A Virtuoso Cellist’s Painstaking Path From Long Covid Back to the Stage

Since he began playing cello at 3, Joshua Roman’s talent has taken him from his hometown of Mustang, Okla., to concert halls all over the world.

He was the youngest principal cellist of the Seattle Symphony, at 22, and has been a soloist with the Los Angeles Philharmonic and many other orchestras. His daily routine often included 10 hours of playing, along with a six-mile run.

Then, on Jan. 9, 2021, in Jacksonville, Fla., the morning after performing Prokofiev’s Symphony-Concerto, a piece he loves for its “giant sections of flashy, virtuosic excitement,” everything changed. He woke up and found he couldn’t smell his toothpaste. Later that day, he tested positive for Covid.

He was only 37 years old, but he felt extreme fatigue, as if “wearing a coat of weighted down metal inside my body.” It would be a month before he had enough energy to fly home to Manhattan. He was so weak that he got stuck on a staircase landing, crying until he managed to crawl up the rest of the steps.

Eventually, most excruciating of all, he lost the stamina to play his cello for nearly three months.

“I just let it sit literally collecting dust.”

“A shadow of pain”

When Mr. Roman finally returned home to New York in February 2021, he had two musical commitments looming, a Saint-Saëns concerto with the Omaha Symphony and a project with the bassist Edgar Meyer.

As he began preparing, his body and mind rebelled. He would start shaking as he played. “Not great for anybody,” he said, “let alone a cellist who relies on steady hands.”

Practicing involves much more than simply playing through a piece. It takes intense concentration and focus, and many incremental decisions — how to phrase a line, whether to emphasize a note. His approach to practicing had always been “more is better.”

But when he tried to practice the Saint-Saëns concerto, a piece he had performed for years, he could only play for about 90 seconds. “To suddenly be sitting at the cello and deciding whether I was going to practice for a minute and a half,” he said, “felt like a giant step back.”

After several weeks, he managed to play straight through the 20-minute piece and perform at both events. But afterward, symptoms overtook him for months.

“He was just totally destroyed after that,” said Tessa Lark, a violinist who joined him on the project with Mr. Meyer.

The mental and physical exertion of playing would cause a “cognitive hangover,” he said, “like feeling the shadow of pain in your head.”

He put the cello away. “I didn’t open that case,” he said, adding, “I felt at my lowest.”

He was stricken with guilt for neglecting his cello, a mellifluous instrument built in Venice in 1899 that he viewed as a friend and had nicknamed Midge. “It’s such a constant companion — we’re, like, literally joined at the hip.”

He considered the unimaginable: giving up playing altogether.

The idea was shattering. Playing cello had anchored and defined his world since he was a child, when his family moved often and even lived for nearly a year in an airplane hangar on his grandfather’s farm near Guthrie, Okla.

He worried about disappointing people. He wondered what else he could do for a living.

“I was getting pretty dark about what the meaning of my life was without the cello and kind of wondering what the point was,” he said.

Then, a friend asked him to perform at a summer solstice party, and he felt he couldn’t say no. He didn’t practice until the day before. His muscles felt cottony, his fingers creaky. But the experience was so powerful that he wept during the practice session.

“Feeling the cello and hearing the cello and letting myself do that again was pretty emotional,” he said.

He performed a piece he used to play almost every day, the prelude from Bach’s Suite No. 1. He was overwhelmed by the realization he needed to keep playing.

“It was like being asked to wake up.”

Treatments, doctors and support groups

Mr. Roman participated in a respiratory program at the Mount Sinai Health System that eased some symptoms, including breathlessness. Doctors prescribed a beta blocker for the trembling in his hands and the spikes in his heart rate.

But there weren’t straightforward treatments for other symptoms — “the brain fog, the fatigue, the crashes,” said Dr. Mariam Zakhary, a Mount Sinai rehabilitation physician who has treated him.

Mr. Roman tried a program involving computer games with tasks like tracking animated suitcases on a conveyor belt. It was technically easy, but the cognitive effort “felt like somebody was pumping mist into my head,” he said.

Dr. Zakhary referred him to Belinda Yew, a neuropsychologist. Dr. Yew administered a cognitive exam that found some deficits, including for tasks requiring prolonged focus. “He would have difficulties, start responding more slowly or making more mistakes,” Dr. Yew said.

“The problem with Joshua is he was really strong in a lot of areas, but the areas he was weaker in were these things that are really crucial to everything else,” she said, adding that “he was struggling with day-to-day life.”

Dr. Yew suggested taking frequent rest periods and sorting activities by the energy they required. “Green light” activities, like listening to the Beatles or a “Harry Potter” audiobook, took less energy, so he could do more of those than “yellow light” activities, such as practicing cello or listening to more complex music. He learned not to do more than one “red light” activity a day, like performing or editing music he recorded.

“I live with long Covid and I’m having a crash,” say laminated cards that he has carried ever since he was unable to speak or get up from the floor for 30 minutes after a concert in Brooklyn. “Make sure my cello is safely in its case,” the cards say. “Tell anyone who needs to know that I’m temporarily incapacitated.”

He participated in a 12-week support group Dr. Yew led, and still meets informally with the other patients. He’s volunteered for several long Covid studies. He started taking nattokinase, an enzyme believed to help break down microclots in the blood, which many long Covid patients have. Doctors also prescribed lorazepam, used to treat conditions such as seizure disorders, which he takes when he notices signs of an impending crash.

“I think Joshua’s experience mirrors the experience of a lot of people with long Covid,” said David Putrino, the director of rehabilitation innovation for Mount Sinai, who researches long Covid and has advised Mr. Roman. “The first few months of living with long Covid is a very harrowing, extremely disabling experience until they start to learn how to live with their condition.”

Since his initial coronavirus infection, Mr. Roman, now 40, has had Covid three more times. Some of his long-term symptoms have improved, but new ones have emerged.

“Every time I’ve had Covid, my long Covid has changed,” he said. Since his most recent infection, in January, he pauses more when speaking, he said, and is more halting when writing.

“Some things I’m getting better at managing,” he said. “Other things are harder now than they were a year ago.”

An album called “Immunity”

At Elmwood Road Studio in South Salem, N.Y., about 50 miles outside Manhattan, Mr. Roman was marshaling all the energy and focus he could.

It was the summer of 2023, more than two years since he first developed long Covid, and he was embarking on a new musical path. Before getting Covid, he had planned to move to France and had defined his career trajectory as “straight up through the middle of classical music.” He hoped to impress the establishment in that field that “I was good enough.”

But long Covid made him feel he needed to follow his own muse, and his eclectic musical interests. He decided to record an album, to be released this fall, incorporating a range of genres, from Bach to modern classical composers to a version of “Dust in the Wind” by the rock band Kansas with Mr. Roman playing guitar.

“This is the first time that I’m putting together something of this breadth and depth,” he said. “Before, I wasn’t ready to be that vulnerable. I would have been too afraid of what people would say. Now, this is what it is, say what you want.”

The album title — “Immunity” — reflected the “experience of Covid and wanting to be immune from this,” as well as the idea that the world is interconnected and people need to depend on each other.

Its title track, which he wrote, was originally called “Fuzz,” a reference to his long Covid brain fog. He composed it by improvising rhythms and phrases, writing down what he liked, revising and assembling small sections over months, as his concentration and energy allowed.

He urged himself on with reminders like “this is just the first piece that I’m writing with long Covid, and it’s not to prove anything except to myself.”

The piece started off “hazy and tentative,” he said, repeating two notes over and over. Then, it swirled into something energetic and almost liberated, intended as music that “acknowledges the pain and is still very joyful.”

During an earlier recording session, Mr. Roman had experienced a cognitive and physical crash after several run-throughs of a sonata by the American composer George Crumb. Worried he would drop his cello, he asked his Grammy Award-winning producer, Adam Abeshouse, to take it from him. Then, he lay on the floor by the microphone stand, staring silently. It was June, but he began shivering, so Mr. Abeshouse covered him with a blanket and sweatshirts.

The day I observed a recording session, Mr. Roman tried to avoid crashing. After he and Ms. Lark spent two hours recording “Duet,” a piece for cello and violin in 5/4 time that he had composed before he got Covid, he stretched out on a sofa, feet elevated and eyes closed. He said he felt “pretty foggy” and took an extended break before resuming recording, resting after each piece.

As the sun set, he played and sang “Hallelujah” by Leonard Cohen, weaving the cello’s resonant timbre around and behind the words. When he was done, he hit the sofa again, his brain feeling as if it was enveloped in a creeping cognitive mist.

He has tried to adapt his performance schedule not just to his medical reality, but to the musical reinvention that long Covid has ignited.

He continues to play classical repertoire with orchestras, but also performs selections from “Immunity” with dancers and other creative artists. He has incorporated the album’s music into workshops and events with the Juilliard School and gives free “Immunity” concerts for patients who attend long Covid clinics.

“I am trying to really remind myself that you don’t know what comes later,” he said. “Now is all you ever have.”