Several months ago, at the suggestion of one of our readers, we ran a survey to look at the impact of COVID on singers. A statistically significant number (265) of you responded, and we thank you for doing so. From your responses, we have, for the first time, a sense of how this virus affected singers, both in their general health and in terms of their voice. The results were reviewed and are presented below.
Almost one quarter (24.2%) of respondents were unvaccinated at the time of infection. This was surprising, but it can reflect a variety of biases. We did not correlate vaccine status with severity of infection. In terms of vaccine protection, almost 42% were fully vaccinated and had at least one booster at the time they tested positive. This reflects the overall impression that, while the vaccine provides significant protection against severe disease, it does not fully prevent infection and viral transmission. This statistic will continue to change as the competition between more effective and specific vaccines vs. new viral mutations continues.
The main issues in terms of transmission are that even infected (and infectious) people can transmit the virus unknowingly, since there is an incubation period during which the person may feel well or experience only mild, cold-like symptoms. We have seen a number of singers with a “cold” who unknowingly performed and only later realized that their symptoms were COVID related.
Almost 90% described their COVID symptoms as “mild or moderate,” and in nearly half (45.8%), the symptoms resolved within 1–2 weeks. Symptoms persisted beyond 3 months in less than 10% of cases. The unknown factors here (age, immune status, coexistent chronic illness) very likely played a role, but it would seem that in generally healthy and vaccinated individuals, the illness tended to resolve without complications.
As we looked more closely at vocal effects, we found that over 70% of respondents complained of respiratory symptoms, which were mild to moderate in nature and most frequently consisted of rhinitis or sinusitis (67.9%), cough (70%), and wheezing (21.7%). We did not look more deeply into whether these were new symptoms or a reactivation of previous sinusitis or asthma. In the majority of cases (73%), respiratory symptoms resolved within a month, rarely persisting beyond 3 months. These symptoms can be managed medically (decongestants, inhalers, etc.) and their impact on the voice can be mitigated.
Less than half (41.3%) of responding singers developed actual voice symptoms. This was unexpected, since more than half (57.6%) of respondents were sopranos, and it was our expectation that these higher voices would be more impacted by respiratory symptoms. Almost half noted an impairment throughout their range, while the next most common was an impairment on the top. Less than a quarter had difficulty in middle voice—another surprise, since we expected, with an upper respiratory type of infection, to see more difficulty in the register change part of the voice.
In most cases, vocal impairment resolved within 1–4 weeks, although in a small number of cases, vocal difficulties persisted for more than 3 months. Most (92.4c%) did not need to see a laryngologist and, for those who did, a specific problem was found in less than half. The most common treatments offered were antibiotics, Prednisone, and steam inhalation. By way of comment, none of these treat COVID, but they may have been helpful in alleviating specific symptoms. In most cases, the voice has fully revered, although about 5% continue to have vocal impairment that prevents singing.
Almost 2/3 of respondents did not report any financial impact from their infection, while less than a third did. Less than 10% felt that COVID had a significant financial impact. Once again, these statistics don’t tell the whole story, since it was not clear how many respondents sing professionally and support themselves from performing vs. others who may be students or who hold part-time nonsinging jobs.
The overall picture that emerges is one of a transient, mild to moderate illness which can impact the voice, but usually resolves over a few weeks without specific laryngological treatment. There appears to be no specific laryngeal “profile” to COVID, rather the general impairment that results from respiratory infections. We cannot, of course, completely assess the global financial impact on the singing community, since this would need to consider not only individual cases of infection but also such issues as shows cancelling, theaters closing, and a decrease in audiences.
The good news in all of this is that COVID has been a steep but manageable learning curve for both the medical and the general community. We have become more adept at rapidly developing effective vaccines, the general community has become more comfortable with preventive hygiene—and our immune systems, challenged by the virus as well as prodded by the vaccines, are more ready to deal with future pandemics such as COVID.