Reentry Following COVID-19: Concerns for Singers

CARE OF THE PROFESSIONAL VOICE

INTRODUCTION

The target of this paper is captured in its subtitle: "Concerns for Singers." While the COVID-19 pandemic has wreaked devastation upon disparate types of people around the world, singers, and those who teach and collaborate with them, are a vulnerable cohort within this larger global health crisis. This vulnerability is due to a number of facts about the SARS-CoV-2 virus, beginning with its three main routes of transmission as outlined by the U.S. Centers for Disease Control and Prevention (CDC): (1) inhalation of very fine respiratory droplets and aerosol particles; (2) the deposition of virus-containing droplets and particles on exposed mucous membranes in the mouth, nose, or eye by direct splashes and sprays; and (3) touching mucous membranes with hands that have been soiled either directly by virus-containing respiratory fluids or indirectly by touching surfaces with virus on them.¹

The CDC has further explained that "the risk of SARS-CoV-2 infection varies according to the amount of virus to which a person is exposed" and notes that the two main variables concerning this amount are distance and time.² Regarding the former, how far away an individual is from the respiratory droplets of an infected person, combined with the observation that the concentration of the virus is diluted by both gravity (heavier drops fall) and mixture with air, illustrates why the CDC states that "the available evidence continues to demonstrate that existing recommendations to prevent SARSCoV-2 transmission remain effective. These include physical distancing."³ The parameter of time exerts a similar dilution of viral viability and potency.

Yet using those same parameters of distance and time, the CDC also notes that "transmission of SARS-CoV-2 from inhalation of virus in the air farther than six feet from an infectious source can occur [emphasis added] under certain preventable circumstances," one of which is "Prolonged exposure to these conditions, typically more than 15 minutes."⁴ The CDC report goes on to note two other factors that increase the risk of SARS-CoV-2 infection.

• • Enclosed spaces with inadequate ventilation or air handling within which the concentration of exhaled respiratory fluids, especially very fine droplets and aerosol particles, can build-up in the air space.

• • Increased exhalation of respiratory fluids if the infectious person is engaged in physical exertion or increases the intensity of their voice (e.g., exercising, shouting, singing).⁵

It has been shown that there are significantly higher emission rates for singing compared to mouth breathing and speaking.⁶ This finding plus the CDC report indicates that the typical voice teacher who instructs singers on a back to back hourly schedule in a one on one setting, often in a small room with poor ventilation, may be especially vulnerable to COVID infection, particularly from unvaccinated students and collaborators (e.g., pianists). Indeed, voice teachers in these situations could be considered "sitting ducks" for multiple respiratory illnesses, from the common cold to influenza, but the virulence of the SARSCoV-2 virus and the mortality rate of COVID-19 illness are without modern precedent: in the United States, a country with 331,449,281 persons⁷, 33,558,862 cases of COVID-19 and 602,275 fatalities⁸ have been reported as of June 22, 2021. These figures indicate that one in ten persons contracted the virus in the US, and of those who contracted COVID-19, one in 56 died from the illness.

This ongoing global health crisis has added a heightened level of urgency to a list of concerns for singers. As noted by this team of authors in a previous article with the same subtitle, that list of concerns includes the COVID-19 sequelae most likely to disrupt or permanently damage those functions that are necessary for singing.⁹

The degree to which voice teachers can protect themselves from communicable diseases like COVID-19 begins with the amount of personal agency they wield. Self-employed singing teachers possess a large...