He wouldn't let long COVID stop the music

Four years ago, celebrated cellist Joshua Roman was returning from a performance in Florida when he collapsed in tears on the stairs to his New York home, unable to take another step.

A bout with COVID-19 left him so debilitated that at times he could barely lift his cello bow or even open his eyes and speak.

"I would have this sudden onset of violent shaking and not know why. I still have that but it's much less often," he said recently.

He experienced periods of monumental fatigue, when he felt as "if my blood suddenly weighs a lot or I'm wearing a coat of armor." And his brain would become mired in a kind of haze that made it impossible to read or remember things.

Like an estimated 2 million Americans, Roman's bout with COVID-19 was turning into an all-out battle with long COVID. And, like many others, it was far more life-altering than one could imagine. His symptoms became so intense that he even temporarily abandoned his cello, the thing he loved most, the instrument that had been his source of identity and livelihood for decades.

I would have this sudden onset of violent shaking and not know why. I still have that but it's much less often.

Joshua Roman

The experience became a kind of reckoning. He was forced to reassess his approach to music, his successful career as a soloist, and his perspective as he learned to adapt to and manage his condition.

Today, Roman, 41, is back on the musical stage, sharing his journey and his music, including his debut U.S. solo album, Immunity, with audiences around the country.

He will play excerpts from the album and talk about his experiences at Stanford's Bing Concert Hall on Feb. 12. The program includes Saint Saen's first cello concerto, which he will perform with the Stanford Medicine Orchestra. (Limited tickets are still available.) A day earlier, Roman gave a Stanford Hospital performance as part of the Reller Family Concert Series.

Overcoming the haze

Roman's experience with long COVID has been similar in some ways to that of patients Linda Geng has seen as the co-director of Stanford Medicine's Long COVID Collaborative. Geng, MD, PhD, said many individuals experience paralyzing fatigue and a brain fog that she likens to the mental haze caused by chemotherapy or repeated concussions.

Roman also has the common symptoms of dysautonomia -- or an inability to control automatic functions such as heart rate, blood pressure and body temperature -- as well as post-exertional malaise, or a collapse of physical and cognitive functions after exertion.

As someone with a classic type A personality, Roman has had to learn to ration his energy and pace himself to avoid "crashing," which he describes as feeling like "the curtain is suddenly coming down."

In the early days of his illness, so overcome by the physical and mental challenges, he chose to put his cello in a closet and not touch the instrument for three months. He said he began to doubt himself and his music, which had dominated his life from an early age. "I began to think, 'What's the point?'"

Joshua Roman rests after a studio session. (Photos courtesy Joshua Roman)

But one day he decided to dust off his case and pick up his bow. He played the Bach Prelude from the First Suite, which had been part of his daily practice routine for decades.

"It was so profoundly meaningful a moment. It connected me to my love of the cello and the history of the cello. The fact that this music felt new to me was so powerful," he said. "I realized the importance of protecting that."

He began to radically change his habits. While he used to start his day by sprinting a six-minute-mile, then exercising for another hour before embarking on four to five hours of cello practice, Roman has learned to limit his activities and his practice time.

He also changed his approach to music, he said, focusing less on the need for technical perfection, trusting that his skill would carry him through, and more on finding ways to connect emotionally with his audience. He also began talking publicly about his challenges.

"In sharing my story, I realized that something had been missing before: the vulnerability, which is part of being human," he said. "If I'm complete and perfect in my own world, there's no connecting with other people."

Managing his condition

Roman takes several medications to manage his symptoms, including a beta blocker to control the trembling in his hands and racing heart, which used to rocket to 200 beats per minute, he said. He takes a seizure disorder medication to help forestall a crash when he feels it coming and an enzyme to help prevent micro-clots in his blood, another side effect of long COVID.

There are no Food and Drug Administration-approved treatments for long COVID, though many clinical trials are under way at Stanford Medicine and elsewhere, Geng said. She and her colleagues were the first to test Paxlovid, an antiviral used to treat acute COVID, as a potential therapy for long COVID. The small, 15-day trial didn't show any measurable benefits to patients overall, though it was clear that the medication was safe and well-tolerated, said Upi Singh, MD, professor emerita of infectious disease and another investigator in the trial.

In sharing my story, I realized that something had been missing before: the vulnerability, which is part of being human.

Joshua Roman

The researchers are involved in a much larger National Institutes of Health-sponsored trial of Paxlovid, with results expected in the next six months, Singh said.

Geng said she applauds Roman's bravery in being so open about his illness and his ability to cope with its many challenges.

"I admire that he's been able to figure out a way to adjust his life to pace his activities. It's such an individual journey," said Geng, who previously invited Roman to present at a Stanford Continuing Medical Education seminar in August of 2024. "He's sharing a very personal story in a way that is moving and inspiring. It's incredible what he's doing now, knowing what he's been through."

He is also raising awareness of a condition that is prevalent but at risk of becoming a "hidden illness," Singh said. Recent studies suggest that nearly 7% of the U.S. population may be affected by long COVID, defined by a range of symptoms that persist for at least three months.

'He's sharing a very personal story in a way that is moving and inspiring. It's incredible what he's doing now, knowing what he's been through.'

Linda Geng

"With long COVID, unfortunately, people may look quite healthy," Singh said. "They may interact with you normally, but that interaction may exhaust them to the point where they cannot get out of bed for a day. Putting a human face on it is very important in increasing awareness."

Recently, Roman said he has felt an improvement in his condition, though he doesn't know why. Perhaps it was the tai chi he began practicing in December. Whatever the reason, he celebrates every little step forward -- especially in light of his early ordeal on the staircase to his home.

"The other day, I was able to walk up the subway steps without stopping," he said with a note of pride.

Photos courtesy Joshua Roman