Nina: Briefly, what are the most important things for yoga teachers, studio owners, and yoga students to understand about the COVID-19 pandemic?
Jarvis: Well, to give a brief summary, over the last few months, the whole world has come to recognize the seriousness of this viral pandemic. SARS-Cov-2, the virus that causes the disease that we have named COVID-19, is highly infectious and has a case fatality rate that is probably at least 10 times greater than that of the seasonal flu. We’ve seen how outbreaks of COVID-19 have played out in China, South Korea, Iran, and Italy, and epidemiologists have learned a lot about who is most affected as well as what strategies may help us control the impact to our societies.
As of March 14, 2020, the US Centers for Disease Control (CDC) reports 1,629 cases of COVID-19 in the United States. However, the likely number of actual cases in the US is probably many times greater than this. The consensus among epidemiologists and infectious disease physicians is that we already have sustained community transmission going on in the US. Unfortunately, we don’t know the true extent of that transmission because we have not had testing capacity to determine it. And because we don’t have testing, containment strategies (identifying cases and contact tracing) have been difficult to implement. So, we have to rely on mitigation strategies like social distancing (described below).
The recommendation of epidemiologists is that if we can implement mitigation strategies like social distancing now, we can greatly reduce the rate of transmission and thereby “flatten the epidemic curve.” The main goal of flattening the curve is to reduce transmission enough so that the healthcare system is not overwhelmed by an explosion of cases that needing hospitalization. This video explains the goal of flattening the curve in more detail.
These strategies are particularly important to protect older people and people with other health conditions (such as asthma, heart disease, and diabetes) or who may be immune compromised (for example, people with HIV, cancer survivors, and transplant recipients). For these vulnerable populations, the risk of dying from COVID-19 is many times more than the reported case-fatality rate of 3.4%.
It is important to understand that mitigation strategies like social distancing are not going to eliminate the risk of getting infected completely. In fact, infectious disease epidemiologists think that 20-60% of the world’s population will be infected with the virus that causes COVID-19 over the course of the next year. The hope is that by slowing down transmission and flattening the epidemic curve, those who do get infected and have severe disease needing hospitalization can get the care they need so that we can control mortality.
Nina: Let’s talk about what social distancing is. The CDC defines it as “Social distancing means remaining out of congregate settings, avoiding mass gatherings, and maintaining distance (approximately 6 feet or 2 meters) from others when possible.”
Jarvis: Yes. As you can see, “social distancing” covers a range of strategies, from maintaining physical distance and avoiding contact while in the same room to more radical steps like social isolation and city-wide lockdowns. I want to stress that recommendations about taking drastic steps around social distancing are based on evidence coming out of China and other countries. In China, we see that when radical social distancing measures were implemented in cities that were at an earlier phase in their epidemic curve, it greatly reduced the rate of infection.
I know that some people are finding it hard to think about taking drastic steps now, given that the number of reported cases of COVID-19 in the US is still relatively low. But what epidemiologists are saying is that the time to implement social distancing to “flatten the epidemic curve” is NOW. If we wait to see many thousands of cases before deciding to implement social distancing, it will be too late to avoid many cases and many deaths. We’re seeing this in Italy now, where the healthcare system in some areas has been overwhelmed by COVID-19 patients who need care.
Nina: In your professional opinion, is it time now to cancel yoga classes and temporarily close yoga studios?
Jarvis: Yes, closing yoga studios for a period of several weeks is the most concrete way for the yoga community to contribute to social distancing. In comparison, behavioral strategies like putting away props, maintaining 3-6 ft of space between students, and avoiding hands-on adjustments do not have the same evidence base. We think that these practices, like hand washing, will reduce transmission, but we don’t know by how much. In contrast, we have strong evidence from other countries that social distancing works to slow the rate of transmission, thereby avoiding many infections and many deaths.
I understand what a difficult choice this is for yoga teachers and studios. Yoga teachers depend on teaching for their livelihood and our students need yoga all the more during stressful and uncertain times. Right now, some state and local governments are restricting large public gatherings to no more than 100 or 250 people, so choosing to cancel yoga classes is still an individual choice that is up to teachers and studio owners. Actually, as of March 15, in Massachusetts, our governor has just announced a ban on public gatherings of more than 25 people. Given the potentially disastrous impact of unchecked community transmission of COVID-19, personally, I would counsel yoga studios to close for a period of at least 4 weeks and then re-assess. This recommendation is in line with what we are seeing school districts, colleges and universities, workplaces, and now state and local governments implementing in the United States.
Nina: How will yoga studios know when the right time to re-open is?
Jarvis: That’s a good question. I suspect that we are going to see stronger mandated social distancing on the part of the government before this thing is through, so it may be that the government will set the schedule for us. But I would say that as improved testing comes online in the US, if we’re continuing to see numbers of cases increasing where we live, we should definitely continue to practice social distancing.
Please keep in mind that if people get tired of social distancing and societies relax mitigation early, there will be a resurgence in the rate of transmission, as the figure at the beginning of this interview shows.
Nina: I will make a point of keeping our readers informed when we know more about this. Next, in your professional opinion, who should stop going to classes now?
Jarvis: Definitely those who are in the high-risk groups for mortality should be seriously considering reducing time they spend outside of the house, and that includes not going to public yoga classes. I should add that if you’re not in a high-risk group but you spend time around people who are at high risk of mortality (for example, if you care for an aging parent), you should also consider avoiding public yoga classes.
An important thing about the social distancing message is that this is not just about our own individual, personal risk; it is about our collective, civic responsibility to reduce the population risk for everyone. So, people who are not in high-risk groups can make the decision to practice social distancing in order to protect others. This is ahiṃsa (non-violence) in action.
Nina: Finally, how can teachers support their students to reduce stress and maintain health and equanimity while they are not teaching classes. And how can students keep up their yoga practices and continue to repeat reap the benefits of yoga when they’re not going to public yoga classes?
Jarvis: I am trying to see this as an opportunity to engage with my students differently with their practice. For example, I am considering giving my students practice assignments of short sequences to practice, and then to asking them to reflect on their experience of practicing it at home. I will be asking them to develop their own sensitivity to learn how to correct themselves or make adjustments for themselves, rather than just relying on the teacher.
I will also be asking students to reflect not just on the physical aspect of their practice, but on the emotional and mental aspects. This includes:
- Addressing fear (abhiniveśa) as it is arising in our lives, and how we can practice pratipaksa bhāvanam (cultivation of the opposite, Yoga Sūtra II.33).
- How do the yamas and the niyamas help us to act ethically to care for ourselves and our community?
- What is the role of faith (śraddhā) in life and in our practice? As Patricia Walden says, "Yoga is a lifeboat.”
For yoga students and teachers alike, I think there are many opportunities to shake us out of our habits. We can get habitual about how we "attend a yoga class" and this is pulling the rug out from under us and making us reflect on:
- What is REALLY important in learning yoga?
- What is my relationship to my yoga teacher? And to my practice? And to my yoga community?
- If I can't be there in person, how do I show up mentally, emotionally, spiritually?
So I am hopeful that, as BKS Iyengar would say, we can transform disappointment into appointment.
Finally, I think just we should just reiterate the essential message that yoga is a refuge and that no matter where we are on the yoga path, whether we are a beginner or a longtime practitioner, the refuge of yoga is available to us whether we are in a class or at home on our own mat.
Dr. Jarvis Chen is a social epidemiologist at Harvard T.H. Chan School Of Public Health. His research focuses on social inequalities in health, and especially racial/ethnic and socioeconomic disparities in cancer outcomes. He is also a Senior Intermediate I certified Iyengar yoga teacher who lives, practices, and teaches in Boston. He studies with senior Iyengar yoga teacher Patricia Walden, whom he assists in classes and workshops. He also travels to Pune, India regularly to study with the Iyengars. In 2008, Jarvis was recognized by Yoga Journal as one of 21 teachers under the age of 40 who are “shaping the future of yoga.” See his Jarvis Chen Yoga Facebook page for more information.
This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.
This post was edited by Nina Zolotow, Editor in Chief of the Accessible Yoga blog.
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