Country Dance & Song Society

Vaccination

• Will you admit only people who have been vaccinated?
• Will you require proof? If so...
  • How will you verify vaccination status?
  • What will you do if a vaccination card looks suspicious?
• How will you handle those who have not been vaccinated for medical reasons or sincerely-held religious beliefs?
• How will you respond to people who choose to not get vaccinated?
• If your group decides not to require vaccinations, what steps will you take to keep your community safe?
• Will you admit kids? If so, what is the lowest age limit you will include? (Refer to your local and state guidelines.)

Masks

• Will you require masks? If so…
  • How will you enforce this?
  • Is it even possible to enforce?
• Note: Whether or not masks are required, some people may choose to wear them. Make sure they know they are welcome to make this choice.

Waivers and Contact Information

• Do you intend to request signing of a waiver? If so…
  • See this link for a waiver template.
  • What will you do if people decline?
• Do you intend to collect contact tracing information? If so...
  • Who will have access to this information?
  • Have you contacted your local Board of Health about their protocol for contact tracing?

Preparing for Welcoming Participants at the Door

• If you’re asking for proof of vaccination, having people sign a waiver, and/or collecting names and contact information, how will that be handled?
• Will you need extra volunteers? If so...
  • How will you engage them?
  • How will you support them?
• Will you need coverage at the door through most of your event?
• What signage will you post?

Venue

• Is your previous venue open and available for your use. If not, when?
• Is the ventilation adequate at your venue? If not, is there a way to improve it?
• Are there adequate washing facilities? Will you offer hand sanitizer?
• Will you need to pay attention to cleanliness in the venue, e.g. bathrooms?
• Do multiple groups use the same venue? If so...
  • Will they coordinate about COVID-19 policies?
  • Will they coordinate when events will resume?
• If your previous venue is not available, what other options would be suitable for your group?

Communicating with Your Community

• Gathering input from your community can give you important information to help inform your decisions. If you’d like to poll your group about a variety of reentry questions, see this Community Survey Template.
• As your reentry plans continue to unfold, what will you convey to your community? Here are some possible topics:
  • What has your organizing group been doing to prepare?
  • When might you resume your events?
  • What will be required? (vaccination? masks? waivers? contact information?)
• When will be the best time to send this communication?
• As you approach the time to re-open, how will you share with your participants what to expect when they arrive?

Check with your callers, musicians, and sound techs to confirm...

• If you’re requiring vaccination, have you confirmed that they are vaccinated?
• If you’ve decided to require masks, can they/are they willing to play/call/run sound wearing a mask?
• Have you tested the acoustics in your venue with callers wearing masks, using your current sound system?
• Are callers willing to share a microphone?
• Do they have the stamina to call/play for a full night, or do they need to do things differently at first?
• Is there anything else they need to do differently?
• For sound techs:
  • Are they willing to provide sound for outdoor events?
  • What additional needs would they have?

Will you make any programmatic changes?

• Length of event
• Length of break
• Refreshments at break
• Tempos: Comments from a caller we heard from recently:
  “I have heard lots of chatter about how hard it will be to dance at full speed again, from those who have been attending virtual dances. I just have to say that dancing at slow tempos is hard. People think it will be easier until they try it. When you are connected to other humans in a physical space, dancing slower is not easier. I think we will all adjust to ‘regular’ tempos much more quickly than we expect. Like, within 5 minutes.”

Related to music sessions

• Will you limit the number of attendees, and/or require some minimum distance between people?
• Will you require vaccination? masks? If so...
  • Will you make any exceptions to either of those requirements?
  • If so, under what circumstances?
• Who is comfortable hosting, and under what conditions?
• Who is comfortable attending, and under what conditions?
• Will you play indoors only, outdoors only, or both?

Related to playing music for dances

• If vaccination is a requirement for dancers, and if any musicians in the band are not vaccinated but are not dancing, can they still come and play?
• If dancers are required to wear masks…
  • Can musicians play without masks?
  • Will we make exceptions for wind players?
• What are the expectations for rehearsals? Will they be in person or continue online?

Related to singing sessions

• Will you limit the number of attendees, and/or require some minimum distance between people?
• Will you require vaccination? masks? If so...
  • Will you make any exceptions to either of those requirements?
  • If so, under what circumstances?
• Who is comfortable hosting, and under what conditions?
• Who is comfortable attending, and under what conditions?
• Will you sing indoors only, outdoors only, or both?

News from two groups about running hybrid song circles

Experiences from Debra Chesman
Valley Folk Music, Corning, NY

The Syracuse (NY) Pub Sing did a hybrid recently for the first time, outdoors for the local vaccinated, and Zoom for the remote. It was great to hear the backyard folks singing together. When someone on Zoom sang, it was just that person, as if everyone was on Zoom.

I have heard that another hybrid group used a protocol where the person leading on Zoom would pause for the chorus and then switch to the people in person singing the chorus each time. So all on Zoom as well as in-person folks get to hear the chorus singers all together.

Experiences from Bruce Baker
Seattle (WA) Folklore Society and Facilitator for Seattle Song Circle

My two cents on re-entry. It will be slow. Prepare for a hybrid, especially to widen the circle beyond the local geography.

The first Seattle Song Circle online was a hybrid in April 2020, with a laptop on a piano bench, 5 people in the room and another 5 online. Sound was pretty horrible and the screen was OK but not great.

Fast forward a year and Gather & Sing has been outdoors in a park with a phone on a selfie stick for the online component. Participants are post-vax.

See the folks online? Really difficult. Sound? Not great but a bluetooth speaker on the music stand was OK. We’re working on ways to employ a couple of mics into a Tascam USB Mixer into the Android phone. I’d love to see some collaboration among others trying this.

Portable Outdoor Hybrid

1. Use power banks to power electronics, including phantom power for Omni condenser mics. Have one mic for the song leader. If the turn passes, it should have a longer cord to hand around.
2. If Android, a special splitter cord is needed to separate the mic and Earset. The earphone should be routed to a portable speaker like a Bose. The splitter is no good unless it has 4 conductors. Speakers help those online be heard.
3. If using Zoom for streaming, assign a co-host ahead of time who can handle muting and admitting participants.

Hybrid—Small room

1. Laptop - suggest external camera for better quality.
2. Work out wifi passwords beforehand and verify connection speed to support streaming method.
3. If wide screen TV is available in the room, use HD connection to drive it.
4. Find a good USB mic to pass around as needed. Mixing is also good for omni versus singer.

Hybrid—Camp room

1. Similar to small room but consider projection and cloth or a screen.

If a group decides to ask for proof of vaccination, are there ways we can include people who are not vaccinated while keeping them safe?

I think “safe” is a relative question here. The question becomes: Are you able to reduce/mitigate risk to a manageable and reasonable level? That involves assessing some of the options that have been in place while we didn't have vaccines. That includes maybe to cohort those who come in together who haven't been vaccinated. You may want to require masking, and you may want to require some distancing. I know that is probably not possible in these events, but things like masking, hand washing, symptoms screening. I think those are probably your best bets for managing the safety risk of having them enter. Again, as more and more people are vaccinated, that risk assessment also probably comes into play. If you were to have, say, 100 people at your event and 80-90% of them were vaccinated, is that a safe risk? That's something that needs to continue to be assessed, and organizations need to decide what they're comfortable with, again, looking at their state and local requirements and any sort of additional bodies that might oversee your organization.

Is requiring masks of people who are unvaccinated a violation of ADA, because it would reveal that they may have a medical issue?

That's an interesting question. Someone wearing a mask in and of itself does not indicate they were not vaccinated. Moreover, it does not indicate if they were not vaccinated that they were not vaccinated for a medical reason. That all said, there are individuals who cannot wear masks due to medical issues, and that has been the case throughout COVID. Spaces of public accommodation have had to assess and provide accommodations for those individuals throughout COVID. So an ADA accommodation may be necessary, but not necessarily because you revealed someone was not vaccinated. And again, that becomes an individualized assessment based on—if they were the only one without a vaccine, maybe it's not as big a threat. So it's hard to give a blanket answer to that.

If masks are required, and participants take off their mask for the event, is it legal to force them to leave if they refuse to put their mask back on?

I'm sorry to continue to say this, but you do need to pay attention to whatever your state and local rules are, because it can vary from area to area. I think in many places requiring masks is still permissible, and here in Massachusetts, our governor has publicly said that private companies can continue to require masking inside if they want to, so I think you really need to be familiar with your local rules. And then also assess why they're taking off their mask. If it's somebody who's saying they're taking it off because they have a respiratory condition that prevents them from wearing it, then you've got an ADA assessment.

Are churches public accommodations? Since many dances are held in parish halls, would that fall under the public accommodation designation?

Unfortunately I did not do any searching into churches, and the reason I'm hesitant to answer that is that churches fall into a unique category. Anyone who helps operate a church may know this: that they are exempt from some parts of federal law, due to their church status and the separation between church and state. So that is one that I'm actually not going to be comfortable answering on the spot without doing some research.

Are we legally allowed to require proof of vaccination outside of ADA?

So if somebody is just saying “I didn't get vaccinated, and I don't want to be vaccinated, and I'm not going to be vaccinated, and I don't have a medical reason, and I don't have a religious reason,” then you probably are able to keep those people out. I think the question is how much you want to get into these questions with people at the door of your event. The other thing is, like I said, if somebody says they have a sincerely-held religious belief, you really can't get into a lot of questioning about that. It's an area that the government has given a lot of protection to, given the First Amendment.

There’s a question about, “You can't deny entry based on a disability,” but there's also the direct threat provision, where COVID is a direct threat, so you can make requirements based off of that. How do those interact?

That's a good question, and sorry for any confusion. You may be able to keep somebody out who isn't vaccinated, even if the reason they aren't vaccinated is for a medical reason. The question becomes: keeping somebody out is the most extreme out of the options. Is there a lesser means to allow them entry that reduces that direct threat risk to a reasonable standard? So that's where this idea of screening people at the door, requiring a negative test, masking comes into play, because that all reduces the risk that they could spread COVID, if they happen to have COVID. 

I think part of that analysis is going to start to become as well: how widespread is COVID in the community as it gets under more control in more places? As well, as more and more people get vaccinated, that assessment may also come into play, that the direct threat may be further reduced just by, if most people attending are vaccinated, This is why it is really, as you can tell, a very specific analysis on the given facts and on the given circumstances.

What is our liability as a board or organizing group, versus as individuals? Could someone sue a single organizer personally if they get sick?

Without knowing exactly your role in the organization, it's hard for me to answer that. I think many organizations, I will say, have Director and Officer liability. Some organizations also have volunteer and employee protections. That's something you probably want to check in with your organization to find out about. And without having more details, it's probably harder to answer that in a specific way.

Are there privacy violations for asking to see people's vaccination cards as proof of vaccination?

That's an interesting question. In the employment context, there's a bit more information out there right now than in this context, though that too is an emerging area. Here, where there is a rationale for the information, you may be able to obtain it. The question is whether you store that information and if so you need to ensure you are in compliance with any federal, state, or local requirements regarding storing this information. In giving the vaccine, you have to ask a whole bunch of medical questions ahead of time. You don't want to ask those questions as it relates to determining whether someone has been vaccinated. You don't want to find out anything other than yes or no, they’ve gotten the vaccine. If no, you may want to ask at a high level whether there was a medical/religious reason they have not obtained the vaccine. And so you do need to be careful about it. I think just having, you know, whether it's the person at the door checking, or whether you have them attesting to the fact that they've gotten it, I think those are the assessments that organizations are going to have to make as we move forward, whether they're actually going to require proof of seeing it, or if they'll accept somebody attesting that they've gotten it.

My dance group is sponsored by a county recreation department, who has said that we cannot require proof of vaccination, but they meet in their facility. Is there a way that you can require it for your dancers, even if the facility has said you're not allowed to?

That sounds like a very specific question, so I'm hesitant to answer without knowing all the details.

Are there differences in what you can require of the musicians and callers who are hired to work at the dance, versus the people who participate in the event, in terms of requiring vaccination?

So that's an interesting question. I've seen a lot of commentary that if you're not requiring your employees, and in this case I'm not positive whether your dancers and your callers are employees or contractors, but I have seen a lot of guidance out there that if you're not requiring your employees to be vaccinated, you may really have a tough time requiring your attendees to be vaccinated. It seems a bit uneven. And I think if they are your employees, then you've got to go through the same analysis, but in the workplace setting, which may require greater consideration for accommodations.

If we require pre-registration, what might we put in the pre-registration documents to mitigate organizational risk?

That's a good question. I think the same types of things you would want to put in your general waiver, so that you could almost be having them fill out the waiver in advance. And so you'd want to make sure that you're noting what COVID is, at a high level, it's a communicable disease spread from person to person. You would want to note that it does currently exist in the community. You might want to require them to check whether or not they've been vaccinated, whether they have any symptoms. I know travel is still on a lot of waivers. I think that's probably a holdover for domestic travel at this point, although as things change, it may become more important again to be asking those questions. So I think including those types of questions so that somebody has been screened to be cleared to come. And then again, having them acknowledge that they're taking on this risk knowingly and voluntarily, and waiving their ability to sue and bring claims against you.

You mentioned a waiver, and it would be great if we could have a template that we could share with people. Is that going to be possible?

So, I had provided in advance, an outline of a waiver that goes through these different things I've been suggesting you include. It's not more specific than that, because where this is a national meeting and a national group, I am hesitant to provide language for various jurisdictions and/or event types that I may or may not know about, and may or may not have practiced within. So it's more of an outline of the types of things you want to be including. So I think that is available to be shared.

Can you require proof of vaccination OR a recent negative test result?

I believe the vaccination question was discussed broadly in the presentation and answers above. As to requiring a recent negative test, that seems like something that can be required. However, it is important to note that there are different types of COVID tests and some are more reliable than others.  In addition, someone can contract COVID following a COVID test, so timing of the testing would also be relevant for effectiveness. In addition, you may want to consider just reviewing and/or attestation of results rather than storing copies of these. You would need to ensure you are in compliance with any federal, state, and/or local laws/ordinances regarding the storage of this type of confidential information.

Should we let people know in advance that there may be people present who are not vaccinated?

As part of creating a waiver or ensuring individuals are aware of the risks they are assuming, it likely does make sense to indicate that vaccinations are not mandated for attendance and that there is a risk of COVID exposure as discussed above and during the presentation.

If we require vaccination for a small/medium size dance gathering, can we simply accept their statement that they are vaccinated rather than checking their vaccine record card (which could be counterfeit)?

This is an individual determination organizations need to make as to what they will require for proof of vaccination assessing various risks.

Is it possible for unvaccinated attendees to somehow agree to assume liability for Covid cases possibly contracted at an event?

I am not exactly sure what is being asked here. As mentioned during the presentation, this is still an emerging area of the law and therefore whether an entity/organization will be held liable for someone contracting COVID while at their event is still unsettled law. Ensuring you are informing individuals about any risks is important, as is providing steps to reduce those risks (as discussed during the presentation).

Again, you cannot prevent someone from suing the organization/entity hosting the event, even if at the end of the day the organization/entity prevails.

Can someone sue an organizer personally for excluding them?

It is worth noting, and reiterating what another speaker mentioned, individuals can bring lawsuits for all sorts of reasons, and there is no way to prevent them from filing. Thus organizations have to defend those claims regardless of merit.

This is a very broad question and therefore I cannot answer it more specifically than that.

What about the privacy concerns of keeping physical or electronic records of a waiver containing medical history?

I am not certain what “medical history” this is referring to. I do not believe I suggested keeping medical records as part of a waiver. As noted previously, organizations need to be cautious about the types of questions asked and information gathered. Organizations will need to decide what information they collect and if it includes personal information that must be protected. Then the organization will need to ensure they are complying with all federal, state, and local requirements regarding storing such information.

Can we save names and dates of attendees’ vaccination?

If you are storing personal information about individuals you will need to ensure you are in compliance with any federal, state, and/or local data privacy records requirements.

If we ask for proof of vaccination, can we note the answer for future reference so we don't have to keep asking them?

If you are going to be keeping such information, you will need to ensure you are in compliance with any federal, state, and/or local personal information records requirements.

See also the answer to the next question.

If we were to require waivers, would they have to apply specifically to each event, or could we have a waiver that would last for some time - a month, 3 months, indefinite?

Given the changing nature of COVID and the speed with which things are changing and information is becoming available, it may be best to require waivers for each event (if an event is ongoing for a week, perhaps it is for that week).

This is something that would need to be individually assessed based on the circumstances and what the waiver indicates.

If a sponsoring county agency sets a mask policy and what screening is allowed, do they absolve our group from legal risk?

As indicated before, this is an evolving area of the law. It is unclear whether those following a masking and screening policy set by an outside agency will be held liable for any spread at their events. Moreover, there is no way to prevent individuals from filing claims against you, even if you are following such policies.

Can we require contact information in order to gain entry into a dance to be able to follow up w/ contact tracing if necessary?

Again, you would want to check any local, state, and federal restrictions on the types of information you are collecting and/or retaining, but requesting names and contact information is likely permissible and depending on state/local requirements may be mandated.

Can we require a doctor’s note for people who can’t show a vaccine card?

This would be an individualized assessment. What are you going to do with the note, who will have access to it, where would it be stored, what type of information would you require to be provided?

If we opt in for Group Policy later in the year, is the cost prorated?

We’re not expecting to offer a pro-rated cost for the policy. Our pricing is by number of events, so it may be cheaper for you to join later in the year if you’re expecting to hold fewer events. The insurance is also retroactive also, so if you happen to be sued for an event that happened earlier in the year, you would still be covered.

Do you recommend getting Directors and Officers insurance to protect organizers?

It’s difficult to give generalized advice on this subject - each organization is unique and has different needs. You’ll need to decide for yourself if the cost of D&O insurance is worthwhile. General Liability and D&O insurance cover separate things. The General Liability policy CDSS has covers Directors or Officers (or employees, volunteers, etc) for their work for the insured entity if there is a claim of liability brought due to their operations. A D&O policy covers you as officers/directors of the organization.

This article provides some information on the difference, and what D&O covers, but you should speak with a lawyer or insurance agent if you have further questions.

Do you have a very general sense of what the cost would be for directors and officers insurance for a local Affiliate?

A very general estimate is $500-$1,000. The exact amount will depend on the size of the organization and location.

Are we covered if someone is injured at a virtual contra event?

Potentially, yes—you could submit a claim for an incident that happened at a virtual event you were running.

Do you know what process would happen if a lawsuit is COVID-related?

My understanding is just that the claim won't be accepted or would be denied without further investigation. This applies to defense costs or any COVID-related claims.

How do we respond to the new guidelines from CDC in relation to the resumption of dancing, singing, and music gatherings?

According to the new CDC guidelines, people who are fully vaccinated, meaning two weeks after their last vaccine, may resume the normal activities that they were doing pre-pandemic. Fully vaccinated people may do this “without wearing a mask or physically distancing, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance.” I think Ann Marie did a quite a thorough job explaining all that. (See Questions & Answers from an Attorney.) However, masks are still required for everyone on public transportation, in health care settings, and in congregate settings, such as nursing homes.

The new guidance does not set any limits for vaccinated individuals with respect to whether the activity is indoors or outdoors; the number of people; the presence of unvaccinated people; or the type of activity. Basically, it says that vaccinated people have a very low risk of infection regardless of these factors. This doesn't mean that there's no risk at all, but it's low enough that CDC considers it okay to engage in these activities if you're vaccinated. And they made this decision in conjunction with the fact that cases have been going down and vaccination rates, although slowing down now, have been going up.

Can we dance and sing the way we could pre-pandemic?

Clearly not everyone is ready to accept the CDC guidance outright. Individuals and local communities need to decide for themselves what they're comfortable with. It would certainly be reasonable for vaccinated people to continue to mask if that makes them more comfortable. It would also be reasonable to continue to follow these measures that we know reduce risks such as dancing outside versus inside, and maximizing ventilation if you're dancing indoors.

If you're fully vaccinated, the science points to very low risk of either becoming infected or transmitting the virus to others. The risk is never zero, since the vaccines are not 100% effective. However, if a fully vaccinated person does become infected, they're at very low risk of serious disease. If you're not vaccinated, the risk of transmission of infection or getting infected is of course higher.

What about variants?

Current data show the vaccine may be effective against some variants, but we don't know about all the variants. And we also don't know how long the protective effect of the vaccines will last. There's some thought that annual boosters might be required, such as what happens with the flu every year, but this is all still being explored.

What are the implications for unvaccinated people?

These implications are among the most difficult aspects of this guidance. If masking requirements are lifted for vaccinated people, then it becomes difficult to effectively track masking for unvaccinated people, unless vaccination is being verified, and as we know, that it's very difficult for public events. According to the CDC, there isn’t significant risk for vaccinated people from unvaccinated people. However unmasked, unvaccinated people certainly increase the risk for other unvaccinated people, and may actually increase the risk for some vaccinated people, since the vaccines are not 100% effective. This is true even if they’re masked, but it's much lower if they’re masked. And risk is also higher for individuals with weakened immune systems in whom the vaccine may be not as effective, or not effective at all.

How do we reduce risk at a dance/singing/music event?

• You can ask people if they have any symptoms and/or if they have been exposed to COVID-19 recently. (If so, they shouldn't be coming to the dance at all and hopefully they know better, but you just don't know.)
• You can have post signs.
• Outdoor venues are always safer than indoors.
• Indoor venues with good ventilation are better than those with poor ventilation, which refers to a flow of fresh air through the dance space, which is accomplished either with a good HVAC system or properly placed fans that drive the air. (This is site-specific, so each venue is going to have to assess what the ventilation is like there, but fans that just recirculate the air are not providing good ventilation.)
• Wearing masks versus not wearing masks is another risk mitigation measure. As we all know, masks reduce risk, and some fully vaccinated people may not be comfortable in certain settings without a mask. We've gotten used to them and they make us safer. Personally, I haven't decided if I'm comfortable going to an indoor dance and not wearing a mask yet, but I've got time to figure that out.
  • Note: Under no circumstances should mask shaming go on, which is someone being targeted because they're wearing a mask even if they're vaccinated. We want people to be comfortable wearing masks, if that is their choice. And we hope that those who are unvaccinated will wear masks.

Is it safe to dance/sing/play music? Is it safe to follow CDC guidance?

CDC is the official government source of information and guidance for health based on science. Their guidance is that the risk is low enough to resume normal activities for fully vaccinated people. Local or venue guidelines which may be more stringent than the CDC also have to be followed. So your state may not require people to mask indoors, but the venue that you rent may require it, in which case you have to follow the venue guidelines.

We can't tell somebody that it's totally safe to dance/sing/play music, and we shouldn't try to encourage people who are reluctant to resume these activities. Each individual has to determine if they're comfortable with the risk level at the event they want to attend. The exact same risk level will seem very low to some people and too high for others. People have to assess their own level of risk. Do they have underlying health issues? Do they live with an immunocompromised person?—and their own comfort with the particular situation. As organizers, we can only try to minimize the risk as much as possible, and be transparent about what we're doing.

When will it be safe to dance/sing/play music?

Organizers have lots of questions about “Why don't we just wait until fall to reopen dances?” or “Why don't we wait till spring?” The timing isn't as important as the local infection rate and the vaccination rate. If infection rates are low, why wait until fall? And if the infection rate is high in the fall, or if there's a local outbreak, it’s much safer to postpone or cancel that event.

What are some metrics to use to determine whether to hold a dance/song/music event?

(See Sources of COVID-19 Guidelines and Statistics.)

You can find information about the local rate of infection and the local rate of vaccination at certain sites. The local vaccination rate may not accurately reflect the vaccination rate among the people who are attending your events, because they may be from other places where the rate of infection is different. So you get back to the issue of: are you going to require vaccinations, and if so, will you require proof of vaccination?

When you look at the CDC website, you can see the date of each update. Just make sure you know the date of the most recent update, since some things may have been updated more recently than others.

What about herd immunity - does it apply?

Herd immunity does not apply to an individual event. It occurs when there's a high enough percentage of people in the general population that are immune to the virus, and that's through either vaccination or natural infection, to help prevent transmission of the virus to those who are not immune. In general, approximately 70-85% of a population needs to be immune for protection of others to occur. We don't know what the rate is for COVID-19, and many experts are unsure if we'll ever get to it. Herd immunity is often recognized well after it's been attained. So the goal right now is to increase vaccination rates, rather than focus on what some people believe to be a magic number.

Is it okay to have an event with vaccinated and unvaccinated people?

The CDC says vaccinated people can engage in vigorous indoor activity and sing in a choir without masks, and unvaccinated people should wear masks. Organizers will have to figure out how they're going to follow that guidance.

How does vaccination status affect organizing events?

There are many categories of events: local (such as weekly or private events), restricted (weekends or week-long events), and large public events. Each of these scenarios has different considerations. The host of a private event has complete control over who they invite, so they can choose to only invite vaccinated people. Organizers of large public events, which will most likely have a mix of people coming from areas with different infection rates, will have to determine what policies make sense for them. Here are some considerations:

• Vaccination could be required. If so, do you need proof?
• Are you going to require masks? If so, how are you going to enforce this? If you do have a policy of requiring masks and someone takes theirs off, there has to be a bad guy. This is also true for the door, where you're asking people for proof of vaccination, if that's your requirement.
• International travelers still have to be tested. So you could do the testing.
• Can you quantify what the CDC means by very low risk, in terms of say an incident of transmission per 100,000 people or so?

They consider low risk to be 10 cases per 100,000 or lower. So that's the infection rate they recommend you look at.

Is that 10 out of 100k per week or per day?

It's a rolling average for seven days.

What is the difference between public transportation and other indoor settings?

Public transportation is often in a confined space, which you’re sharing with people of unknown vaccination status. There’s no control over who you’re sharing the space with. Air circulation may not be optimal. Indoor settings could also have these issues, but organizers also have more control over who is coming and where the event is being held.

Speaking of ventilation, are there established methods for measuring airflow and air exchange rates in a venue?

There probably are, but I'm not familiar with what they are. You'll have to find an engineer for that one.

Should we space out our events, i.e., more than a month between, so we can know if infections resulted from the event?

I don't think you need to, just based on contact tracing. Certainly, a month or more is a lot of time. You're only going to be able to maybe trace it back to a dance within a very short period of time, especially if the dance was really big. So unless your infection rates are really high or if there's an outbreak in your area, I don't think you need to space your event like that.

Since we've been so isolated, is there any concern in the epidemiology world that other communicable diseases like flu are going to see an uptick as people resume activities?

I can tell you that over the winter, the flu rates were really, really, really low because it's a respiratory respiratorily transmitted virus just like COVID. So by doing the precautions we've been doing, the distancing and the masking, our rates have dropped. And so we're probably going to see higher rates of flu next year—and probably any respiratorily transmitted disease, because what we were doing was preventing it. I've heard some people say they're going to always wear a mask in the winter to prevent those diseases.

Do people with a weakened immune system pose a greater risk to others, whether or not they're vaccinated?

They probably have a higher risk of becoming infected, and therefore being able to transmit it to someone else. But, I think the concern would be more for themselves than for transmitting it to someone who's vaccinated. Someone who's vaccinated is pretty protected. That's what the studies are showing.

Are there special considerations regarding minors attending dance events? Would the notice or waiver, etc., have to be provided to be signed by a parent, instead of a minor? This might be more of an attorney question, but since minors are potentially unvaccinated.

I know that the parent would have to sign it, because when we have minors who are exposed, we have to speak to their parents, we can't speak to them. So I'm going to throw that to Ann Marie.

Ann Marie Noonan (attorney): I would generally recommend having a person of legal age. I think it could vary by state. So you'd want to make sure you're familiar with how old somebody needs to be in order to sign their own waiver.

Are negative tests equivalent to vaccination? What types of rapid testing are available and adequate for the safety purposes?

Interestingly enough, just yesterday I found out that there's a rapid PCR—so, the PCR test is our gold standard. And there's also rapid testing. So if someone tests positive with a rapid test, which takes about 15 minutes, but is also tested using a PCR and the PCR comes in negative, they are not considered a case. There is a rapid PCR now, which takes 15 to 30 minutes, and I don't know how generally available it is. So, those tests are really good. So what's the question again?

What type of rapid testing would be available for using a negative test confirmation the same way you would require a vaccine?

I would like it to be a PCR, but that generally takes longer, but now with these rapid PCRs, that's great news. The rapid PCRs are almost as good as the regular PCRs. I don't know much more about them than that.

Can we require, or would you recommend, keeping contact information in order to have contact tracing available after an event?

As an epidemiologist and a contact tracer, I love the idea of getting that information at the door (the name, phone number, and email of people who have attended the event). If the information is collected at the door, the health department’s job is a lot easier in terms of reaching out to the people who have been exposed to a case. In terms of the legality of holding on to that information, I don't know how that works. And if—and how long you might have to get rid of that information after a while, I don't know about that. Ann Marie?

Ann Marie Noonan (attorney): I think for a while here in Massachusetts, organizations and buildings were being required to get that information. Certainly as restrictions are removed or modified in different states, I suppose there may be some changes. I know some organizations have real hesitancy to try to collect that information due to concerns that it might interfere with people's privacy. So I think you probably need to look at local concerns.

Is there a recommendation for how long a hall should be cleared before other events happen in the same space? Is there like a cooldown period between events that makes it safer?

I don't know, but my guess is a place that's better ventilated probably doesn't need as long a time as a place that's not as well ventilated. I don't know if there's a standard for that.

If a group decides to ask for proof of vaccination, are there ways we can include people who are not vaccinated, while keeping them safe?

If someone wants to participate who is not vaccinated, wearing a mask and keeping a six-foot distance makes it safer for everyone, particularly the person who is not vaccinated. How to enforce mask wearing is something the organizer will have to figure out.

How do the CDC recommendations apply in contra dance situations—indoors, people holding each other and breathing into each other's face, and changing partners every dance, for 3 hours indoors?

The CDC guidelines say that people who are fully vaccinated can go back to their normal activities. If you extrapolate from there, contra dancing is fine for those who are fully vaccinated. If you are not comfortable with this yet, you should feel free to wear a mask.

Other than CDC (which are guidelines) is one's State the end/legal authority on whether we can require vaccination -- or proof of vaccination? Our state is very conservative. Who in state government would generally be the person? Attorney General?

This is a question for the attorney.

I'm in an area with very low vaccination rates (~40%). Should we have a target range of community vaccination before we start doing dances?

The higher the level of community vaccination, the better. The vaccination rate among your dancers may actually be much higher - it might be worth your time to do a survey of the usual participants. (See Community Survey Template.) 70-80% would be great; higher is always better. And you can ask those who aren’t vaccinated to wear masks.

Is it okay to allow wind players (flutes/whistles, clarinet) at an outdoor jam?

Yes! Outdoors is always better than indoors. The musicians can distance and/or put bell covers on their instrument.

Do wind players have the same status as singers?

This probably depends on the instrument. Flutes are probably the same as singers, since you’re blowing over the instrument. Sax and clarinet may be a little safer. Distancing helps decrease risk, also being outside instead of inside.

Does the extremely close contact with many different people that is central to contra dancing indicate a higher level of risk than other “normal activities”?

Yes, contra dancing is one of the ‘riskiest’ activities you can participate in, when it comes to a disease that is transmitted through the respiratory route. However, if everyone is vaccinated, the risk is greatly reduced.

Up to now, there have been quarantine requirements for people who are potentially exposed. What is the latest advice on how long one should quarantine after a potential exposure, before, say, visiting with an immunocompromised relative?

The quarantine length is still the same: you should quarantine for 14 days after exposure. This applies to people who are not vaccinated and who are not living with the case.

What is the fourth wave?

We in the U.S. and in North America are in what's being called the fourth wave. These waves come and go, and you can see them very dramatically on graphs of COVID reporting. This particular wave is being fueled by two things: unvaccinated people, which unfortunately, we have too many of in our country without good reason; and the new Delta variant.

What is the impact of the Delta variant?

In early July, a large number of vaccinated people and a few unvaccinated people and the Delta variant all met together in Provincetown, MA. This superspreader event resulted in over 900 related COVID infections amongst people who were mostly but not all vaccinated. This showed the scientific community that indeed vaccinated people can get sick. Most of them didn't get very sick. I think only a few of those 900-some people have been hospitalized; as far as I know, none of them have died.

However this made all of us in the medical community stop and think; we're not quite out of the woods yet. Vaccinated people can indeed pass COVID to other people, both other vaccinated people and people who aren't vaccinated. It also showed us that this vaccine really is effective. So even though this Delta variant weeded its way through a large number of people in a closely packed resort town, most of them did not get very sick if they were vaccinated. In fact, hardly any of them got very sick if they were vaccinated, much like people who get the flu vaccine every year.

How is the Delta variant affecting the vaccine rates?

In my own practice, I am noticing that vaccine rates are increasing. I think people are hearing about the Delta virus and finally figuring out that maybe it might be a good idea to get a shot. The public health person I've been most in touch with at the Massachusetts Department of Public Health said this Delta variant may not last so long, because people are getting vaccinated more, and it's spreading so quickly that likely there will soon be fewer people susceptible in the community. So Delta seems to be moving through communities like a tidal wave, and it's going to get everybody. They're going to become immunized, but not in the way they want to be, if they survive the illness.

What are the symptoms of COVID?

What’s tricky about COVID symptoms is that they can vary from absolutely none at all (people can be contagious of COVID and have no symptoms), to mild respiratory symptoms that can be sort of reassuring, thinking, “Oh, this is just a cold, it couldn't be COVID.” But some people have fever, some don't. Some people have progressive disease that leads to severe lung disease, oxygen deprivation, and far too often, death. It may also present only with headaches or fatigue, GI symptoms like vomiting and diarrhea, and then the most peculiar thing of loss of taste or smell. I have certainly never learned about another infectious disease causing this particular symptom.

Who is at higher risk?

We've known from the beginning that some people are at much higher risk for COVID than others. This includes people who are immunocompromised, whether due to a pre-existing medical condition or due to treatment of the condition they have (people who have cancer, for example, who are receiving chemotherapy). Also people who have immune-related problems, like certain kinds of arthritis and colitis, who have medication that appropriately dampens their immune system, also are at higher risk for getting very sick or dying from this disease. We know diabetics are, we know obese people are, and people with multiple medical problems, whether they be young or old.

It has certainly come very much to light that people of racial and ethnic minorities, at least within our country, seem to be at higher risk. This is difficult to tease out, because these are also people who may be at risk for complicating factors, including poverty, limited access to health care, and a higher rate of comorbid health problems, including the ones I've already mentioned.

Of course, the largest group of people who are at higher risk now are those who are not vaccinated, which includes most of my patient population, since I take care of children.

What does it take to be exposed to COVID?

I asked public health officials in Massachusetts why the CDC hasn't changed its definition of exposure. As you may have heard, an exposure is considered someone who is within six feet of an infected person for more than 15 minutes. One would think that if this Delta variant is much more contagious, that definition might change. But in fact, the CDC feels this definition has worked really well, that no one is really setting a time clock in terms of exposure, and they're not going to change it. But that makes a difference when it comes to whether kids in a school, or people at a dance or wherever, are exposed.

How contagious is the Delta variant?

The variant itself is about one and a half to two times as contagious as the earlier variants, the alpha variant that came out at first. This means that it's about as contagious as chickenpox, which right now, aside from possibly Ebola, is one of the most contagious diseases in the world.

How will this affect the spread of the Delta and other variants?

We expect that we'll continue to see the spread of this variant, and there will be many sick people. Greater numbers of infected people allows for development of other variants. So if you have more sick people, you have the virus replicating in more people, and there is the possibility of other variants, which is why it's so important that we try and encourage people to get vaccinated, so that new and possibly more contagious or severe variants are less likely to develop.

The lambda variant has been mentioned in the news. So far, it too seems to be sensitive to the vaccine, and doesn't seem to be spreading as quickly. But we're more worried about what's on the horizon.

How do we prevent disease?

We know this: we wash our hands, we sanitize surfaces, if necessary. We wear masks. I think most of us participating in this Web Chat are pretty convinced that these things help to prevent the disease. Unfortunately, not all of our fellow citizens or other people in the world are so convinced. We know that social distancing works, we know that testing works. The only way to know whether you are infectious is to get tested. And we certainly know that vaccination works.

What do we think about social dancing, singing, jamming, getting together?

I think for most of these activities it's very, very hard to be socially distant. So when you're dancing with people, singing with them, jamming, one has to consider - who are you? Who are the other dancers, singers and musicians? Where is this taking place? Is it indoors or outdoors? Is it a large venue? Is it a small venue? Is there good ventilation if it's indoors? How many people will be there?

What should we think about if we're planning an event?

I do think that the way the world is today, if you're going to bring people together to do something social in what is unlikely to be a socially distant manner, it is very important that they all be fully vaccinated.

What about including children?

It's important to remember that at least right now, children under 12 are not vaccinated. I think, to bring children under 12 into these non-socially distant venues, which are quite elective in nature and not as necessary as school (although some people might feel it is) is probably not a good idea. At least it's something you should think about.

What about masking?

I asked the public health people what they think about masking, and I told them what contra dancing is like, and they know what singing is like. They say masking may help some, but with vigorous activities like singing and dancing, the risk probably does go up. So if you're dancing masked or singing masked in large groups, there’s still going to be stuff flying around the masks, unless they're in N95 masks that are fitted, fit tested, which I don't think most of us are wearing.

What about testing?

Testing can be helpful and it can also be misleading. If you test everybody who comes into an event, it's a great sieve. Most of the people who are contagious at the time will be caught. But they might be contagious and test negative, and I think that's something always to be remembered. So if you let a dozen people into a dance or a camp who were exposed a day or two before, they might have a negative test, and two days later they might be quite happily shedding virus and even sick. By that time, you would have exposed everybody at the event. They might also already be shedding some and have a negative rapid test.

Other Considerations

Think about the health of the people coming to an event

If you're planning an event, I would certainly say it makes sense to tell sick people to stay home, and to not assume that a sniffle is allergies or a cold. Certainly people who know they've been exposed or are very likely to have been exposed to COVID should not come to an event, even if they're feeling fine. 

Look at the local incidence (how to)

If you are in an area where there really is no COVID at the time, and where dancers are all coming from your local area, you can feel much safer about having people gather in a non-socially distant fashion. How do you know this? You check it. There are a couple of ways to look at it. (See References below.) The CDC and most state Departments of Health have pretty up-to-date maps and ways to look at your local incidence, which can change from day to day, week to week. Again, it's another one of those things you can obsess about, but it's very useful information. And again, you want to think about where the participants are coming from. Might there be a whole bunch of people getting off a plane and coming to visit from an area that's a much higher incidence than your local incidence, and might they bring COVID with them?

Follow CDC recommendations

In July, they came out and said that fully vaccinated people can participate in many of the pre-pandemic activities, which I assume would include contra dancing and singing in groups, and that they should still wear masks indoors in areas of substantial and high risk. So when you go to the CDC website, you can look at maps of the United States, at least by county. And they have four gradations of risk: high risk, substantial, moderate, and no risk. There are also some deceivingly low-risk-looking areas on the map, at least of the U.S. If you drill in on those, it turns out that a number of them, especially in the Midwest, are areas that are not reporting numbers, which is kind of scary. But they probably just don't have the public health people or funding to do that, and hopefully that will change over time. They tend to be the more rural areas.

The CDC does say that even in low-risk areas, you should still wear a mask indoors if you or your household members are immunocompromised, if you have other health risks, or if there are other people who are unvaccinated. They also say, which is different than a few months ago, that if fully vaccinated people are exposed, they should wear a mask. They can go out and don't have to quarantine, but they should be tested immediately if they show symptoms. If they have no symptoms, they should be tested three to five days after an exposure.

Conclusion: So what do you do now?

Is this really the right time to hold large-scale social events that we can't say are socially distant? Based on all these considerations, a level of caution right now is in order. It's really important to acquaint yourselves with your local, state, and county, or if you're in Canada, I guess, territorial, public health departments. We have a really good one here in Massachusetts, and I hope other states have such resources available. They want to help you prevent disease, so they are there to answer questions. Most of them are keeping up their websites quite accurately, and many have phone lines with public health experts to answer questions about confusing situation. They're trying to provide vaccines and testing widely and free, so that these are accessible to all.

I think if you're going to plan an event, you have to have a game plan if something happens. So are you going to keep track of the people who come to your event, so that if someone does come down with a case, you can do contact tracing? Do you know what you're going to do if you're holding a longer event like a camp and a case happens during that event? Again, keeping an eye on news and updates from reliable sources (and not just Facebook) is a good idea. 

References:

• Johns Hopkins Covid dashboard
• CDC Covid tracker
• New York Times Covid maps
• CDC Website – If you are fully vaccinated
• Boston Childrens Website with Covid-19 info
• MA Department of Public Health Website on Covid info and updates (all states by now should have robust online info about Covid)
• MMWR article on outbreak Associated with large public gathering in Barnstable County, MA, July 2021
• MMWR article on superspreader choir practice

Our group is going to start requiring vaccination for our dancers, but obviously some dancers have young children who cannot be vaccinated. Do you have recommendations about what to do in those cases?

As a pediatrician, I think it's just not a good idea right now to bring children who might be carrying COVID, or who might get it, into a place they don't need to be. Again, that may vary depending on the level in your community and who is coming to your dance. And we know that children up until now have not passed this on. But I'm sure you've heard the news that just because of who's susceptible right now, children are making up a larger percentage, a larger burden of the people who are sick with COVID. And we are seeing that in our hospital here locally.

I've heard opinions attributed to medical practitioners that cloth masks don't protect people from the Delta variant. Is that a reasonable statement? Even if masks aren't sufficient for dancing or singing events, what about normal life situations?

The news that is coming out is that cloth masks are not as good, and the scarves you pull up over your face are not as good. Even the loop masks that we use most of the time in the office are not as good, but they're better than a cloth mask. If you really want to be protected, the KN95s are better and N95s are the best. 

We just talked about masks not necessarily helping with close vigorous activities. That was specifically indoors. If you're outdoors doing these activities, does that change anything?

It's probably better doing them outdoors. But if you're wearing a mask and twirling around with someone contra dancing, it's hard for me to think you're not going to be sharing whatever you're exhaling and that person is exhaling, to a certain degree. 

Is there any difference in your mind about the risk factors for something like English country dance, which could be a little bit more distant and not quite so vigorous as contra?

Sure, I think it's a little bit lower risk. I think it's all a bit of a gamble. If people in a room are doing something that doesn't cause them to breathe as heavily and move around as much and exhale as much, it is definitely lower risk. And if you add masks to that, it's lower risk again. However there's not no risk. You know, when I go to the grocery store, it's not no risk. And when I travel or get on an airplane, it's not no risk. But you pick and choose what is lower risk.

Do you have any sense of the timeline for when kids will likely be able to be vaccinated?

Our public health officials are telling us that they're hoping for September or early October, and I'm chomping at the bit.