There seems to be something unique about the bars and restaurants in Oregon: Unlike those in other states and countries besieged by the coronavirus pandemic, Oregon’s indoor eating and drinking establishments don’t appear to be risky places to catch COVID-19.
“In our data, there is no clear evidence of significant transmission in bars or restaurants,” Oregon state epidemiologist Dean Sidelinger said to members of the media in July when a reporter asked if it was safe to keep bars open.
He says that’s still true now.
So have barkeeps, servers and their patrons in Oregon figured out how to safely gather indoors? Or is there a different reason Oregon health officials aren’t seeing transmission in bars and restaurants?
“The fact is, we aren’t really quantifying it,” said Dr. Ann Thomas, a senior health advisor at the Oregon Health Authority.
She says there’s a simple reason Oregon has little data on restaurant transmission: Overtaxed contact tracers and case investigators rarely have time to ask.
”The actual case investigation interview is quite lengthy,” Thomas said. “It’s already an hour, so we can’t ask every little thing that you and I think of or would like to know. We don’t ask if you were in a bar or restaurant.”
At Bars Or At Home?
Since it started reopening in May, Oregon has seen an increase in cases in young adults. Indeed, 20-29 year olds account for 21% of Oregon’s coronavirus cases — more than any other age group. OHA data shows that some of these young people contracted COVID-19 in private social gatherings that might have been larger than allowed or where social distancing wasn’t practiced.
Other states have linked an uptick in cases among youth to rule-defying social gatherings. But they’ve also pegged another culprit: indoor bars and restaurants frequented by young adults.
“Bars. Really not good. Really not good,” Dr. Anthony Fauci, the nation’s top infectious disease expert, told Congress on June 30. “Congregation in a bar, inside, is bad news. We’ve really got to stop that.”
After the U.S. began to reopen, cities around the state reported that bars were crowded, mostly with young people. Customers were often unmasked and social distancing was suspect.
Young adults are less likely to get severely ill if they develop COVID-19. But those young people return to their homes, where they can spread the disease to their friends and family.
Other states have taken action to curb infections in dining establishments. In Texas, Gov. Greg Abbott closed bars and reduced restaurant capacity at the end of June after a similar increase was linked to “bar-type” establishments. Ada County, Idaho, closed its bars after a rash of cases appeared in young people. New restrictions were placed on bars and restaurants in Washington state on July 30, and indoor operations at all bars and restaurants in California ceased in mid-July.
To be clear: Oregon’s bars and restaurants are not as crowded as those in some states with large outbreaks. Restaurant capacity is limited, and 10 p.m. is now the last call for drink orders in bars. Tables are spaced more than 6 feet apart, and guests wear masks until their food is served. But it’s impossible to drink or eat with a mask on, and people don’t just eat and drink when they sit down for a meal. They talk — often loudly to be heard — and in the process release aerosols and droplets that could contain virus into the air.
Oregon health officials say they believe the social-distancing policies instituted at bars and restaurants are enough to keep people safe.
“You need to wear a mask until your food and drink is served. And you’re sitting at a table with people you know, away from other people,” OHA’s Thomas said.
OSHA has been conducting regular checks to make sure bars and restaurants comply with the governor’s orders.
But data from the U.S. and around the world shows that being indoors without a mask on is one of the most dangerous things a person can do, even when everyone is distanced by more than 6 feet. Fifty-three people caught COVID-19 at a choir practice in Washington, although many never stood close to the infected person. And several people were infected at a restaurant in China, even though the customers were seated far apart.
On average, around half of the COVID-19 cases in Oregon can be traced to another infection. And while OHA says it contacts around 90% of confirmed cases within 24 hours to interview them, it can take much longer to follow up and actually track down potential transmissions. Delayed test results across the state have made contact tracing even more difficult.
Contact tracing expands exponentially. Each infected person undergoes a lengthy interview with a contact tracer. During an outbreak or in a large county, it can be a scramble to keep up with the cases that come in.
“The median number of contacts for each case is three. The average is 3.4,” said Sidelinger. “Multiply that by 20 infected people.”
Jason Davis, a public information officer for Lane County’s department of health and human services, said that at the start of the pandemic, when everything was locked down, most cases only had one or two contacts to call. Now, that number can approach four.
“When it starts to get higher, it starts to strain our capacity,” Davis said.
Sometimes, tracers find confirmed cases with 20 or more contacts.
“That’s when it starts to get impossible,” he said.
When officials find two or more cases that share something in common — say people who work in the same place, went to the same party or attend the same church — that can be grounds to check for an outbreak by testing everyone involved. When that happens, both symptomatic and asymptomatic cases are found.
But links between cases can be less clear. It’s not very difficult to get a list of guests at a house party, especially if the size of the gathering is limited. It’s much harder to figure out if two sick people, with nothing else in common, attended a restaurant at the same time.
It gets even harder if they’re not asked about it.
In some states and countries, restaurants are required to keep a list of customers, in case contact tracers need to call them. In others, GPS data from phones is used to identify people who may have been exposed. Other governments have tried push alerts that name an establishment where a diagnosed person has been and encourage anyone who has been at those locations at the same time to get tested. In places where restaurant transmission is tracked, the results are clear: Transmission happens in bars and restaurants, even with social-distancing regulations.
In Oregon, the data might not be able to tell if one table at a bar infects another table, or if customers infect each other, but some cases have shown connections to indoor dining once they’re traced.
“We do see social groups that go out to bars or restaurants together, and we’ve seen cases test positive, but they’ve often gathered in other kinds of social settings [as well],” Sidelinger said. “It can be hard to track transmission directly.”
OHA has also identified a handful of outbreaks in restaurant staff, but they’re all classified as workplace outbreaks. Some of those outbreaks have been traced to a source, but many have not.
“What happens is, you find out that two people who work together in a bar had COVID. But they probably got it from their roommates,” said OHA’s Thomas. “We aren’t seeing a week later that you have 20 patrons who got it.”
Thomas and Sidelinger acknowledged that contact tracers do not notify the patrons of restaurants where those cases pop up: OHA doesn’t have the contact tracing capacity to do it.
“We just don’t have the manpower,” said Sidelinger. “But that certainly doesn’t mean there’s been transmission in those settings.”
At most, the state will add the restaurant to the list of workplace outbreaks on OHA’s website.
For now, bars and restaurants in Oregon are open. The state government seems to be walking a fine line, balancing safety and job security.
“Some people are going to hear this announcement and think these restrictions don’t go far enough. They’ll say we should completely close all restaurants and bars or move them to outdoor service only,” Gov. Kate Brown told reporters on July 22. “Others are going to hear the news and think these restrictions go too far and are too onerous.”
There are economic reasons to keep bars and restaurants open: Many restaurants operate with razor-thin margins. Lost revenue from closing may be irrecoverable. And forgivable loans available through the federal Paycheck Protection Program were designed to keep workers on the payroll — and working. Only 40% of the loan can go to rent, mortgages and other expenses if the business wants to qualify for forgiveness.
Sidelinger told OPB that while OHA has little data on restaurant transmission, they know that transmission has occurred during at-home gatherings. In the absence of evidence, Sidelinger said they are targeting the known instead of the unknown.
The governor’s office is doing the same.
“Before we single out any specific sector of the economy for shut down, we want to exhaust all possible other methods of controlling the virus, and have as much sector-specific data as possible” said Charles Boyle, deputy communications director for the governor’s office, in an email.
But if bars and restaurants aren’t part of the contact-tracing process, “sector-specific data” could be hard to come by.
Instead of closing bars, OHA and the governor’s office are encouraging people to adhere to social-distancing guidelines in public and private.
“At this point we’re really working on reducing sizes of gatherings. Because that has been a big source of transmission in the last few months,” Thomas said. “We want people taking the steps they can to protect themselves. The hand-washing, the face coverings, the physical distancing.”
Still, Sidelinger doesn’t think it’s a double standard to discourage people from having private indoor gatherings while keeping bars and restaurants open.
“We know transmission happens indoors. That’s why my advice has always been to eat outside,” he said, adding that he hasn’t eaten at an indoor restaurant since the pandemic began.
It’s unrealistic to believe that all coronavirus risk can be avoided. But if you really want to reduce your chances of infection while staying social, try doing what Anthony Fauci does: Have a small gathering outdoors with close friends. Have honest discussions with people about their potential exposure history before you meet with them. If you want food from a restaurant, get it to-go and bring it with you. And bring your own beer.
This story was first published by Oregon Public Broadcasting and is posted here through a content-sharing agreement in the Northwest.