Friday, March 13, 2020

Some Considerations for Yoga Teachers re: The Covid-19 Situation

by Jarvis Chen, ScD and Senior Intermediate I Certified Iyengar Yoga Teacher

In the United States, there are a lot of unknowns about community transmission of coronavirus because we do not yet have capacity for large scale testing. At the moment, it appears that only those who (a) exhibit symptoms (dry cough, fever, shortness of breath), AND (b) have had direct contact with a confirmed infected person; OR (c) have international travel history to a known hotspot are being tested. As a result, it is difficult to quantify individual risks.

However, there does appear to be consensus among infectious disease epidemiologists and doctors that communities need to focus on mitigation strategies NOW to reduce transmission. The idea is that if we can implement strategies like social distancing now, we will “flatten the [epidemic] curve” if and when we start having community transmission. Many epidemiologists feel we do already have community transmission in the United States that we have been unable to see because the lack of comprehensive testing.

The mitigation strategies epidemiologists have suggested that the public focus on are:
  • Frequent hand washing with soap and water for more than 20 seconds.
  • Sneezing or coughing into disposable tissues or into the crook of your elbow instead of into your hands. Used tissues should be discarded right away.
  • Maintaining 3-6 feet of space between you and another person when in public.Staying home and avoiding contact with others if you have a cough or fever.
  • Avoiding large and crowded public gatherings.
In particular, people who are over the age of 60, immune compromised, or with other health conditions (such as heart disease, diabetes, or asthma), or who are in frequent contact with such people should socially isolate and reduce trips outside of the house.

Yoga teachers face some difficult decisions about how to reduce the risk of transmission for their students and their communities. At the same time, for many students, yoga is an important way that they manage stress in these uncertain times. And yoga teachers' financial wellbeing is also affected.

Some concrete suggestions are:
  • Reduce class sizes so that students can maintain 3-6 ft of space between themselves.
  • Ask students to bring their own mats and yoga props, for example, belts, blankets, and blocks.
  • If you are using shared hard props that are made of wood or metal, disinfect them before and after use. Cork and foam are too porous to disinfect, unfortunately. (Note that disinfectant wipes with bleach are probably good to use, not all disinfectant wipes are created equally).
  • Avoid sharing soft props (like blankets, bolsters, and straps) because we don’t really know how long viable virus lasts on soft surfaces.
  • Avoid hands-on adjustments of students.
  • Encourage students to wash hands frequently or use hand sanitizer with >70% alcohol content. (Washing with soap and water for over 20 seconds is more effective than hand sanitizer.)
  • Develop alternative modalities for delivering yoga instruction (such as, online courses) to reduce person-to-person contact.
The trickiest decision is about when to cancel class. At the moment, I am thinking:
  • If you have the option of canceling class, it is a good idea to cancel class. Every little bit counts in reducing settings in which transmission or a “super-spreader” event can occur.
  • Obviously, the size of the class factors in here—classes of under 10 people do not present as much of a risk of “super-spreader” events as larger classes.
  • Students in high-risk groups should consider their choice to participate in public classes and make an informed decision. At the moment, I am asking my students to tell me about their comfort with continuing to come to class. If the consensus is that they wish to continue in person classes, I will consider continuing to offer public class until such time that the venues where I teach decide to cancel class or local and state health authorities issue stronger directives about public gatherings.
  • I am however making it clear that, as an epidemiologist, my recommendation is to cancel classes at least for the next four weeks.
The situation is rapidly changing, and I’m seeing a lot more appetite on social media for canceling public events and meetings. I hope that we can support each other through this process of learning and making decisions that protect the health of our communities.

UPDATE: I am gratified to see that we seem to have arrived at a tipping point with many institutions including yoga studios deciding to close for the next few weeks. I want to further articulate why canceling class is a preferable option to the other mitigation strategies described above.

Social isolation strategies are amenable to mathematical modeling: infectious disease epidemiologists can use existing models to study the effect of reducing social contacts on transmission probabilities. In contrast, we don't really have the data to evaluate the effectiveness of behavioral mitigation strategies like not using props, avoiding manual adjustments in class, etc. Given that people are already in the room, we don't know how much of an effect these strategies will have on the overall risk of transmission if there is someone infected in the room. Will they reduce your risk by 10%? 5%? 1%? Yes, everyone gets to decide what strategies they want to employ for harm reduction, but by how much do they reduce the potential harm?

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.” 

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