Singing – where do we go from here? - CEEP Network...•5 choral, 5 opera, 6 musical theatre, 2 gospel, 2 rock, 2 jazz, 1 pop, 1 soul, 1 actor with singing interest •Performed

Singing – where do we go from here?

Declan Costello

Laryngologist and ENT Consultant

CEEP webinar – 7 October 2020

Who am I?• Music degree

St John’s College, Cambridge1991-94

• Medical degreeImperial College, London1994-99

• ENT (otorhinolaryngology) specialist trainingOxford region 2000-2010

• Consultant ENT Surgeon 2010-present

• Ongoing professional singing

Why was singing shut down?

• Several high-profile events at which singers became unwell (and, in some cases, died)

• Unclear at that point why there had been such significant spread in those groups

• Led to an assumption that singing was intrinsically “dangerous” (as compared to speaking/shouting/breathing)

What’s an Aerosol/droplet?

Setting up the PERFORM study

• Team • ENT (laryngologists)• Chest physicians – Professor Pallav Shah and Dr Chris Orton PhD (Royal Brompton

Hospital)• Aerosol scientists (Bristol University) – Professor Jonathan Reid –

Editor in Chief of the journal Aerosol Science and Technology• CFD modellers

• Overseeing body: Public Health England (PHE)• Funding: Ministry of Digital, Culture, Media and Sport (DCMS) £50,000

• NOTE – no “industry” funding – no vested interests

• Protocol design – extremely rigorous scientific methodology and standards, overseen by UK government

• Ethical approval given

Logistical considerations

• Venue

• Equipment

• Recruitment (BBC Singers, Royal Opera House, English National Opera, Eleven Management, Personal contacts)

Introduction

• Working Group for The Investigation of ParticulatE Respiratory Matter to InFormGuidance for the Safe Distancing of PerfOrmeRs in a COVID-19 PandeMic

(PERFORM)

METHODS

• 25 professional performers• 5 choral, 5 opera, 6 musical theatre, 2 gospel, 2 rock, 2 jazz, 1 pop, 1 soul, 1

actor with singing interest

• Performed activities into a 3D printed funnel, which measured the number of & size of the respirable particles released

• Clean air environment (operating theatre) ensured particles detected were from the activity performed

What was measured & how?

Number of particles + Size of particles

= Total mass concentration of particles

• Why is this important?• Counting the number of particles is only half the story.

• To assess the potential dose of SARS Cov-2 released by the individual carrying the virus.

Standard operating procedure

Sing a sustained /a/ in their mid-range

(medium volume)

Sing a sustained /a/

an octave above (medium

volume)

Speak ’HAPPY BIRTHDAY’ at low, medium

and high volume

Sing ’HAPPY BIRTHDAY’ at low, medium

and high volume

Breathe in through nose, out through

mouth quietly

Breathe in and out through nose quietly

Sing a sustained /a/ in their mid-range

(medium volume)

Cough

Experimental setup

Results

Aerosol number concentration & mass

1. Intra-participant consistency

2. Profound effect of volume 20-30 x

3. Small effect of activity 2-3 x difference between singing & speaking @ medium & high dB`

Gender & genre

Risk cannot be eliminated, so how can we mitigate it?1. Location, location, location

• Size

2. Ventilation, ventilation, ventilation

3. Duration, duration, duration

4. Participation, participation, participation • Number of performers

5. Appreciation, appreciation, appreciation • Audience

6. Volume• Amplification, amplification, amplification?

Location, location, location – i.e. venue

• Size of room will determine dispersal of aerosol, and hence concentration

• Comparison of taking a pee in the sea versus taking a pee in a swimming pool • (with thanks to Jenevora Williams)

• Ideally outdoors, but usually impractical• British weather• Acoustics• Instruments • Light

Ventilation, ventilation, ventilation

• Open windows and doors• Fine now, but in winter?

• Mechanical ventilation• Must not re-circulate – check

settings on air conditioning

• Novel solutions• Ventilation engineers

• Computational fluid dynamic modelling

Guangzhou, 24 January

Duration, duration, duration

• Shorter rehearsals/lessons/performances = less aerosol generated

Participation, participation, participation

• Number of performers

Appreciation, appreciation, appreciation

• An audience sitting quietly will generate aerosol • In fact, about as much aerosol as

speaking/singing quietly

• i.e. 200 people in an audience may generate more aerosol than 5 people on stage

• Audience should be discouraged from singing/chanting/whooping/yelling!

Amplification, amplification, amplification?

• Remember – louder vocalisation → massively more aerosol

What is the government saying?

• DCMS guidelines

• DCMS “Singing and wind instruments working group – consensus statement”

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/914628/S0695_Aerosol_and_Droplet_Generation_from_Singing__Wind_Instruments__SWI__and_Performance_Activities.pdf

• Based on the data generated by our study, the government have changed the guidelines:

https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/performing-arts#arts-4-1

Additional mitigations, such as extended social distancing, were previously required for singing, wind and brass given concerns that these were potentially higher risk activities. DCMS commissioned further scientific studies to be carried out to develop the scientific evidence on these activities, which has allowed us to reconsider appropriate mitigations. 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 and venues, performers and audiences matched to 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).

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/914628/S0695_Aerosol_and_Droplet_Generation_from_Singing__Wind_Instruments__SWI__and_Performance_Activities.pdfhttps://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/performing-arts#arts-4-1

Thank you

www.voicedoctor.co.uk

@Voicedoctor_uk