Breathing lessons: A survivor’s guide to long COVID

There’s a place between two houses at the end of my street where I can climb a steep path up the side of Mount Sentinel. It’s not the gentlest transition, even at the best of times. Moving from flat sidewalks to a dirt incline is an adjustment. I have to place my feet differently, more carefully. I have to pay attention to my breath, which comes in jagged pants, and, although I am bundled in heavy winter clothing, I am suddenly very warm and sweating beneath my layers even as the cold air stings my face.

Breathing is more difficult now than it used to be. I’ve always been mildly asthmatic, but now I have long COVID. This means that many months after contracting COVID-19, I still have lingering symptoms that include deep fatigue, brain fog, dry eyes, heart palpitations and the inability to walk uphill without becoming extremely asthmatic. Prior to contracting COVID I mainly got asthmatic while hiking at 12,000 feet (3,660m) or running. This gasping for air at much lower altitudes is new. My doctors, like everyone else, don’t have enough information to know how long my symptoms will last or if they’ll ever go away. They recommend regular, moderate exercise as a way of retaining strength and building stamina.

I can’t go very far up Mount Sentinel, and I must pause to take breaks frequently. I stand, leaning forward, my hands bracing against my thighs as I hang my head and try to catch my breath. When I’m up high enough to see the sunset and the town below, I pause for longer and drink it all in. I reach out to rub sage between my fingers so I may inhale its scent. The Norway maples lining the streets below me look strange with all their brown wrinkled leaves still attached in the dead of winter. Our hard freeze came early last year, before the leaves could turn and fall. When I read about it, later, I learn that leaves slowly develop an abscission layer where the stem meets the branch. This gradually slows the production of chlorophyll and photosynthesis to a stop. The leaf stems can then break free. One article calls it an intentional shedding of limbs.

I read a lot of articles late at night, but most of them are about the latest research into COVID. I want to know what’s happening to my body, or what might happen. I want to know if there’s a cure for me and others like me. As the number of deaths around the United States continues to climb, so do the numbers of people who find themselves with symptoms that linger for months. I know people who have had symptoms for almost a year now. I read a lot about endothelial damage, and the ways COVID creates micro clots in small blood vessels in many places in the body. I read about how this happens in the brain, which explains the brain fog so many of us experience, as well as more serious symptoms like strokes, and in rare instances, psychosis.

I ascend the mountain a little higher. I am not at my limit quite yet, and the sun is not yet behind the mountains across the valley. When I reach a small tree, its brown leaves still attached and stirring in the light breeze, I test their strength. I grasp a handful of leaves, one by one, pinching them between my thumb and forefinger before tugging them earthward with a quick jerk. Of the leaves I pull, only one comes loose. The others are strong, still connected firmly to the slender limb they hang from. So far, we have not had much snow this winter. Although it is January, in Montana the paths are muddy with small patches of ice and snow here and there. The temperature dips below freezing at night but warms to just above that, in the mid-30s, during the day. But when snow does come – and it will, eventually – the leaves still attached to these branches will accumulate additional weight from the snow. Although some small trees like the one I stand before will endure this extra weight, the mature trees in the neighbourhoods below me will crack under the pressure. Rather than losing their leaves in the fall, some will lose full branches. It will be an unintentional shedding.

When anxiety overtakes me, I imagine my haemoglobin carrying oxygen to my brain and being stopped by a clot – my own version of an early freeze perhaps. Sometimes, I feel a cold wind inside me like a gale around my heart. I feel this icy wind most when I am practising my breathing. A craniosacral therapist and an acupuncturist have both been teaching me how to breathe. The former sends me home with balloons to blow into and the latter sends me home with an ancient Chinese breathing technique she tells me I can find on YouTube – though I promptly lose the Post-it note she gives me with the video’s name. I practise all the different ways to breathe: through one nostril, alternating nostrils, interval breathing, fire breath, ocean breath. I never knew there were so many different ways to breathe. Still, despite my months of breathing practice, I often catch myself taking shallow breaths. I catch myself breathing through my mouth. Worst of all, I sometimes notice I am holding my breath. My physical therapist teaches me how to hold my breath on purpose at the end of each exhale. The pause, he explains, allows for the complete dumping of oxygen into all my organs. Still, walking uphill keeps my breath cycle regular, even if it is ragged. I’m supposed to be practising breathing only through my nose while winded, but so far, I have not mastered this. Instead, I exhale from my mouth and inhale the cold wind through my nose, feeling its dry burn in my nostrils, feeling the air swirl down around my heart. Standing on the side of Sentinel, the cold wind inside mirrors the cold wind on my face. My warm body is a barrier between the two.

A week later, on a Wednesday, a mighty wind rocks my house for hours. Friends post pictures of trees uprooted along Bull River Road near Noxon, leaning into power lines and splayed across driveways. Our erratic cycles of freezing and thawing have softened the ground too much for dormant trees to tolerate. Those with shallow roots topple easily in the high wind. And leaves that had clung to their branches for weeks are suddenly airborne. A pile of saucer-sized maple leaves blankets the steps outside my kitchen door. Local reports say 125mph (203km/h) winds were recorded on the face of Mount Sentinel. And then, as if the wind had prepared the trees for its coming, winter finally arrives two days later. Fat, wet snowflakes fall all day, covering the piles of leaves heaped in all the neighbourhood yards. I climb up Sentinel again to assess the change from above. The wrinkled brown canopies that created tunnels over the streets near the university are lopsided now. Some trees still sport scruffy leaves. My friend Camilo, who is knowledgeable about trees, later tells me that the frozen leaves have damaged the flow of nutrients, which could inhibit or diminish new leaf growth in the spring. Other trees are bare now, as they should have been two months ago. Skeletal and fronting death.

When I return home, I see that brown leaves and orange berries still cling to the mountain ash tree on the west side of my house. Mounds of snow have grown into tall caps covering the largest clumps of leaves and berries and pull the tree’s limbs earthward. I think about the limbs that might break under the snow’s weight, and the leaves that cannot grow as a result – the leaves that would have transformed sunlight and water into oxygen. And although the tree has not been uprooted, the cycles of freezing and thawing this winter will be hard on the roots, too. Without sustained snowpack to insulate the soil, the earth will not retain enough warmth during hard freezes to nourish the tree’s roots. The roots may become damaged, which could affect the tree’s growth and longevity. Insects, which should not be alive or active during the winter, will proliferate and trees will be more susceptible to attack and disease.

Researchers studying long COVID are discovering damaged lung and heart tissue that CT scans and MRIs can’t detect. I linger over contrasting images in one report, observing the differences: normal heart tissue looks like rows of neatly aligned, horizontal icicles. Long COVID heart tissue looks like tangled brambles with melted ends. My CT scans and MRIs have all been normal, but I wonder if my heart tissue actually looks like a singed root ball. And what of the mountain ash outside my window? Perhaps its root ball is frozen and unable to absorb nutrients now.

It is hard to avoid anxiety about my future health and the future health of the trees. Some days, I am furious. We humans have brought this all upon ourselves and upon the species we are taking down with us. Other days, when I have energy to work a little longer, or when I look out of my back windows and see deer grazing in the yard, I muster some hope. Perhaps deer will inherit the earth. I am trying to live with uncertainty. Camilo, writing to me about trees, offers some reassurance. “Trees are complex organisms,” he writes. “They never die due to one single reason.” I practise ocean breath – a measured inhale through my nose, followed by a forceful exhale, then a pause before beginning again.