Deadly Mix: How Bars Are Fueling COVID-19 Outbreaks
The Full Throttle Saloon in Sturgis, S.D., draws a crowd earlier this month during the 80th annual Sturgis Motorcycle Rally. (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鈥檚 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鈥檚 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 鈥 only to shut them down again as viral case counts rebounded this summer.
鈥淲e鈥檙e big targets. It鈥檚 just wrong,鈥 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.
鈥淭hey can鈥檛 regulate in ways that are arbitrary or capricious,鈥 said , a law professor at Georgetown University. 鈥淏ut if there鈥檚 good evidence that a certain class of establishment is causing the spread of infectious diseases, it鈥檚 absolutely clear that they have the right 鈥 in fact, they have the duty 鈥 to do it.鈥
The evidence that bars are a particular problem has continued to grow, said , an infectious disease specialist in El Paso, Texas.
鈥淚f 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,鈥 said Alozie. He was a member of the Texas Medical Association committee that created , such as shopping at the grocery store.
Bars top the list as the riskiest.
鈥淵ou can鈥檛 drink through the mask, so you鈥檙e taking off your mask. There are lots of people, tight spaces and alcohol is a dis-inhibitor 鈥 people change their behaviors,鈥 said Alozie.
鈥榃hat Am I Going to Do?鈥
At in West Seattle, the stools are stacked in the corner. These days the craft brewery鈥檚 taps flow for to-go drinks only.
鈥淚t would be very lively,鈥 owner Allison Herzog said about the brewery鈥檚 pre-pandemic days. 鈥淚t is weird to come in here and not feel that vibrancy.鈥
The coronavirus pandemic has compromised the bedrock of Herzog鈥檚 business: people gathering together to drink, talk, laugh and let loose in one another鈥檚 company.
鈥淚 wake up and I think, every day, what am I going to do to keep going?鈥 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.
鈥淚 could hear people laughing in the bar,鈥 she recalled. 鈥淚t just touched my heart and it felt like something was normal again.鈥
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 鈥 including Herzog鈥檚 bar.
Even though it鈥檚 hard on her bottom line, she said, she believes the risk of the coronavirus justifies the decision.
鈥淚 trust that they will open when it鈥檚 responsible and scale back when it鈥檚 responsible,鈥 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, 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.
鈥淭he reality is, man proposes, God disposes,鈥 he said. 鈥淎lcohol disposes even more.鈥
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.
鈥淵ou鈥檙e asking customers who are drinking and doing karaoke to follow the physical distancing and masking requirements,鈥 said , director of the Clark County Health Department, which conducted the investigation. 鈥淪o that was challenging in this particular situation.鈥
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, , who studies the behavior of aerosols, was dismayed.
鈥淚 thought these were superspreading events waiting to happen, and look 鈥 that鈥檚 what happened,鈥 said Luis-Jimenez, a professor at the University of Colorado-Boulder. 鈥淚t was irresponsible.鈥
Many of the risk factors for airborne transmission of the coronavirus come together in a bar 鈥 think of each one like a 鈥渃heck mark鈥 that adds to a person鈥檚 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.
鈥淚 would put my money that a bar is where the transmission is most likely to occur [compared with a restaurant] because that鈥檚 where you鈥檙e most likely to have people that are shouting and who are not wearing masks,鈥 he said.
Bars Are Fighting Back
Bars and taverns have brought legal challenges to coronavirus restrictions in , , Arizona, , Texas and .
In Arizona, more than 60 bars filed a lawsuit to overturn the governor鈥檚 order to shut them down. , 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.
鈥淓ither treat them all equally and shut them all down 鈥 or treat them all equally and allow them all to conform to reasonable health measures,鈥 Wurman argued. 鈥淲hat you can鈥檛 do is pick out a criterion, something like alcohol, that鈥檚 totally arbitrary and that totally discriminates.鈥
Gostin, the Georgetown University legal scholar, said courts historically have sided with public health decisions 鈥 even as recently as last month.
The U.S. 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.
鈥淲e have to remember we鈥檙e in an emergency,鈥 Gostin said, regarding the court鈥檚 decision. 鈥淭he health department should have reasonable discretion so as long as it鈥檚 acting on the basis of good evidence.鈥
Closing bars has a 鈥渄ouble effect,鈥 according to , vice dean for Public Health Practice and Community Engagement at Johns Hopkins鈥 Bloomberg School of Public Health.聽鈥淚t reduces the spread of the virus within the bar and it makes everyone take this situation more seriously.鈥
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.
鈥淵ou can鈥檛 look at the decision about bars separate from the need to save lives in nursing homes or to be able to open schools,鈥 Sharfstein said. 鈥淭hey鈥檙e all connected.鈥
This story is part of a partnership that includes and Kaiser Health News.