Singing therapy can help in COVID-19 patients' recovery

The swath of misery cut through modern life by the novel coronavirus has taken on many forms, and although it may not be one of the more life-altering consequences, one of the bleakest has been the sound of silence.

Not only has the virus halted mass gatherings of joyfulness such as concerts, but as face coverings have become a fact of everyday life, even singing is widely discouraged, because of the perceived potential for projecting and spreading germs.

But a project involving London's Imperial College Healthcare NHS Trust and the English National Opera is helping people recovering from COVID-19 to get back to respiratory health and overcome breathing anxiety, through singing techniques.

Initially COVID-19 was regarded as a disease that particularly affected the respiratory system, and it is this impact that the program, called ENO Breathe, addresses.

Previously, Imperial has worked on other breathing-related issues, developing systems to help patients affected by problems such as asthma or the results of smoking. But COVID-19 and its consequences have led to the new, specialized, remotely delivered program, to be launched as a pilot project in October, with plans for wider future expansion.

The ENO's Suzi Zumpe, an experienced vocal director, facilitator and singer, described it as "shortcuts to better breathing".

"Singers use all kinds of techniques to prepare their bodies and use different muscle groups, so we're finding a way to help people with their anxiety, as well as their medical need," she said.

Focusing on lullabies

Ironically enough for patients who may well have been left bed-bound by their infection, the program focuses on lullabies, because of their cross-cultural accessibility, and also the fact that they are manageable to even the least confident singers.

"Lullabies are ideal, because if ever there was a time when people need soothing, it's now," she said. "We're focusing on different lullabies, each paired with a lullaby in an opera, so people can feel reassured. I want people to feel helped by this program."

The link between the organizations was established earlier in the pandemic, when ENO's costume department made medical scrubs for Imperial staff, and now they have found another way to fuse their particular skills.

"We do run choirs and singing groups, but we're not setting one up here," said Jenny Mollica, the head of ENO's learning and participation department.

"We're using singing as the vehicle to achieve the intended outcome of better breathing, and it's great to be working with such a cutting-edge organization as Imperial because as we design and build the project, along the way we can tap into their latest knowledge.

"This program is different from any lung projects Imperial has been involved in before, because it isn't about managing a chronic condition. In most cases, people will make a full recovery from COVID, so this is about using singing techniques to help them back to wellness."

As both a keen singer and a medic who has worked with many COVID-19 patients, the idea of singing as rehabilitative therapy is of particular interest to Declan Costello.

He was a choral scholar at St. John's College, Cambridge, before studying medicine at Imperial. Long before COVID-19 was a major medical concern, he was a keen advocate of the restorative powers, both physical and mental, of singing.

Emotional benefits

Singing as a therapy is not a new idea. Asthma UK and the British Lung Foundation, both charity organizations, have long promoted the idea, and a paper published by Mary L. Gick and Jennifer J. Nicol in Health Promotion International, a public health journal, in September 2016 quoted one choir member as saying: "Singing's got emotional and physical and social and just all these benefits rolled into one. Stress reducer, enjoyment, connections, spiritual, meditative. There's so many aspects to singing."

In his capacity as both a singer and a medic, this is an opinion that Costello supports.

"Musical medical professionals have been aware of the importance of singing for quite some time and it would be great if this pushed it forward in the public consciousness," he said.

"I've been treating a lot of patients recently with post-COVID voice problems, and I think that's going to become a big issue. Your voice is a big part of your identity, and if you can't use it as normal, particularly if you're a singer, there's a danger you'll feel like you've lost a part of yourself."

The suggestion that the act of singing was in some way more of a health threat than speech or shouting was "really demoralizing," he said, especially as singing is such a beneficial activity.

"We've known for a while singing can have a positive effect on respiratory function, but also there's the psychological aspect," Costello said.

"Group activities have spiritual and mental benefits. If you're singing in any sort of choir, everybody is working toward a common purpose, nobody wants to be the weak link and you all want to work together to achieve something－from a mental point of view, that's hugely beneficial."

One potential positive from the current climate, he added, was that the benefits of singing as something more than just a social activity might be realized.

"It's always frustrating when you politicians talk about it as it's just some nice pastime that makes people feel better about themselves－there's a massive economy attached to it, too," he said. "If this raises the profile of singing, and how it can be helpful for people, then that's no bad thing."