In each of the outbreaks listed, multiple transmission routes may have contributed to overall infection levels. 2020;323(18):1837-8. Available from: Jayaweera M, Perera H, Gunawardana B, Manatunge J. These “super-emitters” have been found to release up to an order of magnitude more particles compared to normal emitters.23,36, Release of infectious virus in respiratory particles, As presented above, singing, and loud vocalization could increase risks of transmission via respiratory droplets of all sizes. Skagit Valley Washington: Choir rehearsal outbreak, The most widely cited outbreak associated with singing in a group was a choir in Skagit Valley, Washington where, following a 2.5-hour rehearsal on March 10, 2020 attended by 61 persons, 53 cases (33 confirmed, 20 presumed) were subsequently identified.2 Three persons were hospitalized and two died. Face coverings can also be considered during breaks or when speaking to each other or entering/exiting the venue. The key risks associated with singing in groups have been identified as common risks associated with large gatherings, as well as the additional risks associated with vocalization (release of greater quantities of small respiratory particles). May 9, 2020 LINK (5) o ^There is no safe way for singers to rehearse as a group until there is a vaccine and a ñ percent-effective treatment for COVID-19, the disease caused by the coronavirus, and it could be two years before both happen, a national panel of music and medical experts 2020. Large quantities of small respiratory particles can be produced, and they can remain in the air for an extended time frame. COVID-19 response committee report. The CDC has revised its guidance to church leaders, deleting a warning about the risk of spreading the coronavirus through choirs and singing. In the early days of the COVID-19 pandemic, several clusters (and subsequent deaths) within choirs in the US and the Netherlands provided a frightening wake up call for the choral community. Participating in choirs and bands may lead to increased risk of COVID-19 transmission if proper precautions are not taken. Available from: Asadi S, Wexler AS, Cappa CD, Barreda S, Bouvier NM, Ristenpart WD. 2020;581(Apr 1):465-9. Due to the widespread secondary attack rate, it is unlikely that fomite transmission and face-to-face contact with the index case were the primary routes of transmission, suggesting that inhalation of respiratory aerosols in shared air over a prolonged duration may have dominated.3 Details on heating and ventilation in the setting were limited; however, no windows or doors were open, and the furnace that was operating used both outside make-up air and combustion air, although proportions were unknown. medRxiv. Close contact while greeting each other, as well as hugging, talking, and laughing increases the risk of transmission via respiratory droplets, fomites, and short-range aerosols. Maintaining physical distancing of at least 2 metres is an important control measure for reducing transmission via large respiratory droplets and should be maintained between members of a choir and between singers and the audience. Anesth Analg. Available from: Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. Jpn J Infect Dis. When inside, moving activities to very large rooms with good air exchange is recommended to reduce risks.43 Larger room sizes allow for greater dilution of respiratory particles, but without proper ventilation, particles can accumulate and disperse within the room over time. In June, the IATF announced that churches in modified general community quarantine areas may conduct religious services at a 50-percent seating capacity. She also said that choir members do not have to face each other while singing during religious gatherings. A study of respiratory aerosols produced by various activities, including loud vocalization in the form of shouting or cheering, found that the majority of particles released were between 0.5 and 5 µm in diameter.31 Another study examining droplet size distribution during speech found that both large and small droplets were released, with droplets in the range of 1 to 10 µm in diameter being more prevalent.32, While large droplets (e.g., ≥ 20 µm) will typically settle to the ground prior to losing moisture due to evaporation, moisture on smaller droplets may evaporate before they settle, causing droplet nuclei to remain suspended for some time.33 Somsen et al. CDC Quietly Removes Guidance That Singing In Church Choirs Comes With Virus Infection Risk. University of Oxford, Centre for Evidence-Based Medicine 2020; Available from: He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. “Isa ‘yan sa dapat mapag-aralan at mapagsabihan rin of course ang ating mga kaparian at ating mga simbahan that this might be a cause of spreading the virus as well,” Health Undersecretary Maria Rosario Vergeire said in a virtual media forum. The singer was later found to be infected with the virus but had not displayed symptoms on the day of the concert. Five days after a Berlin Cathedral Choir practice on March 9, 2020, one of the 80 participants reported that she had tested positive for COVID-19. 2020 Sep;188:109819. A modelling study found that being in the same room with a person (whether or not they are displaying symptoms) with a high viral load can lead to an increased concentration of infectious particles, and risk of infection in a relatively short time.41. The furnace included a MERV 11 filter, with efficiency of up to 65% for particles 1 um or larger.3, Concertgebouw auditorium, Netherlands: Choir performance. Epidemiology of COVID-19 outbreak in Japan, January–March 2020. Among restrictive COVID-19 mandates and government lockdowns that hobbled the economy, significantly more people left blue states to resettle in areas in the southern and western U.S. Beyond the risks and recommended precautions associated with gathering in groups, this review identifies the risks specific to singing in groups, and the suite of precautions that can be considered to minimize these risks. COVID-19 transmission risks from singing and playing wind instruments – what we know so far. 2020 Apr 10;139:105730. Church choirs find new ways to bring joy during pandemic In Associated Press , Church in the US , COVID-19 Sara Pagones, The Times-Picayune/The New Orleans Advocate Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. COVID-19 resources for the Canadian choral community. Lancet Infect Dis. Bioaerosols that do not settle may also be transported beyond 2 m depending on air flow within a space. Crowded spaces also allow for more rapid accumulation of exhaled air due to a greater number of persons emitting. As air is exhaled from the bronchioles, the mucosal layer on the collapsed surfaces forms a continuous film. Since lockdown began in March, those millions of voices have been silenced. Members who do attend can consider avoiding face to face singing, and the use of face coverings when not singing to reduce the release of aerosols due to breathing. (2020) similarly found that airborne particles released by vocalization in a stagnant air environment were detected 8 to 14 minutes after speaking.12 Particles of 5 µm in diameter or less are much more likely to penetrate further into the respiratory tract, including the alveolar region, and particles of 5 to 10 µm can penetrate the tracheobronchial region.34, Quantity of particles produced during vocalization, A study that visualized bursts of speech droplets using laser light scattering found that speech can produce an average of 1000 particles per second, as well as a range of droplet sizes including larger droplets of 10 to 100 µm that remained airborne for at least 30 seconds.35 Asadi et al. Persistence of severe acute respiratory syndrome coronavirus 2 in aerosol suspensions. A number of COVID-19 outbreaks have occurred at churches throughout the country. ), and Google Scholar, with no date or jurisdictional limit, for English language documents. Understanding the dominant transmission pathways in the SARS-CoV-2 pandemic has been complicated by the occurrence of pre-symptomatic transmission (during the incubation phase of an infected person) and asymptomatic transmission (transmission via an infected person who never displays symptoms).17 The precise incidence of pre-symptomatic and asymptomatic transmission is unknown, but it may be significant. Overall, 60 of the 80 participants that attended the March 9 practice became infected. Toronto, ON: Queen's Printer for Ontario; 2020 May 22. Lancet Respir Med. At Greater St. Stephen, 60 to 75 people sing in the choir on a normal Sunday. Three partners of choir members and one choir member subsequently died. Available from: Lai K-M, Bottomley C, McNerney R. Propagation of respiratory aerosols by the vuvuzela. 2009 Dec 6;6 Suppl 6:S783-90. Clinical presentation and virological assessment of hospitalized cases of coronavirus disease 2019 in a travel-associated transmission cluster. COVID-19 – what we know so far about… asymptomatic infection and asymptomatic transmission. Larger groups can also consider reducing the number or participants at any one time. Back in October, the Inter-Agency Task Force on the Management of the Emerging Infectious Diseases (IATF) has allowed churches, mosques, and other places of worship in areas under a general community quarantine to hold religious gatherings at a seating capacity of 30 percent. Raising the voice of choral music. Geneva, Switzerland: WHO; 2020 Mar 29. Choirs may have to remain silent long after society reopens. The COVID-19 pandemic has required a rethinking of how many of our daily tasks and routine activities influence risks of transmission of SARS-CoV-2, the virus responsible for the disease. (2020) found that while large droplets emitted by coughing do not travel far, small droplets of around 5 µm in diameter, emitted by both speech and coughing, can take up to 9 minutes to settle to the ground.32 In well ventilated rooms, the number of droplets produced by simulated coughing (average 5 µm in diameter) halved within 30 seconds, compared to 5 minutes in the unventilated rooms. Pre-symptomatic and asymptomatic transmission. Available from: Kang J, Scholp A, Jiang JJ. “Isa … Vergeire, however, noted that some choirs observe physical distancing. 2010;20(1):31-9. Outcomes of a study on the rate and size of bioaerosols emitted by different singers, and the impact of active and passive control measures by University of Colorado56 is also expected. Available from: Somsen GA, van Rijn C, Kooij S, Bem RA, Bonn D. Small droplet aerosols in poorly ventilated spaces and SARS-CoV-2 transmission. Airborne transmission of SARS-CoV-2: the world should face the reality. Effect of voicing and articulation manner on aerosol particle emission during human speech. Although these events occurred early in the global pandemic, they demonstrate the importance of symptomatic persons, even if only mildly symptomatic, excluding themselves from group activities. Even as church leaders plan for … Available from: Anderson EL, Turnham P, Griffin JR, Clarke CC. As the vocal folds open and close during vocalization, fluid film between them can also rupture, releasing particles.23 Aerosols can also be produced from the oral cavity during speech.24, A combination of processes thus occurs during speaking and singing as release of droplets due to fluid-film burst in the bronchioles varies with inhalation and exhalation, and release of droplets from the larynx may vary depending on vocalization style. THE coronavirus lockdown is having a savage impact on church musicians, member organisations have said.Choristers, classical musicians, and organists who are unable to meet or practice must be offered imaginative solutions, they say. 2011 December 1, 2011;42(12):839-51. “Up until now we have had one of the most vibrant choral landscapes in the world,” the letter reads. If preventative measures are taken, risks can be minimized. For more information on COVID-19, call the DOH Hotline: (02) 86517800 local 1149/1150. We use cookies to ensure you get the best experience on our website. Available from: Riediker M, Tsai D-H. Estimation of SARS-CoV-2 aerosol emissions from simulated patients with COVID-19 and no to moderate symptoms. Gondwana Choirs and UNSW are proud to present a free webinar for the Australian choral community, featuring Professor Raina MacIntyre and Professor Con Doolan from UNSW, in conversation with Lyn Williams, Carl Crossin and Elizabeth Scott. Denver, CO: Colorado State University; 2020. Outside air can help to dilute infectious particles to low levels and air flow can help to disperse particles. Clusters of coronavirus disease in communities, Japan, January-April 2020. As more research and evidence on dominant transmission routes and risk factors for SARS-CoV-2 are identified, the public health guidance is also evolving. The extent to which singing itself contributes to outbreaks among church congregations is unknown, but it may be one of many factors increasing overall risk in crowded indoor spaces. 2011;6(5):e20086. 2020 Jun 18; Pre-print. Portable fans should be used with caution to ensure they are not simply dispersing contaminated air around a room. Berlin, Germany: German Society for Music Physiology and Musicians' Association; 2020. Available from: Riediker M, Morawska L. Low exhaled breath droplet formation may explain why children are poor SARS-CoV-2 transmitters. Available from: Morawska L, Cao J. COVID-19 Scientific Advisory Group Rapid Evidence Report. There has been limited published literature detailing investigations of outbreaks related to singing in groups, with some reports providing only anecdotal accounts of these events. Available from: Anfinrud P, Bax CE, Stadnytskyi V, Bax A. Available from: Choir Alberta. Japan: Clusters associated with large music venues, An analysis of 61 clusters of cases (five or more persons) in Japan between January 15 and April 4, 2020 found that 11 % were music-related events including large numbers of cases associated with large music venues. The choir held rehearsals on February 25, two days before the first official case of COVID-19 was announced in the Netherlands. The potential for transmission via pre-symptomatic and asymptomatic persons via multiple routes, including respiratory aerosols, has implications for activities such as singing in groups. Available from: Firle C, Jabusch H-C, Grell A, Fernholz I, Schmidt A, Steinmetz A. Experts say indoor church services are high risk for COVID-19 because people sit … Religious venues have been at the centre of many outbreaks, with multiple examples of widespread community transmission among church congregations. 2020;20(7):1513-5. (They are all facing towards one direction. Available from: To KK-W, Tsang OT-Y, Leung W-S, Tam AR, Wu T-C, Lung DC, et al. Risk Anal. Don't miss out on the latest news and information. This includes better understanding of how the nature of specific activities and the characteristics of the settings in which they take place can influence risks of transmission. During the rehearsal, members reported being well-spaced while rehearsing but socialized and stood close in line for the coffee break. Transmission of COVID-19 virus by droplets and aerosols: a critical review on the unresolved dichotomy. J Aerosol Med Pulmon Drug Del. medRxiv. On March 7, the day before the concert, a dress rehearsal with the entire orchestra and six soloists was held in a large venue. Contact with contaminated surfaces (fomites) followed by touching of the eyes, mouth, or nose is another potential mode of SARS-CoV-2 transmission, although the relative importance of fomite transmission is still poorly understood. 2020;20(4):411-2. The mass choir is a combination of the three. 2020; Pre-print. J Voice. J Aerosol Sci. High SARS-CoV-2 attack rate following exposure at a choir practice — Skagit County, Washington, March 2020. Some examples of outbreaks where singing or loud vocalization have featured are listed below. Singing in groups also includes a risk of transmission via aerosols, but due to aerosols persisting in the air for a longer duration than large droplets, ambient air currents can cause them to be dispersed within a room. Call 896 6000. Control measures for fomite transmission include good hand hygiene practices and routine cleaning and disinfection of surfaces, as well as avoiding sharing of equipment, musical stands, and microphones, and socializing over food and drink during breaks. Available from: Newfoundland and Labrador Centre for Applied Health Research. If infected persons are asymptomatic or pre-symptomatic, they may be unaware that they are emitting infectious particles and presenting a risk to others in the room. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. Florida Warns of Superspreader Events at Church Choirs and House Parties As All State Coronavirus Restrictions Lifted Aristos Georgiou 9/29/2020 Louisiana Congressman-elect Luke Letlow dies with COVID A review of studies by Heneghan et al. No other concert goers were affected, indicating that transmission likely occurred during close contact during the backstage interaction and not during the singing performance. The UK government relaxed the Covid guidelines for singing in church this weekend. What settings have been linked to SARS-CoV-2 transmission clusters? Proc Nat Acad Sci USA. Fifteen singers reported sick and did not attend the rehearsal. 2020;20(5):565-74. medRxiv. The warning was omitted even though choirs can become “super-spreader” events infecting large groups of people at once. Toronto, ON: Choral Canada Association of Choral Communities; 2020; Available from: Government of Manitoba. Recommendations of the German Society for Music Physiology and Musicians Medicine (DGfMM) to protect against infection when playing music. Available from: Pentreach R. Scientists to carry out spittle test on Salisbury Cathedral Choir to assess hymn safety. Topic: Singing as a risk for transmission of SARS-CoV-2 virus. COVID-19 creates "grim" outlook for choirs, singing in group settings. Emerg Infect Dis. Sci Rep. 2019 Feb;9(1):2348. Oklahoma City, OK: American Choral Directors Association; 2020 Jun 15. COVID-19 & the future of choral singing in Australia. The number of singers, the room size, the level of ventilation, and duration of singing all contribute to determining risk as well as the prevalence of SARS-CoV-2 cases within the community. medRxiv. Aerosol Air Qual Res. 2020 Jun;117(22):11875-7. Available from: Buonanno G, Stabile L, Morawska L. Estimation of airborne viral emission: quanta emission rate of SARS-CoV-2 for infection risk assessment. Environ Int. This brief review has outlined the key risks associated with singing in choirs, including the risks associated with gathering in large groups, and the additional risks related to production of small respiratory droplets via vocalization. Please see Appendix 1 for the literature search method and search terms. A rapid literature search was performed by the NCCEH information specialist using Ebscohost databases (includes Medline, Cinahl, Academic Search Complete, ERIC, etc. (Anfinrud, Bax, et al., 2020) Vocalization, whether whispering, loud speaking, or singing produces a higher concentration of particles than breathing.22 Respiratory particles released by vocalization are generated by a combination of mechanisms in the bronchioles, larynx, and oral cavity. 2020 May;26(5):672-5. Choir singers have been found to have a higher average vital lung capacity than non-singers, and the inspiratory capacity of singers has also been found to be greater on average.29 Children may release fewer respiratory particles due to smaller lungs with fewer terminal bronchioles where production of aerosols via fluid-film burst could occur. 2020 Apr 7; Pre-print. Further research is needed to better understand the concentration, survival, and transport distance of SARS-CoV-2 in aerosols, and the dose/response relationship for SARS-CoV-2.7 Greater understanding of the risk of different activities indoors and outdoors is also needed. The church has four different choirs — men’s, women’s, young adult and mass choirs. According to a 2017 survey by the Big Choral Census, the UK has “at least 40,000 choirs”, including private choirs, church choirs and school choirs, with 2.14 million regular singers. A COVID-19 superspreader unknowingly infected 52 people with the new coronavirus at a choir practice in Mount Vernon, Washington, in early March, … Approximately 5000 cases were linked to the Shincheonji Church of Jesus, where characteristics such as large numbers of attendees, indoor confined spaces, and participation in singing and close physical contact could have led to transmission of SARS-CoV-2 via various transmission routes. 2020. Because of COVID-19, churches no longer reverberate with song; hymnals are neatly stacked and projection screens blank. 2020 Jan 27;15(1):e0227699. Berrien Springs Michigan: Concert cluster. (2019) found a linear correlation between volume of speech and number of respiratory particles emitted.23 Even quiet speech emits more particles than normal breathing and the quantity of emitted particles during all volume of speech are greater than during breathing. Evidence of short-range aerosol transmission of SARS-CoV-2 and call for universal airborne precautions for anesthesiologists during the COVID-19 pandemic. Further examination of bibliographies of key articles were scanned to retrieve more extensive information, and key authors in the subject area were searched to identify additional relevant citations. Available from: Asadi S, Bouvier N, Wexler AS, Ristenpart WD. Then, in March, the early days of the COVID-19 pandemic, two members of a … 2009 Mar;40(3):256-69. Viral load of SARS-CoV-2 in clinical samples. Some of the control measures that can be considered for reducing these risks are discussed below. 2020;Pre-print. Of this figure, 27,781 are active cases with 1,383 newly-recorded infections, 409,058 are recoveries, and 8,701 are deaths. (2020) found that between 5% and 80% of people infected with SARS-CoV-2 may be asymptomatic.18 He et al. This document will be updated as new evidence emerges. Germany: Universität der Bundeswehr München; 2020. Several examples of COVID-19 clusters or outbreaks, where singing or loud vocalization have featured in the venue or activity, have been reported in various media reports and academic journals.1 These outbreaks have also included other risk factors such as crowding or gathering in large groups, enclosed spaces or poor ventilation, long duration of contact, and other types of interactions such as greetings and social interactions, sharing of food, drinks or equipment, and shared transport. Guidelines for vocalists and instrumentalists. Lancet Infect Dis. Available from: Tellier R. Aerosol transmission of influenza A virus: a review of new studies. A number of organizations have developed guidance and recommendations for various levels of choir singing, from school choirs to community choirs. As reopening progresses, groups that were previously prevented from gathering are seeking advice and guidance on when and how to resume activities safely. Available from: Fears AC, Klimstra WB, Duprex P, Hartman A, Weaver SC, Plante KS, et al. Consideration of the aerosol transmission for COVID-19 and public health. Vancouver, BC: National Collaborating Centre for Environmental Health. But this year, Christmas arrives in the midst of a pandemic that essentially shut down church choirs in mid-March. Available from: Scheuch G. Breathing is enough: for the spread of influenza virus and SARS-CoV-2 by breathing only. It is speculated that approximately a few hundred SARS-CoV-2 viral particles is needed to cause infection.37 Viral load in the respiratory tract can vary by location and stage of the disease, but measurements of viral load during the early stages of the COVID-19, when viral loads are highest, have found median viral loads between 104 to 106 copies per mL of respiratory fluid.38-40 Viral loads of SARS-CoV-2 in sputum have been found to be higher than in the throat, and up to 1011 copies per mL have been detected in respiratory fluid.38 Riedeker and Tsai (2020) estimated that an average emitter will release about 106 copies per ml.41 Infected super-emitters who release a greater number of respiratory droplets could present a greater risk for transmitting the virus to others, particularly if they also carry a high viral load in the respiratory particles emitted. 2020;141:105794. There is no evidence that more than one index case was present. Communication with groups prior to rehearsals and events can include screening for symptomatic or highly susceptible persons, who should not attend. The director of the Royal School of Church Music (RSCM), Hugh Morris, said on Tuesday: “Coronavirus has had a devastating effect on church … MMWR Morb Mortal Wkly Rep. 2020;69:606–10. This aligns with findings of investigations of outbreaks and clusters associated with pre-symptomatic and asymptomatic transmission, suggesting that infectiousness may peak on or before symptom onset in the index case.20 Examples of pre-symptomatic and asymptomatic transmission throughout the COVID-19 pandemic have promoted the theory that, in the absence of symptoms such as sneezing and coughing, transmission routes other than via large respiratory droplets are significant, particularly in confined spaces. Available from: Hijnen D, Marzano AV, Eyerich K, GeurtsvanKessel C, Giménez-Arnau AM, Joly P, et al. Available from: Colorado State University. Available from: Alberta Health Services. Available from: Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al. The country has already recorded a total of 445,540 COVID-19 cases as of Thursday. PLoS ONE. J Aerosol Sci. Gupta JK, Lin C-H, Chen Q. Characterizing exhaled airflow from breathing and talking. Mechanical ventilation, or well-planned natural ventilation can help remove particles with upward air flow exhausted to the outside, and can dilute indoor air with clean outdoor air.42, While recirculating systems are discouraged, where unavoidable, control measures to improve conditions such as increased percentage of outside air in ventilation, high quality filters (MERV-12), or integrated disinfection systems (e.g., UV germicidal irradiation, either in ducts or in an upper room configuration) can be used to minimize recirculating virus.44,45 Small and poorly ventilated areas may require ventilation cycles between usage, increased airflow or adding filtration where possible.44. Environ Int. London, UK: ClassicFM; 2020 Jun 29. Other types of barriers may be considered in some situations to limit the spread of aerosols and droplets directly in front of a singer, such as pop shields on microphone stands.46 Other measures that have been suggested include a staggered arrangement of singers in rows, and practices such as tilting the head downwards when singing to limit projection of respiratory particles.46 Further study is needed to identify the impact of these measures on reducing risks of transmission. Available from: Johnson GR, Morawska L, Ristovski ZD, Hargreaves M, Mengersen K, Chao CYH, et al. Sharing of surfaces and objects such as musical stands, chairs, books, microphones, instruments, food, dishes and cutlery, or drink dispensers increases the risks of fomite transmission. Now in their 60s, singing remains a key part of life for the couple, who have been members of the choir at Plymouth Church in Des Moines, Iowa, since 1978. This brief evidence review provides an overview of the key risks associated with singing in groups. Edmonton, AB: Alberta Health Services; 2020 May 22. Tam AR, Wu T-C, lung DC, et al to community choirs advice and guidance on when how... Identified at the Centre of many outbreaks, with some members of the vocal folds occurs for voice.... Reduce accumulation of potentially infectious aerosols hygiene practices and routine cleaning and disinfection of surfaces respiratory particles can reach into. Nililimitahan sa karaoke kasi marami pang pagkakataon na tayo ay kumanta sa public places of sheet music stands... Greater number of organizations have developed guidance and recommendations for various levels of choir singers and nonsingers: a study. Been silenced should be reviewed is uncertain is also evidence that maintaining 2 metres distance can help to reduce short-range! 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Provides an overview of the key risks associated with the sharing of sheet music, stands, or direct! Face the reality R. aerosol transmission of small droplets or bioaerosols before the first official case of indoors! Loud vocalization have featured are listed below reduce the short-range transmission of by! 75 people sing in the air for an extended time frame several organizations are currently research! Doremalen N, Miyahara R, Corman VM, Guggemos W, Seilmaier M, Mengersen K, C! Contributed to transmission in notable outbreaks associated with singing in church this.! Knight LE, group CC-W, Funk S, Mueller MA, et al socializing... Li Y. Indoor transmission of virus causing COVID-19: what proportion are asymptomatic omitted even though choirs can “. More, please click this link young adult and mass choirs the Department of Health singing! No firm evidence as to the level of exposure to infectious SARS-CoV-2 virus latest news and information reduce..., Buonanno G, Dancer SJ, et al, Nielsen PV, Wei J, et al COVID-19 ``!
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