Dance in the time of COVID: Vaccines and Variants

You likely love to dance. I do too. Like you, I am eager to get back to social dancing – but first we need to talk about deciding when to start dancing again that factors in vaccination and variants. Let’s talk about suggestions for organizers that can help minimize infection risks for attendees. Some of the strategies we will examine include requiring vaccination, holding events outdoors, improving ventilation, and symptom screening or rapid-testing.

Acknowledgement

First and foremost, I want to acknowledge the privilege of having access to vaccines. Many communities around the world, particularly in the global south, may not have this access for many months to years. The pandemic has exacerbated existing inequalities in every scale across society, and vaccine access is no different.

I also want to acknowledge all those who have died from COVID in the last year, and their families and friends who are still living with their grief and loss. I want to acknowledge those who are still living with long-COVID; I wish for you recovery. I want to acknowledge all the healthcare workers globally whose work has been deeply impacted, the people living illnesses whose care have been deferred or worsened due to pandemic resource rationing, and everyone who has suffered economically, mentally, and emotionally. This has been a difficult year.

Considerations for dance organizers

When a person or group brings people together for a physical, social activity, during a global pandemic, they are agreeing to take some responsibility for what happens during their event. Organizers need to make conscious decisions on how much responsibility they are willing to bear, and make it clear to attendees what they are agreeing to. Transparent decision-making and clear communication are cornerstones for community trust. If organizers are considering collecting information on vaccination status, they need to share with attendees how authenticity of records will be verified (or disclose that no verification possible), and how data will be stored for privacy and security.

Note from Laura Riva: It is not unreasonable, especially in our current time, to have events for fully vaccinated people only. I would encourage organizers to understand their responsibility for community safety. It is entirely reasonable in a pandemic to require full vaccination for entrance to an event or social given the nature of our dance. There are already organizers who require vaccination, and those who do not. My personal feelings aside, this means there are options for both those who are and are not vaccinated. 

For organizers who are looking to manage COVID-19 screening and vaccine verification, Danceplace has new tools (some free!) that can be used to help you. 

The Risk and Safety Gradient

Risk and safety are relative, and exist on a gradient. Risk reduction is additive, not absolute. One of the representations of this idea is the “Swiss Cheese Model”, seen here:

Everyone has a different risk tolerance as individuals or as an organizer. In addition, threshold of what they can tolerate as risk, both as individual dancers, and as organizers. Organizers have to consider that they have the larger responsibility of bringing multiple individuals together. Let’s talk about some aspects of the risk and safety gradient.

Consideration 1: Local Incidence of Infection

Local incidence of infection is important to consider regardless of how many people in your area have been vaccinated. < 5 new cases per 100,000 people over the last 14 days can be considered low risk. For example, in a city of one million, less than 50 new cases totaled over the previous 14 days, and not increasing exponentially, likely means that the city’s public health infrastructure can conduct proper testing and contact tracing to prevent further spread. This makes the community as a whole low risk at that time. In unvaccinated or partially vaccinated communities, there is still a high risk for superspreading events that will lead to exponential growth. As long as there is mobility between communities, there is always potential of variant introductions as well.

Note from Laura: if you have a high incidence of local infection, or draw strongly from areas that do, I strongly suggest postponing your classes, socials and events until things are safer. This is in line with best practices by health experts.

Consideration 2: Setting and population

There are a few key setting and population considerations when you are deciding whether to host or attend an event: Holding an event outdoors is safer than indoors. Vaccinated individuals are much less likely to acquire or transmit COVID. The larger a group is, the higher potential for transmission.

Symptom screening and rapid tests act as additional layers of protection, but are not sufficient on their own. Masks also add protection; the better-fitting a mask, the better protection. Keep in mind that a “mixed population” with vaccinated and unvaccinated/partially vaccinated attendees increases the risk of disease transmission among everyone in attendance, including among those that are fully vaccinated. Here is a graphic that indicates what I feel would be a reasonably safe event in different settings:

Note from Laura: From what I’ve heard from health professionals, it is important to stress that a policy of masks for unvaccinated people and no masks for vaccinated people is difficult to enforce and not a best practice. Also, I strongly advise against an “honour system” for vaccination status. As an organizer, there are always people who will take advantage of this – especially when they ideologically disagree with the purpose of a rule or think it is stupid. Not having a verification system means that you effectively have no system. Please don’t do this.

If you are looking for a vaccine verification tool, Danceplace has one that allows you to verify vaccine status once for each participant.

What about symptom screening?

Note from Laura: Danceplace has created a free tool for symptom screening, useable by any organizer prior to any class, event, or social. In addition, here are basic and fillable versions of this survey you can use at your event, class or social. 

A “symptom declaration” screen at the beginning of a dance social, event or class is another tool organizers can use.  Screening can still be useful with fully vaccinated people because of breakthrough infections and subsequent risk of transmission. The tool inquires about any symptoms that may be COVID, or potential exposure to COVID. Given the uncertainty posed by evolving variants, the tool serves as an additional layer of protection to reduce the likelihood of spread, and potential introduction of a variant into the communityLike all tools, it has some limitations. For example, it may still not identify all those who are ill, and it is dependent on the honesty of those answering. Please answer honestly, for the good of the community.

A behavioural incentive for people to be honest and not minimize their symptoms or exposure is for organizers to provide refunds or defer the ticket for a repeat of the event. This would concretely reduce the likelihood of COVID spreading at their event, and gain community trust in return.

Here is a sample entrance symptom screening questionnaire:

1. Are you experiencing any of these symptoms?

• Fever
• New or worsening cough
• Difficulty breathing/shortness of breath

2. Are you experiencing any of these unexplained symptoms?

• Fever
• New or worsening cough
• Difficulty breathing/shortness of breath
• Are you experiencing any of these unexplained symptoms? Please read the list
• Fatigue/malaise
• Chills
• Sore throat
• Runny nose
• Nasal congestion
• Digestive symptoms (including nausea/vomiting/diarrhea)
• Loss of taste/smell
• Sore muscles
• Conjunctivitis (pink eye)
• Headache

2. Have you been in close contact at home, at work**, or in the community, with someone who is symptomatic and/or is being tested/awaiting test results of COVID-19?

3. Have you been in close contact at home, at work**, or in the community, with someone who has been confirmed to have COVID-19 in the last 14 days?

4. Have you travelled internationally within the last 14 days?

** not including those who work with COVID patients in healthcare settings in full personal protective equipment which includes surgical mask/N95 mask/respirator, with eye protection, at all times.

If a person answers “Yes” to any of the above, the person should not attend the social, class or event.

Contact tracing 

Many locations around the world now have public health mandates to keep a record of everyone visiting their business establishment. This facilitates contact tracing if someone tests positive after their visit. A dance social, class, or event is no different. It is the responsibility of the organizer to keep updated attendance records. The information does not need to be kept forever; many jurisdictions recommend destroying these records after 30 days.

Note from Laura: Digital sales are a really good way to make this easy, as it usually provides a name and email for all attendees. Consider only selling tickets in advance and using a digital tool. 

What about rapid testing?

Rapid testing is a possible tool, especially for large future events. However, they are prone to both false positives and false negatives. There are many types of rapid COVID tests. Europe has started to use them more widely and are working on more accurate tests. In the future, these jurisdictions using them will offer clearer guidance and examples on how they can act as an additional protective measure.

Are there other things I can do?

Note from Laura: Helen and I put together this infographic to outline some of the steps you can take to make your events safer. Remember that more layers of protection are better; it is not sufficient to just provide sanitizer and call it a day. 

Individual dancers: thinking about risk

With infectious diseases, there is risk to self and risk to others. You probably already know your own risk tolerance and your risk of infection from your social network.

Full vaccination (two weeks after the final dose of your 2-dose vaccine, or 1-dose J&J vaccine) almost entirely eliminates the risk of severe disease requiring hospitalization or death. However, there are exceptions that include people who are on immunosuppressive medication, or very elderly. These people may not have the same robust immune response to the vaccine.

For most people, if you are fully vaccinated, the risk of acquiring severe COVID illness yourself is very low. The risks to others depend on your work, family and social contacts. Are they vaccinated? Are they immunocompromised? Data suggests that the mRNA vaccines (Pfizer, Moderna) are very effective at reducing community transmission, including asymptomatic transmission. However, vaccinated people can still possibly transmit infections to others, with or without symptoms. Different vaccines may fare differently, so look for information on your vaccine. The risk appears to be small, but it is important to update your knowledge as new data becomes available.

Regardless of your vaccinated status, you can decide what events have precautions that match your risk assessment level.

Conclusion

The situation is constantly changing, so it is important to make your decisions based on integrating new information about the virus and its risks. So far, the vaccines protect reasonably well against hospitalization and death from current variants. The data is less clear about protection from transmission for some types of vaccines. It is possible that a new variant will evade the immunity conferred by vaccines, so be ready to adjust your decision-making.

Note from Laura: Dorry’s Thoughts on Dance and the Pandemic is an excellent Facebook group run by a physician in the USA that is a great resource for further reading and information. I highly recommend taking a look at it if you are an organizer in search of further guidance. 

By Dr. Helen Hsu; edited by Laura Riva