A Yogic Approach to Public Health in the Time of Coronavirus

Author’s Note: COVID-19 is the name of the illness caused by the SARS-CoV-2 virus. For the purpose of this article, I’ll simply refer to COVID-19 or coronavirus.

“Take aggressive and urgent action.” —Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization

“I don't think that we are going to get out of [coronavirus] completely unscathed...This is going to be one of those things we look back on and say, boy, that was bad.” —Dr. Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases

“This is hysteria.” 

“Let’s not invent problems.”

“We don’t go through these lengths for flu season.” 

“The flu is worse.”

“I’m just gonna use my essential oils, and I never get sick.”

“Not everyone needs to go to these extremes.” 

—Yogis on the Internet

Novel coronavirus, or COVID-19, is poised to become a pandemic. Public health officials strongly encourage containment measures to reduce harm. Meanwhile, I see a lot of yogis who are suddenly public health experts with a degree from the University of Google. As a yogi with a public health background, I’m disheartened that many yoga teachers are stepping so far outside their scope of practice. We wouldn’t diagnose a student or tell them their injury concerns were merely hysteria. Offering unqualified public health opinions is no different. 

Put down the essential oils. Back away.

I fell in love with public health for the same reason I love teaching yoga and doing my work as a nature therapy guide: It’s an opportunity to be in right relationship with the great web of interconnection. Containing COVID-19 is a call to action off the mat for yogis to practice the yamas and niyamas, ethical principles outlined in Patanjali’s Yoga Sutra.

Let’s dispel some myths about COVID-19 and explore ways our community can live our yogic values. 

An important update as of March 11, 2020. 

As of March 11, the WHO announced that COVID-19 is officially a global pandemic. In his announcement, Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, stressed, “This is not just a public health crisis, it is a crisis that will touch every sector—so every sector and every individual must be involved in the fight.”

Time is of the essence to contain the virus to prevent it from spreading farther. (Please read this excellent article that can help us understand why time is of the utmost importance.)The most responsible thing studio owners can do is to cancel all group classes for the next two weeks, and re-evaluate from there. 

Don’t spread misinformation. 

COVID-19 is fundamentally different from the flu. Twists don’t remove toxins. If you can’t say the exact, specific toxin (e.g., mycotoxin), shush. Sweating out a virus or using essential oils are not a valid means of containment. Strategies and treatments for other viruses currently don’t apply to COVID-19. More than ever, the yoga community needs to have humility around what we can accurately say about the benefits of the practice.

Dr. Anthony Fauci, Director of the U.S. National Institute of Allergies and Infectious Diseases, has directly and wisely contradicted the Trump Administration to dispel the misinformation that COVID-19 can be compared to the flu. The Washington Post reports that “[Fauci] again noted that the novel coronavirus ‘is 10 times more lethal than the seasonal flu’... He was asked whether the worst was yet to come. He said directly, ‘Yes, yes it is. If we are complacent and don’t do really aggressive containment and mitigation, the number could go way up and be involved in many, many millions.’”

This is an evidence-based recommendation to be taken very seriously. It doesn't matter if there isn’t coronavirus in your region. You don’t want it to come to your region. 

I realize many studios and teachers are taking an unbearable financial hit, myself included. Taking action right now can prevent much worse disease and financial outcomes if the virus isn’t contained. Without action right now, this has strong potential to be a catastrophic global event unlike anything most of us have seen in our lifetimes. 

Why are public health officials concerned about COVID-19?

So far, COVID-19 has a fairly low case fatality rate (CFR), which is the proportion of people with a disease that die from the disease and a measure of how severe the illness is. Based on reported infections in China, the CFR is 2.3%. Because the disease generally has fairly mild symptoms or is asymptomatic, public health experts theorize the CFR is likely less than 1%. 

While the virus is currently relatively mild, it’s still a public health priority. It’s a highly infectious virus with an R0 of 2.24-3.48 persons. R0 (pronounced “R naught”) is the basic reproduction number, meaning how many people one person carrying the virus could infect. If I were walking around with COVID-19, I could hypothetically infect almost four people. 

Call me Typhoid Clare-y, but cover your mouth with a tissue before you sneeze. 

The virus is highly transmissible. It’s spread through respiratory droplets, from as far as six feet away. Evidence from other coronaviruses (this outbreak is a specific strain) suggests the virus can live on fomites—surfaces carrying germs—for up to nine days. 

People who are asymptomatic can shed the virus; it’s plausible that someone with a respiratory condition with symptoms of coughing and sneezing—including seasonal allergies—can spread the illness. The etiology (cause of the symptoms) is not the issue; the spread of respiratory droplets is the concern.

Yoga studios are virus heaven, with both a high density of humans in a small space and ample surface area to come into contact with the virus. One yogi on Instagram lamented, “If props were so full of germs, there would be rampant outbreaks of flu, cold, and athlete’s foot since the dawn of yoga studios. Let’s not invent problems.” Fun fact: Transmissibility of disease at athletic facilities—including yoga studios—have been a major public health concern for some time! 

Isn’t this just like the flu?

We don’t make such a fuss for the flu—so why the fuss for COVID-19? 

COVID-19 and the flu are fundamentally distinct and require different public health strategies. The goal for COVID-19 is containment, whereas officials assume the flu cannot be contained and don’t address it at a community level. 

There are no treatments yet for COVID-19. As of March 11, health officials estimate the fatality rate to be 10 times higher than the flu, directly contradicting the misinformation spread by the Trump Administration. 

Flu is predictable, with decades of data. COVID-19 is novel—other coronaviruses exist, but this one is only two months old and inherently uncertain. There is no way to accurately predict the natural disease history, which is the term used to refer to the course the disease will take from onset to resolution. 

Irrespective of health outcomes, one of the most serious threats of COVID-19 is overwhelming health care systems. You might not be able to get treatment for something non-coronavirus related, such as cancer treatment. Multiple epidemics would be an unmitigated disaster. Public health officials are preparing for a disease burden ten times greater than the flu—“disease burden” meaning the impact of a condition in terms of mortality, morbidity, economics, and other indicators. 

Public Health is Yoga in Action

Public health addresses health at a community level; our strategies don’t concern individual health—and yet it relies on individuals to take action for the greater public good. While many of us will face serious consequences, they will happen one way or another. We protect those most vulnerable to the illness in our communities, especially the elderly and the immunocompromised. The global priority is to contain the disease since it will disproportionately affect the world’s most vulnerable populations. 

We take care of each other.

Participating in these efforts is called prosocial behavior. Removing yourself from these efforts is called antisocial behavior. These terms may seem hyperbolic, but it’s proper terminology that reminds us of our responsibility to all beings. COVID-19 is a call to action for liberation. 

How Students Can Practice Public Health Yoga

• Avoid contact, crowds, and unsanitary conditions. Stop going to group classes until further notice. 

• If you feel the studio you’re at is too crowded or doesn’t feel properly sanitized, feel empowered to leave.

• If you have the means, consider paying your teacher for the class you would have gone to. Few teachers can afford to lose income. 

• Properly clean all surfaces that have been in the yoga studio using an effective cleaner recommended by the CDC or Environmental Working Group. 

• Wash your hands. And wash them for 30 seconds—sing the happy birthday song twice (personally, I prefer singing Toto’s Africa)—up to your wrists, and under your fingernails. Any soap is fine. Handwashing is more effective than hand sanitizer. 

• Second choice—hand sanitizer. Use enough volume (most people don’t!) and a solution that is at least 60% alcohol. Rub it in for 30 seconds. Allow your hands to dry completely without wiping them off. Avoid products with fragrance.

• Moisturize your hands to prevent small cracks or cuts.

• Don’t touch your face. (So hard to avoid, but important!)

• Avoid sharing props, water bottles, food, and so on.

• Face masks are ineffective at preventing you from contracting the virus, and healthcare workers are in dire need of those masks. Unless a healthcare provider has told you to wear them, don't. If you're sick enough to want to wear a mask, self-quarantine.

• The containment effort will mean a global binge of disposable products. Look for ways that you can reduce your own use of plastics, fast fashion, and other wasteful consumer items to offset the burden to our more-than-human family.

How Yoga Teachers and Studio Managers Can Help

• Stay within your scope of practice. If you are not qualified in public health, do not offer opinions or undermine public health efforts.

• Cancel your group classes, NOW. Urgent action now can save lives, minimize disruption to health services delivery, and mitigate the financial impact.

• Take it seriously. Have respect for legitimate and evidence-based public health concerns. They are here to protect you. COVID-19 is very infectious and spreads very rapidly. While the numbers might look small now, they don’t reflect how widespread the virus truly is. Without aggressive containment, the incidence (number of new cases) will increase exponentially within the next week. 

• Know how the virus is spread. The primary route is through respiratory drops from an infected person. Even someone who is asymptomatic can be shedding the virus. A person who is sneezing or coughing for any reason (e.g., seasonal allergies or COPD, not just COVID-19) can transmit the virus. Secondary means may be from touching surfaces an infected person has touched. 

• Viruses love yoga studios. If you’re keeping your studio open for private one-on-one yoga, clean your studio consistently and properly according to protocols.

— First, clean the surface of visible dirt or grime. 

— Leave more time between sessions for proper sanitizing. 

— The safest strategy is to reduce or put away props anyway to eliminate fomites—surface areas where viruses can live. 

— If it can’t be done properly after each class, do not offer mats and props to your students. 

— Pay particular attention to surfaces that regularly come into contact with hands and faces (basically all yoga props). 

— Allow the surface to completely dry. 

— Disinfect the surface using hospital-grade solution recommended by the CDC or Environmental Working Group.

• It is the studio management’s responsibility to sanitize the studio. This does not fall to your students because it introduces too many opportunities for human error. 

• Empower yourself and your teachers to assert that students with respiratory symptoms refrain from being at your studio. Avoid practicing “idiot compassion.” The greater compassion is to the community. How can you incentivize home practice, one-on-one sessions, or online classes? 

• Incentivize your teachers to follow best practices. Teachers have financial and personal pressure to show up to teach. Can you pay your teachers when they stay home and make it easier for them to get subs? Can you invite your students to consider paying their teachers anyway? 

• Make sure your studio isn’t pressuring students to show up. Now is not the time to host 30-day challenges or tell your students #yogaeverydamnday. 

• Keep your own nervous system and immune system in check. Practice quiet connection each day: seated or walking meditation, find a sit-spot in nature, do restorative yoga at home, chant, or use singing bowls. Nature bathing is my favorite immune system boost. Use your favorite natural remedies such as elderberry, or—yes—essential oils (research isn’t super conclusive on elderberry for a number of reasons, but this is a great example of a time when using a folk remedy is fine—it's a risk/benefit analysis that only applies to the person taking it. As far as essential oils, the evidence is so-so, but low risk as long as you aren’t ingesting them). 

• Make sure your vaccines are up to date. Having multiple disease epidemics is an apocalyptic horror show. Vaccines are the single greatest public health advance of the 20th century. Anti-vaxx beliefs are quite literally antisocial. 

• Hold off on hands-on assists and partner work. Besides the obvious containment need, your students don’t need the stress of worrying about contact. 

• Get your classes outside. Human health and the health of the natural world are inextricably linked. The health benefits of being in the natural world are well evidenced; nature offers cleaner air and likely fewer fomites over a less dense area.

• Strategize working to support yogis with accessibility needs now rather than later. Containment measures prioritize public health needs over individual health needs, which can be unfair. Reducing or removing props adversely affects students who need them for accessibility reasons. Removing hands-on assists may take the benefit of external feedback from students who rely on it (e.g., hypermobile yogis and those with neurological conditions). How can your local community find ways to support these yogis? How can we as a larger community creatively help each other? Collaboration over avidya—ignorance or avoidance—is the true yogic practice.

• Avoid stigma. Don’t disclose your students’ health status. Discreetly take students aside if you need to speak with them about health concerns. Does your marketing feature Asian people with face masks? Are you encouraging talk of what it means that the virus began in China? Check any assumptions you might have about certain groups being more or less susceptible. Our efforts must be prosocial and anti-racist.

• Find ways to support each other during periods of social isolation. Donate to your local social support organizations. Regularly FaceTime with family and friends. Babysit for your neighbors or play some games with an older adult. One-on-one interactions are not a problem with proper hygiene. Can you channel your nervousness into community support?

• Trust some institutional knowledge. This is going to be particularly challenging. The Trump Administration has been overtly hostile to public health efforts, and many yogis, regardless of their politics, lack confidence in biomedical health for various (and sometimes valid) reasons. How can you practice santosha during this time—allowing yourself to receive the circumstances as they are? 

• Choose your sources of information wisely. Personally, I regularly Google immunologist Dr. Anthony Fauci to see what he has to say. (He’s a national treasure!) Peter Hotez is also fantastic. Helen Branswell has a great Twitter feed. Trust sources like the CDC, NIAID, and the WHO. Go straight to sources of medical information before you access journalism. Many highly regarded peer-reviewed medical journals, such as JAMA and New England Journal of Medicine, post letters and white papers informing the public on expert opinions and theories. I also trust The Atlantic,The New York Times, and The Washington Post for responsibly reporting on COVID-19.

• Remember: This is temporary. Successful public health measures often end modestly, with the absence of disease being restored. May we look back on this time and be pleased with our successful efforts to save many people from becoming very sick or dying—just like we would celebrate when a beloved friend goes into cancer remission.

These days, each time I wash my hands, I invoke the Mangala mantra: 

Om svasti prajābhyaḥ paripālayantām 

nyāyena mārgeṇa mahīṃ mahīśāḥ 

go-brāhmaṇebhyaś śubham astu nityam 

lokās samastā sukhino bhavantu

Om shanti shanti shanti

May you be well and protected.

May the leaders of this land make wise decisions. 

May the earth be abundant for those who know the land as sacred. 

May all beings, without exception, know ease. 

Peace, peace, peace.