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Administration

Administration

Second Edition July 22, 2020
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Second Edition July 22, 2020

Screening and Testing

It is clear that screening and testing, along with other risk-mitigation measures, will play a critical role in a society-wide response to the COVID-19 crisis. The Edmond J. Safra Center for Ethics at Harvard University has published a policy roadmap that lays out a path to pandemic resilience through massive testing combined with contact tracing and social isolation with strong social supports.

Screening and testing before entering a workplace or event space are strategies to reduce the chance that infectious individuals will put others at risk. Types of screening include symptom questionnaires (taken either at home or upon arrival) and temperature screening. There are two types of testing: viral testing and antibody testing. The viral test shows if someone currently has an infection, and therefore may be infectious to others. The antibody test shows if someone previously had an infection, and therefore may have some immunity to the virus.

The implementation of screening and testing protocols for theaters will be a necessary area of consideration. Theaters should be aware of the many current issues around accuracy, availability, and ethics that may be relevant to these strategies. Theaters will also need to consider the qualifications of people performing any screening and testing. For more information on scientific developments to watch in areas including tests, vaccines, and therapeutics, see Developments to Watch.

 

Physical Distancing and De-Densification

De-densification of shared spaces refers to reducing the number of people present in a space at any one time. This strategy protects against all three routes of transmission: fewer asymptomatic infectious people in a space reduces the viral load in air and on surfaces, and fewer healthy people in a space reduces the number of people unknowingly exposed to the virus. De-densification can be achieved in many ways, including having only portions of a workforce come in on different shifts.

Physical distancing reduces potential droplet exposure, since most large droplets expelled in a cough or breath tend not to travel long distances. For individuals who are present in a shared space, even if de-densification has occurred, it is important to continue physical distancing by keeping at least six feet away from other people in the space.

Chains of Contact

When possible, it is prudent to group individuals in all areas of the theater into small, non-overlapping teams, or “chains of contact,” and to eliminate any in-person contact between the teams. The value of this arrangement is that if someone on one team becomes infected with COVID-19, the only people they would have had contact with during the presymptomatic period would be a limited number of people on their own team. Though the infectious person’s entire team would have to self-quarantine for fourteen days, based on the current guidance, the other teams would not have to self-quarantine because they would not have had direct contact with the infectious individual. This strategy could be used to help minimize disruptions to work in the event of illness—although it is clear that further thought will have to be devoted to the best methods of implementing these recommendations in the deeply collaborative, high-contact environment of theater.

Isolating Objects

Objects can become contaminated when an infectious person with virus on their skin (e.g. from covering a cough) touches an object, or when airborne virus (e.g. exhaled by an infectious person) lands on an object. One way to reduce the chances of these contaminated objects serving as sources of transmission to other people who come into contact with them is to isolate objects so they only are used by a single person. This could involve making very clear plans for who will handle tools and specific pieces under construction in various shops. In the context of work spaces that have traditionally not had assigned seats, this strategy could be implemented by assigning a seat to each worker so that the objects at each seat are only touched by the worker assigned to sit there. In addition to isolating objects as much as possible, the best control against fomite transmission in any context is frequent hand washing.

Hand Washing

Frequent hand washing is an important strategy to reduce the risk of transmission of COVID-19. Hand washing with soap counteracts viral transmission by removing and destroying any virus on someone’s hands. If hand washing is performed after touching a contaminated object but before touching one’s eyes, nose, or mouth, the risk of infection is minimized. To employ this strategy, theaters could encourage frequent hand washing by patrons and performers, and could also provide hand sanitizer at building and theater entrances and in the backstage area so performers and audience members can supplement hand washing with disinfection when they aren’t near a sink.

 

PPE for Staff

Personal protective equipment (PPE), though less effective at reducing risk than other strategies, is an important way to protect employees and staff required to work together in close contact. Requiring people working together in person to wear masks or face shields reduces the risk of unknowingly transmitting the virus to other people. Training staff in mask donning and doffing (more information below), as well as in mask care if non-disposable masks are used, will be critical.

Masks

Non-medical grade masks, worn whenever individuals are in close contact, can help reduce droplet and airborne viral transmission by reducing the distance infectious droplets or aerosols can travel when an infectious person coughs, sneezes, speaks, or exhales. In public health, this is called “source control” because interventions address potential viral transmission at its source (i.e. the infectious person). Non-medical masks generally provide minimal protection against healthy wearers inhaling infectious particles. Masks are more likely to be an important means of source control in regions where community transmission is high and in locations where physical distancing is impossible.

Non-medical or homemade masks vary in their effectiveness for source control and in their ease of use. Some of the factors that impact the effectiveness of a mask are the types of materials used, the number of layers of material, and the shape of the mask. In general, the most effective materials remove a high percentage of particles and droplets (i.e. have a high filtration efficiency) but also are easy to breathe through (i.e. have high breathability). Some materials that have reasonably high filtration efficiencies and breathability include knit cotton (e.g. t-shirt) and knit polyester materials. On the other hand, very stretchy materials may have high breathability but likely have low filtration efficiencies. Non-fabric face shields capture fewer droplets and particles than masks do, but face shields that cover the entire face and extend below the chin may be an alternative to masks for people who are unable to wear masks due to medical or other reasons.

The design of the mask also impacts filtration efficiency; masks with more layers of material remove more particles and droplets (i.e. have higher filtration efficiencies) than masks with a single layer of material. According to the World Health Organization, at least three layers of material are desirable in a mask and the ideal ordering of materials would include a layer of cotton or a similar material closest to the face, a middle layer of synthetic non-woven material, and an outer layer of polypropylene, polyester, or a similar material. Outer coatings of wax or similar materials should not be added as these coatings are likely to block airflow through the mask which reduces breathability and causes air to flow unfiltered around the edges of the mask.

The shape of the mask is also important. If the mask does not sit and stay close to the facial features as the wearer breathes or speaks, it is possible for the particles and droplets they expel to travel unfiltered around the edges of the mask, defeating the purpose of wearing it in the first place.

In addition, care and maintenance are important to maintain an effective mask. Masks should not be touched while they are being worn, should not be shared between people, and should be removed if they become wet or dirty. When removing a mask, care should be taken to avoid touching the fabric that sits in front of the mouth and nose and the mask should be immediately disposed of or placed in a sealed container until it can be washed. Hand washing should be performed immediately after removing a mask. Reusable masks should be washed delicately in the highest temperature water the material can tolerate.

 

Creating a Culture of Health

A.R.T. and the Healthy Buildings Program recognize that creating a culture of health, safety, and shared responsibility among theater staff, artists, and audiences can play an important role in the success of any risk reduction plan. This common understanding might be effectively established through a combination of information sharing, educational forums, regularly scheduled discussions of new concerns or policies, community agreements, independent assessments, and regular self-attestations of health and compliance.

Forums

As the A.R.T. works to update its facilities, practices, and policies to minimize risks associated with COVID-19, the A.R.T. and the Healthy Buildings Program are developing a new educational program for the theater’s staff to establish a baseline understanding of public health and infectious disease transmission, to explain the strategies and rationale for changes to theater facilities and processes to reduce COVID-19 risks, to update staff regularly on the latest guidance and recommendations around disease transmission and risk-reduction, to address department-specific questions and concerns, and to create a forum for open dialogue.

This program, “Creating a Culture of Health, Safety, and Shared Responsibility,” will include the following components:

  1. Foundational Training Modules: The Healthy Buildings Program will offer three foundational training modules for the entire A.R.T. staff. Each hour-long module will include twenty-five minutes of expert presentations followed by thirty-five minutes of question-and-answer. The topics of these educational modules will be: “Understanding COVID-19 and the Risk-Reduction Framework,” “Healthy Building Strategies for Theater,” and “Shared Responsibilities for Risk Reduction.” The weekly modules are intended to foster greater collective understanding of the potential SARS-CoV-2 exposures present in a theater setting and the steps that are being taken to minimize the risks presented by COVID-19, as well as the limitations of these interventions. A.R.T. and the Healthy Buildings Program expect that this shared understanding will result in a higher level of compliance with new procedures and policies among staff, a higher level of comfort with the steps the theater takes as it moves forward, and a higher level of confidence in explaining new procedures and policies when interacting with artists and the public.
  2. Monthly Updates: After the foundational modules are completed, the Healthy Buildings program will meet monthly with the entire A.R.T. staff. These one-hour sessions will include two sections: ten minutes to share updates about disease transmission and risk-reduction strategies, and fifty minutes for questions from the staff.
  3. Sessions for Individual Departments: As the A.R.T. staff prepares for in-person activities, the Healthy Buildings program will meet with A.R.T. teams in smaller groups to discuss department-specific questions and concerns.

When in-person rehearsals and performances resume, the A.R.T. and Healthy Buildings Program will extend the “Creating a Culture of Health, Safety and Shared Responsibility” program to include briefings and check-ins to help artists and staff feel safe and understand their responsibilities, and also to evaluate whether additional precautions or policy modifications are necessary.

Community Agreements

As organizations, businesses, and educational institutions reopen their spaces, many are asking staff and customers to acknowledge a community agreement or community compact. Developed in close conversation with the specific values, spaces, routines, and requirements of each organization, these agreements ask anyone returning to facilities or participating in activities to commit in advance to upholding that organization’s safety protocols. The A.R.T. will draft a community agreement, to be shared with staff before in-person work resumes.

Self-Assessments and Attestations

In concert with other interventions, agreements, and screening strategies, theaters might consider asking staff, artists, and audiences to complete regular health self-assessments and/or attestations of compliance with organizational health strategies. Completed on an app or online platform prior to arrival for in-person work, these attestations might require staff to certify that they have acted in concert with a theater’s stipulated safety precautions and are not experiencing any symptoms associated with COVID-19.

In compliance with Harvard University’s reopening plan, A.R.T. facilities are still closed to staff and the public. However, as Harvard buildings reopen, the university requires that staff approved to return to in-person work complete a daily health questionnaire.

Healthy Buildings

This roadmap is provided for informational and educational purposes only. It is not intended as a set of directions. Please see About the Use of This Resource for further explanation.