Aerosols and droplets in church – breathing, speaking, shouting and singing

“Never Sing Louder Than Lovely

 Isobel Baillie, 1895 –  1983

On Monday 17 August, the Church of England published its latest tranche of COVID-19 guidance; these eight updates were made “particularly in light of changes to government advice on choirs singing during services”. The Church Times observed: “It is not yet clear which of the scientific studies of droplet transmission commissioned by the Department for Digital, Media, Culture and Sport gave the Government confidence to “reconsider appropriate mitigations”. Some of these questions were answered on 20 August with the posting of the pre-peer review preprint of PERFORM project set up by Declan Costello, following which the Church of England and the RSCM sought further guidance from government.

Background

The Church of England’s COVID-19 Advice on the Conduct of Public Worship, version 2.2 was issued on 17 August, with version 2.3 on 19 August which included a link to the resources produced by the Royal School of Church Music (RSCM). The Church advice was an adaptation of the MHCLG guidance COVID-19: guidance for the safe use of places of worship and special religious services and gatherings during the pandemic. With regard to singing, the revised MHCLG document indicated that it was now permissible for both professional and non-professional singers, and for musicians, to perform in small groups to people inside and outside of buildings in line with the recommendations for physical distancing and hygiene set out in the Department for Digital, Culture, Media & Sport (DCMS) guidance Working safely during coronavirus (COVID-19): Performing Arts.

At the end of the week, the preprint of PERFORM trial was posted, and on 21, together with the RSCM, the Church of England issued a Press Release stating that following the publication of the PERFORM findings, they would await updated government guidance on singing in places of worship. However, it added that it was not yet known how Government guidance would be amended in light of the study.

UPDATE

The paper Aerosol and Droplet Generation from Singing, Wind Instruments (SWI) and Performance Activities by  Public Health England (PHE) and the Environmental and Modelling Group of the Environment Agency (EMG) was considered at meeting #51 of the Scientific Advisory Group for Emergencies (SAGE) on 13 August 2020, and published on 4 September. In addition to reviewing the PERFORM work, it included information on the SOBADRA, a summary of which has been added below. Extracts from the SAGE meeting report are reproduced in our post Aerosol and droplet generation from singing &c.

Comment

The PERFORM report concludes [235-244]:

“Given that speaking and singing produce numbers of particles of the same order of magnitude, and that increasing volume increases that number by orders of magnitude, guidelines from public health bodies should focus on the volume at which the vocalisation occurs, the number of participants (source strength), the environment (ventilation) in which the activity occurs and the duration of the rehearsal and period over which performers are vocalising.

For certain vocal activities and venues, amplification may be a practical solution to reduce the volume of singing by the performers. Based on the differences observed between vocalisation and breathing and given that it is likely that there will be many more audience members than performers, singers may not be responsible for the greatest production of aerosol during a performance, and for indoor events measures to ensure adequate ventilation may be more important than restricting a specific activity.”

The work was focussed on the respirable aerosol concentrations and particle size distributions aerosols produced by one individual at a time. However, the consequent relaxation of the social-distancing rules in the performing arts guidance, from 3 to 2 metres for singers and woodwind and brass players, has been acknowledged as “a big step forward”.

The findings of the PERFORM study complement the scientific information described by Dr Charlie Bell, a member of the Church’s church music sub-group, at the RSCM webinar in May, What next for the Ministry of Music in our Parishes and Dioceses?; this was reviewed in Churches during relaxation of lockdown – II. The information presented by Dr Bell was also consistent to that reported to the Scientific Advisory Group for Emergencies (SAGE), and reviewed in A sage appraisal of COVID-19. The latter concluded that there was broad agreement on many of the basic criteria:

  • the use of the Risk = Hazard x Exposure methodology in assessing transmission risks;
  • in the absence of hard science, risk assessment becomes important;
  • the use of the “2 metre” rule was supported as general guidance for outdoor situations, but not as absolute guidance;
  • the importance of personal hygiene, particularly hand washing, confirmed;
  • the EMG [Environmental and Modelling Group of the Environment Agency] considered it to be highly likely that short range droplet/aerosol and contact transmission dominate in most settings;
  • whilst there is a degree of certainty in the role of droplets in transmission, the role of aerosols in uncertain;
  • occupant density indoors is a key factor in transmission, in relation to the likelihood of an infectious individual being present and the number of occupants who may be exposed. Building ventilation also a factor.

Consequently, there appears to be qualitative confirmation of the value of much of the current advice on precautionary measures but only limited quantitative information on their practical application. At the RSCM webinar it was suggested that in view of the many variables relating to the performance of music in churches – the buildings, the choirs and the music itself – a “one size fits all” solution was unlikely and different parameters would probably be necessary to address different situations.

In this context, in August the Royal School of Church Music has outlined four Models for playing and singing in church to which members of the church music sub-group of the Church of England Recovery Group submitted contributions; it has also produced a comprehensive 11-page Risk Assessment Template for music in live services. The RCEP notes that its four models are not exhaustive but reflect some potential options that could be employed in a variety of different contexts, from worship band to robed choir, from small to large building. It recommends that these examples or variations of them be offered alongside the guidance documents to showcase some of what may be safely possible in different contexts.

Common to the above advice are a number of key messages:

  • in the absence of definitive science, it is “risk” that was being assessed, and a number of scenarios can be constructed – either specific to certain circumstances, or general with a view to supplementing them with site/situation information before they can be applied.
  • it is unlikely that there will be a “one size fits all” solution;
  • the RSCM document emphasizes: “[t]he responsibility…rests at local level – PCCs, incumbents and churchwardens”; “FAQs are intended to help…plan to resume group-led music making in church, including choirs. They are not definitive; and the key point is that you MUST undertake a proper risk assessment”.
  • Similarly, of his research, Declan Costello commented: “[t]hese results should help performers, venues and organisations to undertake their own risk assessments when deciding how to open up to performances safely”.

With regard to the request for updated government guidance, we suspect that it may be some time before this materializes, since:

  • The culture secretary, Oliver Dowden, is quoted as saying “We have worked closely with medical experts throughout this crisis to develop our understanding of Covid-19, and we have now updated our guidance in light of these findings so people can get back to performing together safely.” This suggests an acceptance that no further work is necessary;
  • places of worship and organizations involved in the performing arts have already begun to resume events involving singing &c on the basis of current knowledge and guidance, such as that produced by the RSCM;
  • in the absence of complementary research, it would be difficult to translate these experimental results to practical guidelines that would be readily applicable to a range of real-life situations. Even if additional research were undertaken, in view of the complexity of the work required, it would be some time before the results became available. 

David Pocklington


EXTRACTS FROM GUIDANCE

[1]. PERFORM project – submitted 19 August; first posted on line 20 August, (reference [i].).

An outline of the PERFORM project was  summarized in a BBC report, which explains:

“Twenty-five professional performers of different genders, ethnicities, ages and backgrounds – musical theatre, opera, gospel, jazz and pop – took part in the study that was led by scientists at the University of Bristol. They individually completed a range of exercises, which included singing and speaking Happy Birthday at different pitches and volumes, in an operating theatre where there were no other aerosols present. This allowed researchers to analyse the aerosols produced by specific sounds”.

Declan Costello outlined the key points of the study in a twitter thread, :

“There is a steep rise in aerosol mass with increase in the loudness of the singing and speaking, rising by as much as a factor of 20-30. However, singing does not produce very substantially more aerosol than speaking at a similar volume. There were no significant differences in aerosol production between genders or among different genres (choral, musical theatre, opera, choral, jazz, gospel, rock and pop).

Musical organisations could consider treating speaking and singing equally, with more attention focused on the volume at which the vocalisation occurs, the number of participants (source strength), the type of room in which the activity occurs (i.e. air exchange rate) and the duration of the rehearsal and period over which performers are vocalising.

Based on the differences between vocalisation and breathing, and the likely difference in the number of performers and audience members in many venues, singers may not be responsible for the greatest production of aerosol during a performance; ways to ensure adequate ventilation in the venue may be more important than restricting a specific vocal activity. These recommendations will add to the research that can more towards allowing live musical performances and the safe distancing of performers and the audience during the COVID-19 pandemic.

These results should help performers, venues and organisations to undertake their own risk assessments when deciding how to open up to performances safely. In the UK, @CommonsDCMS have already made changes to the restrictions around singing and wind/brass playing. www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/performing-arts “.


[2]. Department for Digital, Culture, Media & Sport (DCMS) guidance, updated 13 August

Working safely during coronavirus (COVID-19): Performing Arts.

This document includes guidance for a return to training and rehearsal, and managing audiences and venues or premises, in line with the law and current social distancing advice. The DCMS developed a five-stage roadmap for a phased return of activities within the performing arts, and as of 15 August, this was at Stage Four – performances allowed indoors and outdoors (but with a limited socially-distanced audience indoors). Both professionals and non-professionals i.e. those participating in performing arts other than for work purposes), or groups which include non-professionals, “should refer to this guidance for their activities”.

The scientific studies commissioned by DCSM had allowed it to reconsider appropriate mitigations, and both professionals and non-professionals can now engage in singing, wind and brass in line with this guidance. People should continue to socially distance from those they do not live with wherever possible. Venues, performers and audiences should ensure 2m distancing applies wherever possible. Social interactions should be limited to a group of no more than two households (indoors and out) or up to six people from different households (if outdoors). It also lists eight actions “which organisations should therefore consider”, including “[l]imiting the number of performers as far as possible (with non-professionals being restricted by rules on meeting people outside your home)”.


[3]. MHCLG Guidance, updated 14 August.

COVID-19: guidance for the safe use of places of worship and special religious services and gatherings during the pandemic

This guidance is of a general nature and should be treated as a guide. In the event of any conflict between any applicable legislation (including the health and safety legislation) and this guidance, the applicable legislation shall prevail. It is applicable in England alongside the relevant associated changes to the Health Protection (Coronavirus, Restrictions) (England) Regulations 2020. With regard to singing, chanting and the use of musical instruments in “led devotions”;

  • There should be no group singing by worshippers. Places of worship should take account of the Performing Arts guidance.
  • Small groups of professional or non-professional singers will be able to sing in front of worshippers both outdoors and indoors from 15 August. Singing in groups should be limited to a small, set group of people and should not include audience participation.
  • Where music plays a big part in worship, and recordings are available, we suggest you consider using these as an alternative to live singing.
  • Any instrument played during worship should be cleaned thoroughly before and after use.

In terms of congregational activity,

  • Except for the limited circumstances outlined above, people should avoid singing, shouting, raising voices and/or playing music at a volume that makes normal conversation difficult or that may encourage shouting. This is because of the potential for increased risk of transmission from aerosol and droplets.
  • Therefore, spoken responses during worship should also not be in a raised voice.
  • Activities such as singing, chanting, shouting and/or playing of instruments that are blown into should be specifically avoided in worship or devotions. This is because there is a possible additional risk of transmission in environments where individuals are singing or chanting as a group, and this applies even if social distancing is being observed or face coverings are used.

[4]. Church of England Guidance, updated 19 August

COVID-19 Advice on the Conduct of Public Worship, version 2.3

17. Can we sing? 

It is now permissible for both professional and non-professional singers and musicians to perform in small groups to people inside and outside of buildings in line with the recommendations for physical distancing and hygiene set out by the Government in their performing arts guidance. This includes those who regularly volunteer to do music and singing, as part of a choir for example, to perform as a part of worship.

Congregations are still at this time not permitted to sing as part of worship.

Wherever possible people should continue to physically distance from those they do not live with, venues, performers and audiences should be matched to ensure 2m distancing applies and the number of performers should be limited.

Those assisting with worship through music or singing do not always need to wear a face covering, but face coverings or screens should be used if physical distancing cannot be maintained.

The Royal School of Church Music (RSCM) has produced more detailed resources on singing and music, which can be found here.

18. Can our worship band play?

Yes, please see the guidance on singing above and the Government guidance on performing arts. Players need to be appropriately physically distanced, and the music should not be so loud that it encourages people to shout above it.


[5]. Royal School of Church Music Guidance

 The RSCM has produced this includes:

It is significant that the Church of England Advice on the Conduct of Public Worship acknowledges “[t]he Royal School of Church Music (RSCM) has produced more detailed resources on singing and music, which can be found here“.


[6]. SOBADRA study

Details of this work are included as Annex II to the SAGE paper Aerosol and Droplet Generation from Singing, Wind Instruments (SWI) and Performance Activities. The study was conducted at PHE Porton within a small test chamber (4 m x 2.5 m x 2 m) supplied with HEPA filtered air. The study participants were ten amateur singers (PHE Porton staff; 5 female) and two professional choristers (bass; alto) from Salisbury Cathedral.

The study objectives were: i] To determine the type and concentration of oral respiratory) bacteria dispersed by volunteers; ii] to assess the impact of singing on droplet and aerosol generation; and iii] to investigate factors that could influence droplet and aerosol generation during singing.

The key findings were:

  • Saliva contains a high concentration of oral bacteria (OB);
  • OB can be detected in droplets and aerosols generated during respiratory activities, including singing;
  • Significantly fewer OB are dispersed during singing than during more ‘dramatic’ respiratory activities (e.g. coughing) and dispersion variance between individuals is high;
  • Singing does not generate higher concentrations of respiratory aerosols than talking but ‘voice’ may influence droplet dispersal;
  • Song choice could increase short-range droplet dispersal.
  • Professional singers did not disperse more OB in droplets or aerosols than amateur singers. Singing English-language choral music did not increase bacterial dispersal but singing in German did increase the number of OB deposited immediately in front of the singer, although the concentration of aerosol did not increase

References

[i]. Gregson; Watson; Orton; Haddrell; McCarthy; Finnie; et al. (2020)Comparing the Respirable Aerosol Concentrations and Particle Size Distributions Generated by Singing, Speaking and BreathingChemRxiv. Preprint. https://doi.org/10.26434/chemrxiv.12789221.v1.

This preliminary report has not been peer-reviewed;; it should not be regarded as conclusive, guide clinical practice/health-related behaviour, or be reported in news media as established information.

Cite this article as: David Pocklington, "Aerosols and droplets in church – breathing, speaking, shouting and singing" in Law & Religion UK, 24 August 2020, https://lawandreligionuk.com/2020/08/24/aerosols-and-droplets-in-church-breathing-speaking-shouting-and-singing/

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