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Following the Science: A systematic literature review of studies surrounding singing and brass, woodwind and bagpipe playing during the COVID-19 pandemic.

Authors:
  • University of Stathclyde

Abstract

A systematic literature review of studies surrounding singing and brass, woodwind and bagpipe playing during the COVID-19 pandemic.
Following the Science:
John Wallace, Lio Moscardini, Andrew Rae and Alan Watson
Music Education
Partnership Group
MEPGScotland.org @MusicEducation10
MEPGScotland
November 2020
Authors:
A systematic literature review of studies surrounding
singing and brass, woodwind and bagpipe playing
during the COVID-19 pandemic
Table of
Contents
Overview
Introduction
Research Questions
1
Research Method
Systematic Review
Consistency Checklist
Results
Discussion
2
5
7
Conclusions 14
Appendix
Matrix of identified papers
18
References 39
Thematic Categories
Breathing
Singing
Brass playing
Woodwind playing
Bagpipes
Summary
Research Team 17
Recommended measures to mitigate risk 15
Q - What is the evidence in the literature of risk attached to singing, brass, woodwind and
bagpipe playing, in relation to the spread of airborne pathogens such as COVID-19, through
droplets and aerosol?
Q - How do these music making activities relate to other everyday activities such as breathing,
talking and exercise in relation to aerosol transmission?
Q - What are the recommendations for best practice?
Research Questions:
Overview
The current COVID-19 situation has resulted in widespread concern and considerable
uncertainty relating to the position of musical performance and in particular potential risks
associated with singing and brass, woodwind and bagpipe playing. There is a wide range of
advice and guidance available but it is important that any guidance given should be evidence-
based and the sources of this evidence should be known.
The aim of the study was to carry out a systematic literature review in order to gather historical
as well as the most current and relevant information which could provide evidence-based
guidance for performance practice. This literature was analysed in order to determine the
evidence of risk attached to singing and brass , woodwind and bagpipe playing, in relation to the
spread of airborne pathogens such as COVID-19, through droplets and aerosol. It also informed
the recommendations for best practice.
Introduction
1
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Research Method
Systematic Review
The approach adopted involved carrying out a systematic review of the literature in order to create a
rigorous and transparent form of identifying a wide cross-section of risk-related literature to singing and
brass, woodwind and bagpipe playing during the COVID-19 pandemic. A systematic review has been
described as ‘a replicable, scientific and transparent process that aims to minimise bias through
exhaustive literature searches of published and unpublished studies and by providing an audit trail of the
reviewer’s decisions, procedures and conclusions’ (Tranfield et al. 2003).
The review was designed to provide a complete and exhaustive summary of current evidence, published
and unpublished up until the end of July 2020. These publications have been set out in the matrix of
identified papers (see Appendix). Works published after this period will not necessarily appear in the
literature matrix. However, there are some notable exceptions referenced in the discussion section (page
6) which are highlighted in this report as being notably recent and significant pieces of literature. Papers
in the literature matrix include non-peer reviewed as well as peer-reviewed publications. This was on the
basis that these unpublished and non-peer reviewed papers met the selection criteria..
Before conducting this process, a text-based matrix (see Venn Diagram above) of possible search terms
which would maximise the likelihood of finding ‘relevant’ pieces of literature, pertaining to the research
questions, was structured and implemented to allow the researchers to keep track of all the combinations
and possible results.
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These pre-determined ‘search-strings’ were then used alongside appropriate online databases and social
sites, in order to trace all concurrent literature related to music activity guidelines on a global scale. A
sample list of these search-strings has been provided below:
For instance, taking string no.1 (music-airborne-pathogen-virus) and plugging it into a search engine, such
as PubMed, may return ‘5’ relevant results (n=5), then string no.2 may return the original 5, plus an
additional ‘2’ pieces of literary works (n+2). In this case, for the PubMed database, the running total at
search-string no.2 is 7 pieces of ‘candidate’ literary works.
This systematic process known as ‘scanning’ helps properly assess and obtain all the relevant results
available through each database. This process is then repeated, performing horizontal and vertical scans,
across all search-strings (rows) and databases (columns).
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Consistency Checklist
A total of 342 papers were then tested against a ‘consistency checklist’ made up of the following
components: ‘Relevance’; ‘Keywords’; ‘Reliability’; ‘Discussion’; and ‘References/Data’. An explanation of
these terms is given below:
¨ Relevance - to the research questions - what are we trying to find out? This is always clearly pre-
defined before carrying out the systematic review in the form of the ‘Research Question’ (RQ).
Therefore, by reflecting on the RQ (wording and meaning) an individual literary work can then be
scored on its overall relevance to this component.
¨ Keywords - every search is initiated by the use of ‘search-strings’. This helps keep track of the results
within the review but also helps in identifying strong potential candidate works based on ‘exact’ or
‘partial’ matches to these search-strings. Results which did not match the keywords would likely also
score poorly in terms of ‘relevance’ (see above).
¨ Reliability - what is the source of the work? Was it peer-reviewed? Did it come from a reliable data
source? By answering these questions a reliability metric can be created for each literary work under
review. Works which were found through peer-reviewed databases (e.g. PubMed, Web-of-Science,
and BIOSIS) tended to have higher reliability scores than those from more globally edited databases
(e.g. Google, Bing or Yahoo).
¨ Discussion - is there an adequate amount of narrative or attempt to make a case for a literature’s
argument? Shorter works will not necessarily be penalised here (quantitative research tends to pack
a lot of information into compact lines of text); however, in the case where there is considerably less
presented evidence (e.g. qualitative articles with a small number of references) this will tend to reflect
in a poorer discussion rating.
¨ References/Data - was there sufficient data or references in this literary work? The arguments
proposed by each piece of literature can come in the form of quantitative or qualitative data. Not
every relevant or reliable source will provide its own unique research or sourced data (e.g. online
news articles, magazine and other related works), however, there should be some form of evidence,
referenced or otherwise, that helps consolidate and drive the discussion relating to the work.
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Articles with no data sources or appropriate references will tend to perform poorly in all categories
related to the consistency checklist.
Each literary work was compared against this ‘consistency checklist’ (see above) which identified any
particularly strong or weak candidates subject to further review, before concluding on the final list of
selected literature. This literary archive was then further analysed under thematic categories’ as a result
of reviewing each individual work.
Results
Thematic Categories
This review of the literature concerning the risks of spreading airborne pathogens such as COVID-19
through singing and playing brass, woodwind and bagpipes begins with an investigation of how sound is
produced in these ways of making music. The following list of 80 papers, articles, and studies have been
selected from a larger group of 342 gathered during this research exercise, and have been grouped in the
matrix in the appendix under the headings: Sound production; Hygiene; Airflow; Droplets and Micro-droplets
(aerosols).
The result was 80 literary works (extracted from 342) which best fitted the criteria in terms of ‘Relevance’;
‘Keywords’; ‘Reliability’; ‘Discussion’; and ‘References/Data’.
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The evidence arising from these sections can be broadly summarised as thus:
Sound production - there is a lack of information directly relevant to our research question in this area,
so Alan Watson has provided an explanatory introduction on breathing and sound production in singing,
brass, woodwinds and bagpipes on pages 8-11.
Hygiene - this has general relevance to the question of ventilation, air quality, and environmental
considerations such as relative humidity in the spaces, both indoor and outdoor, in which music making
takes place. These are all factors in the transmission of viral infection. Specific subsections deal with
general aspects of instrumental performance as well as a more focused presentation of brass, woodwind
and bagpipe information.
Airflow - the evidence gathered so far seems to suggest that only the air in the immediate vicinity of the
singer/player moves as a direct result of singing or playing. What the listener’s ear perceives is a sound
wave, which moves independently through the air. In addition some air movement occurs as a result of
the performer’s body heat.
Droplets and Micro-droplets (aerosols) - the earliest text dates from 1968 but the overwhelming weight
of materials are from May - July 2020. Not included in our list are two important pieces of research from
the UK, yet to be peer reviewed - the Brass Band England research carried out under sterile laboratory
conditions, (Parker and Crookston 2020)
1
and research into singing led by Costello and Reid
2
, and held
in similarly controlled laboratory conditions.
1
Parker, A.S., Crookston, K.(2020) Investigation into the release of respiratory aerosols by brass instruments and mitigation measures with respect to COVID-
19. Preprint accessible from https://www.medrxiv.org/content/10.1101/2020.07.31.20165837v1
2
Gregson et al. (2020). accessible from https://chemrxiv.org/articles/
preprintComparing_the_Respirable_Aerosol_Concentrations_and_Particle_Size_Distributions_Generated_by_Singing_Speaking_and_Breathing/12789221).
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Discussion
What does the evidence gathered in these groupings tell us substantively and in sufficient detail to influence
current and future practice making music through singing, winds, brass, and bagpipes?
The way the sound is produced during singing, woodwind, brass, and bagpipe playing, and, how this
relates to the flow of air and water vapour through the instrument, is fundamental to our understanding
of the risks this poses for the transmission of airborne viruses. The vibration of the vocal cords, lips, or
reed generates the sound which propagates as a wave through the air so that it may be heard at a
considerable distance from the player. However, just as the spread of ripples in a pond travels through
still water, the outward movement of sound is not dependent on the movement of air from the musician’s
instrument, which travels only a short distance. Expert singers and instrumentalists project sound into
performance spaces mainly using the muscles of the abdominal wall and chest. During singing and wind
playing, large droplets of mucus and saliva may be expelled from the mouth in addition to the micro-
droplets that are suspended in the breath. These spread into the atmosphere of the teaching and
performing spaces. The large droplets are relatively heavy and do not travel far beyond the musician but
rapidly sink to the floor. It is to minimise the possibility of infection by these larger droplets that the two-
metre rule has been implemented. The micro-droplets are smaller and lighter and form what are known
as aerosols that travel further and can remain suspended in the air of the performance space for tens of
minutes or longer. Whether the number of microscopic particles generated during wind playing is
sufficient to pose a significant risk of infection, is not yet fully understood, though most of the research
makes the reasonable assumption that this is true.
Though a considerable number of preliminary studies have been carried out with orchestral wind players,
many were not carried out under sterile conditions, which undermines their conclusions and the advice
derived from them. Furthermore most have not undergone the quality control process of peer review,
which is essential if their findings are to be accepted. However, a few studies have been carried out under
highly controlled conditions in rooms demonstrably free of aerosol at the beginning of the experiments,
though they are still (as of November 2020) awaiting peer review. These suggest that micro-droplets are
not produced in appreciably greater quantities during singing and brass playing than during normal
breathing or speaking. What does seem to produce more particles to greater or lesser degree is moderate
to strenuous exercise of any sort, shouting, loud speaking, singing and playing. Another important factor,
for singers at least, is that some individuals produce many more large droplets than others though the
reasons for this are not yet understood.
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Interventions such as face-masks, Perspex separator screens, mouth shields in woodwinds and bell
coverings in brass are variously effective in minimising the spread of large droplets and micro-droplets.
Outdoor practice and performance is also less likely to see accumulation of small droplets as aerosols
than indoor performance, although this is not possible year-round in either temperate or continental
climates.
Basic hygiene is essential. Common sense measures, such as regular instrumental cleaning regimes always
have been or should be a regular part of learning and teaching of brass and wind instrument technique.
The discouragement of any build-up of debris that may harbour bacteria,
3
viruses,
4
and moulds,
5
through
regular brushing out and rinsing of instruments and their detachable parts (especially in brass
instruments) is an absolute, however some parts of the instrument will be more accessible than others.
Instrument sharing should not be permitted. Infectious organisms have also been shown to be present in
bagpipes.
6
They have been isolated from the bag, mouthpipe and other parts of the instrument.
7
Hygiene extends to the venues, and their catering and toilet facilities. Overcrowding and lack of sufficient
amenities add to the risk. Many venues, both outdoor and indoor, will need to be upgraded before they
can reopen. Inadequate ventilation is a severe problem in many popular venues and rehearsal spaces.
The same applies to many educational establishments, including some recently built schools, which
because of soundproofing considerations, have no external windows. Though it has not been studied
systematically, evidence of lung infections arising from the playing of brass, woodwind and bagpipes have
all been recorded.
8
Breathing
In singers and wind players, breathing must fulfil two functions. Its most fundamental role is to allow
oxygen to be taken into the body and carbon dioxide to be expelled. In wind musicians and vocalists,
(however), it is also used to control air pressure below the larynx or within the mouth, and to regulate
how fast this flows through the larynx or into the instrument from the opening of the mouth. This is
needed to maintain the vibration of the vocal cords, the lips or the reed. Singing and wind playing often
require deep breathing to sustain long notes and phrases and this increases the risk both of developing
respiratory diseases, because viruses and bacteria may be drawn deep into the lungs, and transmitting
them if they are already present.
3
Glass RT, Conrad RS, Kohler GA, Bullard JW. 2011. Evaluation of the microbial flora found in woodwind and brass instruments and their potential to transmit
diseases. Gen Dent 59(2):100-107
4
Mobley J, Bridges C. 2015. Wind Ensemble Infectious Disease Risks: A Microbiological Examination of Water Key Liquids in Brass Instruments. Texas Public
Health Association Journal 67(2):16-18.
5
Davidson J, McErlane J, Aljboor K, Barratt SL, Jeyabalan A, Medford ARL, Borman AM, Adamali H. 2019. Musical instruments, fungal spores and
hypersensitivity pneumonitis. QJM 112(4):287-289.
6
King J, Richardson M, Quinn AM, Holme J, Chaudhuri N. 2017. Bagpipe lung; a new type of interstitial lung disease? Thorax 72(4):380-382.
7
Ziegler K, Joest M, Turan N, Schmidt D, Rath PM, Steinmann J. 2019. Hypersensitivity pneumonitis of a bagpipe player: Fungal antigens as trigger? Med
Mycol Case Rep 24:44-47.
8
Mobley J, Bridges C. 2015. Wind Ensemble Infectious Disease Risks: A Microbiological Examination of Water Key Liquids in Brass Instruments,. Texas Public
Health Association Journal 67(2):16-18.
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During inhalation, air enters through nose and mouth, into the throat and then down the windpipe to the
lungs. As it passes through the nasal passages and the throat, it is warmed and made moist by layers of
cells lining the airway that secrete a watery fluid that also contains mucus. The moisture saturates the air
and prevents the lungs from drying out, while warming the air reduces the amount of cooling the body
experiences during breathing.
The mucus traps dust, pollen and allergens and is later swallowed, preventing them from building up in
the lungs. The air that is breathed out during singing or playing of wind instruments also contains a lot of
moisture in the form of small water droplets of various sizes and larger drops of mucus that can carry
infectious bacteria and viruses. In the case of singers, the number of these droplets increases with the
loudness of the singing, but the levels appear roughly comparable to those generated by speaking at the
same level of loudness. For reasons that are currently unclear, the number of droplets can vary greatly
from one person to another. Some produce relatively few large and small droplets, but others singing in
the same way, produce much more. This does not seem to be linked to the style of singing. In people
carrying infections, the amount of virus expelled in the droplets also varies a great deal from person to
person, but the reasons for this are also not understood.
Singing
The sound produced by the larynx is generated by two muscular flaps within it called the vocal folds
(vocal cords). During inhalation, these are held open to allow the air to flow freely into the lungs. In order
to generate the sounds of speech and singing, the vocal folds are held closed. The expiratory muscles
contract, compressing the lungs and raising the air pressure below the folds. This forces them apart
briefly, allowing the air to escape. They quickly close again because as the air flows ever more rapidly
between the open folds, its pressure falls. This and the natural elasticity of the folds causes them to snap
shut.
The cycle then repeats. The frequency of the sound produced matches the number of cycles of opening
and closing in one second. For middle C, this is about 260 cycles per second (Hz), and for the C an octave
above, it is just over 520Hz. The pitch of the note is controlled by altering the tension in the vocal folds.
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The air coming from the lungs is moist, carrying many very fine droplets of water, and more water and
mucus will be added from the puffs of air produced by each cycle of vocal fold opening and closing. More
droplets (some very large) are produced from the mouth when consonants are formed by the lips and the
tongue. These large droplets fall to the ground within a few tens of centimetres, but the small ones travel
much further in the air currents produced by singing, and the smallest will remain suspended in the air
for tens of minutes.
Brass Playing
As in singing, the sound created by brass instruments is also produced by a rapid series of puffs of air at
the frequency matching the pitch of the note. In this case it is the movements of the lips within the
mouthpiece that are responsible but they essentially behave in a similar way to the vocal folds of the
larynx. The pitch is controlled mainly by altering tension in the muscles of the embouchure that lie in and
around the lips, and by the speed of the air jet. Valves (or in the case of the trombone, the slide) are used
to alter the length of the vibrating column of air within the instrument. The frequency of lip vibration
must match the modes of vibration of the air column to produce a clear note. The expelled air is very
moist but rapidly condenses when it enters the metal tubing of the instrument.
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Only a small amount of water vapour escapes from the bell of the instrument. In the trombone, moving
the slide upwards may also expel droplets from the bell. How much of the water remains inside depends
mainly on the length of the tubing; the longer this is, the less water vapour escapes from the open end,
therefore the trumpet retains less than the French horn.
The water that remains within the instrument has to be removed frequently as it will bubble during
playing. In many instruments this is achieved by blowing out through a water key, which creates a spray.
Sections of the tubing (crooks and slides) can also be removed to drain the water. Both methods will pose
a significant risk if the player is infected.
Woodwind Playing
Orchestral and wind band instruments fall into three broad categories; single reed instruments (clarinet
and saxophone), double reed instruments (oboe and bassoon) and flutes and piccolos, which lack any
reed. The widely-played tin whistle and recorder are members of the flute family. In all cases, the sound
arises from vibrations in the air column within the instrument. The pitch of the note is largely determined
by using keys to open holes along the tube to change the length of the vibrating column of air, but it can
also be modified by how the player blows. In the clarinet and saxophone, a broad single reed which is
flat and thin, is attached to a plastic or metal mouthpiece, forming one side of a narrow slit-like opening.
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When this in the player’s mouth, the upper front teeth lie in contact with the top of the mouthpiece. The
reed sits on the lower lip, which is wrapped over the front teeth. As the player blows, the reed vibrates
up and down in the airstream opening and closing the thin opening at the frequency of the note and
setting up vibrations within the instrument. In the oboe and bassoon, the air is blown in through a small
opening between two narrow reeds. The reeds are held between the lips, which are wrapped over the
upper and lower front teeth. The gap between the reeds opens and closes at the note frequency. For the
flute and piccolo, the instrument is held against the outside of the lower lip, and air is blown across an
open hole at the top end to set up vibrations in the air column within the instrument. In all woodwind
instruments, moisture from the breath condenses inside and may drip from the open end or have to be
drained though water keys.
As many of the keys are open rings, the player’s finger pads become moist. Water sometimes also collects
under the keys or reeds and may have to be blotted or blown out periodically. Any moisture within the
instrument when playing has finished will be wiped out with a cloth. In reed instruments, moisture from
the breath is only released into the air by passing through the instrument, however in the flute, it is also
blown directly into the air. All of these sources of moisture or water droplets may communicate infectious
agents.
Bagpipes
In Western bagpipes, the chanter generally has a double reed like the oboe and the drones, a single reed.
However, their vibration is driven by air from the bag rather than directly from the player’s mouth. The
bag is either filled through an open pipe which the player blows into (e.g. Highland bagpipes), or by a
bellows operated by the arm (e.g. small pipes such as Northumbrian). In the bellows type, there is no risk
of lung infection to the player or to the audience, but in pipes where the bag is inflated through a
blowpipe, infectious agents (bacteria, viruses and fungi) carried by the moist air of the breath can build
up in the bag and cases of respiratory illness among players are well documented. In such pipes, the bag,
which is either made of leather or a synthetic material such as Goretex, must be disinfected regularly,
particularly if the blowpipe does not have a non-return valve which prevents air from the bag re-entering
the mouth. Air from the chanter and drones will release droplets and aerosols into the air.
The electronic chanter, which does not use air to create the sound, is now available as a practice and
even performance instrument. This may be useful in situations where the risks of using the Highland
pipes is deemed unacceptable.
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Summary
We all inhale and exhale large volumes of air. At rest a person normally breathes 12 times a minute. When
we are not physically active, the volume of each breath is about 500mls, so on average we are using 6
litres of air in that time. During vigorous exercise a person may breathe as many as 30 times a minute
and each breath will be much deeper, with the result that we may use over 90 litres of air in that same
minute. Over the course of a day, a person at rest, without additional exertion, will inhale and exhale
upwards in the region of 11,000 litres. Because the exhaled air is warm, we generate an invisible ‘thermal
plume’ which results in a current of air that rises upwards carrying aerosol droplets with it.
The lung capacity of healthy adult singers, wind and brass players averages 3.5-7.0 litres. This is best
predicted by height but also depends on age, gender, body type (e.g. whether an individual is broad or
narrow chested) and ethnicity. Musicians, both professional and amateur, are from an early age taught
breath control. They are accustomed to breathe in quickly and exhale slowly, sometimes with as few
breaths as 4-6 per minute, depending on the tempo and phrasing of the music. In singing, this slow
exhalation goes straight into the atmosphere, whereas in wind and brass playing the air passes through
the instrument. The exhaled air is warm when it enters the instrument but cools as it flows through it. As
a result, the water vapour it contains condenses into liquid which collects in the tubing, and is expelled
through water keys. Some water vapour does emerge from the bell of the instrument, but surprisingly
little in the case of the longer instruments such as tuba, trombone and french horn, which trap most of
the moisture inside.
9
9
He R, Gao L, Trifonov M, Hong J. 2020. Aerosol generation from different wind instruments. J Aerosol Sci:105669.
https://doi.org/10.1016/j.jaerosci.2020.105669
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Conclusions
Music in all its manifestations forms an important component of our societal, cultural, physical and mental
health and well-being. Ways can and should be found of continuing the practice of music-making despite
the global pandemic. Singing and playing musical instruments are normal and widespread human
activities. Their suppression during the pandemic has aroused a great number of scientific investigations.
The MEPG research paper WeMakeMusicOnline confirmed the utility of online resources whilst
reaffirming from every respondent a unanimous desire for face-to-face, ‘live musical contact.
During the pandemic there has been a tendency, often through media exposure, to demonise certain
musical activities such as singing, woodwind, brass and bagpipe playing as uniquely aerosol-producing
human activities. That is simply wrong. We appear to have been led by subjective judgement rather than
objective analysis of the data. Normal breathing and speaking also produce aerosols within the
approximately 11,000 litres of air inhaled and exhaled by the average person each day. Moderate to
strenuous exercise of any sort, loud speaking and shouting produce a greater number of aerosols.
There is no current available data showing that there is a statistically significant added risk of viral
transmission from singing and the playing of brass and wind instruments on top of the already
considerable risk in gathering socially in both domestic and public settings when suitable mitigations are
in place. This is currently unquantified and more experimental data is needed. The research project
PERFORM (ParticulatE Respiratory Matter to InForm Guidance for the Safe Distancing of PerfORmers
in a COVID-19 PandeMic) being carried out currently at the University of Bristol with the support of
Public Health England and the Department of Digital Media, Culture and Sport, under stringent
laboratory conditions, should help to determine whether there is any added risk of transmission. Until
such information is available we would recommend that music performance and education should be
resumed within the stringent application of whichever current public health regulations are in place, and
risk-assessed appropriately using the common measures below to mitigate risk.
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Recommended measures to mitigate risk
Generic
¨
Self-examination for COVID-19 symptoms and consequent withdrawal and self-isolation if any
symptoms present.
¨
Washing hands regularly with soap and water or sanitising fluid.
¨
Social distancing in ensembles (the preponderant advice currently is at least 2 metres).
¨
Ensuring that all performers at the venue wear face masks when not practicing or performing.
¨
Ensuring that the volume of the performance space is suitable for the numbers rehearsing,
performing and listening when appropriate distancing measures are in place.
¨
Ensuring that adequate passive or active ventilation systems are used to ensure sufficient air changes
in the room (recirculating air is not recommended).
Measures to mitigate risks in teaching and performance spaces should comply with risk assessments
based on the national public health guidelines that are in place at any one given time for adults, children
and young people. The following mitigations have been commonly put in place by arts institutions,
teaching organisations and the management of performance venues. These measures relate to generic,
music-orientated and instrument-specific guidance. This list is not exhaustive; but measures include:
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Music-Oriented
¨
Disinfecting surfaces (stands and chairs) before and after use.
¨
Owning the personal hygiene of your own stand and chair as your own work-station and not sharing
with anyone else during the same period of work.
¨
Using plastic containers and absorbent cloths to collect condensed water emptied from instruments,
and disinfecting these after each use.
¨
No sharing of instruments.
¨
Reducing the size of ensembles, vocal and instrumental, and reconfiguring the way small ensembles
(10 or fewer players/singers) are laid out.
¨
Handing out and taking in sheet music to be carried out by one person wearing gloves and a face
mask.
¨
Printed music should be quarantined for 72 hours prior to re-use.
Instrument-Specific
¨
Ensuring that all audience and performers of strings, keyboard, and percussion in mixed ensembles
wear face masks at all times.
¨
Cleaning instruments thoroughly and hygienically after daily use and where practicable sterilising
mouthpieces.
¨
Clear Perspex Screen Separators (a good idea in ensemble or in the face to face teaching situation).
¨
Brass and Wind Instrument wind shields (as yet untested).
¨
Brass Bell Coverings (proven effective in the Brass Band England research).
¨
No buzzing of brass mouthpieces in performance venues as part of brass warm up.
¨
Humming instead of singing (effective for some rehearsal purposes but musically limited).
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Papers
Peer-
reviewed
Papers
Non peer-
reviewed
Dates
-
significance
Highlights
Risks
Guidance/recommended
practice
Sound production
- instrumental (excl.
brass & woodwind)
Kemp &
Smith
2012
Due to the requirement to measure the
pressure and volume velocity accurately
for waves striking the lips at all
frequencies, it was a requirement that the
lips of the player beheld in a fixed position
by the player with zero DC flow. In
measuring the reflectance when the lips
are placed on the end of a truncated
trumpet mouthpiece we use low
amplitude exponential sine sweep
excitation so that linear propagation holds
good
- brass &
woodwind
Elliott &
Bowsher
1982
This paper is concerned with the
production of musical notes by the
interaction between the lips of a player
and a brass wind instrument. Experimental
measurements of this mouthpiece
pressure are presented, together with
measurements of the steady and
alternating components of the pressure in
the mouth, and of the velocity in the
mouthpiece for blown notes on a
trombone and trumpet.
Hygiene
- ventilation
Cohen et al
(book)
2016
Mass gatherings, such as music
festivals and sports spectatorship an
lead to outbreaks of respiratory
infections such as influenza and gastro
-intestinal illness due to overcrowding
at venues, lack of amenities, problems
with food handling and mixing of
infectious and susceptible populations.
Appendix -
Matrix of identified papers
19
Music Education Partnership Group
CondAir
Jan 2018
Blog
Viral infections such as influenza are
directly influenced by the quality of an
environment’s air, which includes
relative humidity levels and
temperatures. If relative humidity
levels are low less than 40% RH
the space will effectively become a
breeding ground for bacteria and viral
infection potentialities.
DfE England
July 2020
Guidance for schools and performing in
all areas
Social distancing measures, hygiene measures,
ventilation.
- instrumental
Music
Industry
Association
March
2020
Webpage
guidance
Musical instrument businesses across the
country have questions in relation to the
Coronavirus. The MIA has collated
guidance from Public Health England, the
Government and MIA Members and
partners to help the industry deal with the
outbreak…
Don’t share instruments.
Maintain a good hygiene regime for instruments at
all times.
Clean brass instruments with warm, soapy water
and an instrument brush (see Dennis Wick trumpet
brush here). The brush MUST be used as it will
dislodge any build-up of debris in the instrument.
This will prevent any chance of re-infection or
cross-contamination.
- brass &
woodwind
Marshall &
Levi
2011
Walter and Chaffey (1959) found the
combination of brushing and rinsing
mouthpieces to be more effective than
simple wiping or rinsing with plain water in
lowering the numbers of residual
organisms after playing. Nonetheless,
recommendations for improving
instrument hygiene and discouraging
infection transmission (Bryan 1960; APMT
2010) have not been widely adopted.
Mobley &
Bridges
2015
Most large brass instruments do not contain
oral bacteria. French horns and trumpets
may have oral bacterial flora in their
accumulated liquid. Most instruments will
have Alcaligenes faecalis. In general the liquid
from water keys does not pose an
environmental hazard to persons with
normal immune systems. Bands are highly
inclusive and diversified. There may be
special situations in which players are prone
to infection or have cancer or immune
disorders, which would require attention for
the prevention of infections.
Good health practices should be a regular part
of musical instruction. Good health practice
should include cleaning institution-owned
instruments before reissuing them to another
student.
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Music Education Partnership Group
Queensland
Govt
Sep 2019
Infection control Guidance
Mouthpieces of musical instruments.
Instrumental Music Program. (e.g. class sets) -
Clean inside with a brush, warm water and
detergent. Air dry or use paper towels. Use
alcohol wipes to disinfect.
Walter &
Chaffey
1959
In the past, improperly cleaned eating
utensils have been shown to harbor
pathogenic organisms (Cumming et al.,
1920; Saelhof and Heine-kamp, 1920; and
Lyons, 1936), but satisfactory procedures
have been developed for cleaning and
sanitizing such utensils for either
institutional or domestic use.
Various techniques common among
musicians were tried in an effort to
determine how effective they were in
removing bacteria from a mouthpiece. The
method finally employed utilized a
stainless steel tank about 16 cm wide, 40
cm long, and 20 cm deep to which 12 L of
tap water containing a commercial
detergent-sanitizer of recommended
strength was added.
Brushing and rinsing mouthpieces found to be
more effective than simple wiping or rinsing
with plain water in lowering the numbers of
residual organisms after playing
Wase
2008
Unpublishe
d PhD
thesis
Further research is needed to identify the
complete bacterial flora of instruments, to
identify possible viral and fungal flora that
exist in brass instruments and to develop
procedures and materials to quickly
disinfect instruments.
Potential exists for cross
contamination from the
build-up of biofilm in the
mouthpiece from
secretions of the salivary
glands and
oropharyngeal/upper
airway. In particular, there
is a potential hazard for
the transmission of the
Gram-negative respiratory
pathogens,
Pseuedomonas
aeruginosa and
Burkholderia cepacia
complex.
Airflow
- vocal
Veith
May 2020
Blog
As for orchestral instruments, trumpets
and trombones also affect the air only as
far as half a meter. Woodwinds,
interestingly, have a farther effect,
moving the air in a range of one meter,
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Music Education Partnership Group
with flutes going beyond that. Similarly,
singers use their diaphragms to create
vibrations in the air, which eventually
register on the listeners’ eardrums. But
what the listener hears is not the same
air that comes out of the singer, infected
or otherwise.
- brass &
woodwind
Kahler &
Hain
May 2020
University
YouTube
video
A study from the University of the
Bundeswehr Munich into the safety
distance of musical activities, including
singing, brass, and wind instruments.
Explores air movement and droplet
emission in different instruments and
offers solutions including playing outdoors
and use of pop-shields.
-
Nashville
Music
Scoring
June 2020
Online
video
YouTube
This video intends solely to show that the
commonly held belief that wind and brass
instruments "project" air over great
distances is not true. As a result,
"droplets" are not spread a great distance
as some assume. This video does not
address any aerosol issues
-
Smith
1999
The “wave,” often a sign of audience
boredom at stadia events, illustrates how
the alternating part of the air travels
through the instrument. Apart from this
movement they are stationary, and their
vibration is passed onto the next particle
and so on down through the instrument.
This is a longitudinal wave of energy that
is travelling at the speed of sound (350
m/s or 780 miles per hour) far faster
than any air particles you can blow into
the instrument!
-
.
22
Music Education Partnership Group
Aerosols
- general
Barber
June 2020
Online
article
For the risks of singing,
there are clues in the
scientific literature,
primarily from studies on
breathing and talking that
go back to the 1950s,
when the primary interest
was in stopping measles.
One observation is that
loud vocalizations mean
more aerosols. But for
instruments, researchers
lack even that basic
background to assess the
risks and proper
precautions.
-
Barmann
March
2020
Online
article
Marr also tells the LA Times that certain
people simply have "super-spreader"
abilities in their lungs capable of
exhaling 1,000 times more fine material
than most people.
While this case, which remains under
investigation, should not scare people into
hoarding N95 masks that will be key to
saving healthcare workers from infection,
it should give people pause about entering
any enclosed space with strangers,
whether they're coughing or not.
-
Campbell
Feb 2020
You Tube
video
video that shows the difference between
droplets and aerosol. Because aerosol
particles can hang in the air for so long, a
person can walk through an aerosol cloud
hours later and breathe in those particles.
And because the particles are so small,
they can travel into a person’s lungs more
easily than droplets
-
Fernstrom
& Goldblatt
2013
Aerobiology plays a fundamental role in
the transmission of infectious diseases. As
infectious disease and infection control
practitioners continue employing
contemporary techniques, the central
variables affecting the airborne
transmission of pathogens are becoming
better known.
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Music Education Partnership Group
-
Firle et al
May 2020
Recommendations
of the German
Society
for Music
Physiology and
Musicians
Medicine
From instrumental considerations it is very
likely that fine droplets, which are
contained in exhaled air blown into the
instrument by the sounding vibrations of
the reeds or lips (flute, brass instruments)
in aerosols (<5 μm) to be "swirled".
Aerosol formation and spreading, which
appears to exist in several wind
instrument, are possibly different.
It is also believed that due
to deeper inhalation when
playing wind instruments,
potentially infectious
aerosols can reach deeper
lung sections
Hygiene measures, social distancing detailed
recommendations for particular instruments
-
Galton
April 2020
Online
article
English National Opera is to stage socially-
distanced drive through performances in
the grounds of Alexandra Palace. The
series includes a one-hour family-friendly
adaptation of Mozart’s The Magic Flute
and a shortened version of Puccini’s La
Boheme - with singers and musicians
spaced out in accordance with
government guidelines.
-
GMorch
May 2020
Webpage
guidance
Written in Germany, collected
recommendations for orchestras returning
to work, including rehearsal guidelines,
social distancing, protective equipment
(e.g. covering bell with cloth cover,
Perspex separators).
-
Greenfield-
boyce
April 2020
Blog
when a choral group in Washington state
got together to sing, and ended up with
dozens of cases of COVID-19 despite the
fact that members of the group were
careful not to touch each other or stand
close.
"The simplest explanation is that it was
being transmitted through the air,"
People should ventilate buildings and that
concentrations of particles are less likely to
build up outdoors.
-
Harvard
Medical
School
July 2020
General
Guidance
The CDC provides general guidance on cleaning
and disinfecting public facilities, including schools,
that are exposed to someone ill with COVID-19.
These guidelines should be adapted to specific
circumstances.
-
Kupfer-
schmidt
June 2020
Online
article
Individual patients’ characteristics play a
role as well. Some people shed far more
virus, and for a longer period of time, than
others, perhaps because of differences in
their immune system or the distribution of
virus receptors in their body.
A study in Japan found
that the risk of infection
indoors is almost 19 times
higher than outdoors.
(Japan, which was hit
early but has kept the
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Music Education Partnership Group
epidemic under control,
has built its COVID-19
strategy explicitly around
avoiding clusters, advising
citizens to avoid closed
spaces and crowded
conditions.)
-
Mandavilli
July 2020
Online
article
In an open letter to the W.H.O., 239
scientists in 32 countries have outlined the
evidence showing that smaller particles can
infect people, and are calling for the agency
to revise its recommendations. The
researchers plan to publish their letter in a
scientific journal next week.
Aerosols are released even when a person
without symptoms exhales, talks or sings,
according to Dr. Marr and more than 200
other experts, who have outlined the
evidence in an open letter to the World
Health Organization.
Dr. Morawska and others
pointed to several incidents
that indicate airborne
transmission of the virus,
particularly in poorly
ventilated and crowded
indoor spaces.
-
Mixon
April 2020
Youtube
video
a video demonstration of aerosol
suspension from a person. The risk of
infection from a person with micro
droplets becomes even greater in a closed
space with poor ventilation.
-
Netherlands
Govt
June 2020
(updated
Sep 2020)
Public
guidance
It is not yet known whether sports
activities increase the spread of the virus,
for example because vigorous exercise
produces more droplets. The same applies
to musicians who play wind instruments,
and to choral singers. Sports and singing
certainly do release big droplets, similar to
shouting and talking, but not as much as
coughing or sneezing
Social distancing, routine hygiene measures
-
Pasnick et
al.
June 2020
Our understanding of SARS-CoV-2
continues to evolve. Mounting evidence
suggests the virus can be transmitted via
contact, droplet, and possibly aerosol
routes
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Music Education Partnership Group
-
Rogers
May 2020
A vast number of the particles that come
out of a person’s mouth are much smaller,
under 5 microns. They dry out quickly in
the air and become so light they can float
around for hours. Even the slightly warm
layer of air constantly wafting upward
from every personour “thermal plume”
can carry these particles up, up, and away.
Random air flow makes their spread
turbulent, bounced around by currents like
sand in a tide pool. And we emit them all
the time
“If you look at what the
CDC and WHO have been
saying, they downplay the
role of airborne
transmission,” says Joseph
Allen, director of the
Healthy Buildings
Program at the Harvard
School of Public Health. “I
think that’s a mistake.”
-
Saskat-
chewan
Health
Authority
Dec 2017
musical wind instruments not permitted
-
Qureshi et
al.
June 2020
The 2-metre social distancing rule
assumes that the dominant routes of
transmission of SARS-CoV-2 are via
respiratory large droplets falling on others
or surfaces.
A one-size-fits-all 2-metre social
distancing rule is not consistent with the
underlying science of exhalations and
indoor air. Such rules are based on an
over-simplistic picture of viral transfer,
which assume a clear dichotomy between
large droplets and small airborne droplets
emitted in isolation without accounting for
the exhaled air. The reality involves a
continuum of droplet sizes and an
important role of the exhaled air that
carries them
Other important factors to take account when
considering safe social distancing (which were
beyond the scope of this review to cover in
depth) include host viral load, duration of
exposure, number of infected individuals, indoor
versus outdoor settings, air ventilation, wearing
of PPE including facemasks, effectiveness and
type of cleaning measures, individual
susceptibility to infection, and activities that
project airborne particles over greater distances
in exhaled gas clouds, such as singing, coughing
or heavy breathing.
26
Music Education Partnership Group
-
Spahn &
Richter
May 2020
Currently, there is no scientific data
regarding the spreading of aerosols in
closed rooms during rehearsals and
concerts.
As long as this is the case,
we believe that the
greatest possible risk
reduction should be
carried out by using a
combination of measures.
This combination should
be applied to orchestra or
big band - as already
described for chamber
ensemble and choir -
including regular room
airing (see Section 2
above).
Regular airing of the room every 15 minutes or
using rooms with an HVAC system are
important measures for risk reduction.
-
Strain
July 2020
University
webpage
article
The debate largely comes down to size.
Everyone agrees that the coronavirus can
spread through large drops of liquid (think
of the spray that flies out of your mouth
when you sneeze).
Where Jimenez and his colleagues and the
WHO disagreed, at least until recently,
came down to much smaller beads of
moisture. These “microdroplets” are too
tiny to see with the naked eye. But
humans can expel them when they sing,
talk or even just breatheno sneezing
required.
We need as much outside air as possible,” Miller
said. “If you have to recirculate air, then use the
highest rated filter that you can.”
-
UK
Government
4 July 2020
Guidance
Written in England, this guidance provides
advice on how places of worship can
open, for limited permitted activities, in a
manner that is safe and in line with social
distancing guidelines.
Singing, chanting and the use of musical
instruments
People should avoid singing, shouting, raising
voices and/or playing music at a volume that
makes normal conversation difficult or that may
encourage shouting. This is because of the
potential for increased risk of transmission from
aerosol and droplets.
-
UK
Government
9 July 2020
This is the initial phase of the
recommended guidance. Further guidance
will be issued when there is sufficient
scientific evidence to support a move.
Singing and playing wind and brass instruments,
especially in groups, are considered higher risk
activities because of the potential for aerosol
production and the absence presently of
developed scientific analysis to assess this
specific risk.
27
Music Education Partnership Group
-
University of
Bristol
July 2020
University
press
release
article
The research project, known as
PERFORM (ParticulatE Respiratory Matter
to InForm Guidance for the Safe
Distancing of PerfOrmeRs in a COVID-19
PandeMic), is supported by Public Health
England… The researchers will carry out a
number of scientific experiments to
investigate airborne droplets produced
during breathing, speaking, singing and the
playing of brass and woodwind
instruments
The project aims to understand and find out: The
amount of respiratory aerosol particles and
droplets created by breathing, speaking, singing,
coughing, and the playing of woodwind and brass
instruments.
The effect of distance on the mount of respiratory
articles transmitted by breathing, peaking, singing,
coughing, and the playing of woodwind and brass
instrument.
To explore how the length of the performance,
volume, pitch and umber of performers relates to
the amount of respiratory aerosol particles and
droplets produced in venue.
-
.
Volckens et
al
June 2020
proposal
The project will develop two primary
outputs. The first output is a robust and
scientifically rigorous dataset on
endogenous particle release rates
(stratified by gender, age, and activity
type). This dataset will be published in the
open science literature and in a manner
that is accessible and understandable by
stakeholders in the performing arts
community. The second output will be a
guidelines document that outlines the
efficacy of various strategies to control
emissions and reduce exposures to
infectious bioaerosols. This guidelines
document is envisioned to provide the
scientific basis for a “safe to perform”
position statement to be developed in
collaboration with national/international
governance bodies in the performing arts
Only scant evidence exists
to document the rate of
aerosol release during
performing arts activities
[8, 9] and whether there
are effective means to
control such releases (and
reduce the risk for human
exposure). This proposal
seeks to enact a rigorous,
data-driven approach to
inform a safe return to
activities for the
performing arts
community.
-
World
Health
Organisation
July 2020
Respiratory droplet transmission can
occur when a person is in close contact
(within 1 metre) with an infected person
who has respiratory symptoms (e.g.
coughing or sneezing) or who is talking or
singing; in these circumstances,
respiratory droplets that include virus can
reach the mouth, nose or eyes of a
susceptible person and can result in
infection.
28
Music Education Partnership Group
- vocal
Alberta
Health
Services
May 22,
2020
No singing
Ashley, M.
2020
Choral singing not
higher risk
Asadi et al.
Feb 2019
results strongly suggest that more
particles escape the respiratory tract if the
vocalization is louder
Speech greater concern
than breathing
Ashworth
June 2020
Newspaper
article
The Munich study concludes: “Air is only
set in motion in the immediate vicinity of
the mouth when singing. In the case of the
professional singer, the experiments
showed that at a distance of around 0.5 m,
almost no air movement can be detected,
regardless of how loud the sound was and
what pitch was sung. It is therefore
unlikely that the virus could spread
beyond this limit via the air flow created
during singing.”
The researchers deemed this to be “not
surprising, since singing does not expel a
large volume of air in jerks like coughing
or sneezing”.
They concluded, with provisos: “If the findings
and recommendations from our quantitative
measurements are taken into account, then
making music in a community should be
relatively safe.”
Austin
May 2020
Online
article
A few of us even appear to be
“superemitters,” spreading an order of
magnitude more of these fine aerosol
particles for an as yet unknown
physiological reason, the UC Davis
researchers found in a 2019 study in
Nature’s Scientific Reports. Because
aerosols are so light, they may hang in the
air for hours.
Eventually, choruses might meet in smaller
groups, install UV-light air-disinfection systems,
or hold rehearsals outside, where a gentle
breeze may help waft away infectious aerosols.
29
Music Education Partnership Group
Ballard
May 2020
Online
article
Studies commissioned by the Vienna
Philharmonic and the Bamberg Symphony
Orchestra reached the same conclusion
for orchestral players. All the studies
stress the importance of social distancing.
But the singing, or playing, itself was not
the problem. Professional choirs in Europe
have been quick to adapt.
Bollinger
June 2020
Online
article
When Germany locked down in mid-
March, religious services were banned. As
restrictions began to ease in late April,
Angela Merkel met with leaders of the
country’s 16 states to coordinate a
nationwide set of rules, including rules to
govern worship services.
In the end, the German federal government did
not impose a nationwide ban but stated that
singing should be avoided "because of the
increased production of potentially infectious
droplets, which can be spread over greater
distances". Several German states have banned
all singing from services.
Borak, J.
June 2020
This remarkable example of interpersonal
‘super spreading’ best explained by
enhanced aerosolized transmission
resulted from enthusiastic singing
Singing and air turbulence
Buonanno
et al
June 2020
outbreaks are not caused by the rare
presence of a superspreader, but can be
likely explained by co-existence of
conditions, incl. emission and exposure
parameters, leading to a highly probable
event, which can be defined as a
superspreading event
to guarantee an acceptable individual risk for
exposed subjects in naturally ventilated indoor
environments, exposure time should be shorter
than 20 min
Christensen,
G.
May 2020
While it is certain that COVID-19 can be
spread by exhaled “droplets”, there is a
growing amount of evidence to support
the hypothesis that COVID-19 can also be
spread by exhaled aerosols. The dangers
from these aerosols are believed to be
mitigated by the widespread use of
appropriate PPE and masks, but, that is
not always practical, especially when
singing is involved.
Singing in confined or
‘sealed’ spaces
Importance of ventilation
Cockburn
June 2020
Online
article
Analysis of the US choir outbreaks does
suggest ventilation is an issue, and in
those cases ventilation was poor and
the duration of practice was high
(around 2-2.5 hours).
Other actions associated with playing a wind
instrument can pose additional risks, like when
players blow out spit valves. For this reason,
plexiglass between wind instrumentalists has
been recommended.
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Music Education Partnership Group
How much the viral load is reduced by
travelling through an instrument is still
unclear.
Delaware
Government
June 2020
Strong evidence exists showing that
large droplets, such as those in a cough
or sneeze, as well as very small droplets
in the air, such as those produced when
singing or speaking (especially when
speaking loudly or yelling as in coaches
giving directions to athletes or camp
staff giving directions to other staff or
children), spread the disease. In fact,
these very small airborne particles can
travel up to 13 feet away from the
infected person.
Social distancing measures and hygiene
procdures
Evans
June 2020
Droplets produced while speaking, for
instance, depend on speech loudness;
speaking loudly, yelling or singing can
produce an order of magnitude more
saliva than speaking normally.
Ventilation and use of masks
Feder
April 2020
Online
article
The World Health Organization has
taken pains to emphasize that the
coronavirus is primarily spread through
respiratory droplets, unlike, for example,
measles, which is transmitted in
aerosols and can linger for hours in the
air. Projecting your voice could send
droplets further but it's unclear how
infectious they are at the end of their
journey.
Feng et al.
May 2020
Based on the observation from this
study, microdroplets can either suspend
and transport in the air farther than
1.83 m (6 feet) or deposit on human
bodies. Thus, only keeping the social
distancing guidelines as of May 2020 is
not sufficient, and the guidelines should
be scrutinized further.
Six-feet social distancing policy for COVID-19
may not be sufficient with ambient wind.
Wearing PPEs, avoiding handshakes, and
washing hands frequently are necessary
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Music Education Partnership Group
Fairchild et
al.
May 2020
University
recommend
ations
Where teaching involves enhanced
modes of vocal projection (e.g., lecturing
to a large room, demonstrating a wind
instrument, demonstrating
pronunciation in a language class), the
instructor may choose to wear a face
shield. In most of these cases, it is
recommended that where practical
instructors also wear face masks unless
it is absolutely necessary to do
otherwise (e.g., meet the needs of
students with disabilities such as
hearing impairment).
There is currently little current evidence to
guide performance-based activities. Because of
this, we are recommending a balanced risk
approach be taken when considering the risk of
virus transmission and the activities required for
certain performance-based majors
Hamblin
June 2020
Online
article
A cheaper option is using nature to take
services and rehearsals fully outdoors.
This will be only a temporary fix in most
places, because winter will bring its own
challenges. And singing in the open air
will fundamentally alter the effect: it’s
not a zero-risk scenario, but we have
every reason to believe it is safer than
the old way.
the safest thing would be to never gather in
groups for the foreseeable future. Short of that,
the more preventive work that can be done, the
better.
Hamner et
al
March
2020
Choir practice attendees had multiple
opportunities for droplet transmission
from close contact or fomite
transmission (9), and the act of singing
itself might have contributed to SARS-
CoV-2 transmission
Current CDC recommendations: maintaining
physical distancing of at least 6 feet wearing
cloth face coverings, washing hands often,
covering coughs and sneezes, staying home
when ill, cleaning and disinfecting high-touch
surfaces
Louden &
Roberts
1968
Factors described as favouring such
point-source outbreaks include
tuberculin-negative status in a large
proportion of those exposed,
overcrowding and lack of ventilation,
and the presence of a patient with
positive sputum and disseminating
characteristics.
32
Music Education Partnership Group
McKie
May 2017
Newspaper
article
But not all scientists agree with the idea
that our musical appetites pose a health
risk. In particular, fluid mechanics expert
Professor Christian Kähler of the
Military University, Munich was highly
doubtful about the dangers posed by
concerts and decided to conduct
experiments in the wake of the
Amsterdam outbreak to find out how
far singers and musicians expel air and
droplets.
Kähler said the virus was probably
spread among chorus members because
of their close proximity to each other
before and after rehearsals and
performances
Moss
July 2020
Blog
This assessment applies the concept of
risk management with the aim of
identifying specific risks related to
COVID-19 in the field of music and
theatre and offering risk-reducing
measures.1 Two core beliefs underlie
this work: (1) a belief that the greater
the number of risk-reducing measures,
the more the risk of infection can be
reduced; and (2) a belief that until we
have more refereed research on the
spread of airborne infection specific to
music making and theatre productions,
we must over- rather than
underestimate the possible risks in case
of doubt. In this way, by combining risk-
reducing measures, we can lower the
overall risk of infection as much as
possible. Residual unquantifiable risk,
however, will always remain according
to the ALARP (as low as reasonably
practicable) principle.
In combination, these risk
reducing measures may
lower the risk of infection
from Music & Theatre
activities, a risk made
greater by the increased
number of aerosols
emitted through loud
speech, singing, and,
potentially, through
playing wind instruments..
Individually, everyone must have the right to
decide for themselves the level of personal risk
they will take, yet do so without increasing the
risk for others and while preserving unity within
their department and educational community
33
Music Education Partnership Group
Naunheim
et al.
June 2020
Scientific research has not examined
safe singing practices in relation to the
risk of SARS-CoV2 transmission. The
evidence that exists is based on prior
viral outbreaks and situations that may
or may not translate to various singing
environments. Each individual
community of singers and performers
must do what it can to mitigate as much
risk as possible and then decide if that
risk mitigation of SARS-CoV-2
transmission is sufficient to resume
each singing activity considered, taking
into account all of the factors discussed
above.
It is likely the risk can be mitigated with certain
practices, but risks cannot yet be eliminated.
Nelson
April 2020
Blog
Researchers are still not fully in
consensus on whether the SARS-CoV-2
can be transmitted as a live virus in
aerosol. It takes time to thoroughly
study a topic. Good science just takes
time. For now, results are conflicting,
and there’s not enough of a body of
data yet to get a good lay of the land.
However, the most recent research
from the New England Journal of
Medicine relays data that the virus can
remain viable in aerosol transmission for
up to three hours.
It may be more likely that an outdoor space, still
with appropriate physical distancing, could be a
safer way to meet
Neustaeter
May 2020
Online
news article
"The act of singing, itself, might have
contributed to transmission through
emission of aerosols, which is affected
by loudness of vocalization," the report
said. The CDC report also said that
some people, known as superspreaders,
release more of these particles during
speech than others.
If I had to sing in a group, I would do it outside,
and I would pay attention to wind direction to
avoid being downwind of people in the group,".
Furness added that group members could also
be widely dispersed in a large room, however
he recognized that that can pose challenges for
ensemble work and staying in tune. For now, he
said singers should stay home and skip in-
person rehearsals
Read
June 2020
Online
news article
The researchers say that the
coronavirus can spread in respiratory
aerosols, which may linger in the air for
an hour or more, floating farther than
the six feet commonly prescribed for
social distancing..
They say that choir
members are particularly
vulnerable to infection
from airborne particles,
because they exhale and
inhale deeply to sing,
often at close quarters in
poorly ventilated rooms
34
Music Education Partnership Group
- brass &
woodwind
Brandt
2020
Emission of aerosol measured from brass
and w/w instruments very low, and almost
at same level as background
concentrations. Other experiments have
shown very little airflow and very small
aerosol concentrations at short distances
from brass and w/w
-
Eiche
June 2020
Less aerosols are released when playing
wind instruments than when speaking. no
or practically no additional aerosols are
produced in the instrument which would
aggravate the problem. On the contrary,
it seems that the aerosols get stuck in the
instrument and that the instrument works
like a filter.
The louder and more
expressive the speech, the
more aerosols are
excreted.
Singing loudly or softly
makes only a small
difference and for many
singers the emission was
even lower when singing
loudly than when singing
softly.
Social distancing and hygiene measures Wind
players can be treated in the same way as all
other members of the orchestra, i.e. keep the
same distance. It should be noted that for the
winds the "emission point" is the instrument and
not the person's mouth. - The same applies to
the singers.
-
Kahler &
Hain
May 2020
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).
-
Kazushi
June 2020
Online
article
‘The wind instrument tests showed that
players make less spray during a concert
than they do in daily conversations before
and after the concerts and in daily life’
‘[The results] showed much less strength
and speed in the aerosol from the wind
instruments compared with the results
from the European orchestras’
When Professor Okuda measured the
aerosol of the wind instrument players,
there was a strong result when the
measuring instrument was close to their
mouths, but it was less than that of the
male singer. The wind instrument tests
showed that players make less spray
during a concert than they do in daily
conversations before and after the
concerts and in daily life.
After this test the brass instruments
played the Fanfare from Dukas’s La Péri
with the 1.5m distance, and a very big gap
between the fourth horn on the left side
Dr Kunishima was surprised by the tests,
because they showed much less strength and
speed in the aerosol from the wind instruments
compared with the results from the European
orchestras. He suggested that this might relate
to the difference in humidity of the air in Japan
the air in Europe is much drier than in Japan.
35
Music Education Partnership Group
and tuba on the right side almost 8m
from right to left. They couldn’t see each
other well and were not able to play
together, even though they knew the
piece well and the first trumpet gave clear
signs. We positioned them slightly closer,
which was clearly better, but it was still
difficult to blend the sound and be exactly
together. Finally, they were positioned at
1m and adjusted themselves superbly
-
Lai et all
2011
Aerosols play an important role in the
spread of communicable diseases [1], [2].
Aerosol transmission can be airborne,
where contaminated droplet nuclei
exhaled by an infected individual are
inhaled by a susceptible individual.
As far as we are aware this is the first
report in the scientific press regarding the
issue of aerosol dissemination by the
vuvuzela and no epidemiological data
regarding impact of the instrument on
disease transmission have been reported.
Similarly there have been no reports of
disease transmission from sharing
vuvuzelas, or from transfer of non-
aerosolized respiratory secretions that
collect inside the instruments.
-
Lebrecht
June 2020
Online
article
University of Iowa Hospitals and Clinics,
has been working on a full assessment of
the risk of spreading COVID-19 by playing
brass and woodwind instruments.
Together with his colleague Dr Henry T
Hoffman, Dr Schwalje, who is himself a
wind player, has written this paper for
publication in medical journals.
The risk of aerosol
production posed by wind
instrument performance is
not known, though there
are several indications
that it might exceed
background risk of
COVID-19 transmission.
Studies on this risk, and
the effectiveness of risk
mitigation strategies, have
not yet been completed.
Acknowledging the risks and attempting to
mitigate them is important but should not lull
musicians into a false sense of security.
Unfortunately, the available scientific evidence
is too scant to reliably inform decisions about
risk mitigation strategies for wind musicians.
Musicians should be empowered to make their
own decisions based on their individual risk
tolerance. Leaders should be cautious in their
representations of risk and clear about
uncertainty regarding the efficacy of risk
mitigation strategies.
36
Music Education Partnership Group
-
Miller et al.
May 2020
Proposal for
study
The risk of COVID-19 infection from
droplets and aerosols generated by
playing band instruments could be
significant. This study is needed to better
understand potential risk and how to
mitigate the risk so that musicians can
return to playing and music students will
be able to continue playing in school
bands, practicing and performing.
-
Public
Health
Ontario
July 2020
To date, there is no evidence that wind
instruments increase the risk of COVID-
19 transmission, either through the
expulsion of infectious respiratory
droplets or transfer of fomites from the
wind instrument.
There is evidence that the act of singing
may generate droplets and/or aerosols,
however, the degree to which this
contributes to the risk of COVID-19
transmission is unclear.
There is evidence that playing wind
instruments may generate droplets and/or
aerosols, and that instruments themselves
could become contaminated with
infectious pathogens. The degree to which
this contributes to the risk of COVID-19
transmission is unclear.
-
Raybaud
March
2020 Blog
For wind instruments, a fine felt at the mouth
would only slightly affect the sound quality and,
on the other hand, would allow the expired air
to be filtered. Partitioning with these musicians
would be necessary. Sterilization by UV C and
OZONE lamps at the end of the show will be
very useful.
-
Roberts
May 2020
Online
article
Article on PPE coverings for brass and
woodwind musicians, in preparation for
concerts to return post- lockdown. For
trumpeters, the team have designed a face
mask with an opening in the middle for
the musician to make contact with the
mouthpiece, as well as a closed covering
for the bell to reduce the risk of
transmitting of droplets while playing.
37
Music Education Partnership Group
-
Roseburg
Chamber
June 2020
Guidance
doc.
Activities that include brass or woodwind
instruments should increase physical distance as
these instruments may disperse respiratory
droplets farther than 6 feet.
-
Santa
2020
Product
project
webpage
The current COVID19 crisis is bringing into
question the safety of musical rehearsal and
performance. Current governmental
suggestions for containing viral transmissions
do not specify precautions for environments
such as wind sections of orchestras or bands
which have humans emitting air at high
velocities.
A current product on the market, the Win-D-
Fender ™, is a flute accessory developed to allow a
flutist to perform outdoors by blocking the
disturbance of outside air (wind) which easily
disrupts the flutist’s airstream thus impairing sound
quality.
-
Sixto
2020
Online
article
There are many forthcoming studies in the
near future to gather stronger evidence.
Although, it is encouraging that these
preliminary results reported from
Bamberg regarding aerosols presume that
some wind instruments are not as
contagious as we originally thought.
However, social distancing will not go
away anytime soon. It is still strongly
recommended.
-
Schwalje &
Hoffman
June 2020
It is more important than ever to read
studies and guidelines with a critical eye
and keep in mind the basics of scientific
inquiry. A scientific study would cite
sources, would be peer reviewed, in the
case of COVID-19 would have the input
of a physician or infectious disease
specialist, and would be clear about who is
producing the study and any conflicts of
interest. The ability to replicate results is
crucial, though this aspect of scientific
inquiry can take time. Musicians who do
rely on the conclusions of non-
reproducible studies might underestimate
either the risks of their activities or the
uncertainty involved in assessment of
these risks. Unfortunately, there are
several recent, widely-circulated,
pseudoscientific assessments of risk and
risk mitigation strategies for wind
musicians. The good news is that there are
several scientific studies on these
questions also, most of which are still
ongoing.
The risks of wind playing
in the COVID-19 era are
unknown. There is a
possibility, currently being
studied, that the risks of
wind playing and
associated behaviors are
greater than baseline risk
of spread of COVID-19.
This has wide
ramifications as programs
are attempting to re-open.
Acknowledging the risks
and attempting to
mitigate them is important
– but should not lull
musicians into a false
sense of security.
If we assume there's no risk, or if we assert that
unstudied risk mitigation procedures work, then
people can’t make an informed decision about
whether to put themselves in those potentially
risky situations. Also, if there is at least an
acknowledgement of risk, then those who are at
greater personal risk from COVID-19 (the
elderly, those with comorbidities, etc.) may be
able to seek accommodations for risk mitigation
from their local governments. In the US, for
example, this might be accomplished through
the Americans with Disabilities Act (EEOC).
38
Music Education Partnership Group
-
Toronto
Public
Health Plan
March
2007
Guidance
During an influenza pandemic, schools should
consider suspending the use of shared wind
instruments due to the possibility of indirect
transmission of the virus. Schools that continue
the use of wind instruments during a pandemic
must ensure mouthpieces and sections of the
instrument that may contain/retain saliva are
properly cleaned and sanitized in accordance
with school protocols. Hand hygiene should be
practiced following the use of wind instruments.
39
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