An annotated list of the research and news I've been reading
There's nothing fancy here. Pretty much just a list of info that I will update regularly.
Links will be loosely organized into topics, and will be listed in reverse chronological order, with the most-recently published articles at the top of the section.
Speech and Singing Research
The CDC released a review of the Skagit Valley Chorale outbreak, which posited that the social aspects of the rehearsal, such as stacking chairs together and sharing snacks may have been probably modes of transmission, while singing may have augmented the transmission. Published online May 15, 2020
Airborne particles in a stagnant air environment can be detected 8-14 minutes after speaking, making airborne transmission of virus particles from speech a "substantial" probability. I mentioned this study in Update #1, and highlighted the findings because this is very concerning. One thing I think we need to remember, however, is that most places, including church sanctuaries, are not completely air stagnant environments. However, knowing this it is important to be aware of the potential for infection from speaking, according to these researchers.
Non-peer reviewed preprint from the University of Nebraska that observes possible airborne transmission of SARS-CoV-2 from infected patients at their medication center. Available online March 26, 2020.
Aerosol emission and superemission during human speech increase with loudness.
This study in Nature from February 2019 is one of the most fundamental to helping us understand the potential dangers of our current situation.
An older article, vital lung capacity, likely from the expiratory phase of singing, is found to be significantly greater in choral singers than in non-singers. Published November 2016. (Vital capacity is the amount of air that can be exhaled after a person inhales their maximum amount. It can be measured in multiple ways. For an explanation of the different types of lung capacity, click here.)
The most powerful argument for the use of masks in preventing the spread of COVID-19 happened right here in my hometown. Two hairstylists who were positive treated nearly 140 clients while wearing masks, and no clients became ill. Something not included in this report but reported by local media is that the first stylist visited an urgent care when she initially showed symptoms and was misdiagnosed as having allergies, and cleared to work. She was later found to be positive, and she infected the second stylist.
Masks Against COVID-19: An Evidence Review
Non-peer reviewed preprint, available online May 13, 2020
Masks are found to be effective in preventing the transmission of COVID-19. Fabric masks are recommended in order to keep surgical masks available for healthcare workers.
The Missouri Commission for the Deaf and Hard of Hearing is producing masks for interpreters who need their mouths to be seen. Free of charge if you live in Missouri.
From 2014, NIOSH (the research equivalent of OSHA) studied the efficacy of face shields protecting health care workers against droplets and aerosols. In this short video, one of the study authors describes how face shields can be very effective for large droplets, but not as effective for aerosols that can swirl in the air and flow around the face shield.
An excellent interview with Dr. Shelly Miller from UC Boulder regarding indoor air quality and filtration. Broadcast on July 15, 2020.
Schlieren test showing a speaker reciting the alphabet.
From the L.A. Times, scientists are urging the WHO to agree with their assertion that SARS-CoV-2 can be spread by airborne means. Published July 4, 2020.
Podcast: "Connection: The Future of Choirs and Singing During the Pandemic" released June 25, 2020. Not a lot of new information here, but more experiences of how others have dealt with the changes that have come about during this time. I particularly appreciate the perspective that online choirs is not a replacement, but an expansion. At 35:12 a callr gives her experience of being five weeks into recovery from COVID-19.
Dr. Linsey Marr from Virgina Tech talks about aerosol and virus transmission with NYT science journalist Tara Parker-Pope. Note in particular the segment beginning at minute 34 discussing singing in particular. Broadcast June 15, 2020.
My own personal laryngologist, Dr. Lee Reussner in Lawrence, Kansas, has made a wonderful series of videos. This first one published May 14, 2020 talks about the overall issue, and would be a good, brief introduction to anybody who needs just a skim over the facts to get acquainted with our current predicament.
Part 2 published May 18, 2020, is longer and Dr. Reussner answers questions that have been submitted to him. There is a great bibliography in the video description. Check out the following time stamps for particular issues:
1:00-8:00--review of data and how we currently think the disease is spread (mainly through droplets, though aerosol is still a plausible consideration)
8:00-11:20--breathing, speaking, singing, sneezing and particle spread (note 9:17 for a new study on speaking and particle spread)
11:20-12:06--Likelihood of infection equals exposure multiplied by time
12:06-13:34--some evidence of aerosol transmission and the implications it may have for churches and choirs
13:34-16:37--how long the virus lives on surfaces like music, music stands, choir robes, etc.
What Do Science and Data Say About the Near Future of Singing?
Webinar hosted by NATS, ACDA, PAMA, Barbershop Harmony Society, and Chorus America on May 5, 2020
Micro droplets suspending in air
What Other Churches Are Doing
Not a church, but the West Point Music Research Center released their rehearsal protocols for the Army Band on June 3, 2020. A PDF at the top of the article highlights their plexiglass protections.
A well thought out guide to resuming worship by an ecumenical group of clergy and lay leaders, focused mostly on liturgical worship settings. Singing is addressed specifically on page 19.
Wisconsin Council of Churches PDF on Church Music, published May 8, 2020
A news article briefly announcing preliminary results from the CU Boulder study. Published July 17, 2020.
An invited commentary published in Clinical Infectious Diseases on July 6, 2020, "It Is Time to Address Airborne Transmission of COVID-19" by Donald Milton and Lidia Morawska.
Scientists in England are studying the "spittle" produced by choristers in church. A release date of data is not given, and they quote the flawed study from Munich, but it is interesting to note that this work is being done. Congregational and choral singing has been restricted as UK churches are allowed to open to in-person services beginning July 4, 2020. This article was published Sunday, June 28, 2020.
A letter to the editor of the Journal of Nanotoxicology references prolonged gatherings, especially those that involve speaking, chanting, singing, and heavy breathing, that seem to indicate a need to study aerosolization of particles and how those particles behave in various environments. Of note, "The airborne route becomes important when being for a prolonged time in the same room as a virus carrier, especially if that person is singing, shouting or physically active, as seen during superspreading events in choirs (Hamner et al. 2020) and fitness centers (Jang, Han, and Rhee 2020) and having a high viral load in the lining liquid (Riediker and Tsai 2020)."
An infectious disease expert lists common activities and discusses their relative risk. Religious services are ranked as "high risk."
Church blogger Ken Braddy posed 24 questions you should ask before opening your church. Published April 18, 2020.
Helpful Ministry Resources
This document is a bit technical, but it is a risk estimator developed by aerosol researchers and environmnetal engineers at the University of Colorado. You need to know the volume of the room you will be in, and the air change rate for your HVAC system in order to use the estimator. Choose "Make a Copy" to save a copy directly to your computer that you can use.
The CDC Reopening Guidelines for Faith-based Organizations
The CDC guidelines for reopening schools. While this doesn't necessarily pertain to churches, the guidelines could be a helpful guide for how to work with larger groups, and with children's programs.
Webinar archive from NCCO with ideas for continuing choral music online. It's mostly from a collegiate perspective, but may have some ideas for churches.
NATS COVID Resource Page
Includes links to webinars, financial resources, best practices, etc. Updated regularly.
I found this podcast helpful and encouraging: COVID-19 and Calling.
Likewise, the next episode deals specifically with working with teams.
I think there's a lot of truth here when thinking about the hardships of ministering in this time. There's a lot of links to resources at the end of the blog.
Some excellent ideas for church music ministries on the "Church Musician's Assistant" blog. It's being updated regularly.
Several sources for choosing music during this time, in addition to links to various other resource pages.
The New York Times surveyed 511 epidemiologists (not a peer-reviewed study, just an informal survey) about when they might return to 20 normal group or public activities. The responses were broken down into rough increments, starting with this summer, 3-12 months from now, over 1 year, and never again. There was some space left for nuance, as reflected in the comments included toward the end of the article. Generally speaking, when analyzing risk tolerance for certain things, mental health and overall emotional wellness can play a factor in determining whether an activity is important enough to risk it. Published online June 8, 2020.
NCVS writers and researchers suggest turning off ambient noise, including music in restaurants and stores. Because of the Lombard Effect, ambient noise can make people speak louder without realizing it. Churches may want to consider this when thinking about pre- and post-service music when people are more likely to converse.
A collection of articles that address some legal issues surrounding reopening.
Chorolosophy Podcast Episode 36: Are we asking all the right COVID questions? Chris Munce, a Kansas City area choral director, interviewed an infectious disease doctor practicing at Research Medical Center in KCMO. Munce is a school director, and so his focus has been on school choirs and appropriate risk analysis for planning for the upcoming school year. This is a long episode, but I've given some rough time stamps below. The sound quality is a bit poor in spots. I found it a little easier from my computer speakers than from my earbuds.
5:54-17:45--Dr. McKinsey discusses some of the basics of COVID-19, including a discussion of mortality rates and CDC stats
17:45-24:39--new information as of early June. OF NOTE: at age 50 the risk of poor outcomes increases, and at age 65 the risk increases again; also current thought is that an infected person will infect an average of 2.1 other people
24:39-32:40--the process of scientific discovery, and why there is confusion and disagreement
32:40---how we can use the information we have to determine our risk
Heather in the Media
Interview with Australia Broadcasting Company "The Drum" May 11, 2020