Risk management in the performance and education

Risk management in the performance and education space of COVID-19

Professor Martin Ashley, PhD discusses factors to take into consideration if you are responsible for working out how and when it may be safe to bring individuals together to make music once more

Above: Professor Martin Ashley, PhD Risk is an inevitable corollary of uncertainty, and one of the few certainties of the COVID-19 pandemic is that the state of scientific knowledge is far from adequate, despite unprecedented levels of research activity. The prudent response to scientific uncertainty is precaution, and a precautionary response is usually a risk averse one. Risk generally diminishes in proportion to scientific advance, but the process is slow and punctuated by setbacks, and the road of COVID-19 not yet far travelled. As music administrators, educators and performers, ISM members have rapidly had to come to terms with being managers of risk in the unaccustomed field of public health. You and your colleagues have little precedent to draw upon or guidance to follow. How should you proceed?

Some approaches for musical performance have been advocated by Claudia Spahn and Bernhard Richter, heads of the Freiburg Institute for Musicians’ Medicine, who are carrying out detailed research on behalf of the Hochschule für Musik, Freiburg. In the first of several papers published over the past few months under the title Risk Assessment of a Coronavirus Infection in the Field of Music they stated that ‘effective risk management usually requires a precise risk analysis with an associated likelihood of occurrence and knowledge of the effectiveness of certain risk-reducing measures.’

In the UK, the Health and Safety Executive (HSE) publishes a template (hse.gov.uk/simplehealth-safety/risk/risk-assessment-templateand-examples.htm) that has been adapted by organisations such as the Musicians Union and the Church of England. While these versions provide a column for the identification of control measures, they do not demonstrate the extent to which the risk has actually been reduced nor give any real indication of how acceptable the risk was, either before or after the control measures.

Financial, reputational and other risks are taken with most musical performances. Contagion during a novel pandemic is but one more risk to add. Each risk, however, is made up of any number of hazards, defined by the HSE as ‘things that have the potential to cause actual harm’. New COVID-19-related hazards have become apparent through study of relevant scientific literature. The risk you need to consider is the product of how likely each hazard is to occur (the L number) and the seriousness of the consequences of it occurring (the C number): R=LxC. The values of L and C are commonly given as numbers between one and five, with a result of between one and 25 as a computed risk that can be interpreted through a table such as this:

R Value Acceptability ACTION TO BE TAKEN 20-25 Immediate stop Immediate action including cessation of the activity 13-19 Not acceptable Immediate measures required, stop activity if necessary 7-12 Not acceptable Improve within a specified timescale 3-6 Acceptable Look to improve at next review or if there is a significant change 1-2 Acceptable Ensure controls are maintained and reviewed

You can then put control measures in place and re-compute the risk. If the control measures have reduced the risk level to an acceptable category, they can be considered effective.

Let us first consider the C number. Consequences of rehearsing during the pandemic might be:

C Value Meaning 1 Inconvenience – absent child or performer 2 Pattern of significant absences 3 All families have to quarantine for 14 days 4 Several hospitalisations requiring oxygen 5 Catastrophic – life support ventilation or death(s)

C values of four or five have been demonstrated in ‘super-spreader’ events such as the now infamous Skagit Valley choir rehearsal, but if the sort of precautions we now understand to be advisable were put in place, C values of either three or perhaps four might be considered worst case scenarios. Whatever is decided, the C number will be much the same whatever the hazard.

The L number, however, will vary with the state of scientific knowledge, which is in constant flux. An obvious example of this is the increasing recognition of the role of tiny, suspended respiratory particles (aerosols). The scientific consensus is moving away from the initial World Health Organisation position that the likelihood of transmission through these was low. The L number for airborne transmission is therefore increasing, with many consequences for venues.

The next table summarises this as concisely as possible, but also introduces a further equally important factor, that of control potential. If you can perform outside or change your rehearsal space to a much larger room, you will have more control potential than the group that has only a small indoor space available. If you are in a country where overall death rates are high, it is unlikely that you will be able to move your orchestra or choir to another country where they are low. Your control potential then will be low or non-existent. On the other hand, although L is high for contact with contaminated surfaces, the control potential is also high. Almost any organisation can instigate and monitor heightened cleaning regimes as well as taking steps such as removing surplus furniture.

Root Hazard Variability of L Number Control Potential Infection in the general Apparently consistent relationship between Little or no control over where the venue population. numbers infected and transmission rates. is situated. Limited control over undetected Asymptomatic carriers may be more asymptomatic cases numerous than first thought Climate/weather The potency of the virus may increase as temperatures fall and days shorten Limited scope for concentrating performances in summer

Cross-contamination L is higher if singers engage in many other activities, particularly socialising and sport by younger performers Airborne transmission Increasing literature reporting that aerosols transporting the virus may accumulate and develop high concentration in confined, unventilated spaces Age and ethnicity Significant relationships between age and ethnicity have been demonstrated.

Proximity to others Consistently high risk wherever circumstances such as car sharing force close proximity

Contaminated surfaces Consistent evidence of transmission through surfaces and objects, including music copies Personal hygiene Consistent evidence of high transmission through touching face with unwashed hands Higher for professionals or school children than amateurs in most cases

Highly variable according to available space/ventilation

Control may be exercised over the age of performers permitted to attend. Elderly may self-exclude. Ethnicity is harder to manage. Fairly high where numbers of performers can be reduced, or larger spaces used if available. Lower in relation to types of transport used Furnishings can be removed, music copies withdrawn, and movement patterns can be controlled High. Soap effective against coronaviruses, and singers can be educated and reminded

Worked examples: Root Hazard: Contaminated surfaces (fomite transmission)

L C R Action Hazard Contaminated music copies 4 3 12 Improve within a specified timescale Control Performers issued personal copies in plastic 1 3 3 Monitor. Look to improve at next review folders which are kept for duration and or if there is a significant change must not be shared or left lying about.

Root Hazard: Age and Ethnicity

L C R Action Hazard Members of vulnerable groups in the choir 4 4 16 Immediate measures required. Stop activity if necessary Control Over 70s and persons with underlying Monitor. Look to improve at next review or health issues asked not to attend if there is a significant change

In conclusion, it is important to state that even though numbers are involved, this approach is not an exact science. The numbers represent discrete categories rather than a continuously variable measurement such as temperature. Overlaps and borderline cases are inevitable while the biggest weakness is that the numbers depend upon the judgement of a person making an ‘educated decision’. Since nobody is fully educated about the SATS-CoV-2 virus and the science is constantly evolving, it is illusory to imagine that risk has been eliminated. The process is not perfect, but until there is a complex algorithm based upon knowledge not yet attained, it is probably the best we have.

Professor Martin Ashley held a personal chair at Edge Hill University for his post-doctoral work on boys’ vocal identity. Now retired from full-time work in education, he is a trustee of the Association of British Choral Directors and is leading on the organisation’s research into the implications of COVID-19 for choral singing For practical guidance for what you can do when you re-enter the classroom, you can consult the following web resources: • the Health and Safety Executive offers this: hse.gov.uk/simple-health-safety/risk/riskassessment-template-and-examples.htm • the Health and Safety Adviser has produced free templates and checklists: safety-adviser. co.uk/lead/ed/risk-assessment-toolkit • the ISM has produced an advice page on instrument hygiene: ism.org/advice/ instrument-hygiene-preventing-thespread-of-covid-19-when-performing-orteaching • you can also watch the ISM’s webinar on risk assessment: ism.org/ professional-development/webinars/ risk-assessment

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