The best health and economic policies for safe, successful, live theater in 2021-2023 will be dynamic – adapting protocols quickly to new scientific evidence, flexing capacity limits according to vaccination and testing.
On Thursday April 1, 2021, the COVID Theatre Think Tank hosted a national town hall for the theatre industry to address the current state of the virus, what lies ahead, and what it means for the reopening of theatre across the country. Key advisers include Infectious Disease Epidemiologist and Economist Blythe Adamson; CUNY Graduate School of Public Health Professor Bruce Lee; White House Senior Advisor for the COVID-19 Response Andy Slavitt; and SUNY Downstate Health Sciences University Associate Dean of Graduate Medical Education Teresa Y. Smith, discussing the latest information and insights into the vaccination efforts, effect of the variants, and other important factors in the timeline to reopening. This is the first of several COVID Theatre Think Tank Town Halls, which are intended to help the theatre industry hear directly from experts in order to move toward reopening with a common understanding of the underlying science and conditions.
Here I provide supplementary material to help the theater community accelerate the development of cost-effective health and economic policies for a safe, robust recovery of live theater productions. Many of the lessons we learned from operating of schools, professional sports leagues, and businesses during the pandemic are relevant and actionable for live entertainment.
Special Considerations for Theater
New York City has 41 Broadway theaters, many with 8 shows per week pre-pandemic. Jobs work in tight spaces with little ventilation and intimate proximity to other people. Singing indoors without a mask is very risky. What can we do? It will be better to invest in COVID-19 prevention measures that are effective in reducing risk of transmission, rather than putting on a show a hygiene theater with temperature checks and lysol wiping the arm rests.
- Improve theater building ventilation for healthy air (fresh air from outdoors or filtering recycled air) – landlords
- Design a cost-effective testing strategy (eg, pooling) – productions
- Set flexible max capacity and distancing rules (eg, higher if audience has vaccine or negative test) – local government/public health departments
*assuming the theater community will seek vaccination as soon as available
Strategies for Theater in a Pandemic
Casting for New Roles
- Public Health Theater Liaison – for each state/local health department, a staff member tasked with communication of safe practices and effective prevention strategies to unions, theaters, and COVID Compliance Officers
- COVID Compliance Officer – for each production, a trained staff member responsible for securing PPE, testing, mask wearing, monitoring of quarantine and isolation timelines, and more.
- Theater Protocol Chief – for each theater building, a contact responsible to develop and keep updated documentation of building-specific protocols and state/local policies to be adopted by productions using the space. This will be critically important for sharing with the COVID Compliance Officer of traveling productions.
|Risks and Considerations
|Policy to Minimizing Risks
|Landlords of theaters
|Aerosolized transmission attributed to spaces with poor ventilation
|Create government incentives for theater building renovations to improve ventilation (e.g., tax incentives)
|Actors, opera singers
|Preference to perform without masks increase risk of transmission. Singing and yelling produces more potent virus than breathing. Opera singers
|Frequent testing (~3x per week), social contract with colleagues to avoid high risk behaviors in community
|Wind instruments: must remove mask to do job; forceful breathing could create clouds of virus in air (I panic imagining a super-spreading event caused by a saxophone player unaware of infection). Other instruments (strings, drums, keys, etc): low risk
|Add portable HEPA filters if space for musicians is poorly ventilated and some cannot wear masks or distance. Wash hands frequently. Explore adding filter to instrument (eg, covering opening of trombone). Relax distancing rules in pit if all vaccinated. See American Federation of Musicians Return to Work Safety Protocols for Pit Musicians
|Dancers (non-singing/speaking roles)
|Close proximity to on-stage performers not wearing masks. Breath through mask is much lower risk than singing without a mask.
|Wearing mask on stage is preferred. Encourage outdoor rehearsals when able (not possible for the Broadway community).
|Long amounts of time in small spaces with little air flow and close proximity to actors not wearing masks
|N95-like masks with good fit. Portable HEPA filter could be added to small, crowded backstage areas with poor ventilation. Test frequently if unvaccinated, less often if vaccinated. Vaccinated stage hands wearing masks may relax distancing backstage among cast and crew who are tested frequently or vaccinated.
|Low risk, no epidemiological evidence of virus transmission from fabrics
|Wear N95-like mask with good fit when working. Probably not necessary to quarantine wardrobe after use before cleaning.
|Close proximity to actor face who may not be wearing mask
|N95-like mask with good fit. A room with an open window is preferred. Test frequently if unvaccinated.
|Front of the house: ushers, box office, etc
|High number of unique contacts.
|Routine testing if unvaccinated. N95-like mask with good fit.
Outdoor performances are amazing. But not all productions can be done outdoors. Many Broadway theater buildings are historical landmarks, with ancient air systems that recirculate the air inside with very little filtration or pulling in fresh air from the outside. The pandemic creates an opportunity for much-needed upgrades theater ventilation systems for public health safety. These enhancements could include:
- Replace MERV 8 filters in vents with ones that do a better job catching viruses (e.g., MERV 13 or higher)
- Open dampers in vents to pull in maximum amount of fresh air into theater
- Add portable HEPA filters, “air scrubbers,” in high risk areas (may be too loud to have near the stage or seating area)
- Open windows and doors backstage to bring in more fresh air
- Add fans to move air and dilute any floating clouds of virus
Changes to ventilation systems can be costly, but the benefits to the health of the cast and audience would continue long after COVID ends. This area is ripe for government intervention to enable landlords to make ventilation improvements, for example through tax incentives.
Cost-Effective Testing Strategies
Frequent COVID testing of healthy-feeling people will be necessary for a long time, even after a majority have been vaccinated. Some groups, like the NBA, have demonstrated success with daily testing of players and staff. This requires tremendous resources, including labor, supplies, and lab costs. Where resources are more limited, the testing strategy for a stage production requires careful thought to maximize the return on investment in testing. I highly recommend resources inside this Covid-19 Testing in K-12 Settings: A Playbook for Educators and Leaders from the Rockefeller Foundation, as many of the considerations for a theater and a school will be similar.
Here is an hypothetical example of an indoor musical theater show with a 500 seat audience and 8 shows per week:
SUMMARY OF [FAKE] PROTOCOL - Actors and musicians who must remove their masks indoors to perform will be tested 2-3 times per week, regardless of vaccination status (until further evidence of transmission risk from vaccinated individuals is available, and then guidance may change). The production has contracted a lab for all testing needed for the duration of the show, negotiating a bulk discount. After the first few weeks, pooling of swabs will be used to reduce costs. - All unvaccinated staff members working in close proximity to someone not wearing a mask in areas with poor ventilation should be tested 1-2 times per week. Vaccinated staff who wear an n95-like mask at all times indoors may not need testing. - If all audience members have proof of full vaccination or recent negative test result, the maximum capacity can be 90% (with good ventilation) otherwise 50% capacity. Audience members not vaccinated should seek molecular testing in the days prior to the event. Those who do not have a test result by the day of show can purchase a rapid test at the theater for a higher cost.
Below is a summary of considerations for selecting a type of test, given the decision-making situation.
Thinking like a health economist
Here is a hypothetical scenario, intended to help you think like a health economist. It’s about weighing the tradeoffs of costs and benefits. Pretend you have a $30,000 budget to spend on COVID prevention for an upcoming theater production that runs for 12 weeks with 8 shows per week. Would you rather use this money for:
- Choice A: hire staff to check the temperatures of audience at arrival and perform deep cleaning of theater surfaces after each show (total cost of 4 people x $20/hr x 4 hrs/show x 8 shows/week x 12 weeks = $30,720)
- Choice B: upgrade HVAC filters from MERV-8 to MERV-13 ($25K), purchase portable HEPA filter “air scrubbers” for least ventilated and most crowded backstage areas and bathrooms ($500 each), purchase cheap box fans ($50 each) to position near open windows and exterior doors to bring in more fresh air (total cost $25,000 vent upgrade + $500*6 + $50*20 = $29,000).
What would you choose? Both interventions have the same cost. Do they both have the same health benefits during COVID?
- Which choice produces the most visible appearance of COVID prevention effort for people to see?
- Which choice will probably prevent more SARS-CoV-2 transmissions in the theater?
- Which choice will give you the greatest value in health gains for every dollar spent?
Compare your answers to mine at the end.
Creating room for questions from the theater community to continue surfacing.
Q: There’s a lot of debate on whether or not temperature checking is just ‘for show’. What do you think?
Q: Is it okay to use public transportation? How can we mitigate the risk when bubbles aren’t possible?
A: It’s possible to use public transportation safely. When riding the subway and bus in NYC, I swap my comfy casual cloth mask for a KN95 that has better filtration and a tight seal around my face. On the bus, I crack open windows on both sides to get air moving through.
Q: Will all of this happen on a state-by-state basis or will there be potential federal standards?
A: CDC will offer federal guidance and each state has the freedom to implement the guidance differently at the local level. There are levers possible to pull at the federal level if decisions in one state negatively affect other states.
Q: What is pooling? Why does it make testing cost less?
A: Join Yale University’s Dr. Anne Wyllie of SalivaDirect for a Pooled SARS-CoV-2 Testing Strategies Webinar on Wednesday April 7th, 3pm – 4pm to learn more about the different pooled testing options and how to implement these strategies in the lab setting. Includes presentations from key testing partners: Veritas, Lighthouse Lab Services, Gingko Bioworks, and Mirimus. Register here
Special thanks to the experts who helped me understand this space better:
- Matt Ross, Producer, Stairwell Productions LLC & Matt Ross Public Relations
- Charlene Speyerer, 25 years Broadway Stage Manager and COVID-19 Compliance Officer
- Linda Dahl, MD, Dahl Otolaryngology Center
- Ryan “Rudy” Caffall, Commercial HVAC Engineer, Johnson Barrow
- Header Image Credit: The Metropolitan Opera, https://www.metopera.org/visit/tours/
Disclosure and Caution
These unofficial recommendations are intended to serve as a placeholder until CDC releases specific guidelines for indoor theater with unmasked performers. These recommendations reflect my personal opinion alone and are not the official positions of any affiliated organizations.
- Rockefeller Foundation. COVID-19 Testing in K-12 Settings: A Playbook for Educators and Leaders. Jan 2021.
- Allen et al. 5-Step Guide to Checking Ventilation Rates in Classrooms. Harvard T.H. Chan School of Public Health, Healthy Buildings Program.
- Ben Cohen. The Rules of NBA’s Disney Bubble. Wall Street Journal. June 17, 2020
- Ruthie Fierberg. What It Will Take for New York Theater to Come Back as the Industry and Community It Professes to Be. Medium. 23 March 2021.
- Julia Jacobs. Metropolitan Opera to Lock Out Stagehands as Contract Talks Stall. New York Times. 7 Dec 2020.
- Lee Seymour. ‘Multi-Level Chess’: After A Dark Year, Broadway’s Recovery Is Finally Underway. Forbes. 22 March 2021.
- Dan Meyer. Kevin McCollum Explains How Broadway Could Reopen: Money, Time, and Adjustments. Playbill. 15 March 2021.
- David Gordon. NYC Reveals Plan to Reopen Broadway, Including Testing and Vaccination Sites for Theater Workers. Theater Mania. 25 March 2021.
Answers: Which choice produces the most visible appearance of COVID prevention effort for people to see? A Which choice will probably prevent more SARS-CoV-2 transmissions in the theater? B Which choice will give you the greatest value in health gains for every dollar spent? B