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COVID-19 and Singing Risk Assessment Guide

COVID-19 and Singing

Factors to consider when assessing the risk of in-person singing in the time of COVID-19

I believe strongly in people being able to make their own choices. Personally, for my studio, we aren't singing in person. This is because the risk level is too high for me and my business, personally, based on the evidence, and the current situation where I live.

Singing in person isn’t high risk for everyone, everywhere. For some people in some situations, the risk will be low enough to make singing in person possible for them. However…

I believe in evidence-based decision making, and also in correct use of language. There is no such thing as safe (= zero risk) singing in person in relation to COVID-19 – a word I’ve seen bandied around a lot. There is risk reduction, and assessing what level of risk you are comfortable with. I put together this resource to help make what we currently know as accessible and easy to share as possible. I hope you find it helpful in making decisions.

Covid19 and Singing

Disclaimer: This is not a scientific article, and I am not a researcher or a scientist. Instead it is a layman’s collation of information that is readily available, summarised in a very simplified format. For more information, please go to my sources, which are listed in each section. Special thank you to Dr Heather Nelson for compiling resources on this topic on her blog, so they are easy to find for other people in the industry.

1. Aerosols

Singing produces more aerosols than speaking or breathing (1)

There have been several small studies that have come to this conclusion, and it’s one of the reasons singing is more dangerous than other activities when it comes to transmission risk with COVID-19. Researchers in one study found that singing and speaking loudly can produce “36 and 24 times the mass of aerosols respectively as generated by breathing”. They also found that singing quietly produces fewer aerosols than singing loudly, but still produces more than breathing.

We don’t know for sure that aerosols are responsible for transmitting COVID-19. But many scientists suspect this is the case based on the circumstances the virus has been seen to spread in, and agree that aerosol transmission poses a risk.

Sources: – https://chemrxiv.org/articles/preprint/Comparing_the_Respirable_Aerosol_Concentrations_and_Particle_Size_Distributions_Generated_by_Singing_Speaking_and_Breathing/12789221

– https://www.theguardian.com/music/2020/aug/20/performers-could-sing-or-play-softly-to-reduce-covid-risk-study-shows

– https://www.drheathernelson.com/singingandcovid19

2. Social Distancing

1-2 metres isn't enough physical distance, especially when it comes to singing

The 1-2 metres recommended by most governments for social distancing is not enough when it comes to singing, as discussed in this article in the British Medical Journal: “Breathing out, singing, coughing, and sneezing generate warm, moist, high momentum gas clouds of exhaled air containing respiratory droplets…[and] can extend their range up to 7-8 m within a few seconds.”

This makes singing safely in groups difficult, as it requires a huge space. Most singing groups do not have the resources to meet in huge spaces – do you have the room to put more than 8 metres between each of the singers in your choir? If you cannot maintain social distancing, it increases the risk of transmission of COVID-19. One way you can lower that risk is by everyone wearing masks.

Source:

https://doi.org/10.1136/bmj.m3223 – Two metres or one: what is the evidence for physical distancing in covid-19?

3. Wearing a Mask

While not necessarily very comfortable to sing in, wearing a mask can reduce risk of transmission

It’s pretty clear that wearing a mask can make a big difference in reducing the risk of transmission, so this is an important factor to take in to consideration – will everyone be wearing masks?

As you can see from the research, you should definitely consider wearing a mask, particularly if you aren’t able to maintain social distancing of more than 8 metres. There are masks that are adapted to singing, sitting further away from the face so that breathing is a bit easier and the jaw is free to move. If you are needing to sing with a mask, I would look in to finding a suitable one so that you don’t get in the way of your instrument!

Side note – the MOST important time to be wearing a mask is when you would be producing the most aerosols and droplets: when you are singing or speaking loudly. So don’t fall. in to the trap of wearing the mask when you aren’t participating, and then taking it off to improve communication when you are ready to speak or sing.

Read more about this:

https://www.drheathernelson.com/covid-research

4. Ventilation

All ventilation is not created equal.

The different levels of ventilation, from outdoor airflow to indoor enclosed spaces with no mechanical ventilation, pose very different levels of risk in transmitting the virus. Outdoor airflow is preferable, but difficult to achieve with weather considerations. Mechanical ventilation can be anything from an air conditioning unit, to hospital grade ventilation designed to completely renew the air in the room on a regular basis.

Ask about whether windows will be open, what kind of mechanical ventilation is installed, and how often the air is completely changed per hour. If there is no ventilation, then other barrier methods are all the more important (masks, social distancing).

Read more about this:

https://www.drheathernelson.com/covid-research

https://www.theatlantic.com/health/archive/2020/07/why-arent-we-talking-more-about-airborne-transmission/614737/

5. Other factors to consider

This is not an exhaustive list but it should get you thinking

On top of these things, other factors to consider are:

–  The size of the group (especially in terms of the size of the space)

How long you meet for (15 mins and 5 hours carry different risk factors)

Individual health risk factors (if you personally, or someone in your household, has a higher chance of developing severe COVID-19 symptoms)

Age of the group (we know that over 65s are more likely to develop severe COVID-19 symptoms) 

How present the virus is where you live (you can find this through local and national government data)

 

You may also want to consider how much you trust the people you are singing with to:

– Be responsible and not come to rehearsal if they have any symptoms,

– Be aware of the health of all the people in their bubble,

– Notify the group if they test positive for COVID-19 so that you can all self-isolate and prevent any further spread.

There’s a really useful risk assessment template from NATS (The US singing teachers’ association) here: https://www.nats.org/_Library/docs/DecisionAssistReflectionToolFinal.pptx

If you want to learn more about COVID-19 and singing, check out this page on the NATS website – they’ve done some amazing public webinars on important topics, inviting field experts to share what they know in an easy-to-understand format. One thing I haven’t mentioned about is the risk of the long-term effects on the voice as a singer if you do catch it. If you want to know more about this, NATS have a webinar on this particular subject. Fair warning, it’s a bit scary.

https://www.nats.org/cgi/page.cgi/_article.html/Featured_Stories_/NATS_COVID_Resources_Page

5. Questions to ask about COVID-19 and singing

This is a list of questions I would ask to help assess the risk of a particular situation for myself

Before you decide to sing in person, ask the organiser:

  1. Where is it taking place? What size is the room?
  2. How many people will be there?
  3. What ventilation is there?
  4. Will everyone be required to wear a mask?
  5. How long will we be together?
  6. What’s your protocol for contact tracing and protocol in case of a suspected case?

Here’s a useful infographic from the British Medical Journal – use it to help assess your risk based on their answers.

Adapted from: Figure 3, https://doi.org/10.1136/bmj.m3223 – Two metres or one: what is the evidence for physical distancing in covid-19?

 

Conclusion: Make an informed decision about what level of risk is tolerable for you

Do your due diligence so you know the risks of what you're signing up for

Everyone has a different level of risk they are comfortable with. That’s human! It’s why some people love jumping out of planes with a parachute, and why some people would never even consider the idea. COVID-19 brings a new and very serious level of risk to singing in person and one that impacts us not just individually, but also as a community.

With a new danger, the risks are less obvious. Remember when we thought that disinfecting every surface would be enough? The more we know about COVID-19, how harmful it is, how hard it is to treat, and how it is transmitted, the better we are able to make informed decisions about risk. Understanding what factors to take in to consideration, and why they are important, can help you ask the right questions and decide whether singing in person is for you.

In this day and age, there is a lot of misinformation about, so please look to the scientists for guidance, and check the sources of the information you find. One day it’ll be safe (no risk) to sing again together, but until then there will be a level of risk that varies based on all the factors (and possibly more) discussed in this post. Either way, happy singing to you all! My studio will continue to sing online for now, including in my new group class: Voices in Flight

Thanks for reading!

Georgia

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