Is Theater Doing Enough To Fight The Surge? – Deadline

Broadway’s recent and ongoing surge in Covid cancellations is one of those shocking but not surprising things – New Yorkers knew instinctively since theaters reopened in September that disappointment was always just a cough away. Still, the spate of cancellations – with, it must be repeated, only one permanent closing to date – is disheartening to say the least.

So why now? And what now? Is there anything else Broadway should be doing to lessen the impact of the Omicron variant? The Broadway League has indicated that another industry-wide shutdown is not being considered, and New York Mayor Bill de Blasio stated bluntly this week, “No more shutdowns.”

At the moment, Broadway is battling Covid with various weapons – testing, vaccinations, masks, filtration – and while the approach is more rigorous than what can be found in other industries, the fight doesn’t always seem to reflect a unified front. While all theater workers and audiences must be double-vaxxed, and all audiences and off-stage workers are required to remain masked throughout performances, the specifics of cast testing varies from production to production. Some rely most heavily on rapid antigen tests, others the slower but more accurate PCR tests, and many if not most use a combination of the two. Exactly when casts are tested and how often – for example, pre-theater arrival, once or twice during the production day, just shortly before performance time or many hours before – is a decision left to each production, and while official statements on production policies are difficult to come by, anecdotal evidence suggests testing schedules vary fairly widely.

Nor is there an across-the-board Broadway standard for keeping the air clean, with some venues having installed new filtration systems, some using HEPA filters and portable air cleaners to assist spaces with older ventilation systems. Or, again, some combination thereof, and, again, insiders say some venues do a much better job than others in trying to keep the air as Covid-free as possible.

Also of note: Broadway’s producers and unions do not currently mandate booster shots for theater workers or audience members. The Broadway League and Actors’ Equity meet regularly with epidemiologists for up-to-date recommendations. According to the CDC, “The recent emergence of Omicron further emphasizes the importance of vaccination and boosters.”

Deadline spoke to two experts to discuss these and other Omicron issues: Dr. Jon LaPook and Dr. Joseph G. Allen. LaPook is the Chief Medical Correspondent, CBS News, and Professor of Medicine, NYU Langone Health. He’ll be familiar to many in the Broadway community – and its fans – for his role of chief medical correspondent for Stars in the House, the YouTube and streaming series hosted by Seth Rudetsky and James Wesley that raises funds for The Actors Fund.

Allen is Associate Professor, Director of the Healthy Buildings Program at the Harvard School of Public Health, and Commissioner on the Lancet Covid-19 Commission where he chairs the taskforce on Safe Work, Safe Schools and Safe Travels. He is the co-author, with John Macomber, of the book Healthy Buildings: How Indoor Spaces Drive Performance and Productivity. He has proposed that “fully vaccinated” be redefined to include booster shots, that “rapid antigen tests [should be] the gold standard for testing instead of PCR tests,” and that good ventilation and filtration remain major factors in preventing “an infectious person from spreading the virus to others simultaneously across the room.”

More controversially, Allen, who was, and remains, an early supporter of vaccine mandates, recently wrote a column for The Washington Post that asserted that “where all people are vaccinated, we should do away with mask mandates and distancing requirements. Post-vaccines, the control strategy should look like what New York recently adopted: Get everyone vaccinated or tested, or mask up.” (New York State recently reinstated a mask mandate for all indoor places that are not private residences, for vaccinated and unvaccinated individuals, unless a business or venue requires proof of vaccination upon entry.) All Broadway theaters require proof of vaccination and mask-wearing for all audience members, a policy that appears to be working and is under no threat of revision: Despite the recent surge of Covid cases among cast members, there have been no reports of Covid spreading among audience members.

“I think when all the controls are in place,” Allen tells Deadline, “including the audience being masked, everyone is vaccinated, everyone on stage is vaccinated, hopefully boostered, and also testing negative, I think the risks of transmission from cast to the audience and from audience to the performers can be made low.”

The following is a lightly edited and condensed (for clarity and length) of our conversation.

DEADLINE: Let’s just sort of start with the basics. With all these cancellations, what’s happening and why now?

DR. JOSEPH G. ALLEN: We’ve all been talking a lot about the control strategies that needed to be put in place over the past two years, and with Omicron some things are the same, but some things are changing. I think the thing that’s changing is the urgency around making sure you have good ventilation and filtration systems [in theaters]. The urgency has been there for two years, but I think when some organizations didn’t improve their ventilation strategy and maybe got lucky in the past, the margin for luck has run out with Omicron. What good ventilation does is prevent superspreading events. In other words, if I’m infectious and vaccinated but I show up, there’s a chance I could spread it to people around me. In a poorly ventilated space, I can infect everyone in the room, and this is where we see superspreading events with attack rates that are 80 percent plus, meaning one person can infect 80 percent of the people in the room. That’s because in poorly ventilated places, the virus can travel. It builds up in the room, and you can infect others that aren’t near you, that aren’t adjacent to you or a row in front or behind of you.


Joan Marcus

It’s absolutely critical that we pay attention to how this virus is spread: It spreads through the air, and the mitigation strategy for trying to minimize how much virus is in the air is through good ventilation and good filtration.

DR. JON LAPOOK: You can think about the virus, these aerosols, like cigarette smoke. If somebody were 15 feet away from you in a room that’s poorly ventilated, and they were smoking, would you be able to smell the smoke 15 feet away? Of course. Well, the same thing is true with the virus. The virus can float across the room and over time build up, especially if there’s inadequate ventilation and filtration.

DEADLINE: With theaters specifically, we have casts and audiences double-vaxxed – I’m not saying fully vaxxed anymore because I believe you need a booster to be fully vaxxed – and the audiences are wearing masks. So let’s say a cast member has been exposed but hasn’t tested positive yet, or the results haven’t come back yet, what’s the likelihood that the cast member will infect audiences? So far we haven’t heard a lot, or anything, about audience exposure.

ALLEN: I think the risk of transmission from performers to the audience is low for a couple of reasons. One, everyone is fully vaccinated. Broadway is testing unmasked performers so that’s another recurring control. In addition, you have increased distance from performers even to the people in the front row, and you get the benefit of having these larger ceilings in auditoriums and halls and theaters where the virus has more room to dilute. So, I think when all the controls are in place, including the audience being masked, everyone is vaccinated, everyone on stage is vaccinated, hopefully boostered, and also testing negative, I think the risks of transmission from cast to the audience and from audience to the performers can be made low.

LAPOOK: I think one of the places where there’s a hole in the system potentially is that, and especially with Omicron which seems to have a shorter incubation period, we’re hearing of cases where the time between when somebody was exposed until when they actually developed symptoms is 24 to 36 hours, right? Even a little less than 24 hours. So, what that means is if you’re testing every 3 days, 4 days, twice a week, even every other day, that may not be enough. And in addition, if you’re doing it with one of these rapid antigen tests, which are very, very helpful, you need to do the test ideally immediately before you’re entering into whatever the area is where you could possibly expose other people, and I think what that would mean, ideally, whether it was Broadway or in my house, is right before you come in, you do one of these rapid tests. I mean, they can take 15 minutes, and then you get an answer right there. They are not 100 percent, but they are very good. They may not detect very minute amounts of virus, but they are very good at detecting if there’s enough virus in somebody to infect somebody else. There’s not a lot false positives.

‘Jagged Little Pill’
Matthew Murphy

So, that’s one thing that I think is really important, and the second thing is people need to be boosted. There’s no doubt right now that there is waning immunity. There’s diminishing immunity to the variants, and certainly we are seeing this in the laboratory with Omicron. There’s good reason the experts believe that with the booster, you’re going to have increased protection. You certainly see it in the lab where the amount of neutralizing antibodies goes up after a booster, the amount of protective antibodies against Omicron go up. It makes sense that that will lead to protection from severe illness or hospitalization or death. That certainly was true with Delta, and we expect it to be the same with Omicron. All of this amounts to the fact that people need to not only get vaccinated, they need to get boosted, and then we need to do frequent testing, and that’s on the side of the people backstage who are coming into the place. I think the audience should do the same thing, and Joe, you had some interesting points when we were just talking earlier about what’s going on backstage because that can be a special environment, right?

ALLEN: Yeah. I mean, this is a place where you don’t get the benefit of the large [space] volume or the high ceilings. I’ve been backstage plenty of times. These are tight quarters, down in the pit, down in the changing rooms, under the stage. This is where you’re going to want to really be sure your ventilation and filtration are working well, and you’re going to want to get a high number of air changes, either through good ventilation or filtration, and this doesn’t have to be hard or expensive either. It’s just something that needs to be solved immediately. We’ve shown over and over that these portable air cleaners with HEPA filters, when they are sized right for these smaller spaces, do an excellent job of removing the virus-laden particles out of the air. So, this is critical in those spaces.

In fact, if you’ve thought about the highest risk targets or locations, it would be back there. If they are under-ventilated, and someone in there is infectious and happens to be a breakthrough case, well, then the virus can accumulate in those small volume areas pretty rapidly, and it can linger in the air for a significant amount of time, even on the order of hours. So, you want to either remove that through dilution – good ventilation – or clean it out of the air, and the portable air cleaners are a great strategy.

 LAPOOK: I’ll pull the microscope back a little bit and say, philosophically, thinking about this whole issue, there’s got to be transparency. There’s got to be transparency about what is the Covid protocol. It’s got to be clearly communicated to the audience, to the actors. I actually think – and Joe, I’d be interested in knowing your feeling about this – but when we go into a restaurant we see that little notice saying “the Department of Health has inspected this restaurant and given it an A.” I wonder about whether there should be something similar on buildings, especially public buildings, that says, you know, here is the ventilation and filtration picture, here is the environment that you are about to enter. What do you think about that, Joe? Is that too much?

ALLEN: Well, you could use real-time carbon dioxide monitors. They are actually not expensive. Some places are doing this. In fact, guests are starting to do this. Someone brings a CO2 meter, a carbon dioxide meter, and they’ll start posting [the results on social media] saying this is the carbon dioxide concentration [as a way] to prove or show that yes, in fact, the ventilation here is good. If the CO2 levels look good out in the audience, and they look good backstage, it’s going to add a real layer of confidence because the reality is we don’t have a really good way, as humans, to sense if there’s good air quality. We can’t sense if [a building is] getting three air changes per hour or ten air changes per hour. So, the only way to do it is through these monitors. I think that would go a long way to reassuring people that yes, the air quality in this building is good.

LAPOOK: So, Joe, what would you think about little signs in front of a theater that says, “We have HEPA filters. We have MERV 13. Here’s our protocol….”

‘Moulin Rouge! The Musical’, Broadway
Matthew Murphy

 ALLEN: I think it’s critical, and we’ve seen this from the beginning of the pandemic, that every organization has to communicate what their strategy is, and we now have a really savvy and smart public. People know what good filtration is, and what bad filtration is. So, you have to communicate it. I think it should be on multiple levels. Just like they communicate on masks, and they’ll have hand-washing stations and all this. You have to communicate about the air quality, and it’s harder to do because that’s something the public can’t see. They’ll see your hand-washing stations. They’ll see your efforts at distancing. They’ll see plexiglass if you’re using that, but they won’t be able to see that you’ve actually made improvements to the ventilation.

LAPOOK: And Greg, I’m going to plug Joe’s book with John Macomber called Healthy Buildings: How Indoor Spaces Drive Performance and Productivity. One of [the unintended consequences] of the 1970s Green Movement was that buildings got more energy efficient keeping in air, but they actually also got less healthy in terms of the air that was in them. They are so sealed to keep the energy in…correct me if I’m doing this wrong, Joe…that you actually end up having air that’s not as well ventilated. So, that’s something that people need to start addressing, and by the way, you know, respiratory viruses, in general, not just Covid, are spread through the air. So what’s the downside of having cleaner air in our buildings? When was the last time you had a cold? I haven’t had a cold in a year and a half.

DEADLINE: Getting to this idea of transparency though – how do we know exactly what is happening in theaters? Certain theater companies say they’ve improved their filtration systems, but how is the public supposed to really know that? Have either of you had access to these theaters to determine whether they’re up to speed or not?

ALLEN: Definitely I’ve worked with some theaters, and absolutely, I know firsthand that they’ve improved the air quality and higher ventilation rates. They upgraded their filters to what’s called a MERV 13 filter. The standard filter is a MERV 8, and captures very few particles. The MERV 13 captures a lot of them. So, I know this firsthand. I don’t know if all of them have done it. If they haven’t done it, they need to, and they need to do it fast because this is clearly one of the key strategies.

One way to think about it is this: We have very little spread happening outdoors. Why is that? Because we have unlimited dilution, unlimited ventilation. So we need to make the indoors look a lot more like the outdoors. Bring in more of that fresh outdoor air. Because of the way we design buildings, the codes right now are minimum standards designed around energy efficiency. We’ve choked off the air supply in our buildings. We’ve stopped letting our buildings breathe, and that’s causing a major problem right now during this pandemic.

Myles Frost as Michael Jackson, ‘MJ’
Matthew Murphy

So we need to bring in a lot more of that outdoor air and I know many organizations have taken this step, and in fact, the ones that have done it are definitely communicating it because they are quite honestly proud of that effort, and they want to let people know and reassure them that yes, we have thought about these things, even the things you can’t see above the ceiling, our mechanical system, things you’re unaware of in the bathroom, the bathroom exhausts, things you’re not thinking about. They’ve actually looked at that and taken care of it to be sure there’s a high enough ventilation rate to dilute any of these respiratory particles if someone is infectious in the space.

DEADLINE: Dr. LaPook, in terms of the testing, last night there was a situation at Moulin Rouge where they literally cancelled the show once people were already in the seats. Would that suggest the company was using rapid testing as opposed to the slower tests? Or maybe they’d just gotten the results from the slower test. It’s confusing. What should theaters be doing right now in terms of testing, and are they doing it?

LAPOOK: I can’t address whether they are doing it. But it’s a tough one. [Cast and crew] come to the theater and at some point are backstage and on the stage when they are going to be interacting without masks. Whenever it is that you’re about to take off your mask, right before that I think is very reasonable to be doing a rapid test. Now, you have to be prepared for an understudy to go on because by that point people are going to be already on their way to the theater, and you don’t want to have to cancel once people are in their seats. But you have to assume that people are going to test positive and have a contingency plan for that.

I think the danger is that if you test a person the day before, that’s just too early because a lot can happen, especially with Omicron having such a short incubation period. You could test negative the day before and then in the ensuing 24 hours or so since you were tested, you could turn positive. Even the night before, let’s say you get tested at 8:00 o’clock the night before and you’re negative,  how do you know you’re going to be negative at show time the next day? Even if you do a test that morning, with something like Omicron that has such a short incubation period, it’s possible you could be negative in the morning and then turn positive at show time.

I think that’s why – and Joe, you tell me if you think differently – but I think immediately before whatever the [maskless] encounter, that’s when they should do the rapid test. And if you want to also supplement that with the PCR test, that’s fine. That’s belt and suspenders.

The thing that you want to know is, Am I able to infect somebody else? And what the data shows on that is that the rapid antigen tests are not as super sensitive at picking up every amount of nucleic acid, every amount of RNA in the nose, as the PCR – the PCR are the best at picking that up – but the rapid antigen tests are very good at picking up if there is enough virus in somebody’s system to infect somebody else. And that’s really what you want to know.

But rapid antigen tests are expensive – they can be 12 or 14 dollars for two, up to 24 dollars for two and even higher. President Biden has said he wants to make them totally reimbursable by insurance companies, but even then people still have to outlay the money. I think they should be free.

DEADLINE: In an ideal world where money isn’t a concern for Broadway producers – I know, I know – but in an ideal world, let’s say a show has an 8:00 pm curtain, should the cast receive rapid antigen tests at, say, 7 pm?

LAPOOK: I don’t know what happens backstage, like when they take their masks off. but whenever it is that they are about to take their masks off, the test should be before they do that. That’s when I would want to know that they are negative if I’m about to interact with them backstage. If I were an actor, and I were backstage, and I’m about to take off my mask, I would want to know that whoever else is taking off their mask has just tested negative, and that I just tested negative too.

DEADLINE: I‘ve been hearing, anecdotally, about a show that opened recently and had an opening night party with the cast and various invited guests. Everyone was double vaxxed, but it didn’t appear that anyone was wearing masks, and I’m hearing anecdotally that the party was something of a super-spreader. What is your advice on holiday parties, opening night parties and other gatherings at this time?

LAPOOK: There’s always a way for things to go wrong, so I think you want to minimize gatherings where there’s a lot of people in a room without masks. Certainly in terms of vaccination, we know that vaccines wane over time, and especially with Omicron, the ability of these vaccines to protect you diminishes over time, and you really need to get a booster. The booster significantly increases the number of what’s called neutralizing antibodies, and it’s expected that that’s going to provide very good protection. You may still get infected. I’ve reached the point where I’m seeing right now that Omicron is so infectious, and I’m fully vaccinated and boosted, but I’m thinking, you know, I may very well get infected. It’s hard to duck the virus forever. But if I do get infected, I feel that it’s very unlikely that I’m going to get seriously ill, and that really gives me a lot of peace of mind.

I’ve had this week three patients who were fully vaccinated and boosted, and they had breakthrough infections. The good news is they were all doing pretty good. They had like a bad cold or maybe some mild flu symptoms, but they all are doing well. And while it’s still early, it looks like even Omicron is much more infectious, the odds of any one person getting seriously ill is lower than with previous variants. Still, when you have something this infectious where so many people are getting infected quickly, you’re still going to have a lot of people getting sick. You’re going to see increased hospitalizations. And when you put that together with the flu season, you’re going to see a real spike in people who are sick, and there’s going to be a real pressure on the healthcare system and maybe an overload in some areas.

DEADLINE: At this moment, Broadway is not mandating booster shots. I saw on Twitter today an actor – who I won’t name but he’s in a current Broadway show – and he tweeted that he got his booster today. My first thought was, What took you so long? Should Broadway producers and unions mandate boosters at this point?

LAPOOK: The mandate discussion is a really fraught one. I will just say that scientifically there’s no doubt that you’re going to get more protection from these viruses if you have the booster.

ALLEN: I agree with that. I don’t think there’s any doubt of that at all, and I think it’s a separate conversation of what can be mandated. I think the reality is that coming into 2022 “fully vaxxed” is going to mean that you got a booster shot 6 months after your first set of shots. I think that’s really clear. The biggest threat with Omicron for people who are vaccinated right now is that the protection against any infection has really dropped significantly, and that’s why you’re seeing a lot of people who are vaccinated, even some who are boosted, having these breakthrough infections, and we’re going to see a lot more of that in the coming weeks.

DEADLINE: One last question, and it might seem like simplistic, but can we say for certain that the reason for the cancellations on Broadway and at Radio City Music Hall and other venues is Omicron?

LAPOOK: We’re seeing an explosion in the number of cases. Certainly in New York City, you know, it’s spreading very quickly, and the problem is it’s impossible to do contact tracing when you have something that’s spreading this quickly and may have an incubation period of less than 24 hours. By the time that somebody knows that they’re testing positive, they’ve already potentially spread it to a lot of other people, so it becomes impossible to limit it by contact testing. It’s just spreading too quickly.

DEADLINE:  But are you talking specifically about Omicron?

LAPOOK: The thing is this. When you get a Covid test, it comes back positive for Covid. It doesn’t tell you the genetic sub-typing of it. … the percentage of cases that are testing positive for Omicron is going up, and it’s going up quickly, but in terms of routine, like every single person who is testing positive at a Broadway show, do we know it’s Omicron? I don’t know that, and I don’t know that they know it. I think they are probably just getting a test back saying they tested positive for Covid. But I think we can surmise, based on the fact that something is happening now, and more people are being vaccinated now and boosted than they were six weeks ago and yet this is happening now, you have to think it’s probably Omicron.


Source: Deadline

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