Monty Python and the Science of Safe Singing

Monty Python and the Science of Safe Singing

Commentary by Tim Fisher

Two powerful ideas are colliding in the COVID world which may shed valuable light on both these crucial matters to society’s benefit. The first relates to the importance of singing and the dangers it may cause in the midst of a pandemic. The second is the value of science and the rampant scepticism that has emerged as to the value of the scientific approach.

To set the scene it is valuable to introduce the seminal work of Monty Python to illustrate how easily our understanding can be waylaid. Click on the video to reveal the classic Python lesson on logical thinking.

Bedevere uses the Law of Syllogism (i.e., the Law of Transitivity) repeatedly in his argument. If one relates to a second, which relates to a third, then the first is related to the third. His findings aren’t peer reviewed. His logic and his method are flawed.
 

Enter community singing, stage right. Singers have been advised that COVID-19 can be transmitted in the air well before the WHO were persuaded of this last month. Since March there have been reports of mass infection events in choir rehearsals in several countries as the world started to go into the first lock-down. A conclusion drawn in these reports is that singing is therefore more dangerous in a COVID-19 world than other activities.  

The line of reasoning presented is that speaking creates more aerosols than breathing, loud speaking creates more aerosols than quiet speaking. Singing is louder than loud speaking. Therefore singing must create more aerosols than loud speaking making it more dangerous as an infection source. Thank you Sir Bedevere.

In fact singing, due to the breath control and occlusion of airflow through the vocal chords, produces very little airflow from the mouth. The method of generating sound in singing through resonance rather than air flow means that the Law of Syllogism does not hold here. The image conjured in the learned articles of “geysers” of aerosols flowing for many metres from every singer is simply incorrect and yet journalists, and occasionally experts in other fields, have been drawn to these conclusions due to a logical error.

This is not to say that singing is without risk.  People vulnerable to complications from COVID-19 should make informed decisions about all activities that they undertake in a pandemic and singing in groups is an activity that may lead to risk of infection in the event of community transmission of the virus.  The concern is that singing is being unreasonably targeted through insufficient knowledge and flawed logic.

Other experts are being more scientific and conducting experiments to measure how many aerosols are generated when people sing. This must be good news because when these results are in we will not be inferring knowledge but instead will have hard facts…..right? Probably not. If our goal is to understand how to mitigate the risks of contracting COVID-19 from singing rehearsals and performances then we need a lot more facts if sensible conclusions are to be drawn. An incomplete picture, how many aerosols are produced by a singer, does not enable a risk mitigation to be devised unless we also know:

  • what is the equivalent risk of conducting other acceptable activities within a pandemic?
  • How many aerosols are produced in a wide range of other activities such that the relative risk can be assessed?
  • How much viral load is required to become infected? How many aerosol particles from an infected person contain viable virus? How many virus containing aerosols must be inhaled or absorbed through the mucous membranes to cause infection?
  • How long is an aerosol particle viable? Is evaporation a significant variable? What is the effectiveness of various barriers, masks and baffles such that mitigations in addition to physical distancing can be quantified?
  • What is the impact of the volume of the room and the type and quality of ventilation? What is the impact of singing outside?

Fundamentally, the initial science being directed at the question of whether singing can be conducted with an acceptable level of risk during a pandemic is unequal to the task. And rightly so. There are much more pressing questions that science could be tackling in a comprehensive manner at this point, like why health workers with approved PPE are able to catch COVID-19 at such high rates in Victoria more than 4 months into a worldwide pandemic where data must be available as to what works and what doesn’t in the healthcare setting.

However, the lack of scientific testing, experimentation and conclusive results around the question of the risks posed by singing should not be seen as an opportunity to exercise “an abundance of caution” and ban this fundamentally human and social activity as has been suggested in a number of opinion pieces since March. If we accept that we must take risks to survive in a pandemic then we must make a judgement as to what risks are worth taking.

Singing is as beneficial as sport and is practiced by roughly as many people as participate in organised community sporting activity. It is probably less aerobically energetic than most sporting activities and much more controlled than a rugby scrum, a football tackle not to mention a trip to the supermarket or the shopping centre.

As expressed by leading British composers, musicians and choral directors in an open letter to the Guardian newspaper last month:

“Singing in a choir is not only about communality, social cohesion and

harmony; for many it is an essential source of emotional wellbeing and

positive mental health. Moreover it is a powerful expression of our culture

and humanity, and it cannot be allowed to fade away.”

We allow science to fall into disrepute when we fail to understand its limitations. We allow our communities to fall into fear and recrimination when we seek absolute safety in the face of a pandemic. We allow our lives to become meaningless if we don’t strive to preserve the cultural and artistic fabric that enriches us.

If data emerges that singing represents an infection risk greater than going to a restaurant, interacting with hundreds of people at a supermarket, sweating next to dozens of people at a gym, socialising at a noisy pub or joining your extended family at a dinner table then let’s find ways for people who have low vulnerability to complications from COVID-19 to do so at a lesser risk rather than opting to ban it outright……unless it is necessary to ban all of these things outright in order to control community transmission. Singing is as important to our wellbeing as any of these things so let’s find a way.

If the data that emerges isn’t sufficient to demonstrate or quantify that risk then let’s not act on it as if it does.

Community Choirs and COVID

WA Community Choirs and COVID

A discussion paper with resources

Colleen Dixon and Tim Fisher

SongFest Inc is a not for profit organisation with the aim of promoting community singing in Western Australia. To date, SongFest’s most visible work has been in organising or facilitating festivals for singing groups.

Suddenly, and quite unexpectedly, the COVID pandemic seriously challenges community singing in WA, as everywhere. The aim of this document is to share information relevant to directors and managers of choirs to assess how they could resume live rehearsals. It also presents ideas that may assist choir managers to decide whether, when and how to resume rehearsals. The discussion will be ongoing as the virus’ spread is managed in WA and as more information comes to light about the virus in general and its relationship to singing.

This document is not intended as scientific or medical advice. We cannot find any studies that are directly related to the spread of COVID by group singing activities. Consequently there is no certainty or assurance of safety that can be given to participants in group singing.  In fact, quite the opposite.  Singing, like most activities, represents a risk of virus spread.

Does that mean that community singing needs to come to a halt in WA until a vaccine is developed? Singers who are vulnerable to complications from COVID infection may well decide so. Others may decide to sing.  Singers can evaluate risks from an informed position and act to maximise their chances of avoiding infection and infecting others when they do rehearse.

 

Higher risk people

Singers who fall within the high-risk categories for complications with COVID need to decide if they should undertake any high-risk contact activities, including singing.  Group rehearsals in any circumstances will entail some level of risk. Details of high-risk people are detailed in the link below for your information.

https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/advice-for-people-at-risk-of-coronavirus-covid-19/coronavirus-covid-19-advice-for-older-people

 

Risks that may be associated with singing rehearsals and events and the basis for this association

We note the concern regarding group singing based upon a number of clusters identified in several countries where singing groups, rehearsing without precautions or with partial precautions, experienced very high levels of cross-infection attributed to a single rehearsal. The CDC report into the Washington choir cluster can be read here https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm

This has led health authorities to believe that some aspect of the “normal” singing can make singers “super spreaders”. The exact mechanism is not known. It may be a combination of:

  • greater proportion of droplets and aerosols (which can contain the virus) by singing compared to talking
  • Larger numbers of people generating thermal mixing of the air in the rehearsal space which spread the aerosols throughout the space to a greater extent
  • Aspects of the volume of the rehearsal space, the extent to which singers are facing each other, the amount of natural ventilation, use of air conditioning recirculating air and impact of overhead fans
  • The age of the singers
  • The relatively long period of contact across a rehearsal
  • Socialisation and refreshments associated with tea breaks

The WA Health Department have been approached directly by ANCA regarding the health risks of singing.  The advice received from Dr Revle Bangor-Jones Coordinator – (WA) Public Health Emergency Operation Centre was;

“Phase 3 of the COVID-19 WA roadmap allows for indoor and outdoor gatherings of up to 100 people at any one time, per single undivided space, and applying the revised two square metre per person capacity rule. School choirs in WA have recommenced.

Everyone is encouraged to continue to practice physical distancing and good personal hygiene and minimise the use of any shared equipment. Shared equipment should be cleaned between use.”

This indicates that singing isn’t considered by WA Public Health to be special as an activity at this stage.

Other studies have been conducted into the viability of the virus on various surfaces and environments. The first here: https://www.nejm.org/doi/full/10.1056/NEJMc2004973

The second has not been published but was reported in a govt briefing in April. https://www.nytimes.com/2020/04/24/health/coronavirus-summer-ultraviolet-light.html

Relevant data includes:

Research on the longevity of the virus on surfaces and in the air indicates that dark, cool, dry environments maximise the viability of the virus while exposure to sunlight and humidity dramatically reduces the half-life of the virus. The use of cleaning agents which destroy the fatty layer surrounding the virus are the most effective.

The use of masks or other PPE to prevent spread may also play a part in a mitigation strategy. The WHO advice can be viewed here https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/when-and-how-to-use-masks

The effectiveness of masks is impaired by the duration of use (30 minutes is considered an upper bound beyond which the buildup of moisture on the mask enables aerosols to be generated through the mask), touching the mask with hands, incorrect removal and application (by the straps, not the fabric) and by the volume of air generated by the user.

 

Risk Mitigation

Groups with singers who are prepared to accept the level of risk associated with group singing will want to act to maximise the protection of their close contacts should their singing activity ultimately result in an infection.

A key tool to mitigating the risk of infection of close contacts of singers is to utilise the COVID Safe App or for choirs to keep a record of all rehearsal attendees. In Australia we have bought time through our national lockdown to enable us to prepare and boost our testing and contact tracing capability. Our ability to gather together with reduced social distancing and open our community to the rest of the country and to the world, depends on rapid identification and isolation of new infections and isolation of all close contacts. This process will be greatly enhanced by the adoption of the app and singers can lead the way to assist widespread acceptance of our “high-risk” activity.

Factors which may help reduce infection risk during rehearsal may include:

  • Higher spacing between singers.
  • Participant numbers – other mitigation strategies can be enhanced as numbers increase. For instance, making some rehearsals sectional only would limit the number of times the whole group comes together.
  • Outdoor rehearsals — these offer the benefits of natural ventilation and sunshine, which has been shown to reduce the viral load.
  • Shorter Singing aspects of the rehearsal could be focused.
  • Separate singing and socialising: Non-singing aspects of the rehearsal could be conducted in a different space. Groups can avoid conducting refreshments in the rehearsal space. Practice high levels of personal hygiene around all sharing of food, drink and utensils.
  • Practice hand hygiene before and after singing phases of the rehearsal.
  • Chairs can be set out, stacked and cleaned by a small number of people practicing social distancing rather than having everybody congregating and milling around.
  • Singers who are at high risk of serious outcomes with COVID face a difficult period in terms of live singing.  Consider streaming the group’s rehearsals and having high risk members participate on a screen in the rehearsal space.

Some final thoughts: Western Australian conditions

At the time of writing there is little risk in live rehearsals because in WA we have almost no COVID community transmission. However, this is a marathon, not a sprint. The virus may represent a health risk for years to come.  A plan to keep singing when modest levels of community transmission are identified is a key goal that choirs should consider. Do you stop as soon as community transmission is detected or does your group bring in some additional mitigation measures and keep singing together?

Other choir organisations around the world are still seeing significant community transmission and may still be some way from getting back to live rehearsals. Can we develop approaches here which will help choirs in other countries get back to singing together?

Strategies for returning to Sing with and without COVID

Strategies for returning to Sing with and without COVID

Summary of comments from Webinar No.1 by Tim Fisher

Feedback from 62 choirs indicates that:

  1. We need to change the dialogue with our members from certainty and safety to managed risk and quick response consistent with living with COVID-19 for the long term. The risks posed by aerosols, spacing, ventilation etc, etc cannot be quantified and cannot be eliminated and it is not your job to do so.
  2. Choir managers should be confident that they are acting responsibly when they comply with the current state government health regulations. Singing isn’t special when it comes to group activities in a pandemic. Every activity has risk.  WA Health Dept advice received by ANCA 2 weeks ago confirms that they have no special concerns about singing at this stage.
  3. Assisting all singers to make an informed choice about the risks they face when they attend choir rehearsals is a key objective for choir managers. Vulnerable singers may choose to attend live rehearsals now and they may not. They may choose to keep attending live rehearsals even when community transmission of the virus reappears in WA and they may not.  Your job is not to persuade anyone to keep singing.  Your job is to help your choir comply with the current health regulations to give vulnerable singers confidence that your choir take their risk seriously and to discover what measures that the whole choir needs to adopt would make your vulnerable singers feel that the risks involved were acceptable in the future.
  4. Each choir should consider implementing their own COVID Safety Plan to reflect these strategies and share information to enable this decision.
  5. Mitigation (not elimination) of risk and effective contact tracing and isolation are the primary aims
  6. Measures to meaningfully engage with your vulnerable members are an integral part of your plan but may not involve live rehearsals for some.  Shared information and agreed strategies will maximise ongoing engagement, even when community transmission appears. Your vulnerable singers need your support. With COVID the most vulnerable to complications from catching the disease are also generally the most vulnerable to not having the technical or financial capability to maintain an online connection with your group.  How can you maintain a meaningful and hopefully tuneful connection with all your members?  Is now the time to be launching a recruitment drive for new singers?
  7. Behaviour change will be required to ensure that all singers conform to the plan, particularly now when most people believe there is no risk. You need to assist all your singers with training and you need to discuss acceptable ways to hold everyone accountable to sticking to that plan.  This will require leadership.

Access the full presentations from Webinars 1 & 2 here

Singing with COVID – The SongFest BLOG

Introduction to the SongFest Blog Post

Join the conversation

You can add your questions and comments in the box at the bottom of this blog page

The COVID pandemic has disrupted all parts of our society and group singing is no exception.  Restrictions on gathering in numbers shut choirs down for several months.  The not knowing how long this might go on and the loss of social interaction caused profound grief and a real sense of loss in the singing community.  This was made very clear in the SongFest COVID Choir Survey which has so far had over 60 submissions.  

Adding to this misery was often repeated stories of mass spreading events at choir rehearsals such as the now infamous Sagit County incident in USA.  The press picked up on speculation that it wasn’t safe to sing while COVID was around.  Some peak bodies in America declared that choir singing shouldn’t recommence until a vaccine was available.

In response, SongFest Inc. in conjunction with ANCA WA and VoiceMoves WA started a series of initiatives to draw together information and open discussions on the subject.  The first of these was the above-mentioned survey to provide an insight into the current attitude of WA choirs towards recommencing singing together and what support was most required.  The SongFest Survey results were presented in the first of two webinars offered by SongFest/ANCA along with a discussion on “Strategies for Singing with and without COVID”.  The first webinar also proposed that the way forward was for choirs to draft a well thought out Choir COVID Safety Plan using guidelines and templates provided by the WA Government.

The second webinar focused on the practical aspects of how to “Write your Own Choir COVID Safety Plan”. It was proposed that choirs needed to consider a PLAN A to use now while we have benign COVID conditions in WA as well as PLAN B for how to manage if there is renewed community transmission at some later time. 

SongFest Inc. is building a library of informative press articles and scientific studies to help singers make informed choices about participating in group singing.  Follow the link to the COVID Library Resource on this page.

We invite you to join the conversation by adding your thoughts, discussion points and questions to this blog.