Commentary
Video
Noah Greenspan, DPT, PT, CCS, EMT-B, cardiopulmonary physical therapist and director of the Pulmonary Wellness and Rehabilitation Center in New York City, reflects on how the reality of COVID-19 infection proved far more complex than initially thought.
In the early days of the COVID-19 pandemic, the greatest risks for adverse outcomes were seen in elderly patients, very young patients, and patients with preexisting conditions like heart disease, diabetes, or lung disease. But as Noah Greenspan, DPT, PT, CCS, EMT-B, cardiopulmonary physical therapist and director of the Pulmonary Wellness and Rehabilitation Center in New York City, reflects, the reality proved far more complex. "COVID is a master at finding your weakness and exploiting it," he says, a lesson he learned firsthand when the virus reignited old injuries in his body—a phenomenon he saw echoed by countless patients.
An initial focus on acute respiratory distress and pulmonary fibrosis led to widespread ventilator use, he explains in this interview, a strategy later questioned for its potential harm. However, although some patients developed severe lung scarring, these cases often involved older individuals with prolonged stays in the intensive care unit or those with preexisting pulmonary conditions. "Did COVID cause this, or did it accelerate something that might have emerged years later?" he asks. The answer, he suspects, varied by patient, with COVID acting as both trigger and amplifier of hidden vulnerabilities.
There are 2 earlier segments from this interview that can provide valuable information:
Part 1: Lung Trauma’s Role in Quality of Life and System Efficiency
Part 2: Redefining Long COVID Care With Personalized Treatment
Inflammation emerged as a central theme in recovery, and Greenspan describes a "net inflammation" concept: multiple low-grade inflammatory processes—whether in the gut, lungs, or elsewhere—can collectively push the body toward a tipping point. "It’s like keeping a pot from boiling over," he explains. For patients in crisis, the priority isn’t exercise or aggressive treatment but restoring baseline stability. "The body likes consistency," he emphasizes, advocating for therapies that quiet the sympathetic nervous system, such as oxygen therapy, meditation, or gentle yoga.
Oxygen therapy, borrowed from cardiac and pulmonary care, became a cornerstone of his long COVID approach, helping patients recover from exertion and prevent flares. Yet, he cautions that recovery is dynamic, requiring constant reassessment. "It’s not just physical—emotional or cognitive overload can deplete the same energy reserves," he notes, comparing the body’s resilience to a bank account strained by work, stress, or even joyous excitement.
His philosophy hinges on balance: interventions must be replenishing, not depleting. "If someone’s at a –7 on the inflammation scale, we’re not adding exercise," he says. Instead, the goal is to nurture homeostasis, a steady state where healing can begin. In a landscape of unknowns, his approach is both pragmatic and humble: "We don’t really know. But we can listen, adapt, and try to keep the pot from boiling over."
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