What does the science tell us about singing and Covid-19? The world’s largest association of singing teachers explores the evidence in a new webinar. Here’s a rundown of what the scientists had to say.

The global pandemic has turned the lives of singers, vocal coaches and choir leaders upside down, leaving many with their heads in their hands wondering: “What is the implication of singing and Covid-19? How long is this going to go on for?”

Unfortunately, there are no concrete answers. But scientists do have a growing understanding of the virus and how it is transmitted.

To get a clearer view of what the near term future holds for group singing, the National Association of Teachers of Singing (NATS) picked the brains of several experts.

Evidence on the transmission of respiratory viruses, the requirements for a safe return to group performances and the importance of good ventilation in performance/rehearsal venues were all explored in the webinar.

While all the speakers are US-based, their comments are relevant to singing communities around the world. As it’s more than two hours long we thought we’d give you a summary of the key points.

Modes of transmission, ventilation and UV light

NATS spoke to Dr Donald Milton, Professor of Environmental Health, University of Maryland School of Public Health. He is a leading researcher on infectious bioaerosols, exhaled breath analysis and respiratory epidemiology. 

In his presentation, Dr Milton covers the aerobiological pathways of transmission of respiratory disease and draws on evidence from influenza, SARS and MERS studies as well as those relating to SARS-CoV-2 (ie Covid-19). (Here’s a link to Dr Milton’s slides, lots of graphics about respiratory droplets and aerosols, if that’s your thing).

He talks about the way droplets and particles can carry respiratory viruses and emphasises the size of the Covid-19.

“The virus is so small that even a 1micron particle could hold a thousand coronavirus particles,” he says. “You don’t need a large particle to hold a lot of virus payload.”

He also notes that when it comes to aerosol emissions, the louder one speaks the more one generates. “It’s clear that speech – and by extension singing – can be a big source of aerosols.”

Covid-19 and ventilation

Dr Milton cites (35 minutes into the webinar) the case of a Covid-19 outbreak linked to a restaurant in Guangzhou, China. Ten people came down with the virus after dining at the restaurant, a windowless room on the third floor of a building. Here ventilation was poor as the exhaust vents had been sealed up. This meant that the back of the restaurant was a “dead zone” where the air was simply re-circulated.

Even people sitting 14-feet away from the “super-spreader” contracted the virus. Researchers concluded that droplets of the virus had been carried through the air.

Aerosol emissions

A second study (39 minutes in) looks at the case of Skagit Choir in Washington. On March 10 one individual, who was unaware they had the virus, attended a choir rehearsal and unwittingly infected 52 other people – two of whom later died.

The study notes that choir members had been limiting physical contact and using hand sanitiser, although some did help stack chairs and snack on cookies. Researchers from the Centers for Disease Control suggest that a fine mist of particles emitted during their two-and-a-half-hour session of singing might be to blame.

“The act of singing, itself, might have contributed to transmission through emission of aerosols, which is affected by the loudness of vocalization,” says the report.

The implications for group singing

Even though we’re not in a place to return to rehearsing together yet, when we get close to that point choir directors and singing teachers will have to consider more than just utilising hand gel and not sharing sheet music. Ventilation will be a key issue, he says.

Dr Milton believes that the Skagit Choir outbreak would have been significantly smaller with better ventilation – albeit not eliminated.

“Although ventilation can make a difference, if you have asymptomatic persons there it’s not going to drive it to zero,” he says.

UV light

There has been much speculation that sunlight can damage the virus, a theory that Dr Milton supports.

“That’s where upper room UV may play a role [in making rehearsal spaces safer]. In places where you can’t increase the ventilation, or you need very high rates of ventilation because you have a lot of people, that might be an added solution.”

There is a caveat though: Covid-19 is no-where near as “exquisitely sensitive” to UV as say pox viruses. In other words: if you were trying to make a performance space safer, upper room UV might help. But is not a magic bullet.

Some organisations in the US are already looking at installing upper room UV systems (at an estimated cost of about US$1,000 although you need a fan system to move the air around too).

How could we get back to group singing?

The second expert guest to present in the webinar is otolaryngologist Dr Lucinda Halstead. Founder and medical director of the Evelyn Trammell Institute for Voice and Swallowing at the Medical University of South Carolina, Dr Halstead is also President-Elect of the Performing Arts Medicine Association. (View her slide presentation here.)

If only…

Dr Halstead muses on the measures would need to be in place to make group singing safe again. The first answer obviously is a vaccine. But as this is going to take some time – perhaps 18 to 24 months – is there any other way?

Her verdict? Not right now. If a highly effective, portable PCR test was widely available to diagnose Covid-19 on the spot, then perhaps choirs could test singers prior to any rehearsal. This, along with measures like temperature checks, symptom screening and pulse oximetry testing, would make it safer but still not risk-free.

But given the cost, time and admin surrounding all this, even if the technology was available would it really be feasible? Factor in the reality that many choir members are more mature (ie high risk) and it’s pretty clear that there is no clear path for a safe return to group singing any time soon.

Instead, she urges patience. “The time will come. An innovative solution will be found. An amazing amount of technology and expertise is being put into this.”

Other thoughts on singing and Covid-19

This from Tom Clareson, Project Director, Performing Arts Readiness. “If we’re looking at additional months, or what some experts say could be another one to two years of working in the pandemic and social distancing environment, we need to consider how we can keep our skills sharp, how to plan for virtual activities and also ramp up for our re-opening.”

Tips

• Use this downtime to be productive and proactive. Tackle the admin/business-related tasks that you never got around to doing pre-Covid-19.
• Sharpen your skills and the skills of your singers with activities such as online ear training or online part singing.
• Ramp up virtual activity. For example, record interviews with long-standing members of your choirs and share them online.
• Think about your audience. How can you keep them engaged so that they come and watch your shows when you return to performing?
• Review the heating and ventilation of your rehearsal space. Is it up to scratch? How are often are the systems cleaned?
• Reach out to peers and see if there is an opportunity to collaborate on a project.
• Think about what you can do. Don’t get disheartened by what you can’t do.

Watch the webinar here.

Also, read about what three choir leaders have done to continue their choirs online during the pandemic.