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Alcohol directly impairs people’s ability and willingness to adhere to COVID-19 safety guidelines. Getty Images
  • New research questions if bars can mitigate COVID-19 transmission risks properly.
  • Despite the efforts of bar operators and guidance from the government, potentially significant risks of transmission of the coronavirus persists in bars, especially when customers are intoxicated.
  • Experts say alcohol seems to be one of the major factors fueling this risk because it lowers inhibitions, making people less willing to comply with safety protocols.

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Throughout the course of the COVID-19 pandemic, everyone has had to assess risk. It’s become a part of “normal” life.

What is a safer activity to engage in than others? How can one socialize safely while still adhering to protective measures such as wearing masks and physical or socially distancing? These are the questions we constantly debate internally, weighing how we can safely adapt to our current circumstances while keeping the safety of ourselves and others in mind.

These questions most acutely apply to ways we socialize.

Debates over the safety of dining out at and patronizing bars and restaurants have been at the center of these discussions.

It’s been a hot button issue, prompting caution from health experts while drawing the ire and concern of business owners who have been hit hard by the health crisis and offered little to no financial support to adjust to the changes the pandemic has brought about.

A new study out of Scotland plays further into these tensions. Published in the Journal of Studies on Alcohol and Drugs, the new research delves into whether pubs or bars can properly mitigate COVID-19 virus transmission risks.

Ultimately, the authors concluded that “despite the efforts of bar operators and guidance from government, potentially significant risks of COVID-19 transmission persisted in a substantial minority of observed bars, especially when customers were intoxicated.”

To conduct their research, the authors conducted phone interviews with stakeholders in Scotland’s pub industry, including representatives from licensed bars and hospitality trade associations.

The interviews took place from May to June 2020, touching on business practices and some of the challenges posed by reducing new coronavirus transmission in these kinds of establishments.

After these businesses reopened in Scotland, observations of 29 bars were made in July and August 2020, monitoring each space while posing as customers.

While they found the businesses sometimes went to great lengths to ensure COVID-19 safety — from new indoor layouts and signage to contact tracing efforts — they found that at some establishments, not all staff adhered to wearing personal protective equipment (PPE). At the same time, patrons didn’t always maintain social distancing or wear masks.

For these researchers, why might an indoor bar or a pub, specifically, pose more risks than another venue, like a sit-down restaurant or even a store?

Niamh Fitzgerald, PhD, director of the University of Stirling’s Institute for Social Marketing and Health, led the research, funded by the Scottish Government Chief Scientist Office.

First, she said, pubs and bars are social spaces outside the household where people can relax and socialize. For some people, this involves “leaving your cares at the door — so your guard is dropped,” Fitzgerald wrote in an email to Healthline.

People might feel “less inclined to adhere to regulations, and for the time when you’re in the premises, less worried about risks,” she added. This could also apply to indoor social venues such as theaters or cafés.

“The second reason is that alcohol directly impairs people’s ability and willingness to adhere,” she added. “People under the influence of alcohol are less able to judge distances — their hearing is affected, so they speak more loudly and need to lean in to hear others.”

Alcohol seems to be one of the major factors fueling risk. Fitzgerald explained that alcohol “lowers inhibitions,” making people less willing to comply with safety protocols.

Dr. Jennifer Lighter, an epidemiologist at NYU Langone Health, told Healthline that bars are a risk given that they involve people walking around to talk to strangers in close proximity, often shouting over loud music.

“Intoxicated people talk closer and lose a sense of personal space. Those are all factors, which of course increase risk when we’re talking about indoor bar spaces,” said Lighter, who was not affiliated with this research.

Dr. Joseph Khabbaza, pulmonary and critical care physician at the Cleveland Clinic, echoed those thoughts, saying alcohol — just like any drug — alters one’s ability to make judgments. It’s why you shouldn’t operate a vehicle or heavy machinery while under the influence.

Similarly, if you are attempting to protect yourself and others from a communicable respiratory disease in a public space, it will be harder to do so responsibly while heavily intoxicated.

“It’s tougher to enforce guidelines at a bar, especially when there are TVs on and people are watching sporting events, for instance, which generate more emotional dialogue and cheering — anything that causes louder exchanges like that means the potential for more droplets to be released,” Khabbaza, who was also not affiliated with this research, told Healthline.

Of course, gradations of risk and safety exist. Lighter said that people often unfairly lump restaurants and bars together.

She said that while an indoor bar is one of the “riskiest venues,” a restaurant, where people are sitting exclusively with their group or pod, away from others, with dividers between seats and tables, poses fewer risks.

She also cited a difference between indoor and outdoor settings.

“Look at protests in New York City that took place in the summer. You did not see any increased amount of transmission in the thousands of people who were participating together outdoors,” Lighter added.

To that point, she added that an outdoor bar, as long as people still sat apart from groups that were not their own, wore masks when conversing with staff, and adhered to other measures laid out by the establishment and local boards of health, would be safer than an indoor bar.

“Outdoors is significantly safer. It’s easier to distance folks outdoors, but there is still going to be some risk,” Khabbaza added. “If you have people outdoors congregating around an outdoor TV sporting event maskless, well that is going to have some risk — it will be lower than if it was indoors, but still a risk.”

When asked if there was such a thing as a truly “safe” public space in the COVID-19 era, Fitzgerald said “no.”

“No public space, or business where the public gather, can be considered ‘safe’. The question is whether they can be ‘safe enough,'” she wrote.

“There are basic things businesses can do, that most of the premises we observed were already doing – changing their layout, capacity, one-way systems,” Fitzgerald added.

“They could have done more (and probably already are now) on staff PPE, insisting on customer PPE if moving within the premises, preventing queuing inside and outside, etc., and they could have done more on enforcing rules around toilets (one person in the restrooms at a time etc.),” she wrote.

Also, Fitzgerald stressed that the “big change” needed is communicating clearly with customers and staff about established “COVID-safe norms in the premises” and enforcing those rules without “the premises feeling like a policed environment.” Of course, that’s a big challenge for any business.

“For many premises, setting these norms and expectations on entry in a friendly but firm way would help customers feel safer being there, and make it easier to nip any noncompliance in the bud,” she wrote. “But a lot of support is needed for some premises to train staff to understand what expectations are reasonable and how to skillfully set these norms with customers in that friendly but firm way.”

Fitzgerald added that this can be more challenging for places with more inexperienced staff than others or that see a large “rate of turnover of staff.” She wrote that it is also “harder for smaller businesses to find the resources to put in place high-quality training.”

Fitzgerald’s study has certainly attracted some criticism from some stakeholders in Scotland’s bar and nightlife industry.

The Scottish Hospitality Group (SHG) called the study a “sham of a report,” according to industry magazine The Spirits Business.

The organization cited the small sample size and cited its own data on low numbers of transmissions among bar employees.

It’s understandable why feelings are charged within the hospitality industry when it comes to studies like this and discussions over the safety of bars and restaurants. Domestically, the industry has been hit in an unprecedented way.

The leisure and hospitality industry in the United States saw 498,000 jobs lost in December 2020 alone, according to Reuters.

Restaurants and bars accounted for 372,000 of those positions.

It’s forced these kinds of businesses — many of them independently owned small businesses — to be creative in how they adapt to the pandemic. Oftentimes, they’ve sometimes received contradictory guidance from local and national groups as well as limited financial support.

It also doesn’t help that the onslaught of new, more transmissible variants of SARS-CoV-2, the virus that causes COVID-19, have inserted more fear and confusion over how to best combat the pandemic.

What should people consider if weighing whether to go out to a bar this weekend?

Fitzgerald wrote that people should “make sure they are aware of what rules apply,” and if COVID-19 vulnerability is a personal concern, they should contact the business and ask what protective measures they have in place.

“If in a premises and not happy with the safety measures, again, customers should raise their concerns with management, but be prepared to leave if necessary,” she added.

Both Lighter and Khabbaza mused on whether COVID-19 might forever alter how we interact with bars. In the short term, Lighter suggested that, as more people start to frequent bars and restaurants again as restrictions continue to lift around the United States, patrons might have to show “proof of vaccination” at the door along with a valid I.D.

“People might have to show a negative test that day or record of vaccination,” she added.

Lighter said that eventually, this virus will be like the flu — with variants arriving each year requiring us to get regular vaccinations.

This means that treatments and vaccinations will continue only to get better, and as the current dangers of the pandemic subside, the act of frequenting bars and indoor dining will be less fraught.