Below is something I wrote about an idea I have about slowing the spread of COVID-19. It might be interesting to list members in terms of statistics, epidemiology, and seeing patterns. List members who wish to avoid the virus and any other airborne pathogens might also find the information helpful.

I make no statements about any government action.

Slow the spread of COVID-19 by Turning Down the Music

Early in the COVID-19 epidemic the number of people infected was a low enough proportion of the overall population that it was easy to spot the gatherings where multiple new infections occurred. These large COVID-19 infection clusters, also sometimes called “superspreading events,” have characteristics that can yield clues to the question of what, if any, was the dominant transmission mode: infected surfaces, airborne respiratory droplets, or other? Many transmissions have been shown to be from carriers who are asymptomatic,(1,2) and therefore presumably not producing aerosolized droplets by coughing or sneezing. So, how do carriers spread the virus without coughing or sneezing?

Superspreading events in the early part of the epidemic included weddings, funerals, a choir practice, religious gatherings, and sporting events, such as Liverpool’s March 11 football match against Atlético Madrid. At a choir practice in Skagit County, Washington State, at least 45 out of 56 participants became infected, despite the organizers making hand sanitizer available, and participants practicing social distancing.(3)

What many of these settings have in common is loud music. This cacophonous din gives participants a choice between not speaking to other people at all, or leaning in close to other people and shouting at them, which greatly increases the number of particles leaving the mouth of the person speaking. Researchers studying aerosol emission during human speech have found, “the rate of particle emission during normal human speech is positively correlated with the loudness (amplitude) of vocalization, ranging from approximately 1 to 50 particles per second (0.06 to 3 particles per cm3) for low to high amplitudes, regardless of the language spoken (English, Spanish, Mandarin, or Arabic).”(4) In other words, speaking loudly can increase the number of particles emitted from the mouth by a factor of 50. Put bluntly, loud music encourages people to spit viral particles in each others’ faces.

Loud music is often played at weddings and religious gatherings. Announcements at sporting events are often deafening, as is the music in the bars where many spectators gather after the game. A funeral in Albany, Georgia, where the virus spread in late February, was described in The New York Times as an event where participants “belted out hymns.”(5) Many restaurants of all types also play loud music, which might also contribute to the spread. In South Korea an instructor spread the virus to students in her fitness dance class - a type of class where instructors often shout, but didn’t spread it to students in yoga and Pilates classes – types of classes where instructors typically do not shout.(6)

Notably absent from the literature are reports of the virus spreading in airplanes, trains, or buses, despite lots of people still using these modes of transportation early in the epidemic. These are settings where a large number of people sit very close to one other for extended periods of time—so many people think they are pots of contagion. Yet music is usually not played on airplanes, trains, and buses, thus talking tends to be done at a low volume, and can be done from a reasonable distance. There have been several outbreaks of COVID-19 on cruise ships, but unlike airplanes, buses, and trains, cruise ships tend to play loud music in some of the places where people congregate, including dance parties, bars, restaurants, and exercise classes.

It’s true that nursing homes have been reported as superspreading locations, despite them not typically playing loud music. However, many elderly people are hard of hearing, which encourages people to both speak louder and put their faces closer together to be heard. Also, when a television is played in a nursing home the volume tends to be loud, which insures that anyone trying to talk over the television will lean in close and yell, even when speaking to someone with clear hearing.

People shouting over the noise generated by machinery may help explain the superspreading in meat packing plants.

If restaurants and bars and gyms reopen without music they would probably prevent many cases. It is easy to choose a quiet restaurant over a noisy one, and customers avoiding locations that play loud music will be doing their part to reduce transmission of COVID-19, including to themselves. Avoiding loud music is free, and may help stop the spread of any current or future pathogens that are transmissible via aerosol particles.

1  Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19  Monica Gandhi, M.D., M.P.H., Deborah S. Yokoe, M.D., M.P.H., and Diane V. Havlir, M.D.  April 24, 2020  The New England Journal of Medicine   https://www.nejm.org/doi/full/10.1056/NEJMe2009758

2  Furukawa NW, Brooks JT, Sobel J. Evidence supporting transmission of severe acute respiratory syndrome coronavirus 2 while presymptomatic or asymptomatic. Emerg Infect Dis. 2020 Jul [18 May, 2020]. https://doi.org/10.3201/eid2607.201595

3  Post Register, Washington state choir suffers devastating losses to COVID-19 March 11, 2020 By CRAIG PARRISH, BRANDON STONE and RICHARD WALKER Skagit Publishing   https://www.postregister.com/coronavirus/washington-state-choir-suffers-devastating-losses-to-covid-19/article_688594b9-3c5f-5697-a4c7-b1fa9c70a9a9.html

4  Asadi, S., Wexler, A.S., Cappa, C.D. et al. Aerosol emission and superemission during human speech increase with voice loudness. Sci Rep 9, 2348 (2019). https://doi.org/10.1038/s41598-019-38808-z

5  Days After a Funeral in a Georgia Town, Coronavirus ‘Hit Like a Bomb’ New York Times, Ellen Barry, March 30, 2020.   https://www.nytimes.com/2020/03/30/us/coronavirus-funeral-albany-georgia.html

6  Jang S, Han SH, Rhee J-Y. Coronavirus disease cluster associated with fitness dance classes, South Korea. Emerg Infect Dis.  https://wwwnc.cdc.gov/eid/article/26/8/20-0633_article


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