How English National Opera Is Helping People with Long Covid to Manage Their Breathing

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Alexandra Oomens in one of the ﬁlms that is part of the ENO Breathe programme. Photo: Karla Gowlett Royal Opera’s Oliver Mears: ‘We are still adapting to the times, but our ambition is just as strong’ How English National Opera is helping people with long Covid to manage their breathing

FEATURES MAR 29, 2021 BY ROSEMARY WAUGH Singers know more about breathing than most. So last year, English National Opera contacted the NHS with its idea for supporting people with long Covid suffering from breathlessness and associated anxiety. Singers, doctors and participants tell Rosemary Waugh how ENO Breathe has given patients a new appreciation for music

Most Commented Last summer, about three months after the ﬁrst national lockdown was imposed, a new facet to the coronavirus pandemic emerged: long Covid. Characterised by breathlessness, fatigue, chest pains and interrelated symptoms of anxiety, it emerged that the condition could affect patients for weeks or months after their initial diagnosis and after the point when they require care from a GP or hospital.

At around the same time, English National Opera’s learning and participation programme team, ENO Baylis, was looking for a way to contribute to the ﬁght against the virus. Given the respiratory issues caused by Covid, ENO Baylis director Soho's Windmill to reopen as theatre Jenny Mollica and her colleagues started considering whether the company’s following council approval expertise in training opera singers to breathe might also help those suffering from Former Soho strip club the Windmill is to reopen as a theatre with a 250-seat auditorium after long Covid. Westminster City Council approved a licensing application “It became clear that we possibly had a useful skill set to offer from our practice as an opera company in terms of a deep understanding of breathing and what good breath control looks like,” Mollica says.

Building on an existing relationship with the Imperial College Healthcare NHS Trust – the ENO costume department had sewn scrubs for front-line workers at its hospitals – Mollica was introduced to Dr Sarah Elkin, a respiratory consultant and director of integrated care at Imperial.

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Online Event Host Senior Ofcer, Grant Proces... Teaching Assistants – Actors... Crew and Administration Mana... Chair of Trustees and Trustees UK Wide Manchester Elkin was concernedNew Malden about the patients who were still experiencingLondon symptoms of London £85 per day APPLY £33,128 APPLY APPLY £32,615 breathlessnessAPPLY and what the hospital could offer them. She also, by coincidence, had Ofcer, Compliance and Impr... previous experienceTeaching of Fellow singing in Actinggroups for patients with chronicTechnical diseases. Supervisor Although Casual Followspot Operator Accounts crew UK Wide Elkin didn’t thinkGuildford a straightforward singing group was goingLondon to work best for the London £27,668 London APPLY £41,526 to £51,034 APPLY £35,188 APPLY APPLY patients, she was very interested in what ENO was proposing. “We had very little to offer the patients,” she says. “But we did know that they needed something else to help them get back to wellness.” Most Read Out of this collaboration grew ENO Breathe, a six-week online course designed to help long-Covid sufferers manage their symptoms of breathlessness and anxiety themselves. Participation is entirely voluntary, with participants being made aware of the programme by their GP or hospital. It involves online group sessions via Zoom with an ENO singing instructor tutoring them in breathing exercises and the singing of simple lullabies, with an additional package of materials available to browse outside of class.

RELATED TO THIS ARTICLE The Stage 100: Celebrating theatre’s Coronavirus: ENO’s costume department sews scrubs exceptional ﬁgures in a year like no for NHS workers other Instead of ranking theatre’s most inﬂuential people, this year’s edition of The Stage 100 recognises those who have gone above and beyond in the ENO to use lullabies to help patients recovering from face of the Covid-19 pandemic Covid-19 in NHS tie-up

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ENO Breathe lead Suzi Zumpe. Photo: Karla Gowlett

Following the successful pilot version of the programme, which ran from September to November last year, the team behind ENO Breathe was able to announce a nationwide roll-out in January. The national programme initially focused on patients in London and the north of England, with the aim of expanding to other areas. Since the pilot programme, it has reﬁned and evolved the resources using feedback from participants.

This has included shifting the message. “We’re aware the term ‘singing’ is daunting for people,” says Mollica. “So we call it a ‘breathing through singing retraining programme’. Singing is the vehicle for helping people with an intended outcome, which is managing their breathlessness, but you don’t need an interest or any experience of it to take part.” In this respect, ENO Breathe is different from the usual singing groups set up for patients.

ENO Breathe creative director Suzi Zumpe, who leads some of the group sessions, echoes the concern that potential participants might baulk at holding a tune, especially in a public setting. “The thing about singing is there’s a whole bunch of x people who feel very strongly that they will hate it. But the reality is seldom as bad as You are viewing they think it will be and then they surprise themselves and that’s quite exciting.” article 1 of your 5 free articles

Zumpe is interested in “learning by stealth” and making sure people feel as comfortable as possible – they are always welcome to have their microphones muted and cameras turned off. The sessions start with various breathing exercises and gradually work their way towards singing the lullabies. “One of the ﬁrst things we do is look at posture, because singers think about posture all the time,” Zumpe says. “You might have opera singers hanging from all kinds of crazy bits of set, but generally speaking their shoulders and their diaphragm are in a box shape so they have really good access to their breathing apparatus.”

Other activities include learning to release the muscle tension that can build up as a result of respiratory problems and exercises to help slow the breath down. Again, the practices of ENO’s company proved instructive here: “If a singer is singing a phrase and they want their breath to last longer, they’ll very often add a physical gesture to make the most of their airﬂow. If you think about the pace at which you’re physically moving, then your breath wants to echo it.” And so, Zumpe taught them to use gestures to control their breath.

Suzi Zumpe teaches singing techniques to patients over Zoom

Lullabies from across the globe proved the perfect type of song for multiple reasons: they sit well in non-specialist singers’ vocal ranges, they have a universal appeal and appear in a multitude of different cultures, and they’re accessible for people whose ﬁrst language isn’t English. Plus, they’re literally designed to calm and soothe.

Sheeba, a participant in the pilot programme who was suffering from long Covid, which included breathlessness during the night, summarises the programme as “a wonderful and empowering experience”. Along with using the techniques outside of class to manage her symptoms, Sheeba praises Zumpe for “making it easy – it didn’t feel like we were doing any work”. But beyond that, she also thrived on the connectivity the group provided. “I found this ﬂock of people who were in the same boat as me,” she says.

So far, Mollica and Elkin have recorded many participants experiencing relief from their symptoms as early as three weeks after starting, although they are keen to stress that it is designed as a six-week course. They’re about to embark on a randomised control trial to, as Mollica says, “really build the evidence base for the programme”. But response from the medical community has already, in Elkin’s opinion, been positive. “One of the hardest things about being a doctor, which I always say to my trainees, is saying to someone: ‘We don’t understand why you are getting these symptoms.’ It’s much easier to say: ‘Your X-ray is abnormal, that’s why you’re feeling like that.’” ENO Breathe acts as “a holistic mechanism, once we have made sure there is no other cause [for the breathlessness]”.

St Mary’s Imperial Trust respiratory team in scrubs made by the ENO’s costume team

The programme has also had the unintentional effect of instilling a new-found love of singing and opera in many of the participants. For Zumpe: “Music is an absolutely integral part of the success of this programme, because it closes the gap between knowing and doing with emotion. So they feel the efﬁcacy of what they are doing. It’s all intuitive – and that’s the musical experience, right?”

Sheeba adds: “I have a deeper appreciation for what these skilled artists bring. It’s not limited to the stage: they have extended beyond the stage to someone like me, in this period of isolation. And, in these dark times, they have brought in a breath of fresh air.”

How the arts and healthcare are joining forces

Performing Medicine Clod Ensemble, led by artistic director Suzy Willson, is behind Performing Medicine, an ongoing initiative providing creative training programmes for healthcare professionals. Using techniques drawn from the arts, healthcare workers learn communication and self-care skills. Recently, this has included working with front- line staff managing the demands of the pandemic. performingmedicine.com

With You Bristol-based live and digital events specialists Trigger created With You as a means of connecting isolated patients suffering from Covid and care-home residents with their loved ones. A voice album of messages is recorded and can be listened to as many times as the recipient likes. triggerstuff.co.uk/withyou

Signal Fires Another project designed to combat isolation and loneliness, Fuel collaborated with Age Concern Scotland to send its lockdown storytelling project Signal Fires to elderly residences of the remote Highlands and Islands during November 2020. fueltheatre.com/projects/signal-ﬁres

Rosetta Life For more than a decade, arts and healthcare initiative Rosetta Life has worked with stroke survivors on Stroke Odysseys. The project began as a song cycle performed as part of Derry-Londonderry City of Culture 2013. Most recently, it featured the creation of an opera, I Look for the Think, composed by Orlando Gough and based on participants’ lived experiences. rosettalife.org

Dance for Parkinson’s English National Ballet’s Dance for Parkinson’s classes have gone online during lockdown. The weekly sessions are designed for people with Parkinson’s disease, plus their carers and families. They teach gentle dance and movement techniques to improve well-being and general health.

ballet.org.uk/onscreen/dance-parkinsons-class

For more information go to: eno.org/eno-breathe

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