A ‘silent’ epidemic: has Covid-19 damaged the voices of artists like Macbeth’s Lady Macduff??

The hush of the Harold Pinter Theatre turned to stunned murmurs as actor Rona Morison, playing Lady Macduff in Macbeth, faltered mid-monologue. Her voice, once clear and commanding, diminished into barely audible whispers before vanishing entirely.

Macbeth: more on-stage drama

A stagehand appeared, whispering to David Tennant, who quietly exited. Moments later, the house lights came up, and the audience was informed that understudy Gemma Laurie would take over the role. Laurie stepped in seamlessly, yet the disruption may have underscored a haunting reality for the world of live performance: COVID and its aftereffects are reshaping theatre in ways audiences rarely see. 

Until the damage has already been done.

The dramatic scene followed an earlier upheaval for Macbeth at the Harold Pinter Theatre. A month before, in November, the production was forced to cancel four consecutive performances due to “illness within the company.” When it returned, it was only through the extraordinary efforts of six understudies, including for lead actor Tennant himself. The illness was never officially disclosed, but the severity, contagiousness, and population-wide prevalence strongly suggest COVID-19. 

While the company appeared to’ recover’, last week’s incident with Lady Macduff raised a disturbing question: could the illness that swept through the cast in November still be exacting its toll weeks later? Emerging research on COVID-induced dysphonia suggests the answer might be yes.

COVID-induced dysphonia: a silent crisis

COVID-19’s effects on the vocal apparatus are insidious and underreported. Research shows that COVID-19 has far-reaching consequences for vocalists and actors, particularly in professions demanding sustained vocal performance. COVID-induced dysphonia—characterised by inflammation, vocal fatigue, and vocal cord injury—has become increasingly common. 

Research published in the American Journal of Otolaryngology found that 25% of COVID-19 patients experience vocal impairment during their illness, and a staggering 70% of those individuals continue to suffer from long-term effects, including dysphonia. In 2022, a Journal of Voice study revealed that 30% of Broadway singers continued to experience vocal fatigue, reduced range, or chronic inflammation after recovering from COVID-19. The study, conducted well into the post-vaccine era, demonstrates that long-term vocal impairment persists despite vaccination.

For singers and actors, who depend on vocal precision, these aftereffects can be career-ending. 

These symptoms often appear weeks or months after the initial illness, complicating diagnoses and obscuring the connections between cause and effect. Yet despite these findings, the industry’s response has remained fragmented, leaving performers to navigate the stigma and uncertainty alone.

A culture of silence: stigma of vocal injury and the pressure to perform

Vocal injuries carry a stigma in the performing arts. The industry mantra, “the show must go on,” often leaves little room for performers to rest or recover. Acknowledging illness—especially COVID-19—can lead to lost income, missed opportunities, and even career jeopardy.

This silence is further compounded by economic pressures. Funding cuts have put enormous economic pressure on UK theatres, incentivising productions to continue performances even when the performers fall ill. With Macbeth, performances were cancelled as little as two hours before their scheduled to begin, suggesting there was an effort to continue despite illness in the company. Performers, meanwhile, may be discouraged from testing or disclosing symptoms, knowing that admitting to illness could bring a production to a halt. But pushing on is now leading to an epidemic of vocal injuries across the performing arts and an abrupt end of performers’ careers. 

An epidemic of silence: voices lost since 2020

Lady Macduff’s mid-performance voice loss is not an isolated incident.

The list of high-profile performers silenced by vocal injuries since the pandemic began grows longer by the day. Earlier this year, Sam Smith was forced to abandon their Manchester concert mid-performance, cancelling subsequent dates in Glasgow and Birmingham after doctors warned they risked permanent damage without immediate rest.

Similarly, Aerosmith’s Steven Tyler saw his decades-long touring career come to an end after severe vocal cord damage and a fractured larynx rendered his recovery “not possible.” The band’s farewell tour was cancelled, leaving fans heartbroken. In the UK, legendary singer Rod Stewart has also faced a prolonged battle to regain his voice after contracting COVID and strep throat in quick succession. 

Each case highlights a disturbing trend: the cumulative toll of illness, long-term strain, and inadequate recovery is pushing performers to their limits. 

Vocal cord injuries and lost voices aren’t unheard-of in the performing arts, but COVID induced dysohonia is exponentially worsening the strain already put on performers’ voices. If this is ending careers and cancelling shows, why isn’t more being done to protect performers?

Breaking the silence: clean air, safer stages

Advocacy groups like Protect the Heart of the Arts are calling for immediate reforms, including better air quality in theaters through HEPA filtration, audience masking, and regular, accurate on-site molecular testing, like PlusLife. The National Theatre and the Barbican have already implemented advanced air filtration systems, but these remain exceptions rather than the rule. 

Theater unions must also for more humane schedules that allow performers to recover fully between shows. The days of punishing performance runs with no room for illness must give way to policies that prioritise long-term health over short-term profits.

There must also be greater awareness about COVID, its true prevalence, and best practices for testing and recovery. Though many consider COVID to be rare, data from the CDC’s respiratory virus dashboard highlights the overwhelming prevalence of COVID-19. In late August 2024, 96.5% of all positive tests for COVID, flu, and RSV (the “big three” respiratory viruses) were COVID cases. These findings challenge assumptions about other illnesses and reinforce COVID’s dominant role in ongoing health disruptions.

Making matters worse, research shows that, post-vaccines, lateral flow tests—the primary diagnostic tool for many—may not detect SARS-CoV-2 until several days after symptoms appear. This delay in detection increases the risk of unintentional spread and complicates efforts to trace the impact of infections within tightly knit communities, such as theatre companies.

This means that even for theatres and performers who do test for COVID, the mistaken belief that it’s rare, or at least seasonal, or that a single lateral flow test can rule out COVID are incorrect. COVID is omnipresent in the arts and accurate, on-site molecular testing is needed.

The ghost of illness past and future – not just Macbeth

The disruptions at Macbeth are emblematic of an industry struggling to reconcile its pre-pandemic practices with the realities of a post-pandemic world. Despite the theatre’s outward recovery, the silent legacy of COVID-19 lingers, affecting performers in ways audiences rarely see until a performance is disrupted and the damage has already been done. The risk is no longer limited to one-off illnesses or vocal injuries—it has become a systemic issue with far-reaching implications for health, career longevity, and the cultural landscape.

As the theatre world grapples with this new reality, Macbeth may offer an unsettling lesson: the consequences of COVID do not end when the initial symptoms resolve. The question is no longer whether the show can go on but whether it should, without first addressing the invisible toll it’s taking on those who make it happen.

Featured image supplied