Deadly mix: How bars are fueling COVID-19 outbreaks

STURGIS, SD - AUGUST 09: People watch a concert at the Full Throttle Saloon during the 80th Annual Sturgis Motorcycle Rally in Sturgis, South Dakota on August 9, 2020. While the rally usually attracts around 500,000 people, officials estimate that more than 250,000 people may still show up to this year's festival despite the coronavirus pandemic. (Photo by Michael Ciaglo/Getty Images)

From the early days of the U.S. coronavirus outbreak, states have wrestled with the best course of action for bars and nightclubs, which largely have their economic prospects tied to social gatherings in tight quarters. As the virus has pinched the industry’s lifeblood, bar owners in a handful of states are fighting in court against government orders that they stay closed.

But public health experts and top health officials, including the nation’s top infectious diseases official, Dr. Anthony Fauci, have said: When bars open, infections tend to follow.

Some states moved quickly to shutter bars early in the pandemic for months or longer, keeping them entirely closed or open only under very strict conditions. Many other states moved to reopen bars on a faster timeline — only to shut them down again as viral case counts rebounded this summer.

“We’re big targets. It’s just wrong,” said Steve Smith, whose Nashville, Tennessee, businesses include honky-tonks that serve alcohol and cater to tourists. But some legal experts said public health authorities have broad power to close down any business they deem particularly risky.

“They can’t regulate in ways that are arbitrary or capricious,” said Lawrence Gostin, a law professor at Georgetown University. “But if there’s good evidence that a certain class of establishment is causing the spread of infectious diseases, it’s absolutely clear that they have the right — in fact, they have the duty — to do it.”

The evidence that bars are a particular problem has continued to grow, said Dr. Ogechika Alozie, an infectious disease specialist in El Paso, Texas.

“If you were to create a petri dish and say, How can we spread this the most? It would be cruise ships, jails and prisons, factories, and it would be bars,” said Alozie. He was a member of the Texas Medical Association committee that created a COVID-19 risk scale for common activities, such as shopping at the grocery store.

Bars top the list as the riskiest.

“You can’t drink through the mask, so you’re taking off your mask. There are lots of people, tight spaces and alcohol is a dis-inhibitor — people change their behaviors,” said Alozie.

‘What am I going to do?’

At The Beer Junction in West Seattle, the stools are stacked in the corner. These days the craft brewery’s taps flow for to-go drinks only.

“It would be very lively,” owner Allison Herzog said about the brewery’s pre-pandemic days. “It is weird to come in here and not feel that vibrancy.”

The coronavirus pandemic has compromised the bedrock of Herzog’s business: people gathering together to drink, talk, laugh and let loose in one another’s company.

“I wake up and I think, every day, what am I going to do to keep going?” Herzog said.

In the spring, The Beer Junction shut down indoor service as the coronavirus swept through Washington state. Then, as coronavirus numbers improved, restrictions on restaurants and bars were eased in the early summer. Finally, Herzog was allowed to open up a few tables and serve a limited number of customers indoors.

“I could hear people laughing in the bar,” she recalled. “It just touched my heart and it felt like something was normal again.”

But the reprieve did not last long.

By late July, the coronavirus had made a resurgence in the Seattle area and Washington Gov. Jay Inslee soon put another ban on indoor service at places that sold alcohol — including Herzog’s bar.

Even though it’s hard on her bottom line, she said, she believes the risk of the coronavirus justifies the decision.

“I trust that they will open when it’s responsible and scale back when it’s responsible,” Herzog said.

What the evidence shows

There are now many examples across the U.S. of bars and nightclubs that have fueled outbreaks.

In July, Louisiana rolled back its limited opening of bars, reporting that more than 400 people had caught the coronavirus from interactions at those businesses. Texas and Arizona ordered bars to close down when infections skyrocketed and customers continued to crowd into bars. In Michigan, public health authorities have traced nearly 200 cases back to a now-infamous East Lansing pub.

While bars can ask customers to wear masks and sit at tables, Alozie is skeptical that such guidance, however well-intentioned, can be successful, even when bargoers plan to be prudent.

“The reality is, man proposes, God disposes,” he said. “Alcohol disposes even more.”

An outbreak linked to a bar and grill in southwestern Washington state is instructive. For karaoke night, the staff spaced the tables, checked temperatures at the door, even put up plexiglass barriers near the singers. Nonetheless, a few weeks later, close to 20 customers and employees had been infected.

“You’re asking customers who are drinking and doing karaoke to follow the physical distancing and masking requirements,” said Dr. Alan Melnick, director of the Clark County Health Department, which conducted the investigation. “So that was challenging in this particular situation.”

The chance of catching the virus through tiny airborne respiratory droplets, known as aerosols, goes up significantly in indoor spaces. When some states reopened bars after the first round of lockdowns, Jose Luis-Jimenez, who studies the behavior of aerosols, was dismayed.

“I thought these were superspreading events waiting to happen, and look — that’s what happened,” said Luis-Jimenez, a professor at the University of Colorado-Boulder. “It was irresponsible.”

Many of the risk factors for airborne transmission of the coronavirus come together in a bar — think of each one like a “check mark” that adds to a person’s overall risk.

And behavior matters, said Luis-Jimenez. It can determine whether an indoor gathering becomes a superspreading event, which is why a bar is more problematic than even a restaurant.

“I would put my money that a bar is where the transmission is most likely to occur [compared with a restaurant] because that’s where you’re most likely to have people that are shouting and who are not wearing masks,” he said.

Bars are fighting back

Bars and taverns have brought legal challenges to coronavirus restrictions in Colorado, Florida, Arizona, Tennessee, Texas and Louisiana.

In Arizona, more than 60 bars filed a lawsuit to overturn the governor’s order to shut them down. Ilan Wurman, an associate professor of law at Arizona State University, is representing the bar owners who argue that the state has unfairly singled them out, while letting restaurants stay open late and serve alcohol.

“Either treat them all equally and shut them all down — or treat them all equally and allow them all to conform to reasonable health measures,” Wurman argued. “What you can’t do is pick out a criterion, something like alcohol, that’s totally arbitrary and that totally discriminates.”

Gostin, the Georgetown University legal scholar, said courts historically have sided with public health decisions — even as recently as last month.

The U.S. Supreme Court rejected a Nevada church’s challenge to limitations on holding services, although attorneys for the church had argued that the restrictions on worship services were more onerous than the ones placed on casinos and restaurants.

“We have to remember we’re in an emergency,” Gostin said, regarding the court’s decision. “The health department should have reasonable discretion so as long as it’s acting on the basis of good evidence.”

Closing bars has a “double effect,” according to Dr. Joshua Sharfstein, vice dean for Public Health Practice and Community Engagement at Johns Hopkins’ Bloomberg School of Public Health. “It reduces the spread of the virus within the bar and it makes everyone take this situation more seriously.”

Sharfstein, who is a former secretary of health and mental health services for the state of Maryland, said he thinks, in most communities, keeping bars open will only set back other efforts to reopen society.

“You can’t look at the decision about bars separate from the need to save lives in nursing homes or to be able to open schools,” Sharfstein said. “They’re all connected.”

This story is part of a partnership that includes NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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