Dancing in a Mask
As counties begin to increase their guidance on the use of masks indoors and outdoors there has been a lot of talk about whether it is safe for dancers to be taking class, going to competitions, and performing with the use of masks. We touched on this in an earlier episode and Dr. Kat has written some guidance on the use of masks for dancers, we decided to take a deeper look at whether masks are safe to use in a dance setting.
Our goal is to synthesize the data that is out there for you, discuss some of the benefits of training in masks, how to build up to wearing a mask, as well as breathing exercises to incorporate into your daily routine.
Thank you to everyone who is taking part in the calf strength challenge! I hope that you are feeling those strength gains in your calves. We would love to hear from our listeners, any questions you have, specific topics you may be interested in, or new challenges for upcoming months. You can reach us through the contact page on our website thedancedocs.com, or on instagram, and facebook.
There has been a consensus that it has been challenging to navigate the COVID pandemic whether you are a medical professional, a teacher, a dancer, or someone walking down the street. It has caused an increase in overall stress level and with guidelines changing on what feels like a daily basis. Reports will come out one day and then be retracted the next only adding to the frustration that many of us are feeling. One thing that I have to remind myself if that we are dealing with a novel virus:
We are watching science do exactly what it is supposed to do
Research is happening at a very rapid rate- normally we wouldn’t see articles published for months, but the world is collaborating and learning more about this virus every day and so the recommendations are changing.
Science is constantly correcting itself right now as our body of knowledge surrounding the virus continues to expand. I see this as a good thing- if we were still operating off of data and information we had in march I feel we would be in a much different place.
The scientists are adjusting their views, in a constant state of learning, and not just sticking to their own biases and perceptions.
Reminder of why we wear a mask-
Asymptomatic carriers-
These are individuals who are free of fever, fatigue, SOB, cough and other common signs of infection. This does not mean that the corona virus is not taking a toll on the lungs.
CDC 25-50% of cases are asymptomatic- National Institute of Allergy and Infectious Diseases
Not for me for you
Example of decreased transmission with use of a mask Dr. Kat Postotive, Dr. Davenport Negative (This is not 100% proven data)
Dr. Kat w/out mask (+), Dr Davenport with mask (-)= 70% chance of infection
Dr. Kat with mask (+), Dr Davenport without mask (-) = 30%
Dr Kat with mask (+), Dr Davenport with mask (-)= 5% (some studies say as low as 2%)
Chu and colleagues reported that masks and respirators reduced the risk of infection by 85% with greater effectiveness in healthcare settings than in the community.
Masks to do not completely stop transmission
Even if your mask isn’t perfect, or perfectly worn, it may still do a world of good.
Due to the dose of the virus you are being exposed to determines how sick you will get (see previous episode description of viral dose vs. viral load
Even if your mask is only about 70% efficient, the severity of the disease will be much less
But try to wear it as correctly as possible as the better the mask, the wearing, the distancing, and the location (outdoors), the better the chance to limit infection to others and yourself
Respiratory droplets/ Aerosols
the 6-foot rule is based on studies of respiratory droplets conducted in the 1930s
Great starting point but technology has advanced and we are learning much more about COVID and virus transmission at a rapid rate
Aerosols float on air currents. It takes them hours to settle.
In indoor spaces where ventilation is not as good these particles can accumulate, remain infectious in indoor air for hours, and be easily inhaled deeply into the lungs.
This is what has much of the scientific and medical community worried.
WHO is now looking further into this but says that current research is not conclusive
Studies have shown spread in poorly ventilated areas (restaurant, office)
Recent US hospital study showed no evidence of COVID in air ducts on a C+ hospital floor and no evidence of transmission in the hospital through the air system (UF study)
remember hospitals are built to contain disease, offices and restaurants are not
If you look at countries that normally wear masks when people feel sick ... those countries are doing much better than here in the US
Taiwan’s numbers have remained low for both cases and deaths even though they never implemented a national lockdown.
Instead, they aggressively tested their citizens, quarantined people who tested positive for 2 weeks, and had everyone wear face masks.
[Personal story of a friend in Taiwan whose son came home from college in the US in March and was self-quarantining on a separate floor (she left food for him on the stair landing for 2 weeks). The police came in to be shown they were following the appropriate living situation, reminded them of all the guidelines, and checked in to make sure they were following everything]
In response to the commentary, the WHO has softened its position, saying in a press conference on 7 July that it will issue new guidelines about transmission in settings with close contact and poor ventilation. “We have to be open to this evidence and understand its implications regarding the modes of transmission, and also regarding the precautions that need to be taken,” said Benedetta Allegranzi, technical leader of the WHO task force on infection control.
Face Shields
Medical experts and researchers are very split on this
When wearing a face shield you are less likely to be touching your face, and you are also protecting your eyes which is another place for viruses to enter the body
Due to the open nature of the face shield it was effective at blocking larger droplets from coughs or sneezes and heavy breathing but it was not as efficient as a mask in blocking the aerosol transmission (very small particles) still lingering in the air
Face shields were once thought to be as effective as masks, but that is only true for pathogens spread solely through droplets, it does not take into account aerosols
High concern about spread when people are in small spaces, indoors, for long periods of time
CDC stance on face shields
It is not known if face shields provide any benefit as source control to protect others from the spray of respiratory particles.
CDC does not recommend use of face shields for normal everyday activities or as a substitute for cloth face coverings.
Some people may choose to use a face shield when sustained close contact with other people is expected.
If face shields are used without a mask, they should wrap around the sides of the wearer’s face and extend to below the chin.
Disposable face shields should only be worn for a single use.
Reusable face shields should be cleaned and disinfected after each use.
CDC recommendations on masks-
People who are engaged in high intensity activities, like running, may not be able to wear a cloth face covering if it causes difficulty breathing. If unable to wear a cloth face covering, consider conducting the activity in a location with greater ventilation and air exchange (for instance, outdoors versus indoors) and where it is possible to maintain physical distance from others.
Cloth face coverings are a critical preventive measure and are most essential in times when social distancing is difficult. If cloth face coverings cannot be used, make sure to take other measures to reduce the risk of COVID-19 spread, including social distancing, frequent hand washing, and cleaning and disinfecting frequently touched surfaces.
if I am walking/hiking/biking outdoors in a place where I can see other people I have my mask on
Describes as- imagine how far you can smell cigarette smoke or a barbecue. That's how far aerosols can travel between you and another person.
Indoors it lingers much longer and is a stronger smell vs being outdoors
CDC still encourages cloth face coverings for general population
Clinicians should be wearing an n95, or surgical face mask, and eye covering and patients should be wearing a mask as well.
recent studies have shown that homemade cloth masks can be as effective at blocking the virus as surgical masks. There's one big caveat, though. They have to fit your face.
Bandanas and shields are open at the bottom and call allow for aerosols to flow around
Remember aerosols are really light. If you can feel a breeze, they will be in that breeze.
There are many masks that are being developed by activewear companies for athletes
Exercise in a mask
Most of the research related to masks and exercise have been with the use of ETM
Strengthens Respiratory muscles and increases stamina
Causes increased fatigue of respiratory muscles which in turn will help to:
Increase strength of respiratory muscles
Help increase lung capacity
Has also been shown to help increase efficiency of oxygen exchange over time
Causes cellular oxidative adaptation
Which have been shown to decrease blood lactate levels
In athletes this change reduced their perception of overall effort when not wearing the mask, and lead to an overall improvement in performance
One study that showed that there could be some negative effects on alertness, focus and velocity
I think these are things for the dancer to monitor, but also for teachers, choreographers to take note of. We will touch on this a little more later in the show.
How to Adapt to dancing in a mask
Work on building up your time in the mask at home
See if you can wear the mask for plies and tendues
Building up your cardio endurance before
Consider going for a brisk walk in a mask to get used to doing light exercise in a mask
Teachers/Choreographers-
You may need to slow down initially and offer dancers more break times
When should you stop or pause
If you are feeling:
Light headed or like you are going to pass out
Dizzy
Hyperventilating
Hard time catching your breath
Notice someone is turning pale
A dancer is not able to maintain the same speed during an exercise
A dancer is looking slightly confused or not picking up combinations as quickly
MAKE SURE TO SPEAK UP IF YOU HAVE ANY OF THESE SYMPTOMS
Studios may want to invest in an O2 monitor (~$20-30)
Should be in the mid to upper 90’s
If you have any of these feelings make sure to step off to the side away from people and try to:
Not remove the mask if you are in a classroom or/
Teachers may want to designate a backup “safe space” to take off a mask and educate the dancers prior to starting class
Try to take a few deep breaths focusing on letting the diaphragm work, let the belly fill up
May want to go onto all fours or into child's pose- decreases tension on the anterior musculature allowing for better breathing/diaphragm excursion
Or think of the position you go into after a really hard variation
Stand round yourself forward place your hands on your legs
Close your eyes and just focus on calming yourself down, taking deep belly breaths
Also want to avoid just breathing with accessory muscles (muscle of your neck)- common in people who have asthma
Make sure you are doing some deep breathing exercises
If you have a breathing problem, we recommend you speak with your doctor about returning to activity in a mask, any additional signs to look for, and any medication dosing changes.
Notes from A Dancer on wearing a mask-
This dancer just took part in an outdoor performance with The Forest of Arden
It helps to wear a paper/medical mask, felt they were lighter weight and easier to breath in
Fabric masks are thicker ad therefore it heats up quickly and is much harder to breath
“I found that dancing along wasn’t too hard, but singing and dancing was definitely a challenge, even just walking and dancing.”
“you have to be adaptable, the first day of rehearsal with the masks was a challenge, but you get used to it”
Their space was outdoors
How to properly wear a mask
Your mask should cover your face from the bridge of your nose to under your chin.
It should be secure enough to stay in place.
If it has a metal piece, that goes over your nose (not under your chin!)
Double sided tape can help keep a mask in place and avoid fogging glasses
Homemade masks can use pipe cleaner
Make sure you can talk with your mask on and that it doesn’t irritate you, so you are not tempted to touch it or pull it out of place, which could put you at risk from touching your face or limit its effectiveness.
Do your best not to remove your mask during class or rehearsal.
If you do need to remove your mask, dispose of single use masks in the trash or place a reusable mask into its own sealable bag,
wash your hands and/or use an alcohol based hand sanitizer letting it dry for 30 seconds and then replace it with a clean one.
Dancers may require multiple masks to get through the day
If your mask becomes saturated with moisture from breathing or sweat you need to change into a dry mask.
A wet mask is less efficient at filtering bacteria and viruses
Single use masks work, in part, with a static charge to “catch” the virus particles. If the mask gets wet or is washed it no longer has that charge, even when it is dry again. Throw it out.
Masks should only be worn once and then replaced with a fresh mask.
All reusable masks should be cleaned ideally in a washer with hot water and soap and then dried in a dryer prior to next use. Ironing on the highest setting can also disinfect after washing and drying.
There are now multiple commercial reusable mask options available for use during dance/exercise
Breathing exercises to do to strengthen muscles for wearing a mask
Formal Breathing Exercises
Breathing in and out through a straw (preferably a larger one!)
Blowing up a balloon
EMST 150 device for expiratory muscle training
Speech and Language pathologist (SLP), vocal coach, Respiratory Physical Therapist
Pursed lip breathing
Start in a sitting position in good posture with your ribcage stacked on top of the pelvis
Draw a breath in through your nose, breath out through pursed lips (think like you are going to whistle) 10-15 breaths
Diaphragm Breathing
Lying on your back place one hand on your upper chest the other on your belly
Breathe in focusing on the belly rising instead of the chest
I find this hard for dancers
Costumes
Nature of making the work look easy
Alligator breathing
Lying on your stomach with a towel roll under your forehead
Take a deep breath into your back focusing on expanding your lower ribs
Alternate nostril breathing (shown to help cardiovascular function and lower HR)
Use your thumb to block the right nostrils
Breath in through the left
Switch your fingers so that your ring and little fingers close the left nostril
Breath out through the right nostril
Breath in through the right→ switch hands placement→ breath out through the left
Continue alternating breath pattern between right and left sides
Forced breathing
Sitting or standing
Take a big belly breath in
As you exhale draw the ribs together and engage the abdominals as you force the breath out through an open mouth
Things to remember during the COVID-19 pandemic
Best measure is still social distancing, washing hands or using hand sanitizers
Try to adjust your mask as little as possible, if you are constantly touching your mask you are increasing your risk of infection (especially through the eyes)
Try to continue working in bubbles (always with the same people who are taking the same level of precautions that you are.) limit your contact with people
Cleaning procedures- make sure if you are dancing indoors that proper cleaning and sanitizing practices are in place.
References
Asymptomatic Individuals
Mask Specific Literature
Comprehensive review of mask utility and challenges during the COVID-19 pandemic
Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks
Physical distancing, face masks, and eye protection for prevention of COVID-19
Face Shield
Respiratory Droplet/Aerosol Transmission
Elevation Training Masks
Effects of respiratory muscle training versus placebo on endurance exercise performance
Acute Effects of the Elevation Training Mask on Strength Performance in Recreational Weight lifters
Additional Resources
Pointe Magazine- How to Dance In A Face Mask
Apolla Shocks- Safely Incorporating Masks Into Dance Class
DanceUSA- COVID-19 FAQ for Dancers and Dance Companies Returning to the Studios