Consolidated COVID-19 Conclusions/Mitigation Guidelines
Summarized from 2 Studies on Aerosols Cited Below

As of August 18, 2022 summary of guidance from the studies presented below.
For more detailed and up to date information refer back to the original studies (NFHSA/UC Boulder/UMD and CSU).

NFHSA Updated Reports on August 15, 2022

This update pertains to the survey that was conducted on using mitigation strageties.

• COVID-19 Prevention Strategy Results among Elementary, Middle, High School and Collegiate Music Programs in the United States (August 15th)
• 3min YouTube Video "about the Spring 2022 survey study done to determine the effect of recommended COVID-19 prevention strategies in performing arts classrooms in the U.S. during the Fall 2021 semester when the primary COVID-19 variant was the Delta strain."
• Infographic regarding use of mitigation factors in schools
• Paper 

NFHSA Updated Guidelines on March 15, 2022

• This update coincides with general changes in CDC guidelines for schools in which masking was no longer being recommended across the board, but based on local infection rates. " Performing Arts programs should follow the same recommendations that are implemented for the rest of the school." The full guidlines linked below reiterate the previous guidelines for masks and bell covers if the school is masking.
• Full updated Guidelines

CSU Study Paper published on November 9, 2021

• Respiratory Aerosol Emissions from Vocalization: Age and Sex Differences Are Explained by Volume and Exhaled CO2
  Nicholas Good, Kristen M. Fedak, Dan Goble, Amy Keisling, Christian L’Orange, Emily Morton, Rebecca Phillips, Ky Tanner, and John Volckens*
  Environmental Science and Technology Letters, November 9, 2021 https://doi.org/10.1021/acs.estlett.1c00760

NFHSA shared link "It's OK to Play Music - Helpful Infographic (November 8th)"

Website: https://www.nfhs.org/articles/unprecedented-international-coalition-led-by-performing-arts-organizations-to-commission-covid-19-study

• Infographic Link at: https://bit.ly/NFHSAerosolCOVID

NFHSA shared link to published paper about research study on August 31st.

Website: https://www.nfhs.org/articles/unprecedented-international-coalition-led-by-performing-arts-organizations-to-commission-covid-19-study

• Paper titled: “Measurements and Simulations of Aerosol Released while Singing and Playing Wind Instruments”
• Direct Link available from ACS Publications Web Editions: https://pubs.acs.org/doi/abs/10.1021/acsenvironau.1c00007

NFHSA A Conversation on Mitigations for Fall 2021 (Speech, Debate, Theatre, Music, and more!) (August 27, 2021):

Website: https://www.nfhs.org/articles/unprecedented-international-coalition-led-by-performing-arts-organizations-to-commission-covid-19-study

• Video of conversation with Dr. James Weaver (NFHS), Dr. Mark Spede (CBDNA/Clemson), and Bob Morrison (Arts Ed New Jersey) about current mitigations and recommendations for various music, speech, debate, and theatre activities. Based on July 16th report noted below.  
• Direct YouTube Link:  https://youtu.be/1seuGKnKHb0   

NFHSA Updated Guidelines for Fall 2021 Activities (July 16,2021):

• Website: https://www.nfhs.org/articles/unprecedented-international-coalition-led-by-performing-arts-organizations-to-commission-covid-19-study
• Link Title: Updated Guidelines for Fall 2021 Activities (July 16)
• Information here from one page document with title of "International Coalition Performing Arts Aerosol Study Updated Guidelines 7/9/21"

• From introduction: "Importance will need to be placed on local and state respiratory disease transmission rates for use of mitigations."

• Outdoors: Outdoors remains the safest space - No mitigations needed depending on the level of local and state transmission rates.

• Indoors: Indoor environments vary greatly
• Masks. Masking with appropriate material* remains the best way of reducing potential infected aerosol from circulating in an indoor space. Masks are recommended be worn while singing and speaking.
• Bell Covers. Bell covers made from appropriate material* remain the best way of reducing potential infected aerosol from circulating in an indoor space. Depending on your comfort level, instrumentalists can wear masks only when speaking and slitted performance masks are optional.
• Rehearsal Times. In spaces with good ventilation rates and HEPA filtration, increased indoor rehearsal times of 50 minutes may be considered. A minimum of 3 air exchanges per hour should be used, if there are spaces with higher air change rates, you may consider longer rehearsal times.
• Physical Distancing. Distancing may be decreased to 3 feet, adjusting farther or closer depending on local conditions.
• Hygiene. Continue good hygiene practice moving forward, including appropriate elimination of brass fluid.
• Face Shields and Partitions. Plastic face shields only stop large droplets, not aerosol; room dividers inhibit the function of the HVAC system and are not recommended.

CBDNA/NFHS COVID-19 Video, 20 April 21: "COVID-19 Mitigation Strategies for Music"

Found at: https://www.youtube.com/watch?v=u46GJAnpZ7k

From scientific preprint of the research paper: "Measurements and Simulations of Aerosol Released while Singing and Playing Wind Instruments" -  April 13, 2021 

• Website: https://www.nfhs.org/articles/unprecedented-international-coalition-led-by-performing-arts-organizations-to-commission-covid-19-study
• Link Title: Scientific Study Prepress Paper (40+ Pages) (April 15th)
• Information here from Appendix 1
• Refer to document at website and article for full details.   This guidance is also explained in "Updated Statement on United States CDC Distancing Guidance (March 19th)"  presented by the same study.

  Recommendations

• Masks and Bell Covers- Well fitting masks for singers and musical instruments - were found to be effective at “decreasing aerosol and larger droplet emissions” from musical performance. 
• A note on bell covers for woodwind instruments-  They found that air and particles do escape from keyholes but found the number of “particles was minimal” and that using a “bell cover eliminated a majority of the aerosol coming from the instrument.”  Due to the difficulty in playing a woodwind instrument in a bag, they “recommend bell covers as the main control measure for woodwind instruments.”
• A note on material for bell covers- “Standard 3-layer surgical masks were used for small instruments, such as woodwinds. Large instruments were tested with Merv-13 material inside of a nylon spandex material.”  They do not recommend bell covers made from  a “stretchy material such as spandex” as it is easy for aerosol to pass through.
• Face Shields-  are “only effective at close range to stop large droplets”  and “do not prevent aerosol from being emitted or inhaled.”  
• Plexiglass/Plastic/Glass Barriers are Not Recommended- read the report for explanation of why these measures were found not to be effective.
• Social Distancing Recommended - “Performers should follow social distancing protocols as recommended by the CDC for music activities. Aerosol concentrations are highest closest to the source, both inside and outside, and decrease with distance.”
• Rehearsal Space Preference Order- they recommend that performances/rehearsals happen outdoors, if not possible then they have provided recommendations for indoor venues.

1. Outdoors

2. Indoors with elevated outdoor air exchange rate from HVAC
3. Indoors with typical outdoor air exchange rate from HVAC plus recirculation air through MERV 13 filters or addition of appropriately sized HEPA air cleaners
4. Indoors with outdoor air exchange rate from open windows supplemented with appropriately sized HEPA air cleaners when airflow is reduced under certain outdoor wind conditions.

• Limiting Rehearsal Time- for indoor rehearsals  they recommend “having at least three air changes per hour in the rehearsal room and limiting rehearsal time to 30 minutes at a time before leaving the room for at least one air change.”
• HEPA Air Cleaners to Supplement Ventilation- For indoor spaces, they recommend  HEPA air cleaners.  

From Colorado State University Study  “Reducing Bioaerosol Emissions and Exposures in the Performing Arts: A Scientific Roadmap for a Safe Return from COVID19”  December 2, 2020 update and May 21, 2021 update

• Website: https://smtd.colostate.edu/reducing-bioaerosol-emissions-and-exposures-in-the-performing-arts/
• Link Title: 12.02.20 AEROSOL STUDY PRELIMINARY RESULTS — ROUND 2. 
• The information below can be found on slide/page 38 
• Link Title: Study Preliminary Results - Round 3: 05.21.2021
• Information below can be found on slide/page 36 and 48

 Recommendations/Findings from Round 2

• Some instruments produce more aerosols than others
• “Bioaerosol emissions can vary massively from one person to the next.”
• “Masks and bell covers appear to be effective.”

 Recommendations/Findings from Round 3

slide 36:

• "Results suggest that brass instruments tend to have higher particle emissions than woodwinds…BUT the “player effect” is likely larger than the ”instrument effect"... Meaning that almost ALL instruments have the potential for high emissions."
• "Bell covers on brass instruments (single air exit) make sense."
• "Bell covers on woodwinds (multiple exit paths for air besides the bell) show mixed results."

slide 48:

• We still do not know (as a scientific community) how many COVID19 virions it takes to produce an infection in humans.
• Although we cannot define absolute risk, we can define relative risk. Look for continued guidance from our group and others in the coming months.
• Get vaccinated!

Video of NASM Webinar presented by Dr. Volckens which took place on May 20, 2021: https://nasm.arts-accredit.org/leadership/informed-decision-making/#bioaerosol