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Covid-19 live updates: U.S. hospitals in crisis as Idaho rations care

Idaho has one of the lowest vaccination rates in the country.
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When can we start enjoying nightlife again? 
A merry disco in Schleswig-Holstein, Germany, with a rapid Covid-19 test requirement for dancing without masks. | Markus Scholz/Picture Alliance via Getty Images Scientists don’t want you to be going out right now. But if you must … Over the course of the last 18 or so months, I watched as my friends, and flagrantly attractive people I follow on Instagram who aren’t my friends, started picking up hobbies. Some grew plants. Others began knitting. People were reading and hiking and baking and binge-watching, seemingly making the best of a bad situation. As much as I wanted to enjoy these appropriate pandemic hobbies, I found myself wanting to pass the time only one way: dancing to the disco hit “Rasputin” in a crowd of people — preferably, but not limited to, gay men. This has been an elaborate yearning in my soul. Previously, I wasn’t that deeply invested in going out. I don’t know how this desire started, or why, beyond the addictive hook, “Rasputin” is my song of choice. I can’t explain the logistics of this intense personal fantasy. But I think it goes back to the concept of never appreciating what you have until it’s gone. In 2020, nightclubs and bars were shut down abruptly to slow the spread of Covid-19. Had I known the speed at which it was going to happen, I might have gone out at least one more time. A year and a half later, I have the option. Nightlife — clubs and bars — has come back. New York City, where I live, has more than a few really great disco parties, provided you are fully vaccinated. Lawmakers and public health experts have loosened messaging and restrictions, even as warnings about the delta variant continue. But the question that lingers is, if nightlife was shut down so urgently at the beginning of the coronavirus pandemic, should we be going out at all while it continues? Is there really a responsible way to dance to “Rasputin” in a nightclub full of sweaty people? The strict and simple answer from public health experts is no, not yet. But if people were strict and simple when it comes to following public health advice, the US would probably be having a different conversation regarding Covid-19. ​​The answer to these questions then involves understanding personal risk and recognizing our own responsibility to the communities we belong to. This past summer, in Provincetown, Massachusetts, public health experts reported an outbreak that was connected to nightlife and affected many people who were already vaccinated. Very few of those vaccinated people appeared to get severely ill, but it was a real-life illustration of the risk that remains. And on the flip side, some scientists say that outbreak displayed a real-life example of a community coming together and mitigating harm, not only with vaccinations but also by proactively protecting one another. In turn, it provided us a model that we could all use when we think about risk assessment. What to think about if you’re going to go out In an epidemiologist’s ideal world, no one would be going out. All of the epidemiology professors I spoke to — including from UCLA, Columbia, NYU, and the University of Washington — said they would not personally partake in a night at a crowded indoor nightclub or bar right now. Nightlife venues are risky because they satisfy everything Covid-19 needs to thrive. They’re indoors and ventilation isn’t usually great. They’re crowded with people in close proximity to one another. Those people are usually yelling to be heard over the music — yelling propels droplets into the air, which is both gross when you think about it and unnerving when you consider that’s how SARS-CoV-2, the virus that causes Covid-19, is spread. Throw the virus into a place with all those combined factors and it could spread quickly and easily. That’s why the epidemiologists I spoke to wouldn’t be going out. “Epidemiologists are often the buzzkills of the party,” Danielle Ompad, an associate professor of epidemiology at NYU’s School of Global Public Health, told me. “But we are the buzzkill so you can continue having fun. We’re all about harm reduction and let’s have fun in a way where there aren’t consequences. “ Ompad said that on a spectrum of risk assessment, epidemiologists and public health officials skew toward the very careful end. She recently went to a homecoming celebration for her alma mater and said that even with capacity restrictions and vaccination requirements, she still kept her mask on and maintained distance from unmasked partiers. Saeed Khan/AFP via Getty Images Australians drinking in a bar on October 11, after 106 days of Syndey’s lockdown. They are happy. But a huge part of public health is understanding that humans are going to be human, the epidemiologists also noted. Some will make mistakes. Some won’t follow every rule. Some won’t listen to every piece of advice. On top of that is the year-and-a-half of shutdowns, restarts, and disruption to normal life — things that can affect decision-making, especially impulsive decisions. Hence the emphasis on harm reduction. Nightlife establishments are open, across the US, so epidemiologists understand that the human inclination is to go to them. They also understand that an idyllic world of regular and extensive testing, masking, and reduced capacity is pretty far from the world we have. All that in mind, there are a few things epidemiologists say we should consider if we do partake in nightlife. Barun Mathema, an assistant professor of epidemiology at Columbia’s Mailman School of Public Health, explained that there are three general factors to think about with regard to risk: the level of community transmission and vaccination, what precautions a venue is taking to ensure safety, and personal vaccination status. What you’re looking for is high vaccination and corresponding low Covid-19 positivity rates and cases per capita, within your community; venues that take precautions like reduced capacity, vaccination checks, and ventilation; and making sure you are fully vaccinated. Triangulating those three factors, Mathema explains, can help make something as fluid as risk easier to grasp. “Risk is a very difficult concept to understand, even as somebody who studies risk for a living,” Mathema told Vox. “If you are fully vaccinated, are healthy, have no underlying reasons to be put in a higher risk bracket, and your environment and community is in near or full vaccination compliance — you can say that’s a fairly low personal risk environment at that point.” The wrinkle in this risk calculus is, Mathema explains, that there are still a lot of variables. For example, even if everyone presents vaccination records at the door, the efficacy of vaccines generally wanes over time, meaning the people present may have slightly different levels of immune protection. There are also stories popping up about fake vaccine cards. Breakthrough infections do occur and have occurred at nightlife venues. So while these guidelines can help you assess risk in going out, the risk present in nightlife — or really any activity — will never be at zero. The completely safe activity would be staying home alone. What makes Covid-19 precautions so complicated is that our personal decisions don’t just affect us. The coronavirus is contagious. It spreads via airborne droplets. If you get sick from visiting a nightlife venue, you could put the people around you — at the grocery store, at the cleaners, at a restaurant, etc. — at risk. Conversely, you could have a situation in which you contract Covid-19 without even being at a nightclub — you just happen to come into contact with someone who was. “That’s always been the problem with these types of respiratory-based diseases. It’s not just about your risk. You can’t just say, ‘I don’t care’ or ‘I’m young and healthy,’ because you may be unfairly and unknowingly putting other people at risk,” Mathema said. To fully grasp the personal risk of going out to bars or clubs during Covid-19 means not just thinking about if this kind of risky activity presents a danger to you, but also how it affects the people around you. It means thinking about the communities and social circles you belong to, and how to keep people within those spheres safe. If you’re going out, protect the people around you While partaking in nightlife and fun might be optional for many of us, there are a lot of people in the service and entertainment industry where it’s their livelihood. Terence Edgerson, a nightlife producer based in New York City, saw the pandemic shut down the city that never sleeps and then watched it slowly reawaken in recent months. “I would say it’s been a roller coaster without any stops,” Edgerson told me. “Usually you have the option of getting on or off. But this was one where I didn’t have any options. It’s different when your work is your life and that it’s also your livelihood.” Edgerson credits his friends with helping him while nightlife was put on pause. Slowly, outdoor events — New York City allowed outdoor dining and drinking with social distance restrictions in June 2020 — were allowed to happen again. But it wasn’t until around June 2021 that Edgerson’s parties were happening full-time again, with proof of vaccination, for Pride. (New York City announced a vaccine mandate for indoor venues in August, but many businesses, including Edgerson’s parties, were already implementing similar restrictions over the summer.) “All of our parties have been vaccine-only and we’ve gotten no pushback and no blowback from it,” Edgerson explained. The fragility of New York City nightlife in 2020 changed the way Edgerson and many in his cohort looked at vaccination mandates and safety measures. Instead of viewing them as hindrances, he sees them as ways to keep his friends safe and keep his livelihood intact. In epidemiology-speak, Edgerson was thinking about protecting his community. Any pushback against vaccination checks and safety precautions such as reduced capacity, Edgerson asserts, would be dwarfed by the backlash if a party was the epicenter of an outbreak. New York City nightlife, especially gay nightlife, is intensely interconnected. An outbreak at one party could hypothetically set off a chain reaction in which parties, clubs, and bars around the city could get shut down again. “It’s our mental health escape. It’s so vital that we take care of it and take care of each other and ourselves.” An outbreak did happen around the Fourth of July, about 200 miles north of New York City in Provincetown. P-town and its indoor venues, including nightclubs, bars, and live shows, saw an estimated influx of over 60,000 people over the holiday weekend, and with it saw a surge of more than 1,000 Covid-19 cases, according to the Washington Post. Many were alarmed that the coronavirus spread in a town with vaccination checks and in a county with a high vaccination rate. That 1,000-case figure might seem like a startling number, especially for a town that had just a handful of cases prior to July 4. But it’s less than 2 percent of the estimated 60,000 people who visited over the weekend. Further, thanks to vaccinations, many of those cases were asymptomatic or mild. Only seven people were hospitalized, and no one from that cluster died. Instead of being a nightmare scenario, some public health officials are looking at Provincetown’s outbreak as a community success. The vaccination rate and the vaccination checks at the venues are evidence that these pre-emptive precautions help keep people safe, they argue. But there’s also another element: the way in which people in P-town, gay men especially, were proactive about testing and public health measures. This, some experts say, can be traced to the way the gay male community responded to the HIV/AIDS epidemic, especially when the American government failed to act in its early stages. “In P-town, I think that there was a community of gay men who understand the importance of contact tracing,” Pamina Gorbach, a professor of epidemiology at UCLA who has an expertise in HIV. Gorbach explained that in the absence of tools and structural support, the gay male community had to come together to protect one another. Those important lessons are being reflected and praised in this pandemic. “I think being public about infection, letting people know — that’s a great example of community care,” Jennifer Balkus, an assistant professor of epidemiology at the University of Washington, said. “Talking about testing openly is one of the key ways to help reduce stigma. And that is super important to promote testing and eventually isolating, and quarantining if they need to.” Balkus, Gorbach, and epidemiologists I spoke to said that masking at venues would be ideal, as would treating each outing like a possible exposure and following CDC guidelines. This means that if you go out on a weekend, you would then get tested three to five days after, wear a mask in public, and limit your exposure to people in the meantime. Epidemiologists also stressed the importance of regular testing and communicating the results, especially with the lack of robust contact tracing here in the US. That might be as simple as shooting a text to your friends or anyone who was out with you or calling the venue if you test positive. Or in the social media age, it’s posting to your followers. Ilker Eray/GocherImagery/Universal Images Group via Getty Images Here are some people dancing in Istanbul. Are they dancing to “Rasputin”? I’m not sure, but I hope so. Edgerson explained to me that in the wake of P-town, and in rare cases of breakthrough infections, he’s seen friends post about testing positive and telling people who they were with to go get tested. He said he gets tested often, and he urges his followers, friends, and fellow partiers to get tested regularly — before and after his parties. “If one of us gets sick, you know, many more can get sick — it affects us all,” Edgerson said. “And dancing, and queer dancing especially, is so vital to us. It’s our mental health escape. It’s so vital that we take care of it and take care of each other and ourselves.” The response to the Provincetown outbreak offers lessons about personal accountability to the people around us and perhaps a model for anyone who’s going out. Hopefully, there will be a day when we can, if the spirit moves us, dance to “Rasputin” in a sweaty nightclub without a worry in the world. For now, it’s helpful to know how to think about those worries, and how to act responsibly in the meantime.