Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at email@example.com.
Dear Dr. Hamblin,
My daughter is part of an accomplished high-school woodwind quintet. For two years, they practiced constantly and participated in competitions, becoming one of the best in the state. But the shutdowns in March put an end to it. They haven’t played together at all since. The group wants to start practicing again, and one of the parents volunteered to have them play in their backyard. My family has health conditions, so we have been very cautious about the pandemic. Would it be safe for her to play outdoors with her classmates?
At first glance, it clearly doesn’t sound ideal: blowing forcefully through a woodwind instrument in close proximity to other people who are also blowing forcefully through woodwind instruments. Given what we’ve learned about how singing and even talking loudly can increase the amount of coronavirus in the air, a quintet could seem ill-advised.
But the danger of music is all in how you make it. I would let your daughter start practicing again. Although there are no clearly documented cases of coronavirus transmission via woodwind, there is a lot of evidence of the benefit of kids studying musical instruments, and taking part in team-based competition. Even during a pandemic, immersing kids in the arts isn’t an indulgence. It should be a top priority, right alongside that of opening schools. Playing an instrument is not absolutely risk-free, but if you keep a few things in mind, it could be close.
As with pretty much every other activity right now, having the quintet gather outdoors is a great idea. If any neighbors complain, explain that the backyard practices are part of a global effort to keep them from dying. If anyone happens to be infected, any virus that emanates in the heat of performance will likely fade into the sky and disperse like the music itself. Indoors, as any parent of a child who’s learning an instrument knows, everything is trapped and can echo around the room indefinitely.
Some instruments do seem to pose more risk than others. Obviously, string instruments can be played without even opening your mouth, but it sounds like your daughter’s quintet is too far along to take kindly to a suggestion that they all learn new instruments. Because the virus is sent into the air by talking, coughing, and singing—any forcible exhalation of air through the pharynx—playing a woodwind or brass instrument would logically pose a risk. These instruments are effectively designed to amplify what’s coming out of our mouths and to carry the sound. A 2011 study of vuvuzelas (the long, straight plastic horns that people blow at soccer games) found that their capacity for spreading infections could be tremendous. Compared with shouting, blowing through the horn sent several hundred times more particles into the air.
Thankfully for everyone, kids don’t train for vuvuzela quintets. Woodwind and brass instruments send air through a maze of twists and turns, and buttons create turbulent airflow patterns that don’t simply shoot everything out in a piercing plume. Breathing into a convoluted contraption such as a saxophone or a tuba, then, actually serves as a sort of filter that collects the larger droplets you might be spewing out. This is familiar to anyone who has emptied a spit valve and seen what pours out.
The real question is the potential danger of smaller, aerosolized particles that can blast out of an instrument and linger in the air. In May, the Vienna Philharmonic reported that it had conducted a study of the aerosols from various instruments. Researchers hooked tubes up to musicians’ noses, and as they played, they inhaled an aerosolized salt solution that could be visualized when it was exhaled. The researchers mapped the clouds of air around musicians while they were playing and reported that none of the instruments sent respiratory droplets beyond the commonly recommended radius of six feet. In most cases, no significant amount of the aerosolized salt particles were detectable coming out the end of the wind and brass instruments. Flutes were the worst offender, passing a “large amount” of aerosol in a cloud covering two and a half feet.
In July, another study in Germany offered findings and hope similar to those from Vienna. But neither study measured actual coronavirus particles, and the overall evidence is still thin. Doctors at the University of Iowa have expressed concern about the rigor of both findings, given that they weren’t peer-reviewed, and raised additional variables that the research failed to take into consideration: “Wind players buzz on their mouthpieces, blow out tone holes, blow out spit valves, clean their instruments with swabs and feathers, and might have leaking embouchures or nasal emissions during playing,” they wrote. “How to mitigate these risks is not yet known.”
Ultimately, the risk posed by playing a woodwind instrument should fall somewhere between talking softly and aiming a vuvuzela at someone’s face. This is a wide range, but much can be done to ensure that you’re closer to the former. Preliminary guidelines issued by a coalition of performing-arts organizations currently recommend that all musicians presume that aerosols are coming from the keyholes and bells of their instruments, and that everyone should use bell covers—or, in the case of flutes, “flute socks”—which are like masks for your instruments. They’re not ideal for sound quality, but they’re great for practice. Musicians should also wear masks with slits to insert the mouthpiece. And while playing, they should face in the same direction, to avoid sending woodwind emissions into anyone else’s face.
Every musician should have a six-foot radius when outdoors. As it gets colder and the kids want to practice indoors, there will be new challenges: The six-foot rule isn’t sufficient when people are in an enclosed space with little ventilation. Airborne transmission isn’t a problem that can be solved with plexiglass, either. In fact, it might create ventilation “dead zones.” The larger and better-ventilated the space, the safer. All of the standard advice applies: Open windows, use HEPA air filters, and limit the time of exposure. The guidelines suggest that indoor rehearsals should last no more than 30 minutes, followed by 20 minutes to let the air in the room turn over.
Even though a woodwind quintet isn’t an ideal pandemic scenario, the opportunity for these kids to learn and develop artistically and socially is too great to abandon. The goal should be to find a way to come as close as possible to the old ways of practicing and playing music while avoiding any major or unnecessary risk. A little conscientiousness will go a long way.
Good luck to the quintet. I hope they destroy the competition.
“Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.