CHOIR SINGING- COVID-19 CONTINGENCY PLAN Jun 19nd, 2020

1. PRELIMINARY

-As the world started shutting down, many chorals wonder when they will resume their singing

activities. This question cannot yet be answered with a specific date. In any case, it is currently

not possible due to the restrictive measures implemented so far regarding number of people

in gatherings. The current government policy on this issue will be extended until optimum

conditions are met. It will most likely be a progressive evolution of the allowed meetings,

regarding number of people and by specific sectors, comparable to the reopening by phases at

school, which is likely to be in September.

-Any economic, social or cultural sector can only be reopened provided there is an approved

guide or protocol, which contains the conditions and agreements that must be complied with.

-The international choral world, MCC and FCEC work together to have a protocol that is

validated by the government for the choral singing activity. In addition, the federations want

to establish specific guidelines for the choral sector based on this Risk Prevention Plan with a

"Guide to Hygiene and Prevention of Choral Rehearsals".

-It will contain information on the use of the rehearsal room, hygiene and prevention

instructions to be observed, organizational conditions and the like. Choirs will soon be able to

apply this "Guide to Hygiene and Prevention of Choral Singing Rehearsals" tailored to their

own circumstances.

-The limitations of current regulations, medical and scientific knowledge available so far,

official epidemiological data and the particularities of Choral Singing lead us to analyse the

current situation to offer a prospective interpretation of prevention of our musical activity for

the next few months until we return to “normal”.

-These indications are not official instructions until validated by the competent authority: the

Catalan Public Health Agency or the PROCICAT.

-Choral singing is an activity with a high risk of viral transmission through aerosol, droplets,

drops and fomites derived from them.

-Singing yields many more particles than normal speech, as it projects at a greater distance,

and along with the singers deep breathing entails a greater risk of contagion.

-The singers are usually very close, and one singer is surrounded others. Choir singing entails a

second problem, which are the social rapprochement, the grouping and the sociability

inherent in choral practice.

-We suspect that the incidence of COVID-19 in choirs has been significant, with more incidence

than in the general population, at least in Barcelona, and we also have news of incidents in

foreign choirs in the USA and Berlin (see news links below).

https://diarioliricoes.blogspot.com/2020/05/inicio-de-ensayos-en-oviedo-agao.html?m=1) https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm

-To confirm this, a survey is currently being conducted among all partners. -So it is necessary to protect singers, conductors, pianists and musicians during rehearsal.

-Right now, immunity is only considered possible through future vaccination. -It is estimated that the availability of a universal vaccine may be feasible in spring 2021. -We must state, therefore, that resuming “normal” choral singing activities as before lockdown (in our usual rehearsal room or in concerts) may not be before spring 2021 as it constitutes a real high contagion risk factor, unless general health policies achieve effective control of the epidemic. -This period must be re-evaluated in the event of a faster advance in science or the appearance of new methods to guarantee the health safety of singers and the public. Time will tell when to resume choral activities. -In addition, common sense has a say. -In our hobby, social distancing is not easy to arrange; several generations often get together and the high risk of aerosol contamination is inherent in our musical activity. Given that health of the singers, conductors, choir members, and their families must always prevail, it is advisable to cancel all rehearsals, events and other face-to-face meetings until August 31st. -If the activity is resumed before this date, compliant within a phase in which group gatherings are allowed, there must be a commitment to ensure that this protocol can be complied with. -We look forward to re-starting our favorite hobby in September / October 2020. -Before evaluating specific issues in the field of choral music, it is important to emphasize that musicians must also comply with the guidelines, regulations and rules applicable in their country. -These frameworks are subject to constant changes depending on the development of the COVID-19 pandemic and the various phases contemplated. -In this context, it is a challenge to implement the recommendations applicable both in the fields of professional and amateur music, as well as in classical and popular music. Thus, technical assessments aimed at choral singing are intended to provide information for decision-making that needs to be done in terms of people and choirs. Not until reaching an optimal level of collective immunization, which is forecasted for the spring of 2021, will full activities be resumed. However, we want to analyze the measures of prevention and protection of risk of infection and assess its application in the practice of choral singing in person and in a limited way. -Scientific data, as a whole, and especially with regards to the specifics of music practice, have been scarce so far in the field of COVID-19. We do not currently know of any specific and rigorous scientific study on the routes of transmission of the SARS-CoV-2 coronavirus regarding singing in general or in choral singing. -Considering the way the virus spreads through the air, the question among singers is to which extent breathing and phonation during singing leads to a higher risk of infection. -In singing, the sound is produced by a flow of exhaled air. Physiologically, this sound production is characterized by the fact that this exhalation flows in the singers repeatedly through the vocal cords, teeth, lips and the rest of the phonatory apparatus. As a result, according to current physiological knowledge, only small amounts of air per unit time go through the singer's mouth. The air molecules in the vocal tract are stimulated to vibrate and the sound is transmitted into the room by vibrations compared to air molecules to a pendulum. To our knowledge, it has not been scientifically proven to what extent singing leads to a greater spread of aerosol transmission of infectious agents, although it can be inferred from studies of fluid dynamics of different respiratory types, speech, sneezing, and coughing. -In addition, there may be saliva production from singers unrelated to sound production. On the one hand, it is not uncommon to notice that when you sing more saliva is produced, which is then expelled from the respiratory system by coughing or clearing the throat. Also, prolonged singing can cause excess mucus production due to airways overload. -For the aforementioned reasons, we think it makes sense to extend the distance rule for singers. In our opinion, the distance 1-1.5 meters applied to the general population should be

significantly exceeded when singing by increasing it to 2-3 meters to reduce the risk of infection. In addition, the risk can probably be further reduced in very large venues, such as concert halls, by further maximizing distance and through good ventilation. -Given the limitations, the following instructions are based on: (1) applying general technical and scientific knowledge specifically to singing, and (2) on the information gathered from other countries around the world. Therefore, they are personal assessments since there are not enough scientific studies in the field of choral singing so far, but they are based on the evidence of risk prevention in their practice. This document is, therefore, a draft, which will be revised and adjusted as time goes on, according to the developments of the existing regulations and new scientific and technical knowledge.

2 INTRODUCTION

-The health recommendations as well as the document "Recommendations on actions related

to situations that may occur due to the effect of the SARS-CoV coronavirus - 2 ”, prepared by

the Labor Relations Council of Catalonia and the evidence of Risk Prevention have been taken

into account to prepare this draft of the Prevention Plan.

-SARS-CoV-2 virus mainly affects the respiratory tract, and hence the main mode of

transmission is through air, saliva and respiratory secretions. In the field of medicine, it was

also found that a higher than average number of specialists of the ear, nose and throat

suffered from Covid-19 because they performed endoscopic examinations of the area of the

mouth and throat.

-The spread of the virus as a cause of Covid-19 occurs mainly through aerosols, which carry the

virus through the air. An aerosol is a heterogeneous mixture of very small suspended particles

in gas.

-The Finnish working group at Aalto University in Helsinki conducted a computer simulation on

aerosol propagation in an enclosed room. If an infected person emits a virus when coughing,

the simulation assumes that the viruses can still be detected in the air after several minutes;

even if the sick person has already left the room, other people can inhale the virus, which is

suspended in the air. This study coincides with that of the Robert Koch Institute done on April

17, 2020, in which aerosols containing coronavirus RNA were detected in air samples from the

patient's exhaled air or the air in rooms of those who are sick.

-Apart from spreading the infection through invisible droplets, there is also the possibility of

contact transmission, i.e., transmission through contaminated surfaces, such as tables, chairs,

door elements, faucets, etc., which cannot be ruled out, as in certain circumstances SARS-CoV-

2 pathogens can be detected on the surface and get onto our hands, with the subsequent risk

of touching our eyes, mouth or nose, which are gateways to infection.

-Also, the infectious dose is not yet known.

3 OBJECTIVE

-The main objective of the Prevention Plan is to guarantee safety and health conditions in the

event of resuming face-to-face choral singing rehearsals after lockdown, even if they are

partially resumed, and when there are no longer official impediments to normal social life.

-These measures must take into account the necessary preventive recommendations against

the spread of Coronavirus SARS-CoV2, assessing whether these restrictive measures necessary

for prevention can effectively be implemented in the practice of choral music.

-This document must favor the creation of the "Guide to Hygiene and Prevention of Choral

Rehearsals".

-In the current situation, measures must be taken to revive choral singing. The possibility of

carrying out specific elements of the rehearsal can be easily created using digital media. While

it is certainly not possible to reach all members of the choir, this will keep choristers in touch

and, therefore, keep communication. Content to be transmitted can be, for example, recording

rehearsals, work presentations, working groups or simply just participating in choral processes.

This temporary activity will also be beneficial when the crisis is over.

-To limit the spread of infection during the controlled resumption of rehearsals, there are

fundamental measures that must be implemented in our choral activity.

The five pillars for avoiding the spread of infection during musical exercises are:

-Sick people should not participate in choral rehearsals

-Highlight the importance of proper good hygiene

-Avoid physical contact between people

-Avoid sharing common instruments or equipment

-Adequacy of the rehearsal room: enough space which should be proportional to the number of

participants in the rehearsal.

4 RETURN TO ACTIVITY

-No musical activity will be performed unless there is absolute certainty that the activity will

not contribute to an increased risk of infection and can be exercised in accordance with the

recommendations. Otherwise, the activity should be stopped immediately.

-It is not recommended to carry out any face-to-face choral singing activity until August 31,

2020 and, in any case, the risk will be re-assessed on that date, the level of risk will be reported

and a new rehearsal plan issued. In other countries, the interval to re-assess the resumption of

choral singing is August or September 2020.

-The Board of the Choir will appoint a person from the same choir, better still if the appointed

person is a healthcare professional who is a singer at the time, to deal with the measures of

prevention and hygiene related to the infection, prepare the rehearsal room and mark the

individual space to be occupied by each singer.

-The choir director will have to prepare the rehearsal programs for the coming months in

advance, so that all singers are in the know.

It should be anticipated that some singers will not attend in person because they are not

summoned that day, they are people at high risk of infection, or because they decide not to

attend. These people should be able to follow the rehearsal online.

-NB: Each singer decides whether or not to participate in the rehearsal. This also applies to

those people who are not at risk due to age, chronic illness or other medical conditions, but

want to wait for normalization; in this case, freedom of choice comes first.

-The return to the face-to-face activity should be done gradually, by strings or polyphonic. In a

first stage, small groups of up to 5 people can gather. In a second stage, groups of up to 10

people, which could eventually reach 20-30 people and provided the conditions of the

rehearsal room allows it.

-It is also conditioned to the location of the geographical area or region where the choral

activity takes place.

-A possible return to the regular rehearsals will have to be prepared for the months of

September / October 2020. Public concerts will be more difficult to be held until the spring of

2021, depending on healthcare developments and scientific and technical advances.

-In the event that a face-to-face concert is proposed during the pandemic period, a specific risk

prevention plan should be drawn for each concert, outlining and assessing all the risk factors

to ensure whether or not the concert can be held.

-When coming back to the rehearsals, first of all singers will be classified according to the risk

of contagion as follows:

-Immunized people who have passed the infection would be the first to join. Preventive

measures will be taken into account.

-Non-immunized people (who have not passed the infection) are still at risk. They must

observe the preventive measures.

-People who have had contact with a positive COVID-19 patient at home or at work will join

after the 21-days quarantine.

-People who are more vulnerable to COVID-19 would suffer more severe symptoms than other

singers in case of infection. These people must be the last to join the activity. They will have to

wait for the developments of the pandemic and the appearance of the vaccine, in due course,

to be able to re-join.

-There is the possibility of performing an immunity test on all singers prior to the return. This

will be voluntary; in no case mandatory, and would be related to the developments of the

pandemic. Nevertheless, as of now, this test is quite unfeasible to be generally applied to all

singers.

All singers:

In case of having fever, any respiratory pathology or other symptoms compatible with COVID-

19 while at home, singers will NOT ATTEND the rehearsals until completely healed of the

process causing it and after the necessary 21-days quarantine. If in doubt, they should consult

their doctor.

With regard to non-choir members, the aforementioned provisions of all sections will be

equally taken into account.

5 NECESSARY MATERIALS AND EQUIPMENT

Before returning to the activity, the following materials and equipment for the singers or choir

must be purchased:

- Surgical masks for singers and other people attending the rehearsal, along with keeping a 2-

meters distance between people for maximum safety. The total amount of surgical masks

should last for approximately three months.

- In addition to the mask, the conductor should use a screen face shield or goggles, due to a

central position among the choir and the public present in the room.

Conductor - Disposable handkerchiefs should be available at the place of rehearsal. - Containers for paper handkerchief disposal will be distributed in the same way as handkerchief boxes. - Hand soap should be guaranteed for all toilets. - Hydroalcoholic solution for hands should be provided at the place of rehearsal. -Disinfectant spray with 0.1% solution of sodium hypochlorite (bleach) (one cap of bleach per half litre of water to disinfect metal and wooden surfaces at the place of rehearsal, the soles of shoes, etc.) will be available.

- Optional use of transparent plastic clear file score folder organizer. It will be necessary to

design a correct management of the scores to minimize cross-contamination. Another option

to be considered is the use of tablets.

-Laser thermometer

6 ENTRY PROTOCOL IN THE REHEARSAL ROOM

-Disinfection: When accessing the rehearsal room, everybody must disinfect their hands with

soap and water or hydroalcoholic solution.

-Forehead temperature control (by the designated person). In the event that a fever, other

compatible symptoms or significant respiratory problem is detected, the singer will not be

allowed to enter the rehearsal room and will be sent back home and requested to contact the

healthcare services or family doctor.

-Footwear disinfection mats, with 0.1% bleach solution, paper or plastic disposable shoe

covers.

-The singers will wear a surgical mask to access the rehearsal room and to sing.

-The conductor and people required for the rehearsal will wear a surgical mask, and may also

include a face shield or goggles.

- (Optional) Singers will receive the score folder, duly disinfected with 70º alcohol or

disinfectant liquid, and no paper score will be removed from the folder.

-If conditions are not met regarding the premises, a survey will be carried out to find out

where to carry out the rehearsals: large rooms, auditoriums, conference halls, sports centers,

churches..., respecting the room capacity restrictions set at any given time and guaranteeing

adequate previous and subsequent hygiene of the premises. To respect social distancing, the

bigger the site, the better.

-The minimum separation between the shoulders of the singers will be 1.5m and 2m between

rows.

Despite being a grid like scheme, the arrangement can be circular and in parallel but opposing

each other so that a singer in the second row is between two in the first forming a triangle.

2m 1.50m

Conductor

Rehearsal room:

Up to 10 singers + conductor = + 27m², (5 singers for two rows, separation 1.5m x 2m.

Conductor at 2.5 meters, minimum.) 6m x 4.5m.

Conductor

For 20 singers + conductor = + 54m², (5 singers for 4 rows, separation 1.5m x 2m.

Conductor at 2-3 meters.) 6m x 9m

Conductor For 30 singers = + 82.5m² (6 singers for 5 rows, 3-4m conductor) 7.50m. X 11m

Conductor For 35 singers = + 99m² (7 singers x 5 rows, 4m. conductor) 9m x 11m.

conductor -It is advisable to mark the location of each singer with a cross on the ground.

7 ORGANIZATIONAL MEASURES

The following organizational measures will be adopted:

-Rooms with carpeted floors cannot be used due to the difficulty for cleaning and disinfecting.

-There should be windows to facilitate ventilation of the rooms.

-Assess the placement of ventilation / filtration elements in the rooms.

-Sing straight to improve breathing and facilitate the cleaning of the premises.

-It is recommended to rehearse in two parts of 30 minutes each allowing a 15-minute break.

-Rest areas: restrict the number of people depending on the space, so that the safety distance

is guaranteed: 1m. with mask if speaking; and 2m if the singer is not wearing a mask.

-Train and inform all singers about the rules of personal hygiene, through posters or other

means (e.g. proper handwashing, protocol in case of coughing or sneezing, etc.).

-A list of singers attending each rehearsal will be made only for epidemiological purposes in

case of infection.

8 RULES FOR SINGERS

Before the beginning of face-to-face rehearsals, the singers must be informed and trained,

preferably by digital means, in relation to:

-The protocol of attendance and rehearsal.

-Personal hygiene rules, through posters or other means (proper handwashing, protocol in

case of coughing or sneezing, etc.).

-The correct use of masks (mandatory).

-Correct use and non-sharing policy of score folders.

-There will be digital communication support by the federations to facilitate the access of the

choirs and singers to the information and doubt resolution.

-The Board and the director of the choir must be familiar with the "Guide to Hygiene and

Prevention of Rehearsals for Choral Singing". It is important to have a good knowledge of both

the Guide and the contents of this document.

-The Board should provide good information on infection control, hygiene and restrictions

before each rehearsal. All singers must be informed of the Five Pillars listed in section 3-

OBJECTIVES and of the Hygiene and Prevention Guidelines of the Guide by e-mail, social media

and SMS, before each rehearsal.

- One of the choir members should be in control of infection management and will be in charge

of preparing the rehearsal room and marking distances between individual spaces of each

singer in the room so that it is visible to everybody.

-For proper hand disinfection, hydroalcoholic gel and paper towels or paper handkerchiefs will

be provided.

-The use of toilets will be limited to hand washing and users must always dry their hands with

paper towels; the use of toilets will be for urgent cases only.

-All singers must wash their hands thoroughly before and after each rehearsal.

-When finishing the rehearsals, plastic surfaces must be cleaned with 70% alcohol, and metal

and wood ones with 0.1% bleach solution.

-Any kind of physical contact should be avoided; this also applies to the distribution / sharing

of scores, tablets and other equipment.

-It is recommended to ventilate the room well after the activity of each group, if the rehearsal

is divided into several groups.

-The Infection Control Manager will measure and delimitate the space of each singer before

the rehearsal with tape or post-it markers depending on the size of the group and the

regulations. We recommend this to be done prior to the rehearsal and notify the singers in

advance.

-The safety distance in all directions to the nearest singers must always be kept.

-The choir director establishes a plan for the rehearsals and issues it before resuming “normal”

rehearsals.

-Everyone must arrive on time to the rehearsal. No handshakes or hugs are allowed.

-If the rehearsal is divided into several groups, about 15 minutes time out should be alloted

between each group for a proper entry and exit of the room and its adequacy.

-If scores are to be distributed physically, it should be done with protective gloves.

-The piano should only be used by one person (conductor or accompanist). In case it is used by

more than one person, it must be disinfected each time.

9 NON-CHOIR MEMBERS

The following measures must be taken:

-Non-choir members who are not indispensable for rehearsals are not allowed in the rehearsal

site.

-Necessary activities carried out by external companies, such as cleaning, must be carried out

out of rehearsal hours. If the use of cleaning and sanitizing is required, these actions will be

performed after rehearsing.

-Other musicians: keep the safety distance, if possible. Musicians should have an assigned

place compliant with the safety distances. Prevent them from circulating around the rehearsal

room. They must bring the necessary IPE (individual protection equipment).

-Visits: all visits to the rehearsals will be restricted.

-Visits will have to comply with the same entry protocol as singers to enter the rehearsing site.

10 CLEANING AND DISINFECTION OF THE FACILITIES

-Increase the frequency and intensify the cleaning and disinfection of risk surfaces: door knobs,

handrails, buttons, counters, common use tables, taps, etc.). The used materials such as

folders will be disinfected, after using them, to be ready for the next use.

-Provide the singers with the necessary material for cleaning their folder, if necessary, and give

them the time to perform this task.

-Ventilate the rehearsal room before and after.

-Evaluate the use of ventilation / filtration / disinfection elements with HEPA, UV, -OH, O3

filters.

-Share rooms among different chorus during the crisis. Request publicly owned spaces

11 ACTION IN THE FACE OF THE RISK RELATED TO COVID-19 AND ESPECIALLY

VULNERABLE PEOPLE

According to the Ministry of Health, having a disease or being pregnant may increase

vulnerability to COVID-19, and these people are, therefore, considered to be particularly at

higher risk.

Identification of people at higher risk:

People who are most vulnerable to COVID-19 are: older people, people with health conditions

and pregnant women. Health conditions include:

• Chronic heart disease: a history of myocardial infarction or angina pectoris, valvopathy, or

any other heart disease

• High blood pressure

• Chronic respiratory diseases: asthma, chronic bronchitis, chronic obstructive pulmonary

disease, emphysema, pulmonary fibrosis

• Diabetic patients following pharmacological treatment

• Moderate or severe kidney failure

• Immunosuppressed patients or in treatment with immunosuppressants: HIV, transplants,

etc.

• Advanced chronic liver disease

• Morbid obesity (BMI> 40)

• Age conditions: Singers over 65 years old

• Pregnancy: Singers who are pregnant or breastfeeding

Of these groups, people with cardio-respiratory pathology could not rehearse due to their

respiratory limitation, which is INCOMPATIBLE WITH THE USE OF THE MASK, until resuming

normal activity.

People who suffer from any of the other illnesses or conditions included in the previous list

must inform the director or the person in charge of the Choir of their vulnerability, but there is

no need to specifically indicate the pathology. They will have to contact their doctor to assess

their health situation with respect to the performance of the activity in the rehearsals and

concerts of choral singing, as well as to inform the doctor of the protection measures that the

Choir has implemented for the performance of this activity, and it will be a doctor who will

indicate whether or not the activity can be done. This authorization will be sent to the person

in charge of the Choir.

EMERGENCY PHONES

GENERAL EMERGENCIES: 112

COVID-19 POSSIBLE CONTACTS: ??

CHOIR MANAGER:

Written by Dr. Lluís Gómez i Roldán (MD, specialist in Occupational Medicine, senior

occupational health safety specialist. Vice-president of the FCEC and president of the Orfeó de

Sants).

In collaboration with:

Dr. Montserrat Bonet i Agustí (MD, specialist in Phoniatrics and Otolaryngology, professor at

the UB and the ESMUC. Choir director)

Dr. Cori Casanovas i Barberà (MD, specialist in Phoniatrics, professor at ESMUC and Ramon

Llull-Blanquerna University, Singer)

Dr. Pilar Verdaguer i Cardalda (MD, graduate in Geriatrics. Singer and choir director)

Dr. Lluc Bosque i Conde (MD, occupational health and emergencies, EVES voice education

group at the UAB. Singer)

All the choral federations of Catalonia subscribe to this document.

Presented on 20/05/2020 to the GENERAL DIRECTORATE OF POPULAR CULTURE AND CULTURAL ASSOCIATIONISM

AND ACTION for its assessment by the PROCICAT. Catalunya.

This Covid-19 Risk Prevention Plan for Choral Singing activity conforms to the “GUIDE TO GOOD PRACTICES FOR THE

RESUMPTION OF THE STAGE AND MUSICAL ACTIVITY IN SPAIN” of the National Institute of Performing Arts and

Music, from the Spanish Ministry of Culture and Sport of 12/06/2020.

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