For the past two months, Seattle music venues have been slowly reopening, tepidly emerging from a 15-month hiatus brought on by COVID-19. Just as larger theaters and concert halls start flipping the lights back on this fall with touring picking up in September, the delta variant has led to a surge in COVID-19 cases throughout the region.

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As some music fans reassess their comfort levels returning to their favorite venues, we asked Evan Sylvester, Swedish Medical Center’s regional director of infection prevention, about the risk factors, and the health and safety protocol venues have in place.

In addition to the statewide indoor mask mandate, many Seattle music venues are requiring fans to show proof of vaccination or a negative test taken within 48 or 72 hours of the concert. Should vaccinated fans with no underlying conditions feel relatively safe attending indoor concerts with these requirements?

For fans who don’t have underlying conditions — comorbidities — they can feel relatively safe attending indoor concerts as long as they keep masking. The delta variant is highly transmissible, so being vaccinated, paired with the new Washington mask mandate while being indoors is necessary if people choose to go to concerts. Negative COVID tests only capture a moment in time and should not be relied on solely to keep people safe. Those attending shows might have been infected but aren’t to a point where you can detect the virus with testing.

Additionally, while individuals with no underlying conditions may feel safer, they also need to consider family/friends they see frequently who may be at higher risk.

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Even with vaccinations, some fully vaccinated individuals may occasionally become infected. These are called “vaccine breakthroughs,” and while you may become symptomatic, you’re less likely to become severely ill or spread it to others.

In your opinion, are those policies (masking, vaccination/negative test proof) adequate?

Large gatherings indoors while we experience this surge give me pause even with these policies in place. However, as long as proof of vaccination is provided, along with masking, the science shows that transmission should be relatively low, but not zero.

How effective is masking at an indoor concert when many fans will remove them to drink?

COVID-19 is a respiratory pathogen that spreads by aerosol droplets — we need to remember that. So, before you pull your mask down to take a sip of that beer or cocktail, step away if you’re in a large crowd. Additionally, we must not just consider the route of transmission and use of masks, but also the infectious dose. Like toxins, infectious diseases are dose dependent, meaning it takes a certain amount to cause disease. If a person was exposed to one viral particle, it is unlikely that they would become infected. However, if there are large quantities of virus circulating in the community or in an infected individual, you are more likely to be infected as you would likely encounter a higher dose of the virus at a given time. By removing your mask frequently or not wearing it correctly, you can increase the amount of viral particles you are exposed to.

Is there anything else fans can do to protect themselves in crowded venues where social distancing is not possible?

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Know before you go. Is the venue limiting capacity? If not, make sure you’re fully vaccinated before you attend the show, wear your mask and keep your distance from large crowds. Ensure you have a well-fitted mask, that seals well around the edges and is made of multiple layers that are tightly woven fabric.

Outdoor events were thought to be relatively safe. Is the delta variant changing that?

The delta variant is more contagious than the other strains we’ve seen during the pandemic. The majority of Washington state-infected individuals have been with this specific variant. From an infection prevention standpoint, it is still the safest to gather outside, masked and physically distanced. The other important aspect is vaccination. When vaccinated, and wearing a mask, it is safer to gather at outdoor events. The more layers of protection you can add, the lower your risk.

As of Aug. 19, 220 COVID-19 cases had been linked to fans who attended the Watershed country music festival at the Gorge Amphitheatre. More than 25,000 people attended each day. While local health officials have acknowledged there are likely more unidentified cases, what do you make of those numbers? Does this seem like a “superspreader” event?

There is certainly underreporting of COVID-19 cases, simply because not everyone will get tested. Additionally, health officials are urging the public to seek testing if they attended the concert, which may capture individuals that were previously infected due to the sensitive nature of molecular testing that detects nucleic acid from dead or alive viruses. That all said, when you get a lot of people together for a three-day party, there’s bound to be an increase in exposures and infections.

Bottom line: Get vaccinated. Even with breakthrough cases, those people are getting mild illness as opposed to people who are unvaccinated and are at risk for getting severe illness. Protect yourself and those around you. With the continued onslaught to hospitals, health care worker burnout, and sheer death toll across the U.S. and world, it’s no longer just about you. Get vaccinated and mask up.