The factor scientists are closest to understanding is where COVID-19 clusters are likely to occur. “Clearly there is a much higher risk in enclosed spaces than outside,” Althaus says. Researchers in China studying the spread of the coronavirus outside Hubei province—ground zero for the pandemic—identified 318 clusters of three or more cases between 4 January and 11 February, only one of which originated outdoors. A study in Japan found that the risk of infection indoors is almost 19 times higher than outdoors. (Japan, which was hit early but has kept the epidemic under control, has built its COVID-19 strategy explicitly around avoiding clusters, advising citizens to avoid closed spaces and crowded conditions.)

Some situations may be particularly risky. Meatpacking plants are likely vulnerable because many people work closely together in spaces where low temperature helps the virus survive. But it may also be relevant that they tend to be loud places, Knight says. The report about the choir in Washington made her realize that one thing links numerous clusters: They happened in places where people shout or sing. And although Zumba classes have been connected to outbreaks, Pilates classes, which are not as intense, have not, Knight notes. “Maybe slow, gentle breathing is not a risk factor, but heavy, deep, or rapid breathing and shouting is.”