































Highlights in BioScience
ISSN:2682-4043
DOI:10.36462/H.BioSci.202105

Review Article

Open Access

1 Department of Bioinformatics, Colors Medical

Laboratories, Cairo, Egypt.

Contacts of authors

* To whom correspondence should be
addressed: p.habib911@gmail.com

Received: January 01, 2021

Accepted: March 6, 2021

Published: March 15, 2021

Citation: Habib PT . COVID-19 symphony:
A review of possible music therapy effect in
supporting the immune system of COVID-19
patient. 2021 Mar 15;4:bs202105

Copyright: © 2021 Habib. This is an open access
article distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction
in any medium, provided the original author and
source are credited.

Data Availability Statement: All relevant data are
within the paper and supplementary materials.

Funding: The authors have no support or
funding to report.

Competing interests: The authors declare
that they have no competing interests.

COVID-19 symphony: A review of possible music therapy effect in
supporting the immune system of COVID-19 patient

Peter T. Habib*1

Abstract
Coronavirus, the current pandemic that takes lives of 1,936,632 until the time of the

paper. Scientists over the world exhibited all efforts to fight the virus. Many supplements
developed to fight coronavirus by supporting the immune system which is the strongest
worrier against it for now. One of the neglected strategies to enhance immunity is music
therapy. Music therapy can drive immunity into different conditions. Not only able to
boost and suppress immunity but also many physiological and psychological diseases are
treated with music therapy. It is more than just entertainment, and research shows that mu-
sic therapy may be helpful and cost-effective to support standard therapy. This systemic
review tries to explore the effect of music therapy and arrives at a conclusion suggesting
routine procedures to support the patient with music therapy. However, the idea of using
music therapy in improving the immune system must undergo clinical and medical confir-
mation to be used.

Keywords: Psychology, Music therapy, Immune system, COVID-19, Coronavirus, Pandemic.

Introduction
The epidemic by a new Coronavirus, named COVID-19, initiated in late 2019 in Wuhan, China,

is a worldwide public health threat [13]. The virus likely evolved in bat, a zoonotic origin, after

amino acid substitution in the spike glycoprotein, as recently suggested, acquired the ability to bind

to ACE2 receptor and be able to infect humans, which started the new epidemic [4]. Currently,

there is no efficient treatment against the new Coronavirus. Therefore, identifying previously known

antiviral drugs to fight back is urgently needed. A successful drug research strategy is to check

if the current antiviral medicines are efficient in the treatment of Coronavirus infections. Several

drugs, such as ribavirin, ribavirin, chloroquine, and two well-studied broad-spectrum antiviral drugs

remdesivir, and favipiravir have been used a long time ago with SARS or MERS patients, although

the efficacy of some drugs remains controversial [5]. Till now, the immune system is the only barrier

against coronavirus. Before existing of an official drug or vaccine for the coronavirus, many indi-

viduals recovered due to the immune system with the aid of some vitamins to support the immunity

and medications to reduce the inflammation. Although, there were some efforts to develop a vaccine

[6] and discovering some potent molecules that may inhibit the virus attachment [7]. However, the

official protocols aim to enhance immunity with medication. But the neglected fact that not only

medication enhances immunity, but music therapy also does the same effect. Backing to the 10 th

BC century from western the starting from Greeks to the eastern including India and China, history

proves the curative and healing powers of music therapy. The ancient Greeks are thought to have

used music therapy to soothe the mentally disabled. Western thinkers from Pythagorus, Aristotle,

and Plato to Schopenhauer and Nietzsche provided detailed of their interpretation of music’s thera-

peutic forces and their confidence in its practical application to offer peace and unity, and thereby to

cure mental and physical illnesses [8]. Aristotle, who has a strong background in psychotherapy, pro-

vides a theory that "after listening to music, those who suffered from uncontrollable feelings would

return to their regular state, which brought their souls to happiness" [9,10]. There is also Evidence

from 4000 BC of using music therapy as a tool of stress relief and is estimated to stretch back as far

as Palaeolithic times [11].

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Habib, 2021 A review of possible music therapy in supporting the immune system of COVID-19 patient

The investigation of music therapy has increasingly delved
deeper into the mechanisms influencing music therapy interpre-
tation and production, investigating music psychology [12]and
music cognitive neuroscience, also referred to as ’neuro musi-
cology [13] The physiological basis for music-induced emotions
[14,15], the neurobiology of some elements of music such as
harmony [16] and the neuroanatomy of music performance have
been included in this profound study [17]. And the scope of re-
search ranged from the interpretation inside the womb of folk
songs [18] to the production of opera on concert platforms [19],
to the use of mainstream music in working theatres [20]. Mu-
sic is an emotional language. It is known for improving mental
and mood health. Any change in emotions affects the hormonal,
neurophysiological, and physiological processes; thus, changes
in body balance caused by music indicate the efficacy of dif-
ferent musical types [21]. Though still not well studied, sev-
eral studies show that music therapy may promote a decrease
in the stress response, a decrease in heart rate, improved toler-
ance to pain and suffering, change in skin behavior and muscle
function, decreased anxiety, and depression. Different studies
have reported this effect in musically exposed stressed patients
[22-24]. on the other hand, Noise stress could cause adverse
effects on immunity in both human and animal models [25,26].
several studies investigate different stress indicators, including
blood pressure, pulse rate, and respiratory rate recorded measur-
ing vital signs. These are the only anatomical measurements be-
ing used in nine of these. Several research, including [27], used
vital sign assessment as proof of a transition from sympathetic to
parasympathetic processes, equating a shift in immune function
with a wider response to stress. in many trials, calming music
was found to decrease blood pressure, pulse rate, and respiration
rate. No definitive improvement was observed in just four trials.
One of the first music therapy studies reports music as therapy
was in 1963 when Melzack, Weisz, and Sprague report when
evaluating the effect of the auditory stimulus on behavioral pain
due to participants’ fingertips submerged in ice water slow grad-
ually increased discomfort in the group listening to music rela-
tive to control group [28]. In 1966, two famous scientists, Mo-
rosko and Simmons tried to shock to the teeth of volunteers and
found that music and white noise were effective in decreasing
the pain sensation and increase tolerance [29]. In 1974, Peretti
and Swenson used the Galvanic Skin Response (GSR) to assess
anxiety caused during a written maze test by negative responses
to participants. In this case, music lowered GSR responses dra-
matically [30]. The effects of music on a specific physiological
mechanism such as cardiac output, respiratory rate, and blood
pressure were originally reported in many studies including such
as in France in 1880, America in 1899, and Russia in 1903 [31].
however, the immune system is one of the strongly affected sys-
tems in the body that can be manipulated indirectly with music.

Musically immune stimulation
As mentioned, the Immune system is strongly associated

with mood, psychological condition, and hormonal balance. Thus,
as a result of negative mood, stress affects the immune system
may cause dysregulation leads to a change in the humoral and
cellular immunity and increases health risks [32]. Bittman [33]
presented proof that the drummer's team has improved NK cell
response, lymphokine-activated killer cell function, and dehy-
droepiandrosterone - cortisol balance in normal subjects, consid-
ered one of the early signs of the immune system-music interac-
tion. Wachi [34] found that delightful music modulates immuno-
logical responses in adults 65 years of age who are demarcated.
Important changes were reported in the number of lymphocytes,
CD4 + T cells, T cells, and T memory cells as well as in the
development of IFN-π and IL-6. Even music could reverse the
immune stress induced by the immune suppressor. Not only can
affect the immune response but could lead to a reversion of the
effect of the medication. Music appeared to has a reversal effect
as pharmacological interventions (i.e. benzodiazepines, 5 HT
agonists) in immunosuppression induced by stress [35-37].

Many studies state that music minimized stress-induced hy-
peractivity of the hypothalamus-pituitary-adrenal [HPA] axis, in-
cluding ACTH and corticosteroid production [23,38-44], and
modulate norepinephrine, epinephrine, GH, PRL, and endorphin
secretion [45]. This hormonal and neurotransmitter balance low-
ers stress and improving the condition of the immune system.
Other studies show that there a wide range of drugs that sup-
press the immune system, but one common immune suppressor
is the negative mood. On the other hand, Music is well studied
as an immunity enhancer that re-regulates the immune system,
increases NK cell activity, lymphokine-activated killer cell ac-
tivity, lymphocytes, T cells, CD4+ T cells, and memory T cells
[33,34]. Music improves the psychological state, re-balance the
hormonal and neurotransmitter levels in the body, therefore im-
prove immunity.

In the current coronavirus pandemic which began in China,
there is an increasing number of infected people every day. Af-
ter emerging of different vaccines that draw the immune system
attention to foreign invaders, the immune system proves that it
is the only and strongest barrier against the coronavirus. One
promising approach is the plasma transfusion from recovered
people to COVID-19 patients as many studies find that 200 ml of
plasma from recovered people could neutralize the Coronavirus
and lead to the disappearance of viremia in 7 days [46–49] which
shows that the immune system is the only cure for such diseases.

The immune system is known to be strongly connected to
psychological balance. That is when the individual mood is
good which means a high level of dopamine in blood, will opti-
mize and enhance the immune system, and a bad or sad mood
will suppress immunity. So, one of the best strategies to support
the immune system is to keep the mood in a good state. and
some studies support the fact that dopamine is highly liked by
the immune system [50,51].

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Habib, 2021 A review of possible music therapy in supporting the immune system of COVID-19 patient

The influence of music on leukocytes was investigated in six
experiments [33] found that natural killer cells increased, fol-
lowed by an endocrine reaction. [52] Hirokawa and Ohira [53]
carried out other experiments testing the number of CD4 and
CD8 cells. It was observed that inducing recorded music, ana-
lyzed by [52], increased plasma CD4+ T cell levels. The impact
of music on immunoglobulins was also investigated. The most
studied antibody (n = 12) has been immunoglobulin A (IgA).
Some of these studies reported a rise in IgA level after a series
of musical approaches with a wide range of styles and genres.

Fancourt introduces a modern model that connects Central
Nervous System (CNS), Endocrine System, Autonomic Nervous
System (ANS), and Immune System with them effectively to
Psychological effects and Physiological effects which provides
a basis for the creation of a taxonomy of study design variables
linked to music and stress and traces the broad paths involved in
its impact on the body [54].

Gender-dependent response
According to the physiological difference between men and

women, there is a different response to music as shown in Nater
et al., the study [55] that reports different interactive patterns in
men and women. Once met with heavy metal music, according
to finger temperature and skin conductance tests, women dis-
played a significant gradual increase in the sympathetic nervous
system (SNS) response than men's response. However, men dis-
played an abnormal autonomic reaction after exposure to heavy
metals as demonstrated by increased salivary amylase secretion,
which is caused by sympathetic and parasympathetic stimula-
tion [55]. Several studies have suggested that the difference in
sex-based psycho-physiologic responses to music might have a
hormonal basis [56–59]. However, research by Trost [60] using
Functional magnetic resonance imaging (fMRI) indicated that
cheerful music stimulates the left striatum and insula while nos-
talgic sad music stimulates the right striatum and orbitofrontal
cortex in both genders.

Criteria of theraputic music
It is well known that music is related to mood and can make

people feel happy, depressed, alive, or pleasant [61]. listening
to techno music (TM) or fast rhythm music[44] could cause in-
creases in plasma norepinephrine, epinephrine, GH, PRL, cor-
tisol, and beta-endorphin concentrations with a gradual rise in
heart rate, systolic blood pressure, and significant changes in
emotional response. in Gerra [62] that found that exposure to
techno music increases the heart pulse rate and norepinephrine,
cortisol, and adrenocorticotropic hormone secretion levels and
vice versa such in the White study [63] who showed, in a group
of patients in intensive care unite (ICU) when they listened to
relaxing classical music, a reduction of heart rate and blood pres-
sure. other studies suggested that classical music has been found
to improve the mood state caused by TM and increased gastric
slow-wave in adults [31], but not to significantly reverse changes
in hormonal concentrations [64].

An old study investigated the physiologic effect of listening
to no music, fast-rhythm music, and sedative music for athletes
and non-athletes during the exercise of varying intensities. Un-
der conditions of intensive exercise, runners listening to fast
rhythm music had increased plasma cortisol levels [65]. This
indicates a possible metabolic advantage for the use of energetic
music during exercise, considering the role of cortisol in stim-
ulating the catabolism of energy substrates in fat, adipose, and
connective tissues. McCraty's study shows the effects of music
in this study was titled 'Heart Zones'. S-IgA increased by 55 per-
cent (p < 0.01) when listening to the heart Zones' music alone
[40].

Criteria of selected music according to [66] should be full of
character, slow rate, repeated rhythm, predictable tone dynamics,
pleasant harmony with no vocal content. three songs studied by
[67] are consist of 70 to 80 beats per minute and have a slow and
steady, repeated rhythm as reported in the previous study. The
three songs are "Canon in D major", "Love Story", and "Dance
of the Iguana" played by Johann Pachelbel, Richard Clayderman,
and Stevan Pasero respectively.

Valence and arousal in music have also been shown to be ma-
jor factors. For calm, low tempo songs, [68] compared recorded
music with four distinct tempi and moods, but only found a de-
crease in heart rate. [69] found that while heart rate during a
stressful activity was diminished a little by high tempo music,
with low tempo music there was a much greater impact. The
respiratory rate was lowered only due to low tempo songs [70]
found that blood pressure was not changed by soothing music
when contrasting six distinct tempo pieces of music, but raised
by high tempo music. The most compelling outcomes were pro-
vided by experiments that implemented more complicated con-
trols. [71] stated, for instance, that listening to Mozart had a
stronger influence on vital signs than a progressive relaxation
session, and [72] found that listening to relaxing recorded music
was as effective as diazepam in decreasing vital signs of anxiety.

Three specific styles of music were listened to by adults and
adolescents in another study : classical, new age, and designer
(designed to promote a sense of wellbeing) [73]. The respon-
dents surveyed personal emotions at baseline and directly after
listening to each style of song. Classical music reduced anxi-
ety. Through new age music, relaxation increased dramatically
and aggression, mental focus, vigor, and anxiety reduced. The
subjects registered significantly more calm, mental focus, vigor,
and sympathy after listening to designer music, and significantly
decreased aggression, depression, exhaustion, and anxiety.

Although addressed music should be consist of 70 to 80
beats per minute with a slow and steady, repeated rhythm as
reported such as "Canon in D major", "Love Story", and "Dance
of the Iguana", the cultural aspect should be considered when
choosing music and mentioned music example is just to clarify
the type of therapeutic music.

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Habib, 2021 A review of possible music therapy in supporting the immune system of COVID-19 patient

Music therapy for COVID-19 patient
COVID-19 coronavirus disease, which is an infectious dis-

ease, and it was clear that negative feelings were mostly physio-
logically caused by infectious diseases and that a wide spectrum
of health risks could be exacerbated or enhanced as a result of
this infection. [74–76]

In Le Roux's study, he reveals that classical music, such as
J. S. Bach's Magnificat in D MajorBWV 243 has an effect on
emotion, immunity, and endocrine parameters In patients with
specific infectious lung diseases, An experimental and control
group was randomly distributed to patients. The experimental
group received physiotherapy with the preferred music over a 3-
day duration, while the control group only received physiother-
apy. The outcome indicates major changes in parameters of the
immune system, such as POMS-scale, CD4+:CD8+ ratio, corti-
sol, and cortisol: DHEA ratio. And music's intervention reveals
contact between the mind and the body. [77]. Such experiment
which conducted on a patient with infection disease, similar to
coronavirus situation, may be applicable to COVID-19 patient.

Previous studies prove the therapeutic effect of music, which
made music a strong candidate to be used along with medication
for COVID-19 patients. A type of music administered by health-
care professionals For children also has a pain decreasing effect.
The songs used consisted of age-appropriate children’s songs.
Yinger Provides a list of music and its purpose [78]. such strate-
gies may be beneficial for decrease the pain resulted from the
medical procedures.

As a severe case of COVID-19 patients should be placed on
a respirator, One study demonstrated a significant fell in systolic
and diastolic blood pressure fell causing a decrease in anxiety
and depression during music therapy sessions for the patients on
the respirator, as is shown in paired samples [78]. The qualita-
tive part of the study showed that the patients remembered little
of their time on the respirator which may be a good effect to re-
move the memories about the disease to avoid any psychological
complications that may be caused by negative memories.

Recently, in some mild COVID-19 cases, it is recommended
for the patient to be isolated in a room, which may increase pa-
tient anxiety and depression. The same situation reported be-
fore in Brodsky's work where music therapy was most effec-
tive in isolating hospital experiences, reducing distress, and fear-
provoking hallucinations, and helping to have a more positive
effect than other therapies[79].

Although several reports demonstrate the beneficial impact
of classical music, it will be best to encourage the participant,
as much as practicable, to select the type of music [31]. Al-
though music therapy is deemed free of side effects, the tech-
nique should be used with the supervision of medical staff. A
patient may react deeply, emotionally to a specific piece of mu-
sic. Others reported a stress reduction and an increase in T-cell
proliferation in mice who listened to music. In mice exposed
to auditory stress, the NK activity of spleen cells also decreased
during 8 days [80–83]. Such findings have been supported by

previous research on the impact of auditory stress and its nega-
tive effect on the immune system [84].

Applying music therapy way to the patient should be con-
sidered and carefully chosen in order to prevent or at least mini-
mize infection transmission between healthy individuals and pa-
tients. A trained music therapist must deliver music interven-
tions; the music therapist often adapts the live music experiences
to the patients' needs at the time. This also presents the patient
with a highly humanizing and validating experience. Further-
more, listening to self-selected pre-recorded music, introduced
by the patient himself, may lead to an enhanced sense of au-
tonomy and empowerment in a critical care setting where cer-
tain facets of care are beyond the control of the patient. [85,86].
Lee study warning from using headphones that may cause cross-
contamination and nosocomial infections [87] show that speaker
of personal or one-use headphones might be the best way to lis-
ten to music in case of COVID-19 patient

Conclusion
An epidemic of novel coronavirus diseases (COVID-19) in

Wuhan, China has spread widely throughout the nation. The
world focuses all efforts to stop the spreading of the virus using
a different drug, and recently by enhancing the immune system
using vitamins or plasma transfusion from the recovered person.
But, one of the unnoticed supplements for the immune system is
music therapy. The results of a recent investigation of music ef-
fect for medical procedural support shows that there is an urgent
need for more high-quality research on the use of effective mu-
sic therapy before, during, and after medical procedures, with
particular emphasis on the interventions and techniques used by
the music therapist [88] for patients and staff [40,89] in treating
a patient with infection [77]. many studies state the improving
effect of music on the immune system reported in thirteen stud-
ies [66,67]. and it seems that slow, repetitive rhythm, predictable
dynamics, low tonic register, pleasant harmony such as classic
music is the most effective [78] style not only in improving im-
munity but also in a medical procedure such in isolating room or
placing the patient on a respirator [78]. Although this idea must
undergo clinical trials to be proved, developing a "COVID-19
Symphony" a music track based on recent research and experi-
ments may be urgently required to be a part of the medical pro-
tocols alongside supplements and drugs to improve mood and
immunity to help the patient pass such disease with the precau-
tion of addressing the music therapy in a personal way to prevent
infection transmission without using any instrument that may
transmit the infection [87].

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Highlights in BioScience Page 7 of 7 March 2021|Volume 4

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	Abstract
	Introduction
	Musically immune stimulation
	Gender-dependent response
	Criteria of theraputic music
	Music therapy for COVID-19 patient
	Conclusion
	References

