Update #1: Singing, the Church, and COVID-19
Dr. Heather R. Nelson
Published May 20, 2020
Corrected June 5, 2020 to fix bad links
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I have been surprised by the response to my original article, and very grateful that it seems to be helping those of us that are making decisions about what our congregational life will look like as we start to gather together again. This follow up will review some of the new data that has emerged, pull in a couple of things I missed the first time around, and give a few things to consider as you are planning your path forward. As before, please let me know if there are questions or anything you think would be helpful.
You, my colleagues in ministry, are continually on my mind.
Something I Missed the First Time Around
I missed this one in my original article, but I think it’s worth including now. The author gives a really excellent explanation of why the aerosol (or turbulent gas cloud, as she calls it) can hang in the air for so long and the implications it may have for disease transmission. She rightly accedes that there is no direct biological evidence that the disease has been transmitted in this way, but the way the turbulent gas cloud works and some of the characteristics of the disease would seem to fit well together.
We’re Learning a Lot More
In the past couple of weeks, several studies of interest were released. Some of these will be published in journals later in the summer, but are currently available online as early releases. This means they have been peer-reviewed, but the official publication date is still in the future.
https://www.sciencedirect.com/science/article/pii/S2090123220300540
The CDC released a report on an incident at a German business meeting, where an infected but asymptomatic individual passed the disease to 11 of the 13 attendees. Hand shaking and close contact were thought to be possible means of transmission.
https://wwwnc.cdc.gov/eid/article/26/8/20-1235_article
My local county health director is often heard saying that “density and intensity” are the two things this disease needs to spread in a community. One thing churches do well is to gather together in larger numbers, and then hang out for a while. In my church, we are downright loud before services start because of all the hugs, handshakes, and conversations going on. The Baptists are a noisy lot. However, our pattern creates the perfect situation for disease spread if we are not careful. I had the great opportunity to talk with the Australian public television show “The Drum” about this issue and our concerns.
This really excellent early release gives a good overview of what is currently known about all broad aspects of the disease, including origin, transmission, characteristics of the virus, and possible therapeutic measures. There’s a lot here that’s worth a careful read. I’d suggest a cup of coffee to give your brain a little boost, though, because it is a bit dense.
It’s a point of frustration that we don’t know for sure if aerosol is indeed a way this disease hops from person to person. I think this is one reason why all the experts are being so careful right now. Except for computer models and experiments that are set up in a lab, we don’t have a way to collect direct experimental data with humans. Since we don’t have any reliable treatments, there are ginormous ethical hurdles that prevent anyone from studying this directly in humans through experimentation. The best we can do is make educated guesses. As anecdotal data and experimental data grow, those guesses will get better and better. Good science takes time.
The webinar hosted by NATS, ACDA, PAMA, The Barbershop Harmony Society, and Chorus America was chock full of good information. It’s really long, but the first hour has the meatiest content when it comes to the transmission of disease with regards to singing.
I’d like to point out this study in particular that illustrates why aerosol particles can float for so long. Basically, as the particles float in the air, the moisture evaporates, the aerosol becomes lighter and floats for a longer period of time, still carrying whatever viruses, bacteria, or other debris it contains. Of note, “These observations confirm that there is a substantial probability that normal speaking causes airborne virus transmission in confined environments.” (Emphasis mine, because whoa.)
What We Know About Masks and Singing
This is undoubtedly the most common question I have received, and I’ve seen lots of people in online forums asking about it, too. To be honest, we don’t know much. I have no doubt that some scrappy doctoral students are on the case as you read this, though. For now, the best thing we can do is look at what we can see with speech and masks, which, unfortunately, is still very little.
In this non-peer reviewed preprint (published online but not yet officially accepted for publication in a journal) the authors examined the available evidence on mitigating disease spread by wearing masks. Overall, they found that there is good evidence that masks can reduce disease transmission if compliance is high. Considering the need to keep medical masks available to the medical professionals, these authors recommended the use of cloth masks for the general public.
https://www.preprints.org/manuscript/202004.0203/v2
Another non-peer reviewed summary of the current thoughts on masks can be found here. While it does have some numbers and figures that can be a bit mind-numbing, generally, this document is easy to read, contains many categories of information, and highlights the things that are still under investigation. One interesting inclusion is the chart of various countries’ policies on masks. However, I think the wealth of this document is found in the extensive bibliography. There is an absolute treasure trove there.
https://rs-delve.github.io/reports/2020/05/04/face-masks-for-the-general-public.html
Of particular concern is the emerging evidence that asymptomatic carriers are the most contagious, which provides the most compelling reason for masking in public.
Researchers looked at 111 individuals infected with influenza, rhinovirus, or a type of coronavirus (not COVID-19) both with and without masks. Surgical masks were found to reduce the spread of influenza in droplets, but not in aerosols. In general, aerosol transmission of viruses was not necessarily mitigated by wearing masks, though this study had some limitations acknowledged by the authors that would warrant a further look.
Wearing masks lowers blood oxygen saturation, and the longer the mask is worn, the lower the O2 saturation goes.
https://www.sciencedirect.com/science/article/abs/pii/S1130147308702355
https://www.ncbi.nlm.nih.gov/pubmed/20420727
However, wearing a surgical mask by someone without a preexisting breathing condition is unlikely to lead to dangerous CO2 levels.
Again, no one has specifically studied how masks may affect singing, and the data on wearing masks is decidedly mixed. This remains an area that needs more study, and I suspect more will be known in a few months’ time.
I’m About to Dash Your Hopes…Sorry
There have been a couple of articles floating around discussing findings from two researchers in Munich that have described singing as a safe activity. A few of the blog posts and articles that have referenceed this hopeful-sounding pronouncement are linked below.
https://slippedisc.com/2020/05/two-munich-scientists-pronounce-singing-to-be-covid-safe/
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https://www.churchtimes.co.uk/articles/2020/5-june/comment/opinion/it-is-time-to-sing-again
https://www.theguardian.com/world/2020/may/17/did-singing-together-spread-coronavirus-to-four-choirs
The original document, also in German, can be found here:
https://www.unibw.de/lrt7/musizieren_waehrend_der_pandemie.pdf
There are some problems with this study. Hear me clearly, though. This doesn’t mean we must reject the conclusions outright, but it does mean that we must proceed with appropriate caution.
The document released by Kähler and Hain is missing some very crucial parts. Mainly, the detailed methods and results. Without these things, all we have are their conclusions, but the authors didn’t give us enough to be able to see how they came to their conclusions. That’s a very critical error, as far as science research is concerned. It’s possible more complete data will be released at a later date. And as I have already said, this doesn’t mean that we must automatically jettison these conclusions. The authors haven’t given us enough information to either accept or reject their conclusions, and so it must be held in greater scrutiny until we have more information. I would be very hesitant to make any plans based on this very incomplete document.
Steady On, Friends
There is no doubt in my mind that we are still all grieving what this means. We certainly still have more questions than answers at this point, though folks are actively looking for those answers. I’m heartened by the news of several organizations banding together to fund a study looking at the safety of singing in rehearsal halls. I think this will be incredibly important, and look forward anxiously to their conclusions. Preliminary data is expected around the end of June 2020 or so. Beyond what the research will tell us about singing and coronavirus, we’re learning so much about ourselves, our resiliency, and our deep love of our art. This is all valuable and will carry us forward.
In the meantime, the overwhelming consensus of those in the voice science world remains that it is not safe to sing together. This video from the Emory University Voice Center sums it up:
We will sing together again. And won’t it be glorious? It’s just a matter of time.
As you are guiding your congregations forward, I’m very hopeful that we all will learn so much about God and how He provides and carries us through. This time of fasting, of wilderness and quiet, may be a time of incredible growth, as well. I’m hopeful, friends. There are still so many reasons to keep singing.
We’re learning more about this virus, more about ourselves, and I hope more about God. None of this time will be wasted in the light of eternity. If I can support you in any way, please send me a message. I’m happy to answer questions and pray with you. In the meantime, take care of yourselves. Find something beautiful and something that will make you laugh every day.
Let me encourage you that our light and momentary troubles are achieving for us an eternal glory that will far outweigh our present circumstances (2 Cor. 4:17). Keep persisting. Stay faithful. Pray and sing often. Rest well. God is still good, and your calling is still valid and active. The peace of Christ to you.