CDC published epidemiologist returns to the show to discuss the science of schools in the shifting sands of Delta.

Since appearing on the show in November on Episode 49, Dr. Høeg has been very busy both researching and making public commentary about the issues surrounding Covid, kids and schools. Since her first Choralosophy appearance, she was a senior author on a study about in school transmission published by the CDC and subsequently referenced in their “Back to School Guidelines.” In addition, she has written articles in the Atlantic and the New York Times among others.

In this episode, the Dr. and I discuss the data on Delta variant and it’s effect on kids, whether or not masking in schools is as obvious as we present it here in the US, and how other countries are approaching it, her advice on putting singing safety in a broader context beyond the “Aerosol Study” we all know and love. Dr. Høeg has been very generous with her time in the tradition of the other Covid Conversations on this show wandering beyond even the data to the philosophy that governs the “harm reduction” philosophy. You don’t want to miss this one.

Data Representations Discussed in Episode.

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Tweets by TracyBethHoeg

Special Update!

From myself, along with Robin and Jon at MyMusicFolders

Colorado STATE Testing: We were given the opportunity in early July to send prototypes to Colorado State aerosol lab for testing, and those results were published, along with several others, as part of their interactive mask effectiveness charts, and people continue to reference those results. Again, those published results contained tests on our PROTOTYPE Mask.  When we realized that their published comparison charts declared that “ALL Singers’ masks” performed badly, we entered in to several conversations with Dr. John Volckens and more often his assistant, who actually conducted the tests, Dr. Christian L’Orange. We made changes or improvements in the RESONANCE Mask fabric choices and construction as a direct result of those tests.

More info here

We continued to improve our mask by adding the sewn-in polypropylene filter layer beginning with October production.  Unfortunately, the prototype Resonance test results were  permanently published in their charts and embedded in the Music & Performing Arts video broadcasts. Dr. L’Orange has assured us that when they update their Colorado State Lab website, they will include the more recent test results of our actual production Resonance masks, but since their website update has been delayed several times (they are busy working on air exchange measurements for classrooms now) they offered to take down the specific results for our prototype mask for now.

They agreed that leaving those results up were causing mis-information to continue to be distributed.  Filtration is important, but equally important is how the Mask FITs: Simply stated, the Colorado State aerosol labs’ test is for filtration only. There are 2 masks that specifically “look great” in their tests, that do not function nearly as safely as one might assume, as the fit of the mask is loose & in-secure on the face as well as made of a difficult to breathe through neoprene material (TMF Vocal Performance mask) , or in one instance (The NOTEable Mask), instructs the wearer to be certain to leave “2 fingers’ width open at the bottom of the chin”. The NOTEable mask is constructed of such tightly woven material that to actually breathe through the fabric is very challenging, thus the need to allow air passage up from the bottom. 

There are some important factors one needs to consider when choosing a mask for SINGING that differ from considerations for a daily use mask. The mask must fit closely to the face, without moving/slipping/dislodging from the face when engaging the face and mouth in complete width of movement necessary for a healthy singers’ vocal production. The mask must provide “breathability” – early on, the recommendations were to find “tightly woven cotton” and very tightly woven or extruded fibers (such as neoprene) in fact do prevent aerosol transmission, but can be extremely difficult to breathe in, especially when singing. We now know that several layers of more breathable fabrics can provide very good or better protection without impeding breathing.

The mask should be able to accommodate “double-masking” either by adding further filters or by being able to fit securely over a second mask in order to protect against the newer more transmissible Covid virus variations. Even though we added the silver-infused polypropylene filter layer sandwiched between the cover fabric and the lining, we continued to offer the additional disposable filters as an option, and always include 3 in every mask package. Those additional filters are a 3 layer non-woven melt blown polypropylene that we have 3rd party tested each production. Those filters have come back consistently at over 95% filtration efficiency. (Note the Colorado State Lab tests only the mask, not the optional disposable filter.) Using our 3-layer resonance mask with the additional filter should give even higher filtration protection.

Performers using various singers masks seem to prefer either ours or the Broadway Relief mask. Between these 2 masks, the RESONANCE Mask is better fitted – no gaping at the edges of the cheeks, fits snugly beneath the chin, and the silicone lining under the wide cheek-nose-cheek moldable wire really secures the Resonance mask to the face. The main complaints about the Broadway mask that I hear is that their nose wire is very stiff and difficult to adjust, and that the BR mask cannot be wet-laundered, only sprayed with disinfectant for sanitization.

I attach the most recent results from Colorado State regarding the RESONANCE Singers mask. Jon has created an overlay with these results within the graph Colorado State provides on their current website.  The RESONANCE Mask results are the dashed lines (these are 3 separate test – results) and you can observe that our mask is more protective than the Broadway mask (even without  our extra filter) at the lower levels of aerosol transmissions.

Lastly, our Resonance singers’ mask is used by the Colorado State University choirs, after consultation with the testing lab. We know this because their choral director, Dr. Gregory Gentry, spoke with us more than once throughout their Singers Mask selection process, although his University has advised against him actually “endorsing” us – I think they – Colorado officials – are worried about liability.
Second attachment is the current certification at 97% avg. efficiency filtration of the disposable bio-filters that we provide for use with the masks. 

Is school really driving community spread? Or is school safer than the general community?

Dr. Høeg joins me to discuss a topic that is directly pertinent to many of my listeners as colleagues and friends who are concerned or at least interested in understanding how Covid is affecting school from a science and data perspective. We take a depoliticized, hype-free deep dive into what has been going on in the data surrounding Covid in schools during the last few months. Should schools be open? Should they stay closed? What are the risks to students and teachers in terms of data? What are other countries doing about schools? What are the risks of NOT opening schools? Has the politicization of this issue caused us to miss an important middle ground?

The Brown University Covid Schools Data

Dr Tracy Høeg is a Physician Scientist (MD, PhD) Danish-American double citizen based in Northern California, specializing in Sports and Spine Medicine and with a PhD in Epidemiology. In private practice at Northern California Orthopedic Associates. She is also an Associate Researcher at UC Davis and a journalist at UltraRunning Magazine. Mother to four, long-distance runner, lover of mountains, music, photography and anything that makes her kids happy.

Find Dr. Høeg on Facebook!

• Analysis of in school transmission data
• Discussion of risks to students and teachers.
• Review of the varying approach to school opening around the world.
• The negative affects of politicization and media hype
• Much more!

Infection Fatality Rate Published by WHO

As we march through what has been the most challenging semester possibly to EVER face the field of education, we find ourselves twisting our minds in pretzels to discover what works and what doesn’t work on the fly. Every day is an experiment whether you are in person with masks, hybrid or all online, you are having to treat each day as if you are a first year teacher. We cannot predict outcomes because we have never done this. We have to innovate every day. Dr. Kyle Nielsen of Southern Virginia University has been putting together a highly innovative programme for his students this year that changes fluidly all of the time. In this conversation, Dr. Nielsen and I talk through the ideas and the processes that he bas been experimenting with.

Dr. Kyle Nielsen is the Director of Choral Studies at Southern Virginia University, where he was voted Professor of the Semester in Spring 2019 by the students and faculty. He conducts the Chamber Singers and Men’s Chorus, teaches Conducting, Choral Literature, and Applied Voice, oversees the Vocal Music Internship and Music Education programs. Previous to Southern Virginia, Nielsen completed the Doctor of Musical Arts in Choral Conducting at the University of Miami Frost School of Music. While at Frost, he led the university men’s chorus Maelstrom, taught in the Experiential Music Curriculum, directed marketing and recording services for the Choral Studies area, and was the assistant conductor for the internationally-acclaimed Frost Chorale.

An active clinician and researcher, recent conference presentations have included the Western Division and National Conference of the American Choral Directors Association in addition to a recent webinar with Chorus America. An excerpt of his dissertation research was recently published as a Case Study in the Eastman Case Studies series, titled “Kinnara Ensemble, A Project-Based Ensemble.” Upcoming engagements include the Utah State Large Choir Festival coupled with various high school clinics throughout the mountain west.Nielsen also collaborates with some of the country’s leading professional vocal ensembles.

Recent positions include conducting fellow with Grammy-nominated Seraphic Fire in addition to Artistic Administrator for the Santa Fe Desert Chorale, where he coordinated all artistic contracting and operations. Additional appearances as a professional ensemble singer include the Piedmont Singers (Virginia), Schola Cantorum at the Cathedral of the Sacred Heart (Virginia), Brevitas (Utah), and Musica Judaica (Florida).In addition to the University of Miami, Nielsen holds the Bachelor of Arts degree in Music and Theatre from Southern Virginia University and the Master of Music degree in Choral Conducting as well as Vocal Performance and Pedagogy from East Carolina University.

When Science gets thrust to the center of our artistic world, how do we react, how do we gather info, and how do we decide?

An enlightening conversation about our singing with Covid situation with Nick Sienkiewicz. Nick is a young colleague preparing to earn his Masters in Choral Conducting at IU Bloomington. But before that, Nick earned a degree in Bioechemistry. I was very impressed with Nick’s ability to explain the scientific process, as well as some of the pitfalls that those of us who are not trained in science can step into when we aren’t careful. On this show, a major undertaking has occurred and collected under the Covid Conversations page on this site to collect extremely relevant expert opinion on a broad range of virus related topics to help us ask the full range of relevant scientific questions beyond the important aerosol questions. This is unfathomably important as schools and communities begin to open. I think you will enjoy Nick’s perspective and tips for navigating this complicated web.

Nicholas Sienkiewicz is a conductor and scientist currently based in Bloomington, Indiana. Nick obtained his Bachelor of Science in Biochemistry, and Bachelor of Musical Arts from Western Michigan University. During his time at WMU, he served as Music Director for the Unitarian Universalist Community Church, Choir Director for the Kalamazoo Children’s Chorus, and the Executive Director of Open House Theatre Company. On the scientific side, Nick worked as an Undergraduate Teaching Assistant and Supplemental Instructor for the Chemistry Department at WMU. Nick also served as a Research Assistant in the Teske Laboratory and a Protein/Vaccinology Intern for Zoetis Inc. Nick is pursuing his Master of Music in Choral Conducting at Indiana University Bloomington.

Find more about Nick at www.nicksienkiewicz.com

Introducing an AMAZING product from MyMusicFolders.com! The resonance singer’s mask shown in this short demo is an excellent option for risk reduction in Covid-era singing. Ultimately, for choirs who choose to sing using tools like this, you will need a mask that is conducive to comfortable breathing and articulating. This is the mask for you!

Remember: you MUST use the mask in conjunction with local health guidelines and other risk mitigators like hygiene, ventilation and distancing.

Find the Mask Here!

In this episode, I continue my deep dive into attempting to understand how the pandemic may effect our world generally, but specifically the world of music and the performing arts. However, it should be obvious that parallels to our everyday lives are interwoven into this information. In this conversation, Dr, Manian and I focus primarily on the mode of transmission for this virus. Toward the end we spend quite a bit of energy discussing the much disputed concept of “droplet” spread and “aerosol” spread, as well as the benefits of mask wearing in as many situations as possible.

As always, I submit this conversation NOT for the purpose of providing a solution for you or your singers. Just context, and understanding. A more detailed account of Dr. Manian’s thoughts on the role of aerosol with COVID.

About Farrin Manian, MD

Farrin A. Manian, MD, MPH, FACP, FSHEA, FIDSA, received his Masters of Science in Public Health-Epidemiology and MD (cum laude) degrees from the University of Missouri-Columbia, and is a member of the Alpha Omega Alpha National Honors Society. He completed his residency in Internal Medicine and fellowship in Infectious Diseases at Vanderbilt University Medical School in Nashville. He is a fellow of the American College of Physicians, Society of Healthcare Epidemiology of America and Infectious Diseases Society of America.

Dr. Manian has authored or coauthored more than 90 scientific articles and book chapters. He is the author of the book, Mosby’s Curbside Clinician: Infectious Diseases and was the first editor of APIC handbook of Infection Control. He is a member of the editorial board of the American Journal of Infection Control. His publications have appeared in peer-reviewed scientific journals such as the New England Journal of Medicine, JAMA, Clinical Infectious Diseases, Infection Control and Hospital Epidemiology and the AmericanJournal of Infection Control. He has been voted as one of America’s “Top Doctors” in Infectious Diseases.

His hobbies include photography and collecting antique medical books and paraphernalia. He created the website http://www.doctorsbestshots.com donating his photographs in return for a donation to the Care for AIDS Patients fund designed to defray the cost of care of indigent patients with HIV infection.

In this episode, I bring you a substantially in depth conversation with another expert physician who specializes in infectious disease and is on the front lines of treating COVID-19 patients.

Humans have a strong bias towards pessimism and the disregarding of any good news. As a result, we tend to trust bad news without question, and demand proof for good news. We apply this imbalanced approach to evidence to our peril. We should be making an effort to understand as broad of a picture as we possibly can. The goal of this episode is NOT to view the situation through rose colored glasses. In fact, you will hear explanations of the scary side of this virus here. However, we will be weighing these things against the positive developments that have occurred leading to an overall drop in the risk to our society as doctors have continued to learn and discover new and better ways to care for COVID patients.

My concern during the entire month of May and June in choir world has been our hyper focus on one set of questions related to this pandemic. We have asked important questions about how choirs might contribute to the spread of this virus due to increased expulsion, or “super-spreading” of aerosols and droplets that may be produced when singing. This is an IMPORTANT question, but it is not the only question that we should be focused on as we consider a safe return to ensemble singing. Some critical questions that I think we are missing:

1. What do we know now that we didn’t know a month ago about viral transmission and risks to people exposed? (now that data has been collected over many months, and therapeutics have been developed and improved, the risk picture looks much less severe than it did in early March.)

2. What do we know that we didn’t a month ago about therapeutics? (discussed in episode.)

3. What do you know about the metrics being used in your area by public health officials to determine ending or changing certain gathering restrictions? (Discussed in episode.)

I addressed some of these questions in Episode 33 with Dr. Adalja from Johns Hopkins. (I address the danger of hyper-focusing in general here.) In this conversation, we were all fortunate that Dr. McKinsey was able to give us a substantial chunk of time to devote to a broader conversation related to understanding our predicament in a deeper way.

Dr. David McKinsey is a physician with Metro Infectious Disease Consultants-Kansas City. He serves as Regional Medical Director for his group. In addition he is hospital epidemiologist at Research Medical Center, Clinical Professor of Medicine at the University of Kansas, and Infectious Diseases consultant at the Stowers Institute for Medical Research. He received his medical degree from the University of Missouri-Columbia and completed an Internal Medicine residency at the University of Iowa and then an Infectious Disease fellowship at the University of Tennessee-Memphis. He is board certified in internal medicine and infectious diseases. He has served on the boards of several organizations regionally and nationally, has been actively engaged in medical research throughout his career, and has published many manuscripts and book chapters.

Just in case anyone still doubts the docs that have been on this show re the regionality of risk:

“I hesitate to make any broad statements about whether it is or is not quote ‘safe’ for kids to come back to school. When you talk about children going back to school and their safety, it really depends on the level of viral activity and the particular area that you’re talking about. What happens all too often — understandably, but sometimes misleadingly — is that we talk about the country as a whole in a unidimensional away.” Dr. Anthony Fauci

Also, some have seen the article from the British Columbia CDC posted earlier related to “no evidence of airborne spread.” Sadly, I didn’t see this until after I had done the interview with Dr. McKinsey. So I emailed him, and he confirmed that within the physicians circles, this seems well accepted. All of the latest data suggests that it is droplet transmission, not aerosol/airborne. ”Bottom line is that since the beginning of the COVID pandemic, droplet transmission has been postulated as the main means of spread and now the data are confirming this. Airborne spread would have been very bad news.” I followed up and asked if that means masked singing would be a significant increase in safety (a different angle than what we were told in webinar on May 5.) He said, “That’s exactly right. Droplets containing virus are trapped by the face mask, protecting the wearer. (And others if they wear one it’s a two way street.) In theory, with an airborne pathogen, a mask would not filter the virus (unless it was a N-95 mask) but that is not of practical importance with SARS CoV-2”

Lastly, I am really embarrassed by the sound quality of this episode. For that, I am sorry.

https://choralosophy.com/2020/06/03/episode-36-are-we-asking-all-the-right-covid-questions-with-dr-david-mckinsey-of-research-medical-center/

Some critical misunderstandings in pandemic world: (As a lay person I had to work pretty hard to wrap my head around this. I am sure some lay people already get this, but many don’t)

1. Conflating, unintentionally, getting infected or exposed to SARS-Cov-2 (a virus) with being diagnosed with COVID-19 (a disease) One does not always lead to another. (CDC best estimate shows 35% infected will show no symptoms)
2. Conflating, unintentionally, the Case Fatality Rate or CFR with the Infection Fatality Rate or IFR.
3. Not understanding that the number you see on the news and on data tracking websites is real time info that is not at all informative or helpful. Starts as a crude number and gets refined with vetting. Many areas have seen this crude number look like 4-7% or 4-7 out of 100 are dying.

Understanding the two vetted numbers:

CFR is the higher number based on the number of people who pass away, divided by the number of people who are sick enough to seek treatment and then get diagnosed with COVID-19. That number is easier to nail down early in a pandemic when testing is not widespread for obvious reasons. The only ones factored in are the ones actively engaged with the health care system. (Though time from onset to death causes fluctuation in the rate due to the lagging indicator and differs from the reported numbers because not all reported cases are ever confirmed.)

Current overall CFR best estimate: .4% or 4 in 1000 (see number broken down by age below in attached image.)

The health care system uses this number to help plan for the allocation of resources that they can predict they will need to devote to those patients who show severe symptoms to save as many lives as possible. (ie, the much touted “having enough hospital beds, ventilators,” etc.)

IFR is the lower number that reflects all people who become exposed and infected with SARS-Cov-2 and the proportion of those people who pass away. It is a much lower number for all viruses because it includes the people who don’t get sick at all, and the ones who only have minor symptoms and don’t seek medical treatment. This number is MUCH harder to pin down, also for obvious reasons. This requires MANY data collection points from across the world to be aggregated and vetted, and it also requires the widening of the testing net to include people in the general population who would otherwise have no reason to be tested. So, a solid attempt at publishing an IFR is impossible in the early stages of a pandemic.

Seeing that current best estimate from CDC is 35% asymptomatic that puts the IFR at .26% or 2.6 in 1000 (you can find these by age below as well, simply by multiplying the CFR by .65)

This number is a better used for individuals in the community to measure the risk to themselves and their families. Because it represents how the disease statistically effects the general population. In other words, understanding the risk if they or their loved one were to be exposed to another person with the virus.

All of this must then be factored in to our best local indicators in order to assess your overall risk. Best local indicators are new hospitalization and new deaths. NOT new cases because new cases vary greatly depending on the local availability of testing. (Which is why comparing “spikes” in one country or even state to numbers somewhere else, is not productive.)

The CDC latest best risk numbers:
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

How Narrow Focus and Tribalism Leads to Bad Decision Making

A special edition of the Choralosophy Podcast. It’s basically not about choir at all… But, it’s short and I hope it’s thought provoking, or even helpful!

We sure are living in a strange time. The mission of the Choralosophy Podcast is to encourage conversation to zoom OUT and see the big picture, whether it be in matters strictly musical, or on any other topic. Please join the conversation.