Singing is the one musical activity in which almost everybody can participate – all you need is your voice. Through the ages, singing has been a way to unite people through anthems and war cries. It allows us to express devotion, whether religious or romantic. And it helps us to manage and process overwhelming emotion to celebrate or mourn, to soothe and calm. Many nurseries use singing for activity transitions, helping both verbal and pre-verbal children to manage themselves. However, at the moment, singing is still under intense scrutiny due to SARS-CoV-2, otherwise known as coronavirus or COVID-19.

The focus on singing is due to the distribution of particles, and it is thought that the louder we sing, the further the particles spread, with some venues insisting on a 3-metre distance. This extreme distancing is now thought to be unnecessary based on a previous study on tuberculosis, also an airborne condition that affects the lungs. This is because the study found that although 6 times more particles were generated during singing than talking, larger particles dispersed into the air or dropped to the ground, so were not actually transmitted. As a result, they may not actually result in infection, which is why the government requested studies from music and physics specialists.

Despite the risk, singing can manage panic and disruption, and promote physical, mental and social health in times of crisis (2). Increasingly, the arts in general and music specifically, has been recognised for not only its health but medical benefits, as evidence shows that it can reduce high blood pressure and cortisol levels, symptoms of many conditions including heart and lung disease, as well as mental health, like anxiety and depression. This is why a balance had to be found between risk and delivery.

Media

Coronavirus has brought about significant change and disruption to a lifestyle that we had all taken for granted. With the initial awareness of the effect of the virus on the lungs and mouth/nose, the natural activity of singing was bound to be affected. A few choir rehearsals then hit the news (4), with one choir rehearsal resulting in 20 possible and 32 confirmed coronavirus cases out of 61 people, (3 hospitalised, 2 deaths); and another choir with 102 infected (3 hospitalised and one death) out of 130 people. Our current understanding about and explanation for the choir transmissions is that the they were either due to the increased production of respiratory droplets or interpersonal behaviour – hugging, kissing, sharing cups and standing near each other – all familiar nursery and early childhood behaviours. Understandably, all choirs were immediately closed to live rehearsals (and performances) in March, but what are the implications on nurseries and young children?

The science behind the guidance

In June 2020, Dr Naunheim et al (5) considered the data available on respiratory particles and droplets in the transmission of SARS-CoV-2. Because the virus has been found in the respiratory tract, it was assumed that transmission occurred through aerosols which can survive on multiple surface types. The source of infection may be unknown, as non symptomatic individuals are able to transmit it. Droplets and aerosols appeared to be produced through speech, sneezing and coughing, but these did not actually guarantee spread or infection. Compared to normal-volume speech, both louder and whispered speech increased aerosols, but professional singers manage this through breath-control training. The use of microphones also reduced the potential for transmission, and it is not yet known how aerosol production changes according to voice type, register or style, or whether shallow breaths/shorter vocal tract impact aerosol production.

Transmission appears to occur from person to person after close contact, with 82% decreased risk with physical distancing of 1 meter or more. There is no scientific proof that transmission increases due to close quarters, and there is no clear guidance for minimum ventilation standards – although open doors and windows appears to be more effective at dispersing droplets and aerosols than mechanical ventilation. Findings suggest that high temperatures and humidity decrease infection rates. Other coronaviruses show that high quality (N95, surgical) masks protect against SARS-CoV-2 infection, and recent findings show that cloth masks are effective when used with several layers of water-resistant fabric. Although little has been said about PPE (Personal Protective Equipment) when singing, it is reasonable to assume that it will allow for safer interaction. Eye protection has not been identified as necessary or beneficial yet, but it has been beneficial in other outbreaks.

High risk groups include the underlying conditions of obesity and diabetes, as they have been correlated with worse outcomes, and the increased infection in black and Asian communities is linked with historic inequalities rather than a genetic predisposition. These factors must be accounted for in risk assessments (Performing Arts – Working Safely during Coronavirus (6).)

Choir advice

With the effect of coronavirus on choirs – groups that sing together – it would be reasonable to consider their guidance. Choirs have been advised to reduce numbers and rehearsal/performance time significantly, to increase room size, allow for open doors and windows, and wear PPE (cloth masks). Technological options could eliminate risk of transmission but are difficult in real time as they reduce the sound quality and body language cues between performers. Because of the general age and health demographics, professional and community choirs would benefit from COVID-19 testing before each rehearsal as well as temperature and other (symptom questions) screening, although the testing may not be practical.

Many countries are actively researching the use of music in health as music medicine. The Institute of Music Medicine at the German University of Freiberg (8) recommend a three-prong approach to risk reduction: Entrance screening, to determine risk history, potential infection contact and current symptoms with an addition of track and trace app subscription; room parameters, to consider music performance outdoors, or if indoors, ensure sufficient room space, regular ventilation, shorter time, with an addition of CO2 measurement; and PPE, to address distance between people, mouth/nose protection, plastic partitions and an addition of any instrument-specific aspects. These principles have helped to inform the guidance available.

Government guidance

The UK government guidance (1) prevented indoor group singing from March until 1 August while researchers trialled safe ways to sing. Initially, trained/professional singers were permitted to sing to groups outdoors only, but people within groups could not sing at all, along with wind instruments like trumpets, flutes and recorders. Gradually, safe ways are being found to reintroduce music safely within society.

One of the leading organisations for music teaching, the Incorporated Society of Musicians, summarised the government guidance (2). It recommends a return to previous activities as far as possible, with clear risk assessments in place.

Risk assessments should cover:

  • risk of infection
  • room layout
  • cleaning and hygiene arrangements
  • parent communication
  • timing of measures

Risk of infection should address:

  • social distancing (2 metres between adults, minimise time within 1 metre of others)
  • ventilation (at least 10 litres per second per person)
  • regular natural airflow
  • appropriate protective equipment
  • group lessons (limit number singing/playing together/social bubbles), and
  • appropriate timetabling (cleaning, fresh air, handwashing)

Lockdown nursery singing in practice

An article on “lessons learned” (7) considered the experiences of nursery singing in a three countries. Norwegian pre-schools mentioned the “continuation of reading and singing” to children as normal, although in smaller groups, while pre-schools in the United States referred to a “daily routine of music and movement sessions”. All used extra hand washing, smaller group sizes, lower teacher-child ratios, restricting parent access and social distancing (between 1-1.83m). Adults in nurseries in Norway and Sweden used masks, and recognised education as a fundamental value of society, while mask use varied in the United States, where teachers were more concerned with children “falling behind”. All were concerned about personal health, duty to children, lack of preparation for disease control (despite previous protocols in place) and the ability to sustain new hygiene protocols. Teachers also identified positive outcomes, including greater opportunities for personalisation and following up individual interests, learning new technological skills, and a need to continue occasional updates in the future to prepare for similar circumstances.

Conclusion

With close interactions with children, it is recognised that PPE poses a significant impact on the ability to communicate (3), where alternatives have been offered including perspex shields and transparent facemasks (plexiglass screens have only been found effective if completely surrounding individuals’ airspaces). However, research recommends that singing should not stop but be continued as safely as possible using risk assessments, PPE, social distancing and limiting numbers, reducing time, and increasing natural airflow as much as possible.

Please contact Frances for a list of academic references used in this article.

About the author

Frances Turnbull

Musician, researcher and author, Frances Turnbull, is a self-taught guitarist who has played contemporary and community music from the age of 12. She delivers music sessions to the early years and KS1. Trained in the music education techniques of Kodály (specialist singing), Dalcroze (specialist movement) and Orff (specialist percussion instruments), she has a Bachelor’s degree in Psychology (Open University) and a Master’s degree in Education (University of Cambridge). She runs a local community choir, the Bolton Warblers, and delivers the Sound Sense initiative aiming for “A choir in every care home” within local care and residential homes, supporting health and wellbeing through her community interest company.

She has represented the early years music community at the House of Commons, advocating for recognition for early years music educators, and her table of progressive music skills for under 7s features in her curriculum books.

Frances is the author of “Learning with Music: Games and Activities for the Early Years“ “Learning with Music: Games and Activities for the Early Years“, published by Routledge, August 2017.

 

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