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Is Singing in a Choir Safe During COVID-19? A Voice Expert Explains the Risk

Expert Chats

Many industries are navigating the stress and aftershocks of the COVID-19 pandemic, and performance arts has taken a devastating hit. According to a national panel convened of representatives from choral associations, all performance groups from children’s choirs to professional ensembles are being warned that they may have to remain silent for the foreseeable future until there is a vaccine and effective treatment.

Phillip C. Song, MD, director of the Division of Laryngology at Mass. Eye and Ear, was recently featured on the WGBH “In It Together” segment with Arun Rath to comment on the changing landscape and new roadblocks for singers during the pandemic. Dr. Song, who has treated professional singers in his practice, answered some questions that many group singers and performers may have during this unprecedented time. You may listen to the full interview here.

Experts are warning singers that there is no way to safely rehearse and perform live at this time, is that true?

Singers are at high risk for transmission for COVID-19, because of the amount of aerosols they have the potential to generate. That poses an extremely difficult problem in regards to group rehearsals, and since there are real-world examples of people transmitting the disease in choir practices, it’s really hard to think of a way that groups could safely perform and sing together currently.

So, having the best masks and the best air circulation wouldn’t even do the trick?

It has a lot to do with how aerosols are generated in the lungs. It seems that the smaller areas of the lungs are actually responsible for smaller particles, and therefore they disperse more widely. Because singers are vocal athletes and they engage in diaphragmatic breathing, they can actually generate much more aerosols which can spread further. When people look at coughing for instance, even though coughing can produce droplets that are visible and can transmit disease, these droplets settle much more quickly than smaller particles that are generated from higher vocal tasks – speaking, yelling or singing. I think it would be difficult to sing with a mask on, especially with an N-95 or something that occlusive.

Vocal coaches often encourage others to sing from the diaphragm and project the voice, would that be dangerous advice now in terms of virus transmission?

It’s a catch-22: the characteristics that makes someone an effective singer are also traits that makes someone an effective aerosol generator. Physiologically, singing increases air speed and lung pressure, which will produce more aerosols. It could be that well-trained singers are at a higher risk of transmission of aerosols – louder singers are probably generating more aerosols than quieter voices. Choral singing is especially dangerous, for example the Mount Vernon choir in Washington recently had an outbreak where 87 percent of the choir was infected which resulted in two deaths. It was a tremendous lesson and that real world case is a far more effective demonstration than any laboratory test. 

What advice would you give to choral and performance groups who want to continue rehearsing and singing together?

For now, practicing in a virtual setting is probably for the best. We have to start thinking about different ways of practicing and rehearsing, gathering together in a limited fashion with contact tracing, contact precautions and pre-screening or testing– this may offer some mitigation. There may be workarounds, and we have to accept some level of risk. I don’t agree with a blanket statement that you can’t sing over the next year until there is a vaccine, but it has to be done very safely and cautiously. Physical distancing, masks, and contact precautions are extremely important. In terms of live venue events, we’re not there yet, but the landscape is changing very quickly – even at Mass. Eye and Ear. The testing is continuing to get better and so is our ability to screen patients. As the technology and screening processes improve, there is certainly hope for singers in the future.

Download Dr. Song’s interview in a Podcast.

Phillip Song headshotAbout Our Expert

Phillip C. Song, MD is the division director of Laryngology at Mass. Eye and Ear and a board-certified otolaryngology–head and neck surgeon who specializes in laryngology, voice and swallowing disorders, and neurolaryngology. He sees patients at the Mass. Eye and Ear, Main Campus in Boston.