Singing, the Church, and COVID-19:

A Caution for Moving Forward in Our Current Pandemic

 

Heather R. Nelson, Ph.D.

www.drheathernelson.com

Originally published April 29, 2020

Update #1 published May 21, 2020 can be found here

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I’m a music director at a mid-sized Baptist church in Missouri. We have been fortunate to have a low incidence of SARS-CoV-2 in our county so far. Our statewide Safe-At-Home order is set to expire in less than a week. With things getting ready to open back up, the church leadership and I are carefully considering what our corporate gatherings should look like, and how we should care for our people emotionally, socially, and spiritually. It’s a tall order.

 

In my “day job,” I’m a vocologist and a voice teacher with a PhD in Vocal Pedagogy and Voice Science. I have done research on the voice, and continue to read voice research in my spare time. Yes, I am just that nerdy. But it’s also riveting. The voice is one of the most wonderful creations that God has bestowed upon us, and I am endlessly fascinated with it.

 

For a couple of weeks now there have been rumblings of concern among my colleagues in the voice research world and the church world about the safety of singing together during this unprecedented time. Lots of articles and opinions are flying around. The more I read, the more I came to realize that whether I encouraged my congregation to engage in public singing when we met together again would be the most important decision I have made in ministry so far. So, I’ve compiled all the reliable research I can find on it, and distilled it into a single document. It is my hope that this work can be of some help to my friends and colleagues as we all seek to lead our people well.

 

A caveat: This is not a scholarly article, though I’m relying on my skills in reading and writing research to distill what I’ve learned into a condensed form. For the sake of time and space I’m not going to cite everything I’ve read. At some point perhaps I’ll type out my chicken-scratched bibliography to put it in a shareable form.

 

A second caveat: Research in normal times can go at a fairly leisurely pace. We are in extraordinary times, so the pace of the data coming out is fast and furious. It’s tough to stay on top of it. Some of the things I say here today may be changed or clarified as we learn more. I might miss things, and I’d be pleased if someone could point me to anything pertinent that you think I should include or consider. Excellent research is a team sport.

 

A third caveat: Some research is being released to the public before the peer review process is complete. I will be clear when I am citing things that are not yet through that rigorous process. I will also be very clear when I am stating my opinion.

 

A quick primer on the aerodynamics and mechanics

of speech and singing

 

Singing is a complex neurological, emotional, aerodynamic,      

and muscular process. For right now, we’re going to focus

just on those last two.

 

Air originating in the lungs is expelled through the muscle

action of the diaphragm and the muscles in the rib cage

(intercostals). The air can travel at varying rates of speed and

pressure based on lots of things, but for our purposes we’re

mostly thinking about voice projection and loudness.

Generally, the louder and more projected a person’s speech

or singing is, the higher the air speed and air pressure. There’s

a lot more to it than that, but that’s a good place to start.

 

As we continue, let’s just all acknowledge that while the body

is fascinating and it’s really fun to learn about it, sometimes it’s

also gross and can make us uncomfortable. That said, here we go…

 

When a person speaks or sings, air travels up from the lungs,

through the bronchioles, then the bronchi, then the trachea, up

through the vocal folds, then up through the pharynx and mouth,

and then finally exits through the lips (sometimes the nose) and

gets expelled into the outside air. Each of these body structures

is covered with a mucosal lining that makes mucous and keeps

the surfaces protected by keeping them hydrated and by

trapping foreign particles like dust, pollen, food, germs, etc.

 

The air column doesn’t travel exactly in a straight line, either, but

rather bounces around in a rather chaotic pattern. That’s related

to the acoustics of singing and speech, which is endlessly

fascinating, but it is another topic for another time.

The air that travels out of the body is not dry. As it passes all of

those structures that are covered in mucous from the mucosal lining, the air picks up particles of that mucous, including anything the mucous might be holding. I encourage you not to dwell on that fact too much, because ewww. It is important, though, as I hope will become apparent in just a bit.

 

As a person inhales and exhales, the mucosal lining stretches and sometimes breaks. Greater amounts of the mucous then travels on the air column through the vocal folds, and then gets chopped up by the vocal folds into smaller and smaller particles. It’s not a perfect analogy, but think of it a little like a bubble that is popped as it goes through a fan. The bubble doesn’t just disappear, but the particles of the bubble are chopped up into small pieces and dispersed through the air at a higher velocity on the other side of the fan.

The difference between aerosol and droplets

 

Those mucosal particles and anything else that’s in the air can be very, very small as they travel on the air column. The smallest particles in the air column are “aerosol.” These are microscopic, and we cannot see them with the naked eye. They can be as small as 5 microns in diameter. Remember that number, because it will be important soon.

 

When a person coughs or sneezes, they also emit particles of mucous and whatever else in “droplets.” Droplets are much larger than aerosol, and can be visible. Again, don’t dwell, just keep reading.

 

This is important in our current situation because of GRAVITY.

 

Because the droplets are larger, they can travel a few feet from the no-doubt penitent cougher or sneezer, and then they are grabbed by gravity and fall to the ground. If a person happens to be sick, and those droplets contain bacteria or viruses, they can infect another person if the droplets come into direct contact with that other person, or that person touches something the droplets land on and then they touch their mouth or eyes. Droplets are large enough they must be expelled from the body by force, with coughs or sneezes.

 

Aerosol particles are small enough that they can disperse from a person just from the normal act of breathing. Singing or loud speech tends to increase the aerosol cloud in size and in distance (sending aerosol from a person from 3 to 27 feet, varied by numerous factors). Also, because the aerosol particles are so small, they float in the air for much, much longer before gravity finally pulls them to the ground. And when I say much, much longer, I mean 12 hours or more in calm air. If the space where aerosol is present has an HVAC system or a draft that is moving air around, that aerosol can stay buoyant for an indeterminate amount of time.

 

https://www.cdc.gov/niosh/topics/aerosols/pdfs/Aerosol_101.pdf

 

Here’s a great 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. 

 

Here’s a video demonstration of aerosol suspension from a person.

Aerosol and viruses

 

You might recall that I said aerosol particles can be 5 microns in diameter.

For comparison, the SARS-CoV-2 particle is measured at 60-140 nanometers in diameter.

One micron (a.k.a. micrometer) = 1000 nanometers.

One 5 micron aerosol droplet is the same size as ~7 to 167 SARS-CoV-2 viruses.

 

This means that aerosols could be very, very efficient virus carriers. And because they hang in the air for hours at a time, this could be concerning for groups who are gathering in the same space and singing or talking a lot.

 

https://www.nature.com/articles/s41598-019-38808-z

 

Measles can be spread through aerosol transmission rather efficiently.

 

https://www.mdpi.com/1999-4915/8/8/210

 

It has also been shown that some people are “superemitters.” That means they emit a higher volume of aerosol than others. We don’t know why, but I’ll bet you’re thinking of someone right now who just might be a superemitter.

 

https://www.ncbi.nlm.nih.gov/pubmed/30787335

 

 

Aerosol and SARS-CoV-2: A whole lot of questions

 

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.

 

https://www.nejm.org/doi/10.1056/NEJMc2004973

 

Earlier research seemed to indicate that while aerosol transmission was possible in laboratory, it was less likely to be spread through aerosol in real world conditions.

 

https://jamanetwork.com/journals/jama/fullarticle/2763187?

https://jamanetwork.com/journals/jama/fullarticle/2762692

https://www.cdc.gov/mmwr/volumes/69/wr/mm6909e1.htm

 

Late last week (April 24, 2020) a White House official showed a slide in the daily press briefing that discussed the half-life of this virus in conditions of varying sunlight and humidity. An interesting inclusion on the slide was the last two lines, which showed the half-life of this virus in aerosol transmission.

(Photo: Alamy Live News)

 

In this slide, which contains research from a paper that has not been peer-reviewed or published yet, the virus seems to have a half-life of ~60 minutes in an environment with generally low humidity and no direct sunlight. Half-life means that after ~60 minutes half of the virus is dead or ineffective. In another ~60 minutes, half of the remaining would be dead or ineffective, and so on.

 

As an illustration:

 

Time 0 (minutes): 1000 viruses in the air

T60: 500 viruses in the air

T120: 250 viruses in the air

T180: 125 viruses

 

And so on…

 

Relatively low humidity with no direct sunlight describes most of our sanctuaries. If this slide contained results that can be validated through repeat studies, it suggests that live virus could be in aerosol clouds in the air for hours after a person stops singing or talking. Because the full paper is not yet available to the public for scrutiny, this is data that should be considered, but it has not been independently verified. I’m keeping an eye out for this paper, though, because I think it could be very important and I’ll update as soon as the full text is available.

 

A note on sunlight killing viruses: Sunlight is composed of an array of UV light. There is UVA, UVB, and UVC. UVA and UVB light are both dangerous for skin exposure, which is why I have sunscreen available to me all over the place. UVC light seems to be the type that is most toxic to viruses. However, UVC light is mostly filtered out by the ozone layer of our atmosphere, so very little of it reaches the surface of the earth. This may mean that being outside is not enough on its own to kill a virus on a surface. This is still being reviewed and studied.

 

https://news.columbia.edu/ultraviolet-technology-virus-covid-19-UV-light

https://www.bbc.com/future/article/20200327-can-you-kill-coronavirus-with-uv-light

https://en.wikipedia.org/wiki/Ultraviolet_germicidal_irradiation

 

What we know about singing and disease transmission

…and what we don’t know yet

 

Fifty years ago scientists looked at the spread of tuberculosis in an industrial school, where those who were in choir with an infected individual had a higher rate of catching the disease than those who interacted with the individual outside of singing events. Granted, this is a case study of a single individual in a single location, so it is not able to be verified through repeat measures like other types of studies. However, the study was rigorous and has been cited by other scientists numerous times, which attests to its reliability as a good study overall.

 

https://www.atsjournals.org/doi/pdf/10.1164/arrd.1968.98.2.297

 

Scientists have posited that “superemitters” may also be “super spreaders,” being able to more efficiently send viral and bacterial particles into the air at a greater velocity and greater distance than their peers.

 

https://www.nature.com/articles/s41598-019-38808-z (I’ve cited this article already, but it bears repeating.)

https://www.cidrap.umn.edu/news-perspective/2013/02/study-airborne-flu-viruses-may-play-big-role-transmission

 

It has also been shown that vowels emit a greater number of aerosol particles in speech than do consonants, and that voiced plosive consonants emit more than unvoiced fricative consonants. And what do we do in singing? We elongate the vowels. Much, much longer than in normal speech patterns.

 

https://www.ncbi.nlm.nih.gov/pubmed/31986165

 

Churches have been identified as the source of outbreaks around the country and around the world.

 

https://www.redding.com/story/news/2020/04/07/pastor-redding-church-covid-19-outbreak-talks-handling-crisis/2965697001/

 

https://www.kansas.com/news/coronavirus/article241810656.html

 

https://www.kait8.com/2020/03/24/cleburne-co-covid-outbreak-linked-church-outing/

 

There is also a tragic story of a choir who held a rehearsal in early March and later experienced an outbreak among members, and others who contracted the disease after a choir rehearsal.

 

https://skagitbreaking.com/2020/03/27/covid-19-virus-devastates-skagit-valley-chorale-group/

https://www.kxly.com/western-washington-woman-shares-what-it-was-like-to-catch-covid-19/

 

We don’t know, honestly, if it was the singing that created an environment for this disease to spread. We also don’t know that it didn’t. This is a gap in our knowledge that is still being studied. It will likely be years before we have a firm grasp on this with enough data to have confidence in the conclusion one way or the other. That’s a big bummer, to be honest, but it is not the top of the research priority list and I understand that.

 

We don’t know that this particular virus can be transmitted through speaking or singing alone, or whether it needs to be in larger droplets, or transferred directly into a person’s mouth or eyes. These are all questions still being studied, and this information is likely to change rapidly as we try to get a handle on things.

 

All of that said, there seems to be a growing body of evidence that singing, talking, breathing, and laughing are possible ways to transmit disease.

 

https://hartfordhealthcare.org/about-us/news-press/news-detail?articleid=24686&publicId=395

 

What about masks and physical distancing?

 

There are suggestions now that masks can reduce (but not eliminate entirely) aerosol and droplets emitted from a person who speaks or sings. Masks, of course, can also reduce the aerosol a person breathes in from their environment, though children have less benefit of this compared to adults.

 

https://www.nature.com/articles/s41591-020-0843-2

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2440799/

https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html

 

Wearing masks of any type is not recommended for everyone. It can be difficult for those with claustrophobia or breathing problems. Masks make communication more difficult for those who are hard of hearing and rely on lip reading. Churches may not legally be able to require that every person has to wear a mask in the building. The policy on masks should be considered carefully by each church before they proceed, in my opinion.

 

With regard to physical distancing, because aerosol can spread so far

and long, there does not seem to be any amount of physical distancing

in an indoor space that can mitigate aerosol spread. If an infected

person sings in a sanctuary, and 20 minutes later at the conclusion of

the service an uninfected person walks 10 feet in front of where the

infected person was sitting, there is a high plausibility that the uninfected

person would breathe in virus particles from the aerosol still hanging in

the air.

It may be more likely that an outdoor space, still with appropriate physical distancing, could be a safer way to meet. Some states have allowed this, while others have not. In talking with worship leader colleagues around the country, outdoor and drive-in meetings have been a mixed bag. Some congregations did great at following the guidelines put forth by leadership, and others did not. Some problems mentioned included members who would park their cars close and roll down windows to talk to one another, members getting out of cars and walking to other cars, members using the bathrooms in groups, and members hanging around after services had concluded so they could congregate together. Other considerations not related to physical distancing included the difficulty in creating a good sound quality to transmit to people sitting and listening. Again, another topic for another time, but worthy of consideration if this is an avenue you would like to consider.

What do I think this all means?

 

The gist: For now, it is not safe to sing together. And we should be very cautious when talking to one another.

 

There are still a lot of questions, and many things we don’t know about SARS-CoV-2. However, there is a great deal of consensus among my colleagues around the country who are voice researchers, SLPs, and voice teachers. We are almost all in agreement that singing together now is not safe enough. Most of us will not have voice students in our studios for a while, and I can’t tell you how sad that is. Teaching voice lessons online is a very viable way to practice my profession, but online church is not quite the same.

 

There are a few dissenting voices. And dissenting views that are well-articulated and backed with evidence should be carefully examined. I will say that for my part, I am not convinced by the contrary opinions. I do not believe they hold as much water as the evidence I’ve shared above. That said, with everything taken together, I would much rather be overly cautious and eventually be proven to have overreacted than to create a situation where I later found I put people in harm’s way. This is something that has weighed very heavily on me in recent days. It’s robbed my sleep and brought me to tears. I do not take this lightly.

Christians are a singing people. We are social and loving in my particular congregation, and I know the lack of physical touch and togetherness is very, very hard on many of them. However, until we know more about the aerosol survival rate of SARS-CoV-2 particles, I would urge us all to be cautious and avoid putting our congregations at risk. I love these people, and I want them to be safe.

 

And I get it. THIS IS HARD! I am a singer, and I want to sing together with my people! I miss it, even though I am privileged to be able to share songs with them via electronic media in this interim. I am likely to get angry and sad comments from some in my congregation who will not understand the decision to keep our singing private. I am not looking forward to that, but I hope I can love them well through this difficult time.

 

I am not insisting that this means we should not meet publicly at all. That’s going to be a very serious discussion that every church’s leadership needs to undertake prayerfully and wisely. I do think the emerging body of research suggests we meet together with increased caution, even if we are just speaking to one another. I think it could actually be an amazingly instructional time for us as churches to dive more deeply into what worship means besides singing in our public gatherings. We can worship with preaching, testimony, prayer, contemplation…all things that are true worship that just happen to not be set to music. I think it can also be a wonderful opportunity to take music out of the church building and put it back into homes. As a worship leader and a music educator, I have long wanted to empower people to use music in their home lives, making music on their own for worship and entertainment. Too long we’ve left the music to the professionals, and this could be a wonderful opportunity for the church to sing everywhere.

 

These are interesting times, and we all have a great deal to consider as we make decisions that honestly could have very serious implications. It is my hope that we are informed, wise, prayerful, and loving in our decision-making.

 

Whatever you decide, friends and colleagues, may God be glorified and exalted through our decisions as we follow Him. He is not surprised that any of this happened, and He knows what we need to do. May we not run ahead, may we not walk beside, but may we be close behind the Shepherd, following His leadership the whole way home. The peace of Christ to you all.

© 2020 by Dr. Heather R.Nelson. Proudly created with Wix.com

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