The test results that hot day in early August shouldn’t have surprised me — all the symptoms were there. A few days earlier, fatigue had enveloped me like a weighted blanket. I chalked it up to my weekend of travel. Next, a headache clamped down on the back of my skull. Then my eyeballs started to ache. And soon enough, everything tasted like nothing.
As a reporter who’s covered the coronavirus since the first confirmed U.S. case landed in Seattle, where I live, I should have known what was coming, but there was some part of me that couldn’t quite believe it. I had a breakthrough case of covid-19 — despite my two shots of the Pfizer-BioNTech vaccine, the second one in April.
I was just one more example of our country’s tug and pull between fantasies of a post-covid summer and the realities of our still-raging pandemic, in which even the vaccinated can get sick.
Not only was I sick, but I’d exposed my 67-year-old father and extended family during my first trip back to the East Coast since the start of the pandemic. It was just the scenario I had tried to avoid for a year and a half.
Where did I get it? Who knows. Like so many Americans, I had loosened up on wearing masks all the time and physical distancing after getting fully vaccinated. We had flown across the country, seen friends, stayed at a hotel, eaten indoors and, yes, even gone to a long-delayed wedding with other vaccinated people.
I ended up in quarantine at my father’s house. Two rapid antigen tests (taken a day apart) came back negative, but I could tell I was starting to feel sick. After my second negative test, the nurse leveled with me. “Don’t hang your hat on this,” she said of the results. Sure enough, a few days later the results of a PCR test for the coronavirus (this one sent to a lab) confirmed what had become obvious by then.
It was a miserable five days. My legs and arms ached, my fever crept up to 103 and every few hours of sleep would leave my sheets drenched in sweat. I’d drop into bed exhausted after a quick trip to the kitchen. To sum it up, I’d put my breakthrough case of covid right up there with my worst bouts of flu. Even after my fever broke, I spent the next few weeks feeling low.
Of course, I am very lucky. I didn’t go up against the virus with a naive immune system, like millions of Americans did before vaccines were widely available. And, in much of the world, vaccines are still a distant promise.
“You probably would have gotten much sicker if you had not been vaccinated,” Dr. Francesca Torriani, an infectious-disease physician at the University of California-San Diego, explained to me recently.
As I shuffled around my room checking my fever, it was also reassuring to know that my chances of ending up in the hospital were slim, even with the delta variant. And now, about a month later, I’ve made a full recovery.
The reality is breakthrough cases are becoming more common. Here’s what I wish I’d known when those first symptoms laid me low.
1. Is it time for a reality check about what the vaccines can — and can’t do?
The vaccines aren’t a force field that wards off all things covid. They were given the green light because they greatly lower your chance of getting seriously ill or dying.
But it was easy for me — and I’m not the only one — to grab onto the idea that, after so many months of trying not to get covid, the vaccine was, more or less, the finish line. And that made getting sick from the virus unnerving.
After all, there were reassuring findings earlier this year that the vaccine was remarkably good at stopping any infection, even mild ones.
“There was so much initial euphoria about how well these vaccines work,” said Dr. Jeff Duchin, an infectious-disease physician and the public health officer for Seattle and King County. “I think we — in the public health community, in the medical community — facilitated the impression that these vaccines are bulletproof.”
It’s hard to keep adjusting your risk calculations. So if you’d hoped to avoid getting sick at all, even slightly, it may be time for a “reset,” Duchin said. This isn’t to be alarmist but a reminder to clear away expectations that covid is out of your life, and stay vigilant about commonsense precautions.
2. How high are my chances of getting a breakthrough case these days?
It used to be quite rare, but the rise of delta has changed the odds.
“It’s a totally different ballgame with this delta phase,” said Dr. Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute in San Diego. “I think the chance of having a symptomatic infection has gone up substantially.”
But “quantifying that in the U.S. is very challenging” because our “data is so shoddy,” he said.
The vaccinated still have a considerably lower chance of getting infected than those who aren’t protected that way. Los Angeles County collected data over the summer as the delta variant started to surge: Unvaccinated people were five times as likely to test positive than those who were vaccinated.
3. How careful do I need to be if I want to avoid a breakthrough?
Looking back, I wish I’d taken more precautions.
And my advice to friends and family now is: Wear masks, stay away from big gatherings with unvaccinated people and cut down on travel, at least until things calm down.
The U.S. is averaging more than 150,000 coronavirus infections a day (about twice what it was when I fell sick), hospitals are overwhelmed, and the White House has proposed booster shots. Scientists are still making sense of what’s happening with breakthrough cases.
In many parts of the U.S., we’re all more likely to run into the virus than we were in the spring. “Your risk is going to be different if you are in a place that’s very highly vaccinated, with very low level of community spread,” said Dr. Preeti Malani, a specialist in infectious diseases at the University of Michigan. “The piece that’s important is what’s happening in your community.”
4. What does a “mild” case of covid feel like?
In my case, it was worse than I expected, but in the parlance of public health, it was “mild,” meaning I didn’t end up in the hospital or require oxygen.
This mild category is essentially a catchall, said Dr. Robert Wachter, who chairs the Department of Medicine at the University of California-San Francisco. “Mild” can range from “a day of feeling crummy to being completely laid up in bed for a week, all of your bones hurt and your brain isn’t working well.”
There’s not great data on the details of these mild breakthrough infections, but so far it appears that “you do way better than those who are not vaccinated,” said Dr. Sarang Yoon, an occupational medicine specialist at the University of Utah who was part of a nationwide study by the Centers for Disease Control and Prevention on breakthrough infections.
Yoon’s study, published in June with data collected before the delta surge, found that the presence of fever was cut in half, and the days spent in bed reduced by 60% among people with breakthrough infections, compared with unvaccinated people who got sick.
If you’re vaccinated, the risk of being hospitalized is one-tenth that of the unvaccinated, according to the latest data from the CDC. Those who get severely and critically ill with a breakthrough case tend to be older — in one study done before delta, the median age was 80.5 — with underlying medical conditions such as cardiovascular disease.
5. Can I spread it to others, and do I need to isolate?
Unfortunately, you still have covid and need to act like it.
Even though my first two tests were negative, I started wearing a mask at my house and keeping my distance from my vaccinated family members. I’m glad I did: No one else got sick.
“Even in fully vaccinated, asymptomatic individuals, they can have enough virus to transmit it,” said Dr. Robert Darnell, a physician-scientist at The Rockefeller University.
The science isn’t settled about just how likely vaccinated people are to spread the virus, and it does appear that the amount of virus in the nose decreases faster in people who are vaccinated.
Still, wearing masks and staying isolated from others if you test positive or have symptoms is absolutely critical, Darnell said.
6. Could I get long covid after a breakthrough infection?
While there’s not a lot of data yet, research does show that breakthrough infections can lead to the kind of persistent symptoms that characterize long covid, including brain fog, fatigue and headaches. “Hopefully that number is low. Hopefully it doesn’t last as long and it’s not as severe, but it’s just too early to know these things,” Topol said.
Recent research from the United Kingdom suggests that vaccinated people are about 50% less likely to develop long covid than those who are unvaccinated.
After spending much of the past year tending to elderly patients, doctors are seeing a clear demographic shift: young and middle-aged adults make up a growing share of the patients in covid-19 hospital wards.
It’s both a sign of the country’s success in protecting the elderly through vaccination and an urgent reminder that younger generations will pay a heavy price if the outbreak is allowed to simmer in communities across the country.
“We’re now seeing people in their 30s, 40s and 50s — young people who are really sick,” said Dr. Vishnu Chundi, a specialist in infectious diseases and chair of the Chicago Medical Society’s covid-19 task force. “Most of them make it, but some do not. … I just lost a 32-year-old with two children, so it’s heartbreaking.”
Nationally, adults under 50 now account for the most hospitalized covid patients in the country — about 36% of all hospital admissions. Those ages 50 to 64 account for the second-highest number of hospitalizations, or about 31%. Meanwhile, hospitalizations among adults 65 and older have fallen significantly.
About 32% of the U.S. population is now fully vaccinated, but the vast majority are people older than 65 — a group that was prioritized in the initial phase of the vaccine rollout.
Although new infections are gradually declining nationwide, some regions have contended with a resurgence of the coronavirus in recent months — what some have called a “fourth wave” — propelled by the B.1.1.7 variant, first identified in the United Kingdom, which is estimated to be somewhere between 40% and 70% more contagious.
As many states ditch pandemic precautions, this more virulent strain still has ample room to spread among the younger population, which remains broadly susceptible to the disease.
The emergence of more dangerous strains of the virus in the U.S. — including variants first discovered in South Africa and Brazil — has made the vaccination effort all the more urgent.
“We are in a whole different ballgame,” said Judith Malmgren, an epidemiologist at the University of Washington.
Rising infections among young adults create a “reservoir of disease” that eventually “spills over into the rest of society” — one that has yet to reach herd immunity — and portends a broader surge in cases, she said.
Fortunately, the chance of dying of covid remains very small for people under 50, but this age group can become seriously ill or experience long-term symptoms after the initial infection. People with underlying conditions such as obesity and heart disease are also more likely to become seriously ill.
“B.1.1.7 doesn’t discriminate by age, and when it comes to young people, our messaging on this is still too soft,” Malmgren said.
Hospitals Filled With Younger, Sicker People
Across the country, the influx of younger patients with covid has startled clinicians who describe hospital beds filled with patients, many of whom appear sicker than what was seen during previous waves of the pandemic.
“A lot of them are requiring ICU care,” said Dr. Michelle Barron, head of infection prevention and control at UCHealth, one of Colorado’s large hospital systems, as compared with earlier in the pandemic.
The median age of covid patients at UCHealth hospitals has dropped by more than 10 years in the past few weeks, from 59 down to about 48 years old, Barron said.
“I think we will continue to see that, especially if there’s not a lot of vaccine uptake in these groups,” she said.
While most hospitals are far from the onslaught of illness seen during the winter, the explosion of cases in Michigan underscores the potential fallout of loosening restrictions when a large share of adults are not yet vaccinated.
There’s strong evidence that all three vaccines being used in the U.S. provide good protection against the U.K. variant.
One study suggests that the B.1.1.7 variant doesn’t lead to more severe illness, as was previously thought. However, patients infected with the variant appear more likely to have more of the virus in their bodies than those with the previously dominant strain, which may help explain why it spreads more easily.
“We think that this may be causing more of these hospitalizations in younger people,” said Dr. Rachael Lee at the University of Alabama-Birmingham hospital.
Lee’s hospital also has observed an uptick in younger patients. As in other Southern states, Alabama has a low rate of vaccine uptake.
But even in Washington state, where much of the population is opting to get the vaccine, hospitalizations have been rising steadily since early March, especially among young people. In the Seattle area, more people in their 20s are now being hospitalized for covid than people in their 70s, according to Dr. Jeff Duchin, public health chief officer for Seattle and King County.
“We don’t yet have enough younger adults vaccinated to counteract the increased ease with which the variants spread,” said Duchin at a recent press briefing.
Nationwide, about 32% of people in their 40s are fully vaccinated, compared with 27% of people in their 30s. That share drops to about 18% for 18- to 29-year-olds.
“I’m hopeful that the death curve is not going to rise as fast, but it is putting a strain on the health system,” said Dr. Nathaniel Schlicher, an emergency physician and president of the Washington State Medical Association.
Schlicher, also in his late 30s, recalls with horror two of his recent patients — close to his age and previously healthy — who were admitted with new-onset heart failure caused by covid.
“I’ve seen that up close and that’s what scares the hell out of me,” he said.
“I understand young people feeling invincible, but what I would just tell them is — don’t be afraid of dying, be afraid of heart failure, lung damage and not being able to do the things that you love to do.”
Will Younger Adults Get Vaccinated?
Doctors and public health experts hope that the troubling spike in hospitalizations among the younger demographic will be temporary — one that vaccines will soon counteract. It was only on April 19 that all adults became eligible for a covid vaccine, although they were available in some states much sooner.
But some concerning national polls indicate a sizable portion of teens and adults in their 20s and 30s don’t necessarily have plans to get vaccinated.
“We just need to make it super easy — not inconvenient in any way,” said Malmgren, the Washington epidemiologist. “We have to put our minds to it and think a little differently.”
An estimated 10% to 30% of people who get covid-19 suffer from lingering symptoms of the disease, or what’s known as “long covid.”
Judy Dodd, who lives in New York City, is one of them. She spent nearly a year plagued by headaches, shortness of breath, extreme fatigue and problems with her sense of smell, among other symptoms.
She said she worried that this “slog through life” was going to be her new normal.
Everything changed after she got her covid vaccine.
“I was like a new person. It was the craziest thing ever,” said Dodd, referring to how many of her health problems subsided significantly after her second shot.
As the U.S. pushes to get people vaccinated, a curious benefit is emerging for those with this post-illness syndrome: Their symptoms are easing and, in some cases, fully resolving after vaccination.
It’s the latest clue in the immunological puzzle of long covid, a still poorly understood condition that leaves some who get infected with wide-ranging symptoms months after the initial illness.
The notion that a vaccine aimed at preventing the disease may also treat it has sparked optimism among patients, and scientists who study the post-illness syndrome are taking a close look at these stories.
“I didn’t expect the vaccine to make people feel better,” said Akiko Iwasaki, an immunologist at the Yale School of Medicine who’s researching long covid.
“More and more, I started hearing from people with long covid having their symptoms reduced or completely recovering, and that’s when I started to get excited because this might be a potential cure for some people.”
While promising, it’s still too early to know just how many people with long covid feel better as a result of being vaccinated and whether that amounts to a statistically meaningful difference.
In the meantime, Iwasaki and other researchers are beginning to incorporate this question into ongoing studies of long haulers by monitoring their symptoms pre- and post-vaccination and collecting blood samples to study their immune response.
There are several leading theories for why vaccines could alleviate the symptoms of long covid: It’s possible the vaccines clear up leftover virus or fragments, interrupt a damaging autoimmune response or in some other way “reset” the immune system.
Before getting the vaccine, Dodd, who’s in her early 50s, said she felt as if she had aged 20 years.
She had trouble returning to work, and even simple tasks left her with a crushing headache and exhaustion.
“I’d climb the subway stairs and I’d have to stop at the top, take my mask off just to get air,” Dodd said.
After she got her first dose of the Pfizer vaccine in January, many of Dodd’s symptoms flared up, so much so that she almost didn’t get her second dose.
But she did — and a few days later, she noticed her energy was back, breathing was easier and soon even her problems with smell were resolving.
“It was like the sky had opened up. The sun was out,” she said. “It’s the closest I’ve felt to pre-covid.”
In the absence of large studies, researchers are culling what information they can from patient stories, informal surveys and clinicians’ experiences. For instance, about 40% of the 577 long-covid patients contacted by the group Survivor Corps said they felt better after getting vaccinated.
Among the patients of Dr. Daniel Griffin at Columbia University Medical Center in New York, “brain fog” and gastrointestinal problems are two of the most common symptoms that seem to resolve post-vaccination.
Griffin, who is running a long-term study of post-covid illness, initially estimated that about 30% to 40% of his patients felt better. Now, he believes the number may be higher, as more patients receive their second dose and see further improvements.
“We’ve been sort of chipping away at this [long covid] by treating each symptom,” he said. “If it’s really true that at least 40% of people have significant recovery with a therapeutic vaccination, then, to date, this is the most effective intervention we have for long covid.”
A small U.K. study, not yet peer-reviewed, found about 23% of long-covid patients had an “increase in symptom resolution” post-vaccination, compared with about 15% of those who were unvaccinated.
But not all clinicians are seeing the same level of improvement.
Clinicians at post-covid clinics at the University of Washington in Seattle, Oregon Health & Science University in Portland, National Jewish Health in Denver and the University of Pittsburgh Medical Center told NPR and KHN that, so far, a small number of patients — or none at all — have reported feeling better after vaccination, but it wasn’t a widespread phenomenon.
“I’ve heard anecdotes of people feeling worse, and you can scientifically come up with an explanation for it going in either direction,” said UCSF’s Deeks.
Why Are Patients Feeling Better?
There are several theories for why vaccines could help some patients — each relying on different physiological understandings of long covid, which manifests in a variety of ways.
“The clear story is that long covid isn’t just one issue,” said Dr. Eric Topol, director of the Scripps Research Translational Institute, which is also studying long covid and the possible therapeutic effects of vaccination.
Some people have fast resting heart rates and can’t tolerate exercise. Others suffer primarily from cognitive problems, or some combination of symptoms like exhaustion, trouble sleeping and issues with smell and taste, he said.
As a result, it’s likely that different therapies will work better for some versions of long covid than others, said Deeks.
One theory is that people who are infected never fully clear the coronavirus, and a viral “reservoir,” or fragments of the virus, persist in parts of the body and cause inflammation and long-term symptoms, said Iwasaki, the Yale immunologist.
According to that explanation, the vaccine might induce an immune response that gives the body extra firepower to beat back the residual infection.
“That would actually be the most straightforward way of getting rid of the disease, because you’re getting rid of the source of inflammation,” Iwasaki said.
Griffin at Columbia Medical Center said this “viral persistence” idea is supported by what he’s seeing in his patients and hearing from other researchers and clinicians. He said patients seem to be improving after receiving any of the covid vaccines, generally about “two weeks later, when it looks like they’re having what would be an effective, protective response.”
Another possible reason that some patients improve comes from the understanding of long covid as an autoimmune condition, in which the body’s immune cells end up damaging its own tissues.
A vaccine could hypothetically kick into gear the “innate immune system” and “dampen the symptoms,” but only temporarily, said Iwasaki, who has studied the roleof harmful proteins, called autoantibodies, in covid.
This self-destructive immune response happens in a subset of covid patients while they are ill, and the autoantibodies produced can circulate for months later. But it’s not yet clear how that may contribute to long covid, said John Wherry, director of the Institute for Immunology at the University of Pennsylvania.
Another theory is that the infection has “miswired” the immune system in some other way and caused chronic inflammation, perhaps like chronic fatigue syndrome, Wherry said. In that scenario, the vaccination might somehow “reset” the immune system.
As hospitals across the country weather a surge of COVID-19 patients, in Seattle — an early epicenter of the outbreak — nurses, respiratory therapists, and physicians are staring down a startling resurgence of the coronavirus that’s expected to test even one of the best-prepared hospitals on the pandemic’s front lines.
After nine months, the staff at Harborview Medical Center, the large public hospital run by the University of Washington, has the benefit of experience.
In March, the Harborview staff was already encountering the realities of COVID-19 that are now familiar to so many communities: patients dying alone, fears of getting infected at work and upheaval inside the hospital.
This forced the hospital to adapt quickly to the pressures of the coronavirus and how to manage a surge, but all these months later it has left staff members exhausted.
“This is a crisis that’s been going on for almost a year — that’s not the way humans are built to work,” said Dr. John Lynch, an associate medical director at Harborview and associate professor of medicine at the University of Washington.
“Our health workers are definitely feeling that strain in a way that we’ve never experienced before,” he said.
Until the late fall, the Seattle area had mostly kept the virus in check. But now cases are rising faster than ever, and Washington Gov. Jay Inslee has warned a “catastrophic loss of medical care” could be on the horizon.
“This is the very beginning, to be honest, so thinking about what that looks like in December and January has got me very concerned,” Lynch said.
Lessons Learned From Spring Surge
When the outbreak first swept through western Washington, hospitals were in the dark on many fronts. It was unclear how contagious the virus was, how widely it had spread and how many intensive care beds would be needed.
Intensive care unit nurse Whisty Taylor remembers the moment she learned one of her colleagues — a young, active nurse — was hospitalized on their floor and intubated.
“That’s really when it hit — that could be any of us,” Taylor said.
Concerns over infection control and conserving personal protective equipment meant nurses were delegated all sorts of unusual tasks.
“The nurses were the phlebotomists and physical therapists,” said nurse Stacy Van Essen. “We mopped the floors and we took the laundry out and made the beds, plus taking care of people who are extremely, extremely sick.”
A lot has changed since those early days.
Staff members besides just nurses are now trained to go into COVID rooms and be near patients, and the hospital has ironed out the thorny logistics of caring for these highly contagious patients, said Vanessa Makarewicz, Harborview’s manager of infection control and prevention.
How to clean the rooms? Who’s going to draw the blood? What’s the safest way to move people around?
“We’ve grown our entire operation around it,” Makarewicz said.
The physical layout of the hospital has changed to accommodate COVID patients, too.
“It’s still busy and chaotic, but it’s a lot more controlled,” said Roseate Scott, a respiratory therapist in the ICU.
Harborview has also learned how to stretch its supplies of PPE safely. And as cases started to rise significantly last month, the hospital quickly reimposed visitor restrictions.
“In the past, we’ve had visitors who then call us two days later and say, ‘Oh, my gosh, I just came up positive,’” said nurse Mindy Boyle.
Boyle said months of caring for COVID patients — and all the steps the hospital has taken, including having health care workers observed as they don and doff their PPE — has tamped down the fears of catching the virus at work.
“It still scares me somewhat, but I do feel safe, and I would rather be here than out in the community, where we don’t know what’s going on,” said Boyle.
‘We’re All Tired of This’
Preparation can go only so far, though. The hospital still runs the risk of running low on PPE and staff, just like so much of the country.
During the spring, the hospital cleared out beds and recruited nurses from all over the nation, but that is unlikely to happen this time, with so many hospitals under pressure at once.
“All things point to what could be an onslaught of patients on top of a very tired workforce and less staff to go around,” said Nate Rozeboom, a nurse manager on one of the COVID units. “We’re all tired of this, tired of taking care of COVID patients, tired of the uncertainty.”
Already, COVID’s footprint at Harborview is expanding and bringing the hospital close to where it was at its previous peak.
“The fear I have personally is overwhelming the resources, using up all the staff — and the numbers are still going to go up,” said Scott.
And she said the realities of caring for these desperately ill patients have not changed.
“When they’re on their belly, laying down with all the tubes and drains and all these extra lines hanging off of them, it takes about four to five people to manually flip them over,” Scott said. “It feels intense every time. It doesn’t matter how many times you’ve done it.”
Hospitalized patients are faring better than in the spring, but there are still no major breakthroughs, said Dr. Randall Curtis, an attending physician in the COVID ICU and a professor of medicine at the University of Washington.
“The biggest difference is that we have a better sense of what to expect,” Curtis said.
The few treatments that have shown promise, including the steroid dexamethasone and the antiviral remdesivir, have “important but marginal effects,” he said.
“They’re not magic bullets. … People are not jumping out of bed and saying, ‘I feel great. I’d like to go home now,’” Curtis said.
Taylor said nursing has never quite felt the same since she started in the COVID ICU.
“These people are in the rooms for months. Their families can only see them through Zoom. The only interaction they have is with us through our mask, eyewear, plastic,” Taylor said. “We’re just giving their body a runaround trying to keep them alive.”
This story is from a reporting partnership that includes NPR and KHN.
Republished courtesy ofKHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
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 barstools 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.
Bars and Clubs in a Pandemic: 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.
Published courtesy of KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
I was just one more example of our country’s tug and pull between fantasies of a post-covid summer and the realities of our still-raging pandemic, in which even the vaccinated can get sick.
