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COVID-19 Considerations for Flutists

Aug 6, 2020, 12:14 PM by National Flute Association

We are receiving many requests for information on returning to teaching, playing together, and best practices for returning to school.

While we don't have official recommendations, we can point you to a July 31 webinar—hosted by the International Double Reed Society and presented by Dr. Adam Schwalje, MD, DMA (otolaryngology, University of Iowa) with Dr. Peter Chin-Hong, MD (Infectious Disease, University of California San Francisco), Dr. Henry Hoffman, MD (Otolaryngology, University of Iowa), and Dr. John Volckens, Ph.D. (aerosol expert, Colorado State University)—which gives recent information on the risk assessment of COVID-19 for wind players.

There are no definitive studies on how to prevent or mitigate the risk of spread of COVID-19 for wind instrumentalists. In particular, the community of wind musicians has been focused on the potential for aerosol creation and spread during wind playing and its associated activities; while we do not know whether micro-droplets will carry infectious virus through the air, there are several indications that this may be an important route of spread for SARS-CoV-2. Keeping in mind that the efficacy of any of these methods is unknown, here are some of the ways you may be able to mitigate your risk.

Distance. While researchers from University of Colorado at Boulder recommend a 6’ x 6’ distance around each player and playing in straight, rather than curved, lines based on computer modeling from University of Maryland, this does not apply to all spaces or ventilation systems. The general recommendation of six-foot distancing is based on old research on droplet spread (in which larger droplets fall to the ground within about six feet) and does not apply directly to aerosols. Indeed, recent work from the University of Minnesota highlights the idea that aerosols can collect in rooms in ways that do not respect the six-foot boundaries. Nonetheless, more distance is probably better in most cases. Peabody guidelines call for 15 feet, for example. Moreover, the other thing that distancing ensures is a limitation on the number of people in a space. Fewer people means less risk.

Ventilation. Outdoor spaces are likely less risky than indoor spaces because of their increased ventilation. When indoors, one method to reduce risk is to increase the air exchange rate, by opening a window and allowing outdoor air in or by increasing the activity of the ventilation system. Work at University of Cincinnati highlighted the potential utility of a portable HEPA filter in reducing aerosol burden. When investigating HEPA filters, look for real HEPA filtration, and consider the clean air delivery rate (CADR) in cubic feet per minute. Electronic air cleaners are not advised.

Time. Risk of contracting the virus depends on exposure over time. Less time exposed means less risk of being infected. Work from University of Maryland suggests that, in their modeled space at least, more than 30 minutes of aerosol-producing activity leads to an increased risk of infection for others in the room. Leaving time between aerosol-producing activities might allow aerosols to disperse, further reducing risk—but the rate of reduction is dependent on characteristics of each space. 

Barriers. Plastic shields may block larger droplets, but smaller particles (aerosols) can still move in convection currents within the room. Large barriers and shower curtains are not advised as they can disrupt air currents in the room and may create pockets of increased concentrations of potentially infectious aerosols. Wearing a mask is one of the best things you can do to minimize the spread of virus, but it is not guaranteed, and can be difficult or impossible when playing wind instruments—though every musician should strive to be masked at least when not playing and during extended rests. Studies are ongoing regarding efficacy of the modified mask and other potential interventions for flute. 

Testing. One way to reduce risk is serial testing, with the caveat that depending on the test and local conditions, false negative results can be common. An adjunct to this is “cohorting,” in which a group of musicians would agree to essentially quarantine after a negative test result, further decreasing likelihood of disease within the group.

Associated activities. Flute swabs should be treated with care as they may contain infectious material. There should be no forced air used to “blow out” tone holes. 

Other guidelines: All federal, state, and local guidelines should be followed. Music-making with wind instruments, brass, and singers is an “edge case” and as such is not considered in such guidelines. Additional care is needed when playing the flute. An acceptable certainty of risk reduction may not be possible in all situations. Assessment of risk and consideration of mitigation strategies should, wherever possible, be accomplished in consultation with building engineers, ventilation designers, infectious disease experts, and aerosol experts.

Each flutist should consider their own situation: the building ventilation systems, local infection rates, and personal comfort level with using interventions that may lower transmission risk but for which there is no proven effectiveness.

The NFA does not promote any of these mitigation efforts and notes that the scientific results and recommendations are still preliminary. 

The NFA extends its appreciation to Adam Schwalje, MD, DMA, for his guidance on this statement and special thanks to Performance Health Committee member Stephen Mitchell, MD, for his ongoing guidance on COVID-related matters.