A Virus Walks Into a Bar …

Everything you love about your neighborhood bar — the ambience, the crowds, the music, the free-flowing alcohol — makes it the ideal place to catch Covid-19.

Around the country, bars are becoming a common source of coronavirus outbreaks. In Louisiana, at least 100 people tested positive for the virus after visiting bars in the Tigerland district, a popular destination for Louisiana State University students. In Idaho, health officials shut down bars in Ada County after reporting clusters of infections among young adults who had visited several bars in downtown Boise.

And several Florida bars are the source of large outbreaks. In Jacksonville Beach, a group of 16 friends went to a pub to celebrate a birthday — and within days all 16 tested positive for Covid-19. The Orlando Pride women’s soccer team was forced to withdraw from the upcoming National Women’s Soccer League tournament after six players and four staff members tested positive for Covid-19 — reportedly after younger players visited bars and nightclubs in the area that had reopened.

“Except for maybe a hospital with sick patients, I couldn’t imagine too many more risky places than a super cramped indoor bar with poor ventilation and hundreds of people,” said Dr. Asaf Bitton, executive director of Ariadne Labs at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. “That to me is a concern from a public health perspective.”

What makes bars so risky? Every bar is different, but many bars are housed in dark, narrow, indoor spaces with no windows and little room to move around. Unlike restaurants, which can space tables far apart, bars typically have fixed bar stool seating along the bar and a layout that forces people to gather closely in clusters.

“People go to bars so they can drink and socialize with other people” said Dr. Adaora A. Adimora, professor of medicine and epidemiology at the University of North Carolina School of Medicine in Chapel Hill. “They usually want to sit fairly close to each other so they can have intimate conversations. Most people are not going to want to sit six feet apart and yell.”

Long conversations in close contact are believed to play an important role in transmission of many viruses, including the novel coronavirus that causes Covid-19. Research shows that we can release up to 10 times more particles through speech than a cough. The pattern tends to hold up across languages, although for unknown reasons, a small fraction of individuals are “speech superemitters,” making them particularly risky for spewing a large volume of particles in close conversation.

Studies also show that the particles we emit during talking and loud speech are potentially more infectious than the larger droplets we expel during a cough or a sneeze. Smaller particles persist in the air for longer time periods before settling, increasing the risk that someone nearby could inhale them. Smaller particles also can travel further into the respiratory tract.

Studies using a special imaging mirror show how exhaled plumes during speech can easily reach another person’s breathing space during conversation. In the video, Dr. Julian W. Tang, a virologist at the University of Leicester, is having a normal-voice conversation with a student standing about one meter (about three feet) apart. The conversation was similar to “chatting over a beer or coffee,” he said. (The undulating background is caused by body heat.)

“You can see similar plumes exhaled from our nose and mouth, and how the airflow can be inhaled and exchanged between the two of us,” said Dr. Tang. “In a pub, bar or restaurant, if you’re sitting close enough to someone to smell their breath (garlic, curry or alcohol), you could be inhaling any exhaled virus, so this would be too close.”

Bars also tend to play loud music, which can prompt people to move closer together to talk, increasing risk for infection. “Bars have music, and you need to speak louder in order to be heard,” said Erin Bromage, a comparative immunologist and biology professor at the University of Massachusetts, Dartmouth. “You can’t social distance when it’s loud, and you need to move closer to hear a person.”

Dr. Bromage said he has advised bars trying to reopen that even if they move outdoors, they still should keep music levels very low. While quiet music changes the atmosphere, it also allows people to socialize without yelling and getting too close to each other’s faces.

Loud speech can be more risky for viral exposure than normal speech. Last year the journal Scientific Reports, published by Nature, reported that particle emission increases with the amplitude of speech. A person speaking quietly emits about six particles per second, while loud talking (without yelling) emits 53 particles per second. If a person has coronavirus, loud speech would increase the number of emitted particles and the risk of infecting another person nearby.

A spike in cases in South Korea shows the risks that barhopping can pose. In May, a 29-year-old man visited five bars and clubs in Itaewon, one of Seoul’s most popular nightlife districts. He later tested positive for coronavirus, and public health authorities have linked him to more than 100 cases of infection.

  • Frequently Asked Questions and Advice

    Updated June 24, 2020

    • Is it harder to exercise while wearing a mask?

      A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

    • I’ve heard about a treatment called dexamethasone. Does it work?

      The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

    • What is pandemic paid leave?

      The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

    • Does asymptomatic transmission of Covid-19 happen?

      So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

    • What’s the risk of catching coronavirus from a surface?

      Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

    • How does blood type influence coronavirus?

      A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

    • How many people have lost their jobs due to coronavirus in the U.S.?

      The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

    • What are the symptoms of coronavirus?

      Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

    • How can I protect myself while flying?

      If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

    • What should I do if I feel sick?

      If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Another factor that makes bars so risky is alcohol. When people drink, they can forget that coronavirus is even a worry. “Alcohol of course can disinhibit people and perhaps promote even more breaches of social distance and sharing of drinks and food,” said Dr. Bitton.

While the bar scene is risky, it also depends on the bar. Bars in bigger spaces and newer buildings with good ventilation pose less risk than a crowded basement bar. Although it’s safest to avoid large gatherings altogether, an outdoor bar area with plenty of space to social distance is far less risky than a crowded indoor bar.

Bar owners say that many of the precautions needed to keep bar patrons safe — spaced seating and limiting capacity — would erase already razor-thin profit margins. Opening up sidewalks for bar patrons would require permission from local officials, but it might be a solution for saving neighborhood bars from permanent closure.

“Better to stay outside where the wind can remove the virus and the sunlight can kill it off,” said Dr. Tang. “It is very difficult to saturate the whole atmosphere with virus — even if there are 100 people outside, so the concentration of virus will not build up to high levels like indoors.”

The biggest challenge for slowing the spread of coronavirus may be the demographic group that likes to frequent bars. Around the country, more young people are testing positive for coronavirus after ignoring social distancing measures.

Doctors say more work needs to be done to convince young people to stay away from bars and adopt social distancing measures. According to the Centers for Disease Control and Prevention, there have been 395 Covid deaths in the United States in people between the ages of 18 and 29, and 1,137 in people between the ages of 30 and 39.

“They should consider the possibility that they could easily give infection to someone they love who’s older or who has medical problems that increase their risk of dying from Covid-19,” Dr. Adimora said. “Although young people are less likely to have severe illness from Covid, they can still die from it.”

Source: nytimes.com

Tags: health

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