Research and guidance on COVID-19 and musical activity

This page assembles all the information we have found in one place to make it easier for you to refer to. It will never be complete, as new research and guidance becomes available all the time. So do let us know when you come across something not listed here and we will add it.

This page was last updated 6 October 2020

Research available now

  1. Research - general
  2. Various practical music-related studies (mostly in German)
  3. Ventilation
  4. Miscellaneous
  5. Face coverings
  6. Aerosol transmission

Guidance

  1. Guidance issued by other countries to amateur music groups
  2. Specific and entire guidance - Republic of Ireland

 

Research - general

Most comprehensive collection and analysis of research available with relevance to the playing of music in any context (teaching one to one or groups, professional or amateur ensembles), with risk management measures for mitigation suggested. Includes four pages of links to other research.

  • Paper by Prof Martin Ashley, trustee of the Association of British Choral Directors (abcd), summarising research, there’s also a summary, and a separate sheet on aerosols (see also below).
  • Prof Martin Ashley’s follow-up paper – First Choirs Standing – is now available: what risks were taken by choirs returning early to singing during the 2020 Covid pandemic, how were the risks managed and what were the outcomes?  Download this paper here.
  • This eagerly awaited US performing arts aerosol study has some preliminary recommendations, which are really useful.
  • A webinar from Australia is very interesting on transmission and research.
  • Here is an episode of Inside Health (BBC Radio 4) with Prof Jackie Cassell on singing (17 minutes in approx.).
  • The European Choral Association has a useful document with links to a lot of research and guidance in other European countries, as they have nearly all now resumed amateur music activity.
  • For anything to do with music for young people, in schools or outside, see the Music Mark resource pages
  • An evidence review by the Canadian National Collaborating Centre for Environmental Health. 
  • Research about the Skagit County choir event (which has become well known as originating a lot of cases). It is in fact likely to have been caused by a combination of factors including long rehearsal, close proximity of singers, 75% of singers over age 65, attendance of symptomatic Covid-19 sufferer, lack of ventilation in room, snack sharing and touching the same surfaces (chair stacking), all 3 hospitalised cases had two or more underlying health conditions. The report surmises also (as other studies do) that some people may emit more aerosols than others when speaking or singing. Creating the terms ‘super-spreader’ (for an infectious high-aerosol emitting individual) and ‘super-spreading event’ (for an event which combines a number of high risk factors: crowds, proximity, sharing of surfaces, etc).
  • 'Comparing the Respirable Aerosol Concentrations and Particle Size Distributions Generated by Singing, Speaking and Breathing,' is research supported by Public Health England and the Department for Digital, Culture, Media and Sport (DCMS), and carried out by a collaborative team from Imperial College London, University of Bristol, Wexham Park Hospital, Lewisham and Greenwich NHS Trust and Royal Brompton Hospital, including 'Voice Doctor' Declan Costello.
  • The ISM bring together of lots of research and guidance, including for music education.

Various practical, music-related studies (mostly in German) 

Ventilation

  • A German study (available in German only) looks at the risks associated with different kinds of rehearsal rooms, recommends mechanical ventilation over windows/doors, that rehearsals be kept to less than 2x 30 mins with at least 15 mins ventilation in between where everyone leaves the room. Also emphasise social distancing and small size of group. 
  • study on the role poor ventilation in enclosed spaces plays in increased transmission.
  • Another study that highlights why ventilation is important in indoor environments to minimise infection via aerosols.
  • A study that examines the theory that in naturally ventilated indoor environment to minimise infection via aerosols exposure should be less than 20 minutes.
  • This new paper looks at ventilation for buildings and includes a section on wind/brass and singing as well 
  • The Chartered Institution of Building Services Engineers (CIBSE) has published this guidance looking at why indoor ventilation is important to reduce Covid-19 cases, as well as recommendations to improve ventilation naturally and mechanically.
  • See also this practical guidance from Music Mark

Face coverings 

Aerosol transmission

Extract from Cornell University's paper, 'The ventilation of buildings and other mitigating measures for COVID-19: a focus on winter 2020'. Download the PDF version.

  •  A Cornell University paper by Alison McMillan et al provides advice for ventilation during the coming winter, plus an appendix on singing and musical instruments.
  • This page from the Netherlands assembles all research to be had on this subject
  • Eagerly awaited PERFORM study by Declan ‘The Voice Doctor’ Costello et al. Notable quotes are below:
    o    ‘At the quietest volume, neither singing or speaking were significantly different to breathing. At the loudest volume, a statistically significant difference is observed between singing and speaking, but with singing only generating a factor of between 1.5 and 3.4 more aerosol mass.'
    o    'Guidelines should create recommendations based on the volume and duration of the vocalisation, the number of participants and the environment in which the activity occurs, rather than the type of vocalisation. Mitigations such as the use of amplification and increased attention to ventilation should be employed where practicable.’
    o    ‘…for indoor events measures to ensure adequate ventilation may be more important than restricting a specific activity.’
  • This editorial in the British Medical Journal summarises the science behind the airborne transmission of Covid-19. Also see this article published in Time magazine.
  • Several studies reference that different activities may lead to different levels of aerosols being emitted – sitting quietly, speaking/singing/shouting, exercising all have various levels, but they are all significantly lower than sneezing or coughing. See this Danish study.
  • This study researches which direction and how far aerosols spread from wind/brass/singing. 
  • This study (German only) also talks about how aerosols are thought to penetrate further into your lungs when inhaled than droplets.
  • And this study (German only) examines how the louder the volume, the greater the emission of particles.
  • This study from 2019 discusses aerosol transmission.
  • Also unknown at present, is how long a dangerous amount of aerosol can survive in the air in an enclosed room if there is no ventilation. See for instance this study.
  • See this study with interesting photos of Vienna Philharmonic members breathing against a black background, back in May. And even better, here are singers’ breaths visualised, commissioned by the Austrian Choir Association.
  • This is an excellent article summarising most of the aerosol transmission discussions.
  • And for something different, here is an interactive explanation about how pandemics spread.
  • This study from Germany confirms the higher emission of aerosols when singing (compared to speaking) and even higher for louder singing, but also says that ‘comprehensive information on the transmission quantity and survivability of SARS-CoV-2 viruses in aerosols is still missing’, and that ‘there is a lack of data on whether specific breathing characteristics of singing (deep inhalation, higher intrapulmonary pressures) influence the risk of transmission when singing loudly.’
    o    Includes lots of references to other interesting research
  • Article in the British Medical Journal calling for an urgent need to recognise aerosol transmission as a significant route for Covid-19 infections and for more research. Notable quotes below:
    o    ‘Inhalational risk may be reduced by social distancing, limiting interaction indoors, avoiding air recirculation, improved natural and artificial ventilation, and innovative engineering solutions which collect and neutralise aerosols to provide clean air in personal and community spaces.' 
    o    'The infection risk associated with deep breathing, talking, and singing indoors is underappreciated and urgently needs attention.’

Miscellaneous

  • A German team examine how CO2 concentration relates to presence of other aerosol particles in a room (so therefore how measuring CO2 could help estimate likelihood of virus concentration and thus danger levels).
  • Some researchers have actually come up with a spreadsheet calculator which can help you work out how large your room and how short your rehearsals should be. Download it in Excel and experiment with the ‘master-choir’ tab.
  • You can also download also this PDF version of a calculator, and this German PDF calculator.
  • Interesting research from Japan on how to re-shape the orchestra on stage
  • Many studies reference the fact that transmission appears to be very low outdoors and negligible when social distancing is maintained outdoors; this indoor transmission study focuses on this.
  • Brass Bands England have published results of a study into how covering the bells/ends of brass/wind instruments mitigates the emission of aerosols and droplets.
  • Interesting research on the after effects of Covid-19 and includes a personal risk assessment and risk calculator for individuals
  • This study from Italy concludes – teachers rejoice – that asymptomatic children (<18) are far less likely to be Covid-19 spreaders than asymptomatic adults (>18).
  • This study examines why Covid-19 is spreading less in less densely populated areas:
    o    ‘People will be equally social regardless of population density, but when population density is lower, the groups that they spend time with will be less diverse. The number of possible unique contacts for each individual declines linearly with population density. 
    o    Rural communities – you are safer. Everyone: limit the number of people you interact with closely.  
  • This study analyses data from 45 countries representing 85% of the world’s population and concludes dramatically that Covid-19 fatality case rate (i.e. how many infected people die of the disease) is higher in well-off countries, with explanatory factors being higher life expectancy, greater co-morbidity (i.e. they have better health care systems who look after people with diseases well and keep them alive for longer), and higher levels of obesity. Acute lack of Vitamin D also seems to be a common factor.
  • This study examines the percentages of IFR (infection fatality rate) in different age groups, concluding: ‘The estimated IFR is close to zero for children and younger adults but rises exponentially with age, reaching 0.4% at age 55, 1.3% at age 65, 4.2% at age 75, and 14% at age 85. We find that differences in the age structure of the population and the age-specific prevalence of COVID-19 explain nearly 90% of the geographical variation in population IFR. Consequently, protecting vulnerable age groups could substantially reduce the incidence of mortality.’  
  • This study states bluntly that epidemiological forecasting has failed – the predicted millions of deaths predicted early on have not materialised. Not surprising in the early stages of a pandemic when much is unknown, but becoming more unforgivable as data become available and much more targeted measures could be introduced, rather than blunt instruments such as total lockdowns. ‘Extreme case predictions for COVID-19 deaths should be co-examined with extreme case predictions for deaths and impacts from lockdown-induced harms.’
    o    And in a plea for more consideration, rather than mathematical panic-modelling: ‘Being more cautious does not mean acting indecisively, but it requires looking at the totality of the data; considering multiple types of impact; involving scientists from very different disciplines; replacing speculations, theories and assumptions with real, empirical data as quickly as possible; and modifying and aligning decisions to the evolving best evidence.’
  • Wowza. This research says there may be a lot more immunity to Covid-19 than originally assumed due to the helpful presence of T-cells, therefore herd immunity may be achieved at levels of 10-20% of the population (rather than the 50%+ originally assumed). ‘The research offers a powerful reminder that very little in immunology is cut and dried. Physiological responses may have fewer sharp distinctions than in the popular imagination: exposure does not necessarily lead to infection, infection does not necessarily lead to disease, and disease does not necessarily produce detectable antibodies. And within the body, the roles of various immune system components are complex and interconnected.’ 
    o    So will there be a second wave and/or will it really be that large? It seems the scientific community is not sure. ‘Could pre-existing immunity be more protective than future vaccines? Without studying the question, we won’t know.’ More research needed!
  • You think you can get crystal clear guidance from scientists? Well, think again – this correspondence illustrates that even scientists at times hold different views. Things are never clear-cut, and science is also a matter of interpretation:
    o    See this open letter to the UK’s chief medical officers
    o    And this letter from professionals in medicine, academia and other areas and their open letter to the Prime Minister and his team.

You can use Making Music’s guidance tool to find out what the current guidelines are in any of the four nations of the UKguidance means for your nation and type of music group.

Guidance issued by other countries to amateur music groups

The Norwegian Music Council has issued practical guidance, e.g. room size, with a great poster (even without fluent Norwegian!). Use Google Translate.

This webinar from Gondwana Choirs in Australia is about how choirs might get back to singing.

Guidelines for amateur groups in Belgium

Austria (choirs)

France (choirs)

German choir association

Guidance from one German state

Another German choir association has brief guidance (in English!)

Swiss guidance (in German)

The Berlin Senate enables choir rehearsals and performances to resume (read guidance from Berlin Choir Association in Germanarticle in English) 

Specific and entire guidance (Republic of Ireland)

For group singing, choirs and playing certain brass musical instruments in groups ONLY.

Choir rehearsals have previously been linked to outbreaks in a number of countries (UK, US, Netherlands, South Korea).  In addition, there is some evidence emerging that the playing of brass and some woodwind instruments (e.g. trumpets, trombones, flutes) in groups may be associated with a higher risk of infection due to increased droplet transmission or aerosol emission.  

  • Given the potential increased risk of transmission especially due to group singing, choirs, and playing brass and some wind instruments in groups, the following precautions are recommended: 
    • Choir practice, teaching and performance, brass and wind instruments music group practice, teaching and performance should be done while maintaining very strict physical distancing of a minimum of 2 metres from other people, ideally outdoors, limit duration of indoor practice, teaching and performance with frequent breaks to facilitate regular ventilation of rooms and instrument cleaning (where applicable).
    • Singers, choirs and musicians of brass and some woodwind instruments should consider protective equipment and measures to minimise the potential for droplet or aerosol emission (e.g. instrument covers, screens, face coverings etc). 
    • Where group practice or performances are organised, a risk assessment should be carried out to minimise the risk to the participants and their audience, including bearing in mind the age profile and risk factors of the participants/audience in question.

 


We hope you find this Making Music resource useful. If you have any comments or suggestions about the guidance please contact us. Whilst every effort is made to ensure that the content of this guidance is accurate and up to date, Making Music do not warrant, nor accept any liability or responsibility for the completeness or accuracy of the content, or for any loss which may arise from reliance on the information contained in it.