As coronavirus cases surge in parts of the country, bars are increasingly under scrutiny for their role in the spread of COVID-19 since the end of the national lockdown.
In Louisiana, almost 20% of COVID-19 cases reported outside of group living facilities like nursing homes and homeless shelters since the start of the pandemic were attributed to bars as of Aug. 12.
In Colorado, about a tenth of all coronavirus outbreaks have been in a bar or restaurant, NBC affiliate Channel 9 in Denver reported at the beginning of August.
Some states, including Arizona and California, have shut down bars to slow down the rate of infection, while others have rules on how many people can enter and other restrictions.
"Congregation at a bar, inside, is bad news. We really got to stop that right now," Dr. Anthony Fauci told lawmakers at the end of June.
Officials have been alarmed by incidents such as the one in Michigan where at least 85 people connected with a visit to an East Lansing bar test positive for coronavirus.
In Jacksonville Beach, Florida, a group of at least a dozen friends said they all tested positive for the coronavirus after visiting a newly-reopened pub to celebrate one of their birthdays.
So why does the bug thrive in bars?
There are three main ingredients: people, close proximity and alcohol, said Dr. Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida in Tampa.
“For the virus, it’s a wonderful (combination); for us, not so good,” Levine told TODAY.
“The indoor bar settings are really tough, especially when you have a lot of disease in your community … It’s much harder in that setting to put in the kind of re-engineering that we’ve seen in traditional restaurants and other facilities.”
Dr. Lou Ann Bruno-Murtha, division chief of infectious diseases at Cambridge Health Alliance in Cambridge, Massachusetts, called the decision of some states to close bars “an excellent move.”
“I think it’s a venue that’s highly concerning,” Bruno-Murtha said, adding she’s always taken aback by footage of bar patrons without face coverings: “It’s very disconcerting for me when I see those pictures on the news or on social media.”
Opportunities to spread
A pub may be closely watching its occupancy rate and providing social distancing opportunities, but patrons could still spread the disease, Levine noted.
COVID-19 is mainly spread from person to person through respiratory droplets, and the transmission works best when people are close to each other over a period of time — the typical scenario in a bar, which is usually smaller and more cramped than a restaurant.
Bar patrons cluster to enjoy each other’s company rather than staying 6 feet apart and come to drink alcohol, which lowers inhibitions and causes people to think less clearly.
“It may not be your top priority anymore to maintain social distance or even think about the virus,” Levine said.
“We’re also talking generally about a younger clientele and folks at a younger age generally feel more invincible.”
It’s hard to drink while wearing a mask, so many patrons skip face coverings. They also talk loudly because bars are often noisy — making it much more likely to spread the virus. "Speech droplets" produced by people who could be infected but don't show any symptoms can linger in the air for several minutes, a recent study found. Loud speech produces more droplets than a normal tone of voice.
Another factor is the casual nature of bars. States are using contact tracing to limit the spread, but when you strike up a conversation with somebody in a bar, you often don’t know who that person is or how to contact them, Bruno-Murtha said.
If you want to go to a bar:
Both experts said they would not feel comfortable going to a bar right now. But if someone insisted on going, they offered the following precautions:
Do your own risk assessment first: How likely is it that you could experience serious complications and maybe even death from COVID-19? Even if you have no risk factors, how likely are you to infect friends or family you live with who are more vulnerable? “You can’t just think about yourself,” Levine noted. Skip going to higher risk settings if you or your loved ones could be at risk.
Keep the basics in mind: Wear a face covering when you’re not sipping your drink, maintain physical distancing, don’t let your guard down and practice good hand hygiene.
Seek an outdoor bar or one with a patio, terrace or balcony: Outdoor settings where the virus is diluted and there's room for social distance have a lower risk potential for COVID-19 than indoor spaces, where ventilation can spread the bug. Ideally, go during the day when there’s still ultraviolet light to help kill any virus that might be circulating, Bruno-Murtha advised. Stay outside even when going at night. “Generally, everything outdoors is safer, but you still have to maintain physical distancing and be prepared to put a face covering on if that doesn’t happen,” Levine said.
Don’t share drinks: It could be risky, particularly if you’re doing it with people you don’t know and haven’t asked what they’ve been doing to prevent COVID-19. You could hold a drink that may have the virus on the glass or put an infectious spot right to your mouth.
Consider going to the restroom with a mask on: There’s been some concern that toilet flushes can aerosolize the virus.
Limit your alcohol intake: Promise yourself to stop at a certain number of drinks to maintain control and stay safe.
"I so miss being able to go out with friends and being social," Bruno-Murtha said. But until she feels comfortable, she's skipping the bar.