COVID-19: Is singing dangerous? When can the choir meet again?

From our conductor Martin Everett.

It’s easy to say what we want to happen. We want to be able to meet again on Monday evenings, in the first instance to rehearse as usual, and eventually to give concerts at the end of every term. Can we achieve this as things are at present?

On a personal note, I want to make it clear that I miss the South West more than I could possibly describe. In all the time I have known it – more than 60 years now – there has never been as long a period of inactivity as this. It has been extremely frustrating, to say the least. So I want the choir’s activities to resume as soon as they possibly can. When we get the go-ahead, I will be there like a shot: I’m as keen as anyone to get back to our regular routines. But I’m also a realist. So over the months since the Pandemic began, I have been following closely all the reports of research, all the ideas put forward by directors and members of other choirs and all the contradictory theories about what is possible and what isn’t.

Any decision we take about when and how to start up again has to be made in the light of what we understand about this wretched virus. In particular, though, we need to remember that when it all started, choir members died – not our members, thankfully, but enough people from enough choirs to mean one simple thing: starting up again may literally be a question of life or death – not for everyone, but just maybe for one or two of us. Is it worth a risk as high as that? In deciding how the choir can start up again, that’s what we must always keep in mind.

So this is a summary of what is known or believed at the time of writing. I haven’t written it as an academic article, with lots of references and citations, but everything that follows is a summary of information that can be found by anyone, summarised in non-technical language without distorting what it all means. At the end of it, when I hope you will all have a better idea of what the issues are, I’ve summarised the steps we might need to take to get singing once again. It’s a bit long – I’m sorry about that – but there is a lot to say and a lot to think about.

Why is there a problem?

At the start of the Pandemic, a number of choirs were badly affected by the virus. The first case I heard about was the Skagit Valley Chorale from Washington State, USA, where 61 members had met for a rehearsal. On 17 March 2020 it was reported that 52 of them had developed symptoms of Coronavirus, two of whom later died. Then there was the Amsterdam Mixed Choir, which gave a performance of Bach’s St John Passion on 8 March. Out of 130 members, 102 developed symptoms and there were four deaths. 50 members of the Berlin Cathedral Choir also fell ill at about the same time. And finally, two choirs from Bradford (the Voices of Yorkshire Choir and the All Together Now Community Choir) reported that several members had suffered from Covid-like symptoms as early as January – well before the virus was regarded as a major problem in Britain.

The evidence from these cases was not scientifically proven at the time, but there did seem to be reasons to believe that the act of singing together in a choir, in close proximity to other people, had contributed to, or may even have caused, the spread of the virus. As a result, choirs right across the world took the same decision that we did, and stopped both rehearsing and giving concerts.

Things we have learned about the Coronavirus

Since the start of the Pandemic, people who are interested in choirs and singing have learned a lot about two specific phenomena: ‘Droplets’ and ‘Aerosols’. These things have always existed, but they have developed a new significance since the onset of Covid-19. Put simply, they are different types of moisture, expelled through the mouth when people speak or sing. This moisture comes from the lungs, larynx and mouth and there is nothing that can be done to prevent it: it’s something that is produced by all living creatures.

‘Droplets’ are relatively large – roughly 5 micrometres in diameter (though scientists disagree about this figure). For comparison, a human hair is about 50 micrometres in diameter. In other words, they are tiny, but still can be visible. One expelled, they drop fairly quickly to the floor or any other nearby surface, where they eventually evaporate.

‘Aerosols’ are much smaller – below 5 micrometres – and they are light enough to float on the air, forming a cloud that is invisible in normal life, but can be seen under certain laboratory conditions.

The problem with both Droplets and Aerosols is that they can carry particles of active virus. When the Pandemic began, it was thought that only Droplets were really dangerous: the virus can survive on surfaces (how long it survives is related to the nature of the surface), so if you touch a door handle or light switch that an infected particle has landed on, and then rub your eye or pick your nose, you can catch the illness. That is why hand washing is important.

As the understanding of this virus has developed, the ways it is transmitted have become clearer. It is now generally understood that the Coronavirus is airborne, and can be carried as much by Aerosols as by Droplets. Aerosols linger in the air for minutes or even hours before they disperse. They also accumulate, so that the more people there are in a room, the more they build up.

One very helpful article by an American researcher from the University of Colorado-Boulder compared the spread of Aerosols to cigarette smoke, because the smoke is an Aerosol that can be seen. If you are in a room with someone who is smoking, there is a good chance you will breathe in some of the smoke, especially if you are close to the smoker. If you are in a room with several smokers, the chances are higher. Eventually the smoke will disperse, but only if the room is reasonably well ventilated. Many of us can remember what it was like going into a stuffy pub in the old days, and seeing the cigarette smoke literally hanging in the air.

Now imagine that the smoke is carrying tiny particles of the Coronavirus. As you breathe it in, you might well be infecting yourself without being aware – no one can tell which bit of the smoke is carrying the virus. So it is with singing, or with any activity which brings a lot of people together in a confined space. Everyone’s breath produces Aerosols; if just one person is infected with the virus, particles of it will be carried into the air invisibly, and anyone else might be unlucky enough to breathe it in and become ill.

Research findings

A major British research project recently reported its findings. You may well have seen the headlines: “Singing is no more dangerous than speaking”. Choir directors and choir members right across the country leaped on these findings – at long last there seemed to be hope that we could soon start rehearsing again! So it’s worth considering exactly what this project set out to do, and how the research was conducted.

A group of people – brass players of different instruments, opera singers (real ones!) and jazz singers were asked to play, speak and sing into a tube which measured how far the Aerosols travelled. They read, sang and played Happy Birthday, as well as singing or playing single notes of different pitches, at a variety of dynamic levels. The results of these experiments showed that the Aerosols from singing fairly quietly travelled no further than those from speaking, but the distance increased as the dynamic level got louder.

It is important to note that this project did not set out to measure the effects of Aerosols floating in the air – it measured the distance they could travel, nothing more. It was also restricted to one speaker or singer at a time, so it did not attempt to address the issue of the cumulative effect of several people speaking or singing together in an enclosed space. Unfortunately, therefore, the results were of limited relevance to choirs – and most of the headlines were quite misleading.

To make things more complicated, reports of a second study, using the same approach as the British one, were published on 24 August 2020. This study came from Lund University in Sweden and it focused specifically on singers. Seven professional singers were involved, covering all voice parts, and five amateur singers (tenors and altos). These 12 people spoke and sang into a tube, at different pitches and at different dynamic levels. There were two main differences between the Lund study and the British one: in Lund the Aerosols from the singers were measured both with and without face masks (in the British study face masks were not used); and in Lund measurements were also taken from two people known to be suffering from Covid-19.

The Lund results directly contradict those of the British study. In Lund they found that there was a big difference between speaking and singing, even at quiet dynamic levels, but the difference was significantly reduced when the singers wore face masks. No measurements were taken, however, from the sides of the face masks. The authors of the report wrote that “…as surgical masks have a loose fit, some particles may have exited on the sides where we did not measure.”

In the air samples collected from the Covid-19 patients, the Lund researchers could not detect active particles of the virus. That seems to be encouraging news, but the report is very cautious about it and it is clear that more research needs to be done in this area.

Mitigation, preventative measures

The research projects described above are the first two of their kind ever attempted. Since they are contradictory, neither of them can be taken as definitive. We need to wait until more studies have been done using the same or similar approaches before we can form a clear opinion about exactly how far Aerosols travel from an individual’s mouth or about the differences between normal speech and quiet singing, or between shouting and loud singing.

Testing choir members might help, of course, because there can be no danger at all if no one is carrying the virus. Droplets and Aerosols have always existed (we just haven’t needed to be very conscious of them before now) and they have always expelled viruses such as influenza or the common cold (both of which, as it happens, are Coronaviruses – but not usually as dangerous as the Covid-19 version). I have therefore tried to find out whether any research is being done into the development of a simple test, rather like a breathaliser, that would be easy to self-administer, quick to produce results and more accurate than the current average of 38% false positives/negatives. It appears that research into such a test is indeed going on, but that (a) it will take time to develop and (b) there is no such thing as a test that is 100% accurate. Research in this area is like trying to find no just one but two Holy Grails: an effective vaccine and a quick, reliable test. For the time being, therefore, we have to work around things without either of these having been developed.

Testing: April 2021 Update

Since I wrote the original version of this article, two different types of test have become widely available in the UK. The simplest one is the Lateral Flow Test (LFT) which measures the presence of antigens and can be self-administered with a swab down the throat and up the nose. Results are usually available in about 30 minutes. Initially it was reported that these tests gave a high number of false positives and – more worryingly – false negatives. As they have been used more widely, research is now suggesting that there may be less than one false positive in every 1,000 tests carried out. Even more helpfully, these tests can identify people who have the Coronavirus without showing any symptoms: this is potentially very significant for the SWLCS and for other choirs like it all over the country.

The other type of test is the Polymerase Chain Reaction Test (PCR) which detects the genetic information (RNA) of the virus. That is only possible when someone is already infected. This type of test requires analysis in a laboratory, so it is not suitable for providing quick results. Its commonest use at the moment is in confirming diagnoses from LFT tests.

Resuming our Activities

Four aspects of meeting to rehearse need to be addressed: the number of people present and the space between them (distancing), the length of singing time in relation to breaks, the ventilation of the space in which the rehearsals take place and the hygiene regime that may be required by any venue we use. It is worth bearing in mind the final sentence of the Lund University report, which says, “Based on these results, singing in groups is likely to be an activity at risk of transmitting infection if appropriate control and prevention measures are not applied, such as distancing, hygiene, ventilation and shielding.” Consequently, the relevant considerations we need to consider are as follows, with questions that stem from them that I have made relevant to the specific needs of the SWLCS:

Number of people and distancing

The more people are present, the more Aerosols are produced and the more they accumulate. Can we proceed with around 60 people present? Would it be safer to limit attendance to a smaller number (20? 30?), perhaps by dividing the choir into two or three smaller groups and having rehearsals on different evenings?

How distant should people be from each other? Is 1m sufficient? – probably not. Would 2m be better? – almost certainly. And because Aerosols can spread to the sides as well as in front of the singers, the distancing should probably be 2m in all directions around any individual participant.

Some questions arise from this. Will people still feel like members of, say, an alto or a tenor section if they are required to stand that far apart from each other? Or will it feel more like singing on your own? Part of what singing in a choir means is being a member of a voice group, so how will distancing affect people’s motivation to come?

Length of singing time in relation to breaks

In order to avoid too much accumulation of Aerosols, it is widely recommended that choirs ought not to sing for longer than 30 minutes before taking a break (which means moving somewhere else, so that the rehearsal space can be empty for enough time to allow the Aerosols to disperse). One recommendation I have read is that this time needs to be long enough for three complete changes of air within the space. Is that feasible in Balham Baptist Church, where there is no powered air extraction system? – probably not. Is opening the windows enough, assuming enough of them can be opened? – maybe, but how could we tell? How long should we allow for the Aerosols to disperse? – 20 minutes? an hour?

What should we do in cold weather and throughout the winter? Singing in a space with a lot of open windows would mean singing in the cold. Would people be willing to accept a level of discomfort like that?

What would people do during the break? Close association with other people who are not members of one’s own household is to be discouraged. In the case of Skagit Valley Chorale, choir members had a break during which they had coffee and biscuits just as we do. Some people have attributed the spread of the virus to this, as much as to the actual singing. So we ought not to have our usual kind of break. Would people be willing to come if we couldn’t have the kind of social break that we are used to?

Ventilation

This is related to the length of breaks, as I have described above. Aerosols disperse more quickly in the open air than in any enclosed space, however big it may be. One solution might therefore be to meet outside, but this is not feasible during the winter for obvious reasons. Some inside spaces can be safer than others, however. Halls with modern air extraction and filtration systems can have their air changed completely in a relatively short space of time, but such halls are not available to us. It may be true that a larger space is safer than a smaller one, so we might consider rehearsing at St Anne’s Wandsworth rather than at Balham Baptist for a time (assuming the church would allow us to do so). But we would still need to keep doors and windows open.

Hygiene

Because Droplets fall on surfaces and any virus they contain can remain active for a long time, cleaning of chairs, pews, floor, light switches, door handles, etc. will have to be done each time we rehearse.

Testing and Vaccination

Should we ask members to take a Lateral Flow test before they attend a rehearsal? Should we make this a condition of attendance? Should we ask for evidence of vaccination? Would either or both of these make it possible to reduce the distancing we allow between people? Would members willingly accept stipulations such as these?

Conclusions

Resuming normal choir life is going to be difficult, whenever and however we decide to do it. We have a lot of things to consider, including of course the bad psychological effects of being deprived of an activity that we all value. But we must prioritise the safety of all our members, many of whom are also our friends. Every individual in the choir matters as much as everyone else – that’s the kind of group it is, and I certainly wouldn’t have it any other way. We don’t discriminate, as a matter of conscious policy. So any decision we make will, I trust, be made for the whole choir, in its entirety. As I said at the start, I want to get back to singing as much as anyone, but only when it is safe enough to do so without undue risks to the health and safety of our members.