their levels of anxiety had dropped. When asked if they would continue practicing the techniques after the program ended, 100 percent agreed. By this fall, ENO Breathe will reach 1,000 patients from more than 30 post-Covid clinics across England. (The pilot program included an ethnically diverse pool of 12 patients, ranging in age with candidates in their early 30s to late 70s. As of April, 150 students have taken part in the program.)

“Sometimes people will get embarrassed when they sing, but with the classes taking place on Zoom, most people don’t,” Elkin says. “We also offer online resources [like exercises, song sheets, and audio and video recordings] that patients can use, and many of them wish to utilize those resources to aid their recovery even after they’ve finished the program.”

Despite a lack of formal vocal training prior to the program, Sheeba, for example, has taken a liking to singing and applies what she's learned in her daily life.

“It was a completely new experience for me; I think I watched opera only once in my life,” Sheeba says. “When I first heard about the program, I had inhibitions and thought it was all about singing, but every week we learn something new, and I was surprised at how effortless it was.”

Soon, Sheeba noticed her anxiety improving.

“My breathlessness was making me anxious, especially at night when I would be in bed and it felt like I was about to drown,” she said. “I talked to [one of the vocal instructors] about it and she explained the science behind why I felt this way, and how I wasn’t getting enough oxygen in my lungs and that caused my body to go into fight or flight [response]. The program and the exercises took care of that aspect [of my symptoms] fairly immediately, within one week.”

However, Sheeba still faces challenges as a long-haul Covid-19 survivor—but now, she has a new community to support her recovery.

“I have to pace myself; I don’t think I’ll ever get back to how I was [before Covid-19], which is difficult,” she says. “Before the program, I didn’t have many people to talk to about my experience, but [through ENO Breathe] I met others who were in a similar situation. Everyone had a similar experience to mine and we’re all at the same stage in our lives. Through singing, I feel rejuvenated.”

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