10/14/2020

Is singing ok again? A science based update for congregations

Bishop Dillahunt and the SOS staff thank, Dr. Curt Passafume, Pharm. D. , for his continuing expertise and tracking of safety protocols as they relate to singing and other formal church activities. Below is his latest findings for rostered ministers and church councils to consider as they work together to develop a plan for indoor worship.

In what seems almost a lifetime ago back in March of 2020, the act of singing became one of the pandemic’s most widely publicized and well known “super-spreader” activities. Based on outcomes across the globe, it was quickly determined that choral or group singing as we were practicing at that time was too risky from a health science perspective. We presented information at that time that was designed to drive conversations at the congregational level around “best practices” that could be used to keep our communities’ risks mitigated, fully realizing there was never going to be a “no-risk” option. Since that time, many congregations have returned to in-person worship in some level while others have remained completely virtual. With the weather rapidly changing as we move through fall and into winter, we felt it was time to once again review what has been learned during these past eight months as we still yearn to include corporate singing back into our indoor worship activity.

The intent of this article is not to rehash the information we presented back in early spring, but rather to review new and emerging information that can help inform this decision making. The synod office has the information from the spring still available for your use if you want to review that information. Here is a summary of the current thinking around choral and congregant singing.

1. Is SARS-CoV-2 (coronavirus) an airborne disease? This issue has been bounced around since the early days. Experts across the globe have vacillated based on rapidly changing science. We moved from assumptions to early science to current science. Our best evidence to date reinforces that this virus is indeed airborne and can remain viable and infectious for up to three hours at a distance greater than 6 feet. (https://www.cdc.gov/coronavirus/2019-ncov/more/scientific-brief-sars-cov-2.html) The WHO and CDC’s most current guidance reinforce the airborne nature of this disease (https://www.who.int/publications/i/item/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations)
2. Distancing, time, and airflow remain contributing risk factors. This has not changed over time and in fact is being reinforced by emerging science. Strong use of safe distancing, significantly limiting time spent together and understanding the air dynamics of the worship and gathering spaces all are factors that must be first understood and then adhered to, so that risk can be mitigated.
   1. The scientific community is still not aligned on the issue of whether singing produces more volume and more travel distance of droplets and aerosolization. Until such time as there is scientific consensus on this issue our guidance is to err on the side of caution and place greater safe distance between singers and themselves and other occupants of the space.
   2. While there is too much variability for scientists to come up with solid recommendations on the amount of time spent together in a space it can still be said that less is better. Activities between 30 and 45 minutes are preferred but are highly DEPENDENT on the space.
   3. It is still our recommendation that the HVAC dynamics of the spaces being used be investigated and understood. If this is not possible due to age of building and equipment then our guidance remains to use greater distance, occupy for less time and when possible add supplemental external airflow to the space.
3. Face coverings have been shown to make a positive difference in risk reduction and should be included in any safety plan. A few details include:
   1. Masks for everyone involved should be the expectation. We now know that face shields WITHOUT a mask are no more effective in risk reduction than wearing nothing. This could be problematic for congregations who have adopted this approach.
   2. Masks are needed for everyone over the age of two years.
   3. There have been developed “special” singing masks. While the design is to ease the actions of singing they are no more or less effective than well designed regular masks. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/about-face-coverings.html)

So, the question remains, is it safe to sing again? The answer can be a qualified ‘yes’ if the organization is willing to follow strict guidelines and do their homework for each specific congregation, worship or meeting space and the activities wanting to be included. Here are some guidelines that could help with the evaluation. As always the synod is not able to issue any mandates nor perform specific evaluations of your programs. We are here to provide information and guidance based on what is deemed most current in science and medicine.

1. Groups must be kept small and aggressively distanced. Current information suggests 10 or less individuals spaced greater apart than the typical six feet. More could be possible completely dependent on space size and HVAC efficiency. Yes, this will prove problematic for full congregation singing and should be considered in all planning and communication.
2. Face MASKING should be considered mandatory. Review the links above on masking and deal firmly with the issue of the use of face shields without masks.
3. Rehearsals and performances should be held in the largest spaces available with as much predictable airflow as possible. HVAC and science guidelines tell us that space air exchanges of more than 8 per hour are optimal and reduces risk to the greatest degree.
4. Organized singing groups, which includes church vocal ensembles should strongly consider the use of routine screening processes before each rehearsal and any performances. This would include a short list of symptom reporting, temperature checking and if possible the use of oxygen saturation (O2 sat) monitoring.
5. Encourage a written commitment to these processes by every participating member to assure the highest level of accountability and risk mitigation.
6. Plan well and communicate often. This should go without saying but in these times of misinformation and disinformation each leadership group needs to be honest, transparent and science based to keep the risk to our members as low as it possibly can be.

A recent article that was published reported the following information concerning a wide-ranging study on this topic that is ongoing with results due out in December. “Almost immediately after the shutdown, a nationwide coalition of more than 100 performing arts groups commissioned a study of how singing, playing instruments, dancing and acting produce aerosols. Researchers at the University of Colorado Boulder and the University of Maryland released preliminary results in July and a second round in August. (A final report is expected in December.) The simplified version of the findings was that in an outdoor or well-ventilated indoor space — with performers masked and practicing social distancing — there was no greater risk of COVID-19 infection than any other activity. “What I think is different now is all of the amazing research that has been done,” said Dr. Lucinda Halstead, president of the Performing Arts Medical Association and medical director of the Department of Otolaryngology (specializing in the ears, nose and throat) at the University of South Carolina. “So now we can say with confidence, ‘If you do A, B and C, these mitigations will reduce — not eliminate — your risk.”

For those of you who remember our earlier webinar on this topic you will recognize Dr. Halstead as a trusted resource. We believe she is still a trusted resource and someone who we will be looking to for signaling based on the final report due in December.

In summary: Lutherans sing…that’s what we do. Lutheran are always also community-focused and strive to keep ourselves and our members safe. It appears there is emerging to be a position that can combine both truths into guidance that can…and should…inform our decision making and risk mitigation conversations. Let’s stay true to our roots and do both.