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Respiratory Illness and Osteopathic Medicine: What Osteopathic Medicine Brings to the Current Coronavirus Global Health Challenge

March 19, 2020


Paul DeMiglio
Manager of Media Relations

This letter is not intended to be a comprehensive scientific review of the topic, but rather a reminder to the osteopathic community about the importance of our philosophy and training and about raising calm in the storm.

The osteopathic community has an opportunity to demonstrate the value of its educational model in the way it contributes to managing the current public health crisis at the front lines. Importantly, we should remember that our unique principles and practice are applicable to every patient, every day, not just during times of crisis. It is simply moments like this that serve as a reminder to us of the knowledge and skill we possess as a DO.

The foundation of our patient-centric and holistic practice of medicine has been guiding us for over 125 years. Our philosophy of practice may be of particular importance during a complex situation like the current coronavirus global health challenge. Now more than ever, as the public is nervous and our patients are seeking answers, it is time to make sure that the individual patient doesn’t get lost in the cacophony of panic and the endless reporting of numbers. We are all human beings requiring a human touch. Even if we medical professionals have to work behind a protective mask or gear, we must constantly remind ourselves, our patients, and the broader public that this impacts real flesh and blood people. We must remember there is a person in need behind every statistic we read.

We chose DO because we embrace that principle of simple kindness and wellness of the entire human being, from mental care to physical care. And our unique approach was evident in the global pandemic of 1918. It was a very different time in medicine and medical research, but published papers at the time addressing outcomes of influenza cases from the 1918 pandemic suggest the patients of osteopathic physicians fared significantly better than the alternative practices at the time. Many factors will keep us from knowing with certainty the accuracy of this statement, but it was a prevailing belief then, and it remains so to this day. We can surmise why it may be true.

One hundred years ago, osteopathic physicians were less inclined to use medications or apply other treatments of uncertain value out of concern they might worsen the condition of a patient. This was a key teaching in osteopathic medical schools. If nothing else this approach to patient care may have allowed the body a chance to heal itself without adding insult to the damage otherwise caused by the virulent influenza infection. Another possibility explaining better outcomes for the patients of osteopathic physicians is the benefit of manipulation directed at improving function of the chest wall and the associated respiratory structures along with improving lymphatic drainage of the pulmonary parenchyma.

Based upon modern research, patients suffering severe effects of the ‘Spanish Flu’ were noted to have an overly aggressive immune response—a cytokine storm. It is not unreasonable to consider the possibility that an anti-inflammatory response occurred from the manipulation (OMT) used to relieve symptoms—a response that contributed to a reduction in complications and death.

What does this mean today as we consider our current situation? Perhaps our understanding of the VUCA (volatile, uncertain, complex, ambiguous) environment can help.

We clearly face both uncertainty and ambiguity with the rapidly changing conditions associated with COVID-19.

From an uncertainty perspective, we know a lot more about infectious disease than we did in 1918. We also have far better medical equipment and supplies to face a pandemic. A challenge of the current situation is predicting the results of our actions. Quarantine, isolation, and community separation work, but how are they best applied to COVID-19? When dealing with an environment of uncertainty a good approach is to collect, interpret and share data. We see evidence every day of how this is being done across the world.

From an ambiguity standpoint, there is a lot we don’t know about this novel virus. There is no approved anti-viral treatment. There is no vaccine. Care for those who are more severely ill is largely supportive. When dealing with an environment of ambiguity a good approach is to test hypotheses. From a medical decision-making standpoint, this means using what we know and applying it in a thoughtful way to a plan of care as we work to achieve positive outcomes. Alongside advanced intensive care services there is a tremendous opportunity to integrate our principles and practice as osteopathic physicians.


Personal protective equipment (PPE) creates a barrier between the physician and the virus—and we must use it to reduce risk of infection. It also creates a barrier between the physician and the patient—but only if we let it. Keep in mind the human needs of our patients and consider how they are heightened by the fear they are experiencing. Compassion and kindness affect our physical health and potentially the outcomes of our care.


Patients developing coronavirus related pneumonia will experience among other things increased work of breathing (WOB) from a change in respiratory system compliance. These changes will likely involve a combination of the chest wall (rib and spine dysfunction), lung parenchyma (cellular infiltrates and edema) and airways (mucosal edema, inflammation, secretions, and bronchospasm). Your hands have been trained to assess the respiratory system for somatic dysfunction and to eliminate impediments to optimal function through use of OMT. By including OMT (with proper precautions) in your plan of care there is opportunity to reduce WOB and potentially improve lymphatic drainage.

Innate Capacities to Heal

There will be ample opportunity to assure impediments to recovery have been eliminated (like avoiding unnecessary antibiotic use unless there is clear indication of a bacterial infection responsive to such an agent), that adequate nutrition is provided, mobility is maintained as the patient’s condition allows, and that rest and sleep are promoted to reduce fatigue.

I am confident our whole-person approach to care, active attention to optimizing structure and function, and recognition of the body’s natural capacity to heal combined with the best of modern medicine may contribute to positive outcomes for patients. We cannot, at this time of national concern, lose sight of this framework learned when earning your DO degree.

Once again, the osteopathic community has an opportunity to demonstrate the value of its educational model in the way it contributes to managing the current public health crisis at the front lines. It is vital that we bring our own unique way of thinking and solving problems to the current health crisis. We have much to offer; now is the time to lead, with our patients foremost in our mind.

Robert Cain, DO
Robert A. Cain, DO, FACOI, FAODME
President and Chief Executive Officer
American Association of Colleges of Osteopathic Medicine