Crazy times!

Singing prohibited!

Two weeks ago the Catholic church launched a petition for the limit on attendees at churches in New South Wales (NSW) of 10 people to be increased to the 50 person limit that applied to pubs and clubs, cafes and restaurants. This increase was granted on 1 June as the restrictions to control the spread of COVID-19 are relaxed slowly. Now a maximum of 50 people (adults and children) can attend a religious service at a place of worship. But there are other requirements to fulfill like:
– People attending a religious service at a place of public worship will be required to provide their name and contact details when they enter so that they can be used for contact tracing, and
– Communal singing is prohibited! And singing with facemasks is not a current alternative.
And there is confusing advice about how many people can be in a room (Appendix A). We’re going through crazy times!

Communal singing

The coronavirus is thought to primarily spread through droplets (rather than aerosols) when an infected person coughs or sneezes – this is the reason for the physical distancing of 1.5m (6 ft).

NSW Chief Health Officer Dr Kerry Chant says, “Communal singing and chanting should not occur because of the high risk of transmission of the coronavirus. Instead, measures such as one singer standing at least three meters away from others would be safer.”

Dr Chant also said, “Places of worship will be asked to find alternatives to practices that might spread the coronavirus, like singing, sharing books and even passing around the collection plate”.

This advice is based on instances of COVID-19 infection spreading amongst choir members in North America and Europe in March 2020. But the role of singing in the transmission of the coronavirus is a debatable topic. A range of viewpoints have been expressed on the internet.

One instance involved Washington’s Skagit Valley Choral. But on this occasion the singers didn’t social distance. They sat roughly 15-25cm (6-10 inches) apart in different configurations during a two-and-a-half-hour rehearsal. There were several opportunities for droplet and fomite transmission, including members sitting close to one another, sharing snacks, and stacking chairs at the end of the practice. Other instances involved the Berlin Cathedral Choir and the Amsterdam Mixed Choir.

The Centers for Disease Control and Prevention (CDC) investigation of the choir practice in Washington State concluded:
– “transmission was likely facilitated by close proximity (within 6 feet) during practice and augmented by the act of singing” and that
– singing “might have contributed to transmission through emission of aerosols, which is affected by loudness of vocalization.” Note the word, “might”; it wasn’t proven!
The incident could be explained by the lack of social distancing for 2.5 hours in a confined space.

These outbreaks of COVID-19 were either in areas where there had been a lot of transmission or they occurred prior to the introduction of social distancing.

Professor Christian Kähler of the Military University, Munich; a fluid mechanics expert; conducted experiments to find out how far singers and musicians expel air and droplets (Appendix B). He found that the flute, oboe and clarinet generated powerful air flow. But he found out that singing was safe  – the air was only propelled about half a meter in front of a singer, and that is not far enough to cause the infection levels of these outbreaks. He demonstrated this on YouTube. He also said, “In a choir or in the church, a safety distance of at least 1.5 m (or 5 feet) should still be maintained in order to protect yourself effectively against a droplet infection even if you cough unprotected”.

Kähler said the virus was probably spread among chorus members because of their close proximity to each other before and after rehearsals and performances. As he pointed out: “These outbreaks among choir members all occurred during the early days of the COVID-19 pandemic, before lockdowns were imposed and before our minds were concentrated on the importance of social distancing. Choir members probably greeted each other with hugs, and shared drinks during breaks and talked closely with each other. That social behavior was the real cause of these outbreaks, I believe.” But Ashley (2020) wondered if these scientists were venturing a little beyond their normal sphere of work.

Mary Reid asked, “So why has coronavirus taken hold in some choirs? Well, put 100 or so people in close proximity in a room for a couple of hours and you have ideal conditions for spreading the virus. Choir members are a friendly lot and they mix even more before the rehearsal begins and during the tea break.”

Some discussions about singing focus on the number of droplets generated, but they don’t seem to address the distance that the droplets are projected, which is a critical factor.

A German risk assessment of a coronavirus infection in the field of music stated that “congregational singing appears possible if the distancing rule of 2 m (6.5 ft) is observed and face masks are worn, since it can be assumed that there is no greater risk of being infected by singing than by speaking” (Spahn and Richtner, 2020).

But an expert panel assembled by the US National Association of Teachers of Singing (NATS) in May 2020 found that there is no spacing solution for singing groups that would eliminate risk and that masks don’t provide safe methods of singing. They said there is no safe way for singers to rehearse together until there is a COVID-19 vaccine or there are no new cases, no community spread, and travel bans in place.

The US CDC advised that churches should ensure choirs at services follow social distancing, revising previous advice that said they should “consider suspending or at least decreasing” singing in services.

But NSW authorities seem to be taking a precautionary approach with singing. Because of the following two reasons, I think these control measures are excessive. First, our state has gone 14 days with no community transmission of COVID-19. So, community transmission is very rare now. And second, the WHO says that the spread of coronavirus by those who do not show any symptoms appears to be “very rare”. This is because they are not doing things like coughing or sneezing. So if people with those symptoms are prohibited, the risk of infection from communal singing is minimal. And if no one in the congregation is infected, there can be no transmission! Furthermore, social distancing rules still apply! So the government is currently advocating multiple levels of control.

Poor journalism

Because of these cases there have been claims like, “churches are one of the most dangerous places to be” and “churches and singing are a combination for a disaster”. And some say that Washington’s Skagit Valley Choral practiced social distancing. But the choir actually sat close to one another – 15-25cm (6-10 inches) apart, shared snacks, and stacked chairs together at the end of the practice! Also see Appendix C.

People who make such claims haven’t read reliable reports of these incidents. And they fail to realize that the coronavirus spreads via droplets and not by aerosols.

Professor Adam Finn of Bristol University said,  “The evidence for a link with singing and spreading the virus may look compelling but is still anecdotal. Without data from comparably large groups who interacted in the same way but didn’t sing, it’s hard to be certain that the singing was responsible.”

Yes, the Skagit Valley, Amsterdam, and Berlin incidents all had singing in common. But they also had another thing in common: large numbers of people indoors in close proximity — exactly the thing that we have all been told we must avoid. Correlation doesn’t imply causation.

Why do we sing in church?

The Bible says that a person controlled by God’s Spirit expresses the fruit of the Spirit (Gal. 5:22-23). Joy is a fruit of the Spirit which is an inner happiness not dependent on outward circumstances. The Bible says, “Is anyone happy? Let them sing songs of praise” (Jas. 5:13NIV). Spiritual singing is an expression of spiritual joy. For example, Paul and Silas sang “hymns to God’ while they were imprisoned (Acts 16:25).

Christians are commanded to “be filled with the Spirit, speaking to one another with psalms, hymns, and songs from the Spirit. Sing and make music from your heart to the Lord, always giving thanks to God the Father for everything, in the name of our Lord Jesus Christ” (Eph. 5:18-20). The filling of the Spirit produces a song in the heart. And “Let the message of Christ dwell among you richly as you teach and admonish one another with all wisdom through psalms, hymns, and songs from the Spirit, singing to God with gratitude in your hearts” (Col. 3:16). When the “message of Christ” in the Bible lodges in our soul it produces a song in our heart.

Do we need to sing in church? Singing integrates truth and emotion. And it unites us corporately. Yes, the Bible certainly commands and encourages communal singing. But the Bible also commands obedience to governing authorities (Rom. 13:1-7; 1 Pt. 2:13-17)!

Discussion

The reason for the range of viewpoints on the  role of singing in the transmission of the coronavirus is mainly because people confuse droplets (>5 μm in diameter) with aerosols (≤5 µm in diameter), whereas they should be concentrating on droplets. Are droplets spread more than 1.5m when we sing? Not according to Professor Christian Kähler, but has anyone else investigated this topic?

In churches congregational singing is generally preferred to performance singing, but now because of government requirements we might just have to hum along to performance singing with joy in our hearts.

As face masks are good at stopping us infecting someone else, could they be used when singing? Cloth masks are fine – they can be washed between uses. Although I don’t think this is necessary, it could be a way to obey the intent of the government restriction on communal singing. But it has been stated that it “is not possible to wear suitable respiratory masks when singing and playing music with wind instruments” (Kähler and Hain R, 2020).

Conclusion

In a state that has had no instances of community transmission of COVID-19 over the past two weeks, the ban on singing at church services seems to be excessive. Hopefully this ban will be relaxed when authorities realize that the risk of COVID-19 infection is insignificant under the current circumstances in NSW.

Appendix A: How do I calculate the maximum capacity of a room?

The Public Health Order [in NSW] no longer requires 4 square meters of space [per person] to be provided in the context of a funeral, wedding, memorial or religious service, though it does for private worship. It is nonetheless recommended that you apply the rule for all services and gatherings for the time being.”

This is confusing advice from the governing authorities. Is the 4 square meters of space [per person] mandatory or advisory? And what about the members of a family that don’t need to socially distance from each other?

Appendix B: Experiments with singers and orchestral musicians

Professor Christian Kähler and Dr Rainer Hain from the military university in Munich found:

“Our quantitative measurement results show that the dispersion of droplets when singing and making music with wind instruments is in general relatively small. A safety distance of 12 m is therefore completely exaggerated.

However, when singing, the safety distance should in any case be greater than 1.5 m, in order to be largely safe even when people in the vicinity are coughing without observing the rules of hygiene (cough into the crook of your arm and turn away from other people).

In addition, a staggered positioning of the persons is recommended, as this increases the distance to the person in the direction of flow even more.

To be sure that the spread of droplets and aerosol is contained, popscreens are highly recommended when singing.

In our opinion, this popscreen is absolutely necessary for a transverse flute in order to allow safe playing at moderate distances.

For the oboe, clarinet and bassoon we also recommend the use of a popscreen for safety reasons.

According to our measurements, the large brass instruments are not able to influence the flow over a large area and therefore these instruments can be played without protection.

However, we recommend to let out the condensation water more often under consideration of the hygiene standards and to wipe the woodwind instruments as often as possible.

In addition to these protective measures, which each musician can control himself, it is also very important to ensure that the room is sufficiently large, well ventilated and provided with sufficient fresh air. The automatic fresh air supply should be significantly increased compared to the legal requirements in order to keep the virus load in the room low. An open window cannot replace a high-quality automated fresh air supply.

If the findings and recommendations derived from our quantitative measurements are taken into account, then making music in a community should be relatively safe. However, there is of course no absolute certainty that droplet infections or infections by aerosols are completely excluded by these measures. Risk groups and people with relevant previous diseases should therefore protect themselves as well as possible.

We would like to point out that we consider compliance with all recommendations to be important in order to minimize the probability of infection. If individual recommendations cannot be followed, e.g. because no suitable room is available, what should be done? It is better to find another room that meets the requirements or to stop singing in the choir than to do without individual protection measures.”

Appendix C: When and how can choirs sing again without becoming ‘super spreaders’?

An article with this title was posted by the Australian Broadcasting Corporation on 14 June 2020. It says that “Some experts have even described choirs as ‘super spreaders’”. They say that “singing is a very effective way of spreading COVID-19”. But where is the evidence?

So far the evidence is that the coronavirus is primarily transmitted by droplet spread and not by aerosol spread. The idea that large droplets of virus-laden mucus are the primary mode of transmission, guides the US CDC’s advice to maintain at least a 6-foot distance: “Maintaining good social distance (about 6 feet) is very important in preventing the spread of COVID-19”. “Larger respiratory droplets (>5 μm) remain in the air for only a short time and travel only short distances, generally <1 m” (less than 3.3 feet).

As social distancing and hand washing have been effective in reducing the spread of the virus, this would suggest that direct person-to-person contact is the most important mode of transmission and that aerosol transmission is minimal. Research has shown that the virus typically is transmitted from person to person through relatively large respiratory droplets that travel only a few feet before falling to the floor or ground. People can also become infected by touching contaminated objects — known among scientists as fomites — and then, for example, touching their face.

The WHO states that “Respiratory infections can be transmitted through droplets of different sizes: when the droplet particles are >5-10 μm in diameter they are referred to as “respiratory droplets”, and when they are <5μm in diameter, they are referred to as “droplet nuclei”. “According to current evidence, COVID-19 virus is primarily transmitted between people through respiratory droplets and contact routes”. So droplets are >5μm in diameter and aerosols are ≤5 µm in diameter. It is generally accepted that droplets can travel 1-2 m before falling to surfaces and that aerosols can travel much farther.

References

Ashley M, 2020 “Where have all the singers gone, and when will they return? Prospects for Choral Singing after the SARS-CoV-2 Pandemic”, ABCD Coral Directions Research, June 2020.

Kähler C and Hain R, 2020, “Singing in choirs and making music with wind instruments ‒ Is that safe during the SARS-CoV-2 pandemic?”, University of the Bundeswehr Munich.

NATS, 2020, “A conversation: What do science and data say about the near term future of singing?” National Association of Teachers of Singing, May 2020.

Spahn C and Richtner B, 2020, “Risk assessment of a coronavirus infection in the field of music”, University Medical Center and University of Music Freiburg, May 2020.

Written, June 2020

Also see: Using a sledgehammer to crack a nut