Persistence of severe acute respiratory syndrome coronavirus 2 in aerosol suspensions. CDC Quietly Removes Guidance That Singing In Church Choirs Comes With Virus Infection Risk. Other types of barriers may be considered in some situations to limit the spread of aerosols and droplets directly in front of a singer, such as pop shields on microphone stands.46 Other measures that have been suggested include a staggered arrangement of singers in rows, and practices such as tilting the head downwards when singing to limit projection of respiratory particles.46 Further study is needed to identify the impact of these measures on reducing risks of transmission. The American Choral Directors Association committee report from June 15, 2020 includes detailed recommendations for instruction, rehearsals and performances.47 Choir Alberta, Choral Canada, and Government of Manitoba have also produced resources, and many individual groups and choirs are now developing their own guidance and plans for safe singing.48-50 Quick response evidence reviews from Alberta Health Services on Singing as a risk for transmission of SARS-CoV-2 virus,51 Newfoundland & Labrador Centre for Applied Health Research on Choirs and COVID-19,52 and Public Health Ontario on COVID-19 Transmission Risks from Singing and Playing Wind Instruments53 have also been produced, summarizing recent literature and media reports on COVID-19 and choirs. Effect of voicing and articulation manner on aerosol particle emission during human speech. Available from: Irzaldy A, Wiyasihati SI, Purwanto B. J Aerosol Med Pulmon Drug Del. Production of this website has been made possible through a financial contribution from the Public Health Agency of Canada. May 9, 2020 LINK (5) o ^There is no safe way for singers to rehearse as a group until there is a vaccine and a ñ percent-effective treatment for COVID-19, the disease caused by the coronavirus, and it could be two years before both happen, a national panel of music and medical experts Then, in March, the early days of the COVID-19 pandemic, two members of a … 2020. Close contact can also be associated with the sharing of sheet music, stands, or microphones that make physical distancing difficult to maintain. Reducing the duration of rehearsals or performances can also reduce accumulation of potentially infectious aerosols. Reducing the number of participants in the space at one time or moving rehearsals into larger rooms or performances into larger venues can reduce crowding. The mass choir is a combination of the three. Raising the voice of choral music. St John, NL: NLCAHR; 2020 May. Indoor Air. Surfaces that are frequently touched by many people, such as door handles or faucets, may be more important in fomite transmission compared to objects or surfaces that are only touched incidentally and less frequently. Even as church leaders plan for … Further examination of bibliographies of key articles were scanned to retrieve more extensive information, and key authors in the subject area were searched to identify additional relevant citations. Available from: Buonanno G, Stabile L, Morawska L. Estimation of airborne viral emission: quanta emission rate of SARS-CoV-2 for infection risk assessment. What you need to know about Coronavirus. On the day of the concert, thirty members of the choir reported being ill, and in the weeks following, most of the choir members reported being ill. Of the thousand-member audience that watched the concert, subsequent follow-up inquiries with concert goers did not identify widespread transmission. Approximately 5000 cases were linked to the Shincheonji Church of Jesus, where characteristics such as large numbers of attendees, indoor confined spaces, and participation in singing and close physical contact could have led to transmission of SARS-CoV-2 via various transmission routes. N Engl J Med. Germany: Universität der Bundeswehr München; 2020. Available from: Liu L, Li Y, Nielsen PV, Wei J, Jensen RL. Five days after a Berlin Cathedral Choir practice on March 9, 2020, one of the 80 participants reported that she had tested positive for COVID-19. Over the past few months, the coronavirus pandemic continues to spread in different countries all around the world. At the time of this event, there were no known cases of COVID-19 in the local community; however, the index case was experiencing cold-like symptoms for three days prior, and several members of the group also attended a rehearsal together the previous week. Risk Anal. medRxiv. Churches should also be advised that it might be a cause of the virus spread.). Available from: Colorado State University. As air is exhaled from the bronchioles, the mucosal layer on the collapsed surfaces forms a continuous film. 2020 Jun 18; Pre-print. A minimum distance to prevent transmission via aerosols cannot be easily determined. Size distribution and sites of origin of droplets expelled from the human respiratory tract during expiratory activities. The choir held rehearsals on February 25, two days before the first official case of COVID-19 was announced in the Netherlands. Available from: Alberta Health Services. Leclerc QJ, Fuller NM, Knight LE, Group CC-W, Funk S, Knight GM. Baritone-for-hire David Newman was looking forward to a year of singing gigs. 2011;6(5):e20086. Within two weeks, 30 members had tested positive and another 30 were experiencing symptoms. Sharing of surfaces and objects such as musical stands, chairs, books, microphones, instruments, food, dishes and cutlery, or drink dispensers increases the risks of fomite transmission. Studies have shown that some people emit a much larger quantity of particles than others. Please see Appendix 1 for the literature search method and search terms. Contact with contaminated surfaces (fomites) followed by touching of the eyes, mouth, or nose is another potential mode of SARS-CoV-2 transmission, although the relative importance of fomite transmission is still poorly understood. Closed environments facilitate secondary transmission of coronavirus disease 2019 (COVID-19). Scientific brief. Several examples of COVID-19 clusters or outbreaks, where singing or loud vocalization have featured in the venue or activity, have been reported in various media reports and academic journals.1 These outbreaks have also included other risk factors such as crowding or gathering in large groups, enclosed spaces or poor ventilation, long duration of contact, and other types of interactions such as greetings and social interactions, sharing of food, drinks or equipment, and shared transport. 2020;20(5):565-74. Available from: Furuse Y, Ko YK, Saito M, Shobugawa Y, Jindai K, Saito T, et al. Mechanical ventilation, or well-planned natural ventilation can help remove particles with upward air flow exhausted to the outside, and can dilute indoor air with clean outdoor air.42, While recirculating systems are discouraged, where unavoidable, control measures to improve conditions such as increased percentage of outside air in ventilation, high quality filters (MERV-12), or integrated disinfection systems (e.g., UV germicidal irradiation, either in ducts or in an upper room configuration) can be used to minimize recirculating virus.44,45 Small and poorly ventilated areas may require ventilation cycles between usage, increased airflow or adding filtration where possible.44. medRxiv. Pre-symptomatic and asymptomatic transmission. Available from: van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. The UK government relaxed the Covid guidelines for singing in church this weekend. Available from: Stadnytskyi V, Bax CE, Bax A, Anfinrud P. The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. Early in the response to the pandemic, gathering in groups was identified as high-risk and limits on the number of people gathering was an essential public health tool for reducing community transmission. Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. Proc Nat Acad Sci USA. COVID-19 response committee report. She also said that choir members do not have to face each other while singing during religious gatherings. Available from. The COVID-19 pandemic has required a rethinking of how many of our daily tasks and routine activities influence risks of transmission of SARS-CoV-2, the virus responsible for the disease. Make music during the SARS-CoV-2 pandemic. Anesth Analg. Available from: Woelfel R, Corman VM, Guggemos W, Seilmaier M, Zange S, Mueller MA, et al. Japan: Clusters associated with large music venues, An analysis of 61 clusters of cases (five or more persons) in Japan between January 15 and April 4, 2020 found that 11 % were music-related events including large numbers of cases associated with large music venues. General features such as gathering indoors in large groups for prolonged duration, and with close personal interactions, have also featured in other outbreaks. Production of this document has been made possible through a financial contribution from the Public Health Agency of Canada through the National Collaborating Centre for Environmental Health, Copyright © 2020 National Collaborating Centre for Environmental Health. Aerosol emission and superemission during human speech increase with voice loudness. Available from: Furuse Y, Sando E, Tsuchiya N, Miyahara R, Yasuda I, Ko YK, et al. Control measures for fomite transmission include good hand hygiene practices and routine cleaning and disinfection of surfaces, as well as avoiding sharing of equipment, musical stands, and microphones, and socializing over food and drink during breaks. The warning was omitted even though choirs can become “super-spreader” events infecting large groups of people at once. Available from: Tellier R. Aerosol transmission of influenza A virus: a review of new studies. The University of Montevallo choirs are practicing in the First United Methodist Church of Montevallo near campus so they can sing 9 feet apart (Source: Dr. Melinda Doyle) Dr. Doyle believes one of the best parts of choir is building community, something that is desperately needed during the age of social distancing. A noted researcher reports that COVID, its associated restrictions – and people's reaction to those restrictions – could mean one in five churches in the … Environ Int. Short-range airborne transmission of expiratory droplets between two people. 2020 Jun;117(22):11875-7. J Voice. Available from: Johnson GR, Morawska L. The mechanism of breath aerosol formation. Control measures to reduce pre-symptomatic and asymptomatic transmission include self-isolation for persons who have tested positive for COVID-19 or may have been exposed to known cases of COVID-19, limiting the number of social contacts and restricting group sizes, maintaining safe physical distancing, and mask wearing in public. There is also evidence that maintaining 2 metres distance can help to reduce the short-range transmission of small droplets or bioaerosols. Outside air can help to dilute infectious particles to low levels and air flow can help to disperse particles. Available from: Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. 2018 Jul;32(4):390-5. Toronto, ON: Queen's Printer for Ontario; 2020 May 22. Environ Res. For more news about the novel coronavirus click here. SARS-CoV-2 Transmission from presymptomatic meeting attendee, Germany. 2020;581(Apr 1):465-9. These small particles can reach deep into the respiratory tract where they can potentially cause infection. 2020 Aug;131(2):e102-e4. 2009 Dec 6;6 Suppl 6:S783-90. There has been limited published literature detailing investigations of outbreaks related to singing in groups, with some reports providing only anecdotal accounts of these events. Opening windows or exterior doors can be effective where mechanical ventilation systems are not available, but consideration of how air is flowing within a space should also be considered. Clusters of coronavirus disease in communities, Japan, January-April 2020. “But this is still a venue for the transmission of the virus and we will be, siguro mas magkakaroon tayo ng advisories sa ating mga simbahan (maybe we will issue advisories to churches) regarding this matter,” Vergeire added. Outcomes of a study on the rate and size of bioaerosols emitted by different singers, and the impact of active and passive control measures by University of Colorado56 is also expected. Church leaders warned that because of social distancing restrictions services during Advent in December and at Christmas 'are inevitably going to look very different'. Lung vital capacity of choir singers and nonsingers: a comparative study. Aerosol Air Qual Res. Adjusting timings to allow for shorter rehearsals or performances, with fewer people, and more scheduled breaks outside of the rehearsal space can allow for aerosols to disperse or settle. Oklahoma City, OK: American Choral Directors Association; 2020 Jun 15. If infected persons are asymptomatic or pre-symptomatic, they may be unaware that they are emitting infectious particles and presenting a risk to others in the room. The ban on singing to prevent COVID-19 transmission, especially during the holiday season festivities, covers church choir groups, the Department of Health said Friday. A number of COVID-19 outbreaks have occurred at churches throughout the country. This brief review has outlined the key risks associated with singing in choirs, including the risks associated with gathering in large groups, and the additional risks related to production of small respiratory droplets via vocalization. Available from: Heneghan C, Brassey J, Jefferson T. COVID-19: What proportion are asymptomatic? Professional singers may be more skilled in adjusting their breathing mode to produce sound more efficiently, with less forceful inhalation and exhalation.27 Deep exhalation can increase the concentration of exhaled particles by four to six fold, and rapid inhalation can also increase concentration of released particles by two to three fold.28 In contrast, rapid exhalation has less impact on the aerosol concentration released. Available from: Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. medRxiv. Emerg Infect Dis. medRxiv. Overall, 60 of the 80 participants that attended the March 9 practice became infected. Airborne transmission of SARS-CoV-2: the world should face the reality. COVID-19 resources for the Canadian choral community. The extent to which singing itself contributes to outbreaks among church congregations is unknown, but it may be one of many factors increasing overall risk in crowded indoor spaces. Berlin Cathedral, Germany: Choir practice. Lancet Respir Med. Guidelines for vocalists and instrumentalists. Close contact while greeting each other, as well as hugging, talking, and laughing increases the risk of transmission via respiratory droplets, fomites, and short-range aerosols. Gupta JK, Lin C-H, Chen Q. Characterizing exhaled airflow from breathing and talking. “Kapag nagbigay tayo ng ganitong protocol, hindi ito nililimitahan sa karaoke kasi marami pang pagkakataon na tayo ay kumanta sa public places. 2020; advance publication. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. 2010;20(1):31-9. Large quantities of small respiratory particles can be produced, and they can remain in the air for an extended time frame. As the vocal folds open and close during vocalization, fluid film between them can also rupture, releasing particles.23 Aerosols can also be produced from the oral cavity during speech.24, A combination of processes thus occurs during speaking and singing as release of droplets due to fluid-film burst in the bronchioles varies with inhalation and exhalation, and release of droplets from the larynx may vary depending on vocalization style. Respiratory events such as coughing and sneezing have a higher velocity and can release a high concentration of droplets of various sizes but these events have a low frequency compared to breathing, speaking, or extended periods of singing. Available from: Firle C, Jabusch H-C, Grell A, Fernholz I, Schmidt A, Steinmetz A. To find out more, please click this link. I am not saying transmission of the virus is now possible but there is a limit on the possibility of the virus being transmitted.). 2016 Nov;30(6):717-20. According to a 2017 survey by the Big Choral Census, the UK has “at least 40,000 choirs”, including private choirs, church choirs and school choirs, with 2.14 million regular singers. Topic: Singing as a risk for transmission of SARS-CoV-2 virus. When inside, moving activities to very large rooms with good air exchange is recommended to reduce risks.43 Larger room sizes allow for greater dilution of respiratory particles, but without proper ventilation, particles can accumulate and disperse within the room over time. Choirs may have to remain silent long after society reopens. Viral load of SARS-CoV-2 in clinical samples. Available from: Morawska L, Tang JW, Bahnfleth W, Bluyssen PM, Boerstra A, Buonanno G, et al. Available from: Fears AC, Klimstra WB, Duprex P, Hartman A, Weaver SC, Plante KS, et al. 2020;Pre-print. Choir singers have been found to have a higher average vital lung capacity than non-singers, and the inspiratory capacity of singers has also been found to be greater on average.29 Children may release fewer respiratory particles due to smaller lungs with fewer terminal bronchioles where production of aerosols via fluid-film burst could occur. Evidence of short-range aerosol transmission of SARS-CoV-2 and call for universal airborne precautions for anesthesiologists during the COVID-19 pandemic. Members of the choir avoided handshakes and hugging and used hand sanitizer but also spent time singing together spaced at 15 to 25 cm apart. Florida Warns of Superspreader Events at Church Choirs and House Parties As All State Coronavirus Restrictions Lifted Aristos Georgiou 9/29/2020 Louisiana Congressman-elect Luke Letlow dies with COVID Modality of human expired aerosol size distributions. While singing may have contributed to transmission in notable outbreaks associated with choirs, the degree to which singing impacted transmission is uncertain. COVID-19 Risks and Precautions for Choirs, O’Keeffe, J. COVID-19 Risks and Precautions for Choirs. (2019) found a linear correlation between volume of speech and number of respiratory particles emitted.23 Even quiet speech emits more particles than normal breathing and the quantity of emitted particles during all volume of speech are greater than during breathing. In a pre-print by Riediker and Morawska (2020), the authors propose that reduced formation of respiratory droplets may partially explain why children are poor transmitters of SARS-CoV-2 compared to adults; however, further study is needed to investigate this theory.30, Size of particles produced during vocalization, The size of particles produced by singing and loud vocalization may be important to identifying predominant transmission routes. Vancouver, BC: National Collaborating Centre for Environmental Health. As noted in the outbreaks in Skagit Valley, and Amsterdam, participants with symptoms attended the rehearsal(s) that resulted in additional transmission of SARS-CoV-2. Forward chaining of key papers added to the search results and news reports identifying localized outbreaks associated with group singing were scanned for details of outbreak investigations. Although I am not saying na hindi posible ang transmission pero mas nagkakaroon ng limit ang pagtransmit ng virus,” she said. The number of singers, the room size, the level of ventilation, and duration of singing all contribute to determining risk as well as the prevalence of SARS-CoV-2 cases within the community. 2009 2009;22(3):229-37. Available from: Public Health Ontario. 2020 Jun 10;26(9). 2020 Aug;26(8). CSU Aerosol Emissions Study - Reducing bioaerosol emissions and exposures in the performing arts: a scientific roadmap for a safe return from COVID19. Environ Int. The Inquirer Foundation supports our healthcare frontliners and is still accepting cash donations to be deposited at Banco de Oro (BDO) current account #007960018860 or donate through PayMaya using this link . Aerosol Sci Technol. Temporal dynamics in viral shedding and transmissibility of COVID-19. A rapid literature search was performed by the NCCEH information specialist using Ebscohost databases (includes Medline, Cinahl, Academic Search Complete, ERIC, etc. Available from: World Health Organization. Surfaces can be contaminated by expelled droplets, or by direct contact with a contaminated hand. Groups should avoid singing in closed, unventilated rooms even with distancing measures in place.42, Short of suspending the activity all together, an approach to maintaining good indoor air quality includes reducing indoor emissions by limiting the number of participants and the duration of participation.3 It is more difficult to maintain safe physical distancing in crowded spaces, and occasional encounters less than 2 m are more likely to occur as crowding increases. Two additional women who had participated in a backstage VIP experience with the singer also tested positive. Production of respiratory droplets and aerosols during speaking and singing, Loud speech and singing, while less forceful than coughing or sneezing, can result in bursts of air releasing respiratory particles large enough to transport viruses. In June, the IATF announced that churches in modified general community quarantine areas may conduct religious services at a 50-percent seating capacity. Indoor Air. Stadnytskyi et al. 2020 Jun 5;5:83. The potential for transmission via pre-symptomatic and asymptomatic persons via multiple routes, including respiratory aerosols, has implications for activities such as singing in groups. There is still no firm evidence as to the level of exposure to infectious SARS-CoV-2 virus that is required to cause an infection. Communication with groups prior to rehearsals and events can include screening for symptomatic or highly susceptible persons, who should not attend. Sci Rep. 2019 Feb;9(1):2348. JAMA. Additional resources will be added to this document as they emerge. At Greater St. Stephen, 60 to 75 people sing in the choir on a normal Sunday. Aerosol and surface stability of SARS-CoV-2 as Compared with SARS-CoV-1. Epidemiology of COVID-19 outbreak in Japan, January–March 2020. MedRxiv. The singer was later found to be infected with the virus but had not displayed symptoms on the day of the concert. For more information on COVID-19, call the DOH Hotline: (02) 86517800 local 1149/1150. Bioaerosols that do not settle may also be transported beyond 2 m depending on air flow within a space. 2009 Mar;40(3):256-69. The Department of Health bans singing including church choirs during holiday season to prevent spread of COVID-19. N Engl J Med. Few details on the setting and types of interactions at the March 9 practice could be identified at the time of writing. Beyond the risks and recommended precautions associated with gathering in groups, this review identifies the risks specific to singing in groups, and the suite of precautions that can be considered to minimize these risks. Gupta et al (2010) found that the total volume of air exhaled during breathing and talking for two hours were an order of magnitude greater than 100 coughs.26 Over an extended period, the quantity of droplets produced by non-coughing or sneezing activities could be greater. This document will be updated as new evidence emerges. Call 896 6000. 2020. medRxiv. Available from: Scheuch G. Breathing is enough: for the spread of influenza virus and SARS-CoV-2 by breathing only. High SARS-CoV-2 attack rate following exposure at a choir practice — Skagit County, Washington, March 2020. 2020 May;26(5):672-5. MANILA, Philippines — The Department of Health (DOH) on Friday warned about the possible spread of the new coronavirus through church choirs. (2020) estimated that 44% of secondary cases became infected while the index case was pre-symptomatic.19 This study estimated that infectiousness can begin two to three days before symptom onset and may peak 0.7 days before appearance of symptoms. Don't miss out on the latest news and information. Back in October, the Inter-Agency Task Force on the Management of the Emerging Infectious Diseases (IATF) has allowed churches, mosques, and other places of worship in areas under a general community quarantine to hold religious gatherings at a seating capacity of 30 percent. This includes better understanding of how the nature of specific activities and the characteristics of the settings in which they take place can influence risks of transmission. These findings could inform safety guidelines for restarting choirs during and after the COVID-19 pandemic and other similar respiratory infection outbreaks. Experts say indoor church services are high risk for COVID-19 because people sit … Edmonton, AB: Alberta Health Services; 2020 May 22. Winnipeg, MB: Government of Manitoba; 2020. 2020;40(5):902-7. 2020 Apr 6; Pre-print. 2020 July, MU University Hospital Munich and the Universitätsklinikum Erlangen (FAU), https://wellcomeopenresearch.org/articles/5-83, https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm, https://www.medrxiv.org/content/10.1101/2020.06.15.20132027v2, https://doi.org/10.7883/yoken.jjid.2020.271, https://www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations, https://dx.doi.org/10.1101%2F2020.04.02.20051177, https://dx.doi.org/10.1213%2FANE.0000000000004933, https://doi.org/10.1016/j.envint.2020.105794, https://doi.org/10.1016/j.envint.2020.105730, https://www.pnas.org/content/117/22/11875, https://www.medrxiv.org/content/10.1101/2020.04.04.20053058v1, https://www.publichealthontario.ca/-/media/documents/ncov/what-we-know-jan-30-2020.pdf?la=en, https://www.cebm.net/covid-19/covid-19-what-proportion-are-asymptomatic/, https://doi.org/10.1038/s41591-020-0869-5, https://wwwnc.cdc.gov/eid/article/26/8/20-1235_article, https://www.medrxiv.org/content/10.1101/2020.02.28.20029272v2, https://doi.org/10.1016/j.jaerosci.2008.11.002, https://doi.org/10.1038/s41598-019-38808-z, https://doi.org/10.1111/j.1600-0668.2009.00623.x, https://doi.org/10.1016/j.jvoice.2017.07.008, https://doi.org/10.1016/j.jvoice.2015.08.008, https://aaqr.org/articles/aaqr-20-06-covid-0304, https://doi.org/10.1371/journal.pone.0020086, https://dx.doi.org/10.1016%2FS2213-2600(20)30245-9, https://royalsocietypublishing.org/doi/10.1098/rsif.2009.0302.focus, https://www.nejm.org/doi/full/10.1056/NEJMc2007800, https://doi.org/10.1080/02786826.2020.1749229, https://dx.doi.org/10.1016%2Fj.envres.2020.109819, https://doi.org/10.1016/s1473-3099(20)30113-4, https://doi.org/10.1016/S1473-3099(20)30196-1, https://www.nature.com/articles/s41586-020-2196-x, https://www.medrxiv.org/content/10.1101/2020.04.27.20081398v3, https://www.citt.org/_Library/Resources_/Making_music_during_the_SARS-CoV-2_pandemic_Recommendations_of_the_German_Society_for_Music_Physiology_and_Musicians_Medicine_English.pdf, https://www.liebertpub.com/doi/abs/10.1089/jamp.2020.1616, https://www.medrxiv.org/content/10.1101/2020.05.21.20108894v3, https://doi.org/10.1016/j.envint.2020.105832, https://www.unibw.de/lrt7-en/making_music_during_the_sars-cov-2_pandemic.pdf, https://acda.org/wp-content/uploads/2020/06/ACDA-COVID-19-Committee-Report.pdf, https://www.choiralberta.ca/?fbclid=IwAR2P095hWPcrQf_zCY3lzDk8ufb4kDA-eL7Y4-0aRkBOKEeKoYoHzr0ASAU, https://www.choralcanada.org/covid-19-resources.html, https://www.gov.mb.ca/covid19/restoring/music-guidelines.html, https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-singing-risk-transmission-rapid-review.pdf, https://www.nlcahr.mun.ca/CHRSP/COVID19ChoirsJune32020.pdf, https://www.publichealthontario.ca/-/media/documents/ncov/covid-wwksf/2020/07/what-we-know-transmission-risks-singing-wind-instruments.pdf?la=en%E2%80%8B, https://www.classicfm.com/music-news/coronavirus/safety-of-singing-salisbury-cathedral-choir-rehearsal-tested-lab-conditions/, https://healthcare-in-europe.com/en/news/singing-in-times-of-covid-19.html, https://smtd.colostate.edu/reducing-bioaerosol-emissions-and-exposures-in-the-performing-arts/, Choirs review_NCCEH_Jul10_2020-EN_REF.pdf. General precautions associated with close-contact and fomite transmission can also be applied to singing groups. London, UK: ClassicFM; 2020 Jun 29. The key risks associated with singing in groups have been identified as common risks associated with large gatherings, as well as the additional risks associated with vocalization (release of greater quantities of small respiratory particles). As reopening progresses, groups that were previously prevented from gathering are seeking advice and guidance on when and how to resume activities safely. COVID-19 & the future of choral singing in Australia. Singing in times of COVID-19: more space to the front than to the side: MU University Hospital Munich and the Universitätsklinikum Erlangen; 2020.
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