








































CLINICIAN EXPERTISE COMMENTARY 

 

32 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 
 

Creating and Implementing a COVID-19 Prevention and Response 
Program in the Performing Arts: A Clinician Expertise Commentary  
David Tomchuk, DAT, ATC; Kyle Schneider, EdD, ATC; Jacklyn Bascomb-Harrison, MS, ATC 
*Southeast Missouri State University, Cape Girardeau, MO 
 

 
 
Correspondence 
Dr. David Tomchuk, Southeast Missouri State University, Department of Kinesiology, Nutrition, and Recreation, MS 7650, Cape 
Girardeau, MO, 63701.  
E-mail: dtomchuk@semo.edu 
 
Submitted: December 15, 2021 Accepted: March 2, 2022 

Full Citation 
Tomchuk D, Schneider K, Bascomb-Harrison J. Creating and implementing a COVID-19 prevention and response program in the 
performing arts: A clinician expertise commentary. Clin Pract Athl Train. 2022;5(2): 32-39. 
https://doi.org/10.31622/2022/0005.02.6.      
 
COMMENTARY  

The novel coronavirus disease of 2019 (COVID-19) resulted in a worldwide pandemic that shut down various 
aspects of business, education, sport, recreation, and entertainment venues worldwide.1,2 These public health 
measures particularly disrupted the performing arts sector, resulting in hardships such as performance hall 
closures, decreased revenue, limited opportunities to transition to online work, and unemployment.3-5 
Additionally, colleges and universities implemented protective protocols to promote student, faculty, and 
staff safety. Throughout the summer and fall of 2020 and into the spring of 2021, professional, collegiate, 
high school, recreational, and amateur sports leagues across the globe commenced operations and 
competitions after developing and implementing COVID-19 safety protocols.2,6 This clinician expertise 
commentary presents how athletic trainers at one United States public university developed and implemented 
a COVID-19 safety protocol for its integrated performing arts academic campus during the 2020 – 2021 
academic year. 

FACILITY DESCRIPTION 

The Southeast Missouri State University performing arts campus is separated geographically from the main 
university campus by approximately 3 miles and built to promote the constant interaction and creativity of 
the performing arts majors and faculty. The performing arts campus encompasses several interconnected 
buildings and complexes, including campus residential housing and living spaces for approximately 180 
performing arts students, offices and studios for 30 faculty and staff, a dining hall, areas designed for 
classroom instruction and rehearsals, and public performance spaces for large and small-scale productions 
(190 to 950 audience members). The layout and daily operations of the performing arts campus contrasts 
with the design of the main University campus, where residence halls and living spaces, dining areas, 
classrooms, and faculty offices are separated across multiple buildings, and individuals rarely spend more 
than 2 hours in any one location. Compared to the main University campus, these differences present unique 
COVID-19 challenges. Most of the daily personnel traffic in the performing arts campus results from 
individuals who live in the buildings or spend 40+ hours of work functions inside a confined collaborative 
space. Additionally, the performing arts campus contains the Clinic for Health in the Arts (CHART Clinic), a 
joint venture between the university and a regional hospital system that provides two on-site athletic trainers 
throughout the day and during university-sponsored performances and shows. These athletic trainers work 

mailto:dtomchuk@semo.edu
https://doi.org/10.31622/2022/0005.02.6


Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

33 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

cooperatively with physicians and the performing arts faculty to provide health care that focuses on the 
prevention, evaluation, treatment, and rehabilitation of musculoskeletal and general medical conditions 
specific for undergraduate performing arts majors across various dance disciplines, theater, musical theater, 
and the university marching band.  

LIVED EXPERIENCES AND SKILL DEVELOPMENT 

During the summer of 2020, the CHART athletic trainers, collaborating physicians and hospital, and the 
performing arts faculty met to review University and county public health COVID-19 safety protocols to 
determine how best to implement these guidelines, specifically the performing arts campus. These meetings 
resulted in a multi-pronged approach based on county and Universityprotocols to mitigate the transmission 
of COVID-19 among the students, faculty, staff, and visitors while allowing the performing arts campus to 
operate and promote on-campus learning, social interactions, and inclusive creative thought. Additionally, 
these stakeholders agreed that the CHART athletic trainers would be the COVID-19 experts of the 
performing arts campus by implementing, creating, and adjusting policies and procedures as appropriate.  

Before COVID-19, athletic trainers could not foresee that their job descriptions would include group and 
facility-level infection prevention protocols of a novel airborne virus. The CHART athletic trainers were 
previously trained and understood how to prevent the spread of skin infections,7 influenza, and other 
communicable diseases. However, these policies and protocols were insufficient for managing COVID-19. 
Like all healthcare providers, the CHART athletic trainers rapidly adapted to develop COVID-19 specific 
prevention and mitigation protocols and implementation measures on a unique university academic campus 
and patient population that required guest access. This clinician expertise commentary describes the 
framework of creating, adjusting, and implementing a COVID-19 mitigation protocol for a university 
performing arts campus, the unique challenges that arose, and their solutions. 

EDUCATION, PREVENTATIVE SANITATION, AND MINIMIZED GROUP GATHERINGS 

The CHART athletic trainers instituted COVID-19 transmission prevention protocols recommended by the 
county health department and the University by mandating the wearing of face coverings, social distancing, 
and placing capacity limits on classrooms and facilities.8 Wall signage, floor stickers, modeling, and 
electronic communication educated and promoted COVID-19 personal responsibility prevention methods. 
The only daily situations where removing a face-covering was allowed were when students were physically 
inside their primary residence and when faculty and staff were alone inside their offices. The University 
employed part-time workers to stock hand sanitizer, surface disinfectants, and facemasks throughout the 
rooms and traverse the public areas throughout the day to disinfect high-touch areas such as doorknobs, 
elevator buttons, and communal furniture. During weekly campus meetings and gatherings, the CHART athletic 
trainers educated the faculty, staff, and students about the importance of mask-wearing and disinfecting 
chairs, tables, desks, and shared equipment after classroom and academic sessions. 

Faculty and staff meetings, media events, and community gatherings transitioned to online video platforms 
(e.g., Zoom) or otherwise restricted to prevent unnecessary congregation inside the performing arts campus. 
To promote safety within the 300 square foot CHART Clinic, all patients and providers minimally wore 
double-layer cloth facemask over their mouth and nose, enforced handwashing and hand sanitizer usage, 
and disinfected touched surfaces and equipment after each patient encounter. Only two patients were 
allowed physical entry into the CHART Clinic simultaneously, and the CHART athletic trainers screened each 



Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

34 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

patient for COVID-19 symptoms before allowing access (Table 1). These same screening and entry protocols 
occurred for all rehearsal and production situations where physical distancing could not be ensured. The 
CHART athletic trainers implemented an electronic appointment system for all non-emergency injury 
evaluations and treatment sessions to facilitate clinic safety and maximize capacity. Additionally, the CHART 
athletic trainers created a telehealth process to check in with patients and perform virtual COVID-19 
symptom screening without requiring physical attendance in the CHART Clinic.  

Table 1. Pre-Screen (before entering CHART Clinic)* 
Current Symptoms • Fever/Chills  

• Cough 
• Shortness of Breath/Difficulty Breathing  
• Fatigue  
• Muscle/Body Aches  
• Headache  
• Loss of Taste/Smell 
• Sore Throat  
• Congestion/Runny Nose  
• Nausea/Vomiting  
• Diarrhea  

Exposures/Diagnosis 
in past 14 Days 

• Been in contact with a confirmed COVID-19 patient  
• Visited an area with a high COVID-19 community transmission rate 
• Received a positive COVID-19 test/diagnosis 

Body Core 
Temperature  

• Obtained each patients' body core temperature. Any reading above 
100.4°F (38°C) was considered a "yes."  

*All patients were required to answer these questions utilizing the EMR system before entering the CHART 
Clinic for athletic training services. All questions required the patient to designate a yes/no response. Any 
"yes" response prompted further investigation and/or contact tracing by the CHART athletic trainers. 
 

SYMPTOM MONITORING, REPORTING, AND CONTACT TRACING 

Under the supervision of the CHART athletic trainers, the performing arts campus implemented the University's 
general COVID-19 symptom monitoring and reporting guidelines, which mandated that faculty, staff, and 
students self-report any symptoms of illness (e.g., fever, sore throat, or excessive tiredness) and interactions 
with a known or potential COVID-19 positive individual. All potential exposures and COVID-19 symptoms 
were reported to a centralized system and were investigated by the University's designed contract tracing 
personnel. Because of the performing arts campus's unique nature and off-campus location, the CHART 
athletic trainers advocated for and received approval from university administrators to become the lead 
individuals to identify and perform contact tracing activities for the performing arts students and report those 
findings to  University personnel. The CHART athletic trainers sought this capability at the beginning of the 
fall 2020 semester because the university contact tracers were overwhelmed, requiring up to a week for 
some investigations. This extended timeline potentially jeopardized required student productions by enabling 
potential positive patients to spread COVID-19 or delayed the decision to adjust casting. With the CHART 
athletic trainers performing contact tracing for the 180 performing arts students, investigations and contact 
tracing required only 24-48 hours. Based on the contact tracing findings, rehearsal and production schedules 
could remain or be quickly altered. This independence further allowed the CHART athletic trainers to create 



Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

35 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

targeted policies for the unique needs of the performing arts campus and population. The CHART athletic 
trainers administered contract tracing for the performing arts campus students and transmitted the names to 
the Dean of Student's office, who maintained the list of quarantined and isolated students campus-wide and 
communicated findings to non-performing arts faculty. The performing arts campus was the only academic 
entity to have health care providers implement University policies, contract trace, or perform and track a 
daily symptom monitoring system. 

ISOLATION AND QUARANTINE 

The CHART athletic trainers operated and enforced the University isolation and quarantine protocols for the 
performing arts campus. Any dormitory-resident student who tested positive for COVID-19 or was identified 
through contact tracing as a potential positive was quarantined and isolated in their room with any 
roommate(s) per University, county, and CDC requirements for between 10 and 14 days.8 The CHART athletic 
trainers informed the performing arts campus dining services, which coordinated meal deliveries for the 
duration of the isolation or quarantine. Off-campus residents had identical requirements, except no meal 
delivery service. All isolated and quarantined students attended their courses via video streaming and 
completed assignments through the online learning management platform. Quarantined and isolated students 
were required to maintain and track their symptoms and upload the results to the CHART Clinic online 
database daily. The CHART athletic trainers would visit the isolated and quarantined students via video chat 
to confirm symptoms and timelines for return. 

TRANSITION OF EVIDENCE INTO PRACTICE AND UNIQUE CHALLENGES 

The University canceled all fall 2020 athletic competitions. However, the performing arts campus could not 
discontinue student productions because participation was a required component of the academic degree 
programs for graduation and course credit. The prior sections described how the CHART athletic trainers 
were charged with implementing the general University COVID-19 protocols, received the authority to adjust 
University protocols, contact trace, and created a targeting symptom monitoring program. The subsequent 
sections contain specific instances where the CHART athletic trainers created and implemented enhanced 
COVID-19 mitigation policies during the 2020 – 2021 academic year that only affected the performing 
arts campus, students, and faculty because the general University COVID-19 protocols primarily discussed 
masking during social and academic gatherings, room capacity limitations, and surface disinfection.  

VOCAL PERFORMANCE ALTERATIONS  

The CHART athletic trainers and performing arts faculty worried that the forceful movement of air during 
the act of singing rehearsals and performances could potentially transmit COVID-19.9,10  To decrease 
droplet and aerosol transmission risk during solo rehearsal, detailed voice coaching sessions transitioned to 
online video platforms (e.g., Zoom). Background vocal and group rehearsals occurred in smaller gatherings 
when video platforms were impractical. In the days immediately preceding the show performance, the 
production recorded passages of background vocal sessions in the recording studio to be played during the 
live performance. Prerecording of singing (lip-syncing) was limited to situations where multiple cast members 
must gather on-stage during the performance's aesthetics and narrative to eliminate the need for close group 
live singing and further reduce the risk of air droplet virus transmission. On-stage live solo vocals from the 
lead cast members or duets were allowed, with the singing individual(s) projecting their voice away from 
any other stage members (Figure 1). Finally, shared and non-personalized microphones during rehearsals 



Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

36 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

and performances were eliminated. Each performer had their assigned microphone and was responsible for 
its cleaning and maintenance. Microphones were stored in separate plastic bags when not actively used 
within the venues.  

MASKS, COSTUMES, AND STAGE DESIGN ALTERATIONS 

During the 2020 – 2021 academic 
year, the CHART athletic trainers used 
their position as the performing arts 
campus COVID-19 coordinators to 
work with the faculty and students to 
develop and alter on-stage personas 
and characters based on the wearing 
of transparent face masks during 
performances. The CHART athletic 
trainers educated and assisted the 
wardrobe and make-up designers 
who integrated masks into on-stage 
costumes that contributed to the 

character and story (Figure 1). Additionally, the CHART athletic trainers collaborated with the costume and 
stage design shops, performers, and faculty to create fewer costumes for each character and reduce on-
stage physical background props and sets. The faculty, performers, and designers learned how to 
incorporate masks and fewer costumes and props that supported character portrayal while maintaining 
audience appreciation of the performance.  

PERFORMANCE ALTERATIONS 

Outside spectators were not allowed into the performance halls during the fall 2020 and the first half of 
the spring 2021 semester, and the performing arts campus implemented live-stream performances. The 
CHART athletic trainers worked with the performing arts faculty to identify alternative productions that would 
require fewer participants on stage and backstage to promote social distancing and reduce potential 
COVID-19 transmission. The CHART athletic trainers ensured the backstage area was limited to only essential 
cast members or production personnel on the official casting roster. The reduction of physical on-stage 
backgrounds reduced the need for some backstage personnel to change stage design between acts, and 
on-stage performers utilized fewer props. Electronically created and projected backgrounds and lighting 
effects replaced select physical stage backgrounds and props for the audience's appreciation of the 
storyline while serving as a modern way to create background and staging effects for the undergraduate 
students. The fewer number of costumes reduced quick costume changes during productions, the unnecessary 
congregation of multiple performers in enclosed backstage locations and made costume sanitation more 
effective between productions. The CHART athletic trainers implemented a daily symptom self-report 
screening process (Table 2) for any student assigned to a production throughout the 2020 – 2021 academic 
year to identify possible COVID-19 infections that could potentially alter or cease a production run. During 
the final months of the spring 2021 semester, the main performance hall was allowed to sell 10% of its 
available 950 seats for in-person viewing. Traditionally, the cast and faculty would have a meet-and-greet 
style interaction with the campus patrons and supporters after each production run.  

Figure 1. Example of a stage mask worn during performances and on-stage 
social distancing. Photo by: Kenneth L. Stilson 



Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

37 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

Table 2. Daily Symptom Checklist for Production Participants* 
Daily Symptom Checklist 

Questions 
• Have you had any signs or symptoms of a fever in the past 24 

hours (chills, sweats, felt feverish)?  
• Have you had a temperature above 100.4°F (38°C)? 
• Have you had any of the following signs and symptoms: cough, 

shortness of breath, sore throat, nasal congestions, body aches, 
loss of smell/taste, diarrhea, or vomiting?  

• In the last 48-hours, have you been in direct contact with 
anyone positive or presenting COVID-19 symptoms for longer 
than 15 minutes with no mask and within 6-feet?  

• If you have any "yes" responses, please explain how long the 
signs and symptoms have been present.  

Body Core Temperature  • Obtained each patients' body core temperature before a 
rehearsal or performance. Any reading above 100.4°F (38°C) 
was considered a "yes."  

*All participants in productions (cast and crew) were required to complete this online symptoms checklist 
at the beginning of each day during all rehearsals and production days. The results were reviewed by 
the CHART athletic trainers daily, and any positive symptoms required consultation with the CHART Clinic 
staff before arriving on site. 

 

However, the CHART athletic trainers requested alterations to enforce and promote social distancing 
requirements to prevent COVID-19 infection between the community and the performing arts campus 
participants. Table 3 describes other performance and rehearsal alterations. All 13 scheduled productions 
throughout the 2020 – 2021 academic year occurred without any incidence of COVID-19 traced to a 
production.  

Table 3. Alterations to performances and rehearsals during the 2020-2021 academic year 
Pre-recording music to be played during productions 
Pre-recording group background vocals (lip-synching during performances) 
Decreased dressing room admittance for non-essential personnel 
Decreased backstage presence to only essential personnel 
Limiting ensemble numbers (performers and stagehands) to the minimum needed 
Decreased number of set-changes during performances/designing sets for entire performance 
Less on-stage group performances 
Cast members and stagehands learning more roles 
Livestreaming events and productions online 
Choosing and developing productions that would promote physical distancing 
Integrating masks and physical distance into productions 
Elimination of live orchestra during performances 
Symptom screening before each performance and rehearsal  

 

MARCHING BAND SPIT VALVES 

One unexpected issue that arose during the fall 2020 semester was the ability of the marching band 
members to discharge the spit valves of their brass instruments (e.g., trumpets) safely during rehearsal. The 



Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

38 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

CHART athletic trainers worked with the marching band faculty to create a policy where the brass instrument 
performers had a designed area of the marching band rehearsal field to discharge their spit valve over 
indoor puppy pads to absorb the salvia and discard the potentially infected material into a receptacle 
safely. Additionally, the marching band developed alternative formations and patterns to promote proper 
social distancing during rehearsals and performances.  

COVID-19 VACCINE EDUCATION AND TRACKING 

Since the university administration designated the CHART athletic trainers as the COVID-19 experts for the 
performing arts campus, they were charged with vaccine education and tracking efforts. The CHART athletic 
trainers provided scientific material about the COVID-19 vaccine throughout the facility, distributed 
information about vaccine opportunities throughout the region, and discussed becoming vaccinated during 
weekly performing arts campus meetings and gatherings.8 The CHART athletic trainers inserted 
documentation of all provided COVID-19 vaccination cards into the student's electronic medical record and 
adjusted the quarantine and isolation policy for fully vaccinated students according to evolving local and 
federal recommendations. Finally, when the University developed a campus-wide vaccination incentive for 
the students and staff, the CHART Clinic was 1 of 10 locations where students, faculty, and staff could provide 
their vaccination cards for entrance into incentive drawings and similar university vaccine drive efforts. 

CONCLUSION 

Athletic trainers can quickly become infectious disease experts, solve unique problems, and positively 
promote on-site athletic trainers' value to create and implement policies and procedures specific to the 
patients and populations in their care. This clinician expertise commentary demonstrated how a group of 
athletic trainers became COVID-19 experts and advocated for their autonomy to develop and implement 
policies and procedures specific to the performing arts patient population within an academic structure.  

REFERENCES 

1. Hughes D, Saw R, Perera NKP, et al. The australian institute of sport framework for rebooting sport in 
a covid-19 environment. J Sci Med Sport. 2020;23(7):639-663. 
https://doi.org/10.1016/j.jsams.2020.05.004.  

2. Mulcahey MK, Gianakos AL, Mercurio A, Rodeo S, Sutton KM. Sports medicine considerations during 
the covid-19 pandemic. Am J Sports Med. Feb 2021;49(2):512-521. 
https://doi.org/10.1177/0363546520975186.  

3. Guibert G, Hyde I. Analysis: COVID-19's Impact on Arts and Culture. 2021. COVID-19 RSFLG Data 
and Assessment Working Group. https://www.arts.gov/sites/default/files/COVID-Outlook-Week-of-
1.4.2021-revised.pdf.  

4. Radermecker A-SV. Art and culture in the COVID-19 era: for a consumer-oriented approach. SN 
Business & Economics. 2020;1(1):4. https://doi.org/10.1007/s43546-020-00003-y.  

5. Spiro N, Perkins R, Kaye S, et al. The effects of covid-19 lockdown 1.0 on working patterns, income, 
and wellbeing among performing arts professionals in the United Kingdom (april-june 2020). Front 
Psychol. 2021;11:594086-594086. https://doi.org/10.3389/fpsyg.2020.594086.  

6. DiFiori JP, Green G, Meeuwisse W, Putukian M, Solomon GS, Sills A. Return to sport for north american 
professional sport leagues in the context of covid-19. Br J Sports Med. 2021;55(8):417. 
https://doi.org/10.1136/bjsports-2020-103227.  

https://doi.org/10.1016/j.jsams.2020.05.004
https://doi.org/10.1177/0363546520975186
https://www.arts.gov/sites/default/files/COVID-Outlook-Week-of-1.4.2021-revised.pdf
https://www.arts.gov/sites/default/files/COVID-Outlook-Week-of-1.4.2021-revised.pdf
https://doi.org/10.1007/s43546-020-00003-y
https://doi.org/10.3389/fpsyg.2020.594086
https://doi.org/10.1136/bjsports-2020-103227


Creating and Implementing a COVID-19 Prevention and Response Program in the Performing Arts: A Clinician Expertise 
Commentary 

 

39 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 5 – Issue 2 – September 2022 

 
 

7. Zinder S, M. , Basler R, S. W. , Foley J, Scarlata C, Vasily D, B. National athletic trainers' association 
position statement: Skin diseases. J Athl Train. 2010;45(4):411-428. 
https://doi.org/10.4085%2F1062-6050-45.4.411.  

8. How to Protect Yourself & Others. Centers for Disease Control. Updated August 13, 2021. Accessed 
November 18, 2021. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-
sick/prevention.html.  

9. Westphalen C, Kniesburges S, Veltrup R, et al. Sources of aerosol dispersion during singing and 
potential safety procedures for singers. J Voice. 2021. 
https://doi.org/10.1016/j.jvoice.2021.03.013.  

10. Mariam, Magar A, Joshi M, et al. Cfd simulation of the airborne transmission of covid-19 vectors 
emitted during respiratory mechanisms: Revisiting the concept of safe distance. ACS Omega. 
2021;6(26):16876-16889. https://doi.org/10.1021/acsomega.1c01489.  

 

https://doi.org/10.4085%2F1062-6050-45.4.411
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
https://doi.org/10.1016/j.jvoice.2021.03.013
https://doi.org/10.1021/acsomega.1c01489

