North Carolina is cutting off alcohol sales to stop COVID-19 spread. But will it work?

Raleigh and Charlotte last week joined Chapel Hill and other cities cutting off late-night alcohol sales to slow the spread of the coronavirus, especially among young people.

On Tuesday, Gov. Roy Cooper announced a statewide order that will stop the sale of alcoholic drinks in restaurants, breweries, wineries and distilleries at 11 p.m. effective Friday. Bars that are currently closed will remain closed.

The governor’s order will not apply to grocery stores, convenience stores or other businesses allowed to sell alcohol for off-premises consumption. And communities with earlier cut-off times like Chapel Hill and Orange County, where sales end at 10 p.m., can keep them.

At a news conference, Dr. Mandy Cohen, the secretary of the N.C. Department of Health and Human Services, said the state is concerned about the growing number of COVID-19 cases in people 18 to 40 years old.

In Raleigh where sales already end at 11 p.m., Mayor Mary-Ann Baldwin cited unmasked crowds ignoring social distancing in Glenwood South and other parts of the city.

But in the middle of the pandemic, with over 116,000 laboratory-confirmed cases in North Carolina, does science support these measures?

In April, the World Health Organization encouraged countries to restrict access to alcohol during lockdown measures for two major reasons.

First, myths were circulating that drinking high-proof alcohol could kill the coronavirus in a person. In reality, alcohol tends to weaken the body’s immune system, making a person more vulnerable to COVID-19.

Second, health officials worried that people buying alcohol and drinking at home would be more likely to harm themselves or others.

A survey by RTI International in Research Triangle Park recently found people are drinking more during the pandemic, especially parents, women, unemployed people, people of color and adults with mental health conditions, The News & Observer reported.

Greenland and South Africa broadly restricted alcohol during their lockdowns in the spring. In Greenland, the sale of drinks with an alcohol content over 2.25% was banned in the capital, Nuuk, and two other cities. (A typical “light beer” contains about 4 percent alcohol.) Low-alcohol drinks were permitted to prevent dangerous withdrawal symptoms in people dependent on alcohol.

South Africa implemented a nationwide ban on the sale of all alcoholic beverages, initially for lockdown, but then extended it to three months even as reopening began.

In the current pandemic, risky behaviors associated with alcohol are especially concerning because they take up medical resources when people are injured in fights and accidents. In South Africa, where an estimated 40% of ER visits are alcohol related, the BBC reported, the ban is credited for reducing visits to emergency rooms by about two-thirds. That allowed hospitals to focus more on treating coronavirus patients.

Restricting alcohol sales

In the United States, few states and cities restricted alcohol sales during stay-at-home measures in the spring, beyond closing most bars and restaurants to indoor dining.

As confirmed coronavirus cases now surge across the country, officials are looking at new ways to contain the virus.

Zenreach, a marketing and technology company, estimates that nationwide, foot traffic to bars and nightclubs increased by almost 70% from May 1 to July 15. At the same time, coronavirus cases increased by over 120%.

North Carolina’s foot traffic increase by 30%, with a 400% increase in coronavirus cases.

In Florida, bars and other venues that sell alcohol without food service have been ordered to only sell alcohol for off-premises consumption. Texas restricted bars to delivery and take-out, and California has done the same in most counties.

South Carolina has ordered bars and restaurants to stop selling alcohol after 11 p.m. but is otherwise keeping them open.

Raleigh’s order goes further than many by including grocery-store alcohol sales in the curfew.

Bars as ‘superspreaders’

With so many different policies in effect, which, if any, work best at containing the virus?

“In the midst of the pandemic, it’s difficult to evaluate these policies,” said Pamela Trangenstein, a professor of health behavior in the UNC Gillings School of Public Health.

What unites many of these orders is an attempt to prevent bars and restaurants from becoming hot spots.

“When it comes to COVID, bars are acting as superspreaders,” Trangenstein said.

A bar near Michigan State University has been linked to almost 200 COVID-19 cases. Contact tracing and research shows many COVID-19 cases acquired from outside the home can be linked to bars and restaurants.

Health experts consistently rank going to a bar as one of the riskiest activities during the pandemic. Aside from being indoors with many people, drinking can lower inhibitions, keeping people from using masks and maintaining a physical distance.

There isn’t a specific best time to stop drinking, which may be one reason different places have different cut-offs.

According to Trangenstein, “every additional two hours of late night alcohol-sales are associated with increased harms.” While there isn’t data specifically on COVID-19 and alcohol sale hours, a review found that longer sales hours led to more injuries, drunk driving, and violent crime.

Raleigh’s order includes grocery stores to prevent people from buying alcohol and congregating elsewhere at night after bars stop their sales. This could help reduce the other alcohol-related harms, Trangenstein said, while bar restrictions primarily focus on reducing risks associated with a lack of social distancing.

Pia MacDonald, an epidemiologist at RTI International, said these restrictions will only be a small part of adjusting to life with the coronavirus. Business will need to come up with innovative ways to protect employees and serve customers.

“Setting up a timestamp of when to stop serving alcohol may not be the most effective way to reduce transmission in those settings,” she said.

People will need to agree on new social norms, like consistently distancing and wearing masks, so businesses can safely stay open, MacDonald said.

“It’s very disrespectful to show up in a place with other people and not wear a mask. ... We need to make it cool, we need to make it popular, we need to make it considerate and modern to wear the mask as long as we have got coronavirus transmission going in our communities,” she said.

As bars, restaurants, businesses, schools and other venues reopen, MacDonald said people should not expect “reopening into how it was before,” she said.

“It’s opening into a new world.”

This story was originally published July 28, 2020 at 11:54 AM with the headline "North Carolina is cutting off alcohol sales to stop COVID-19 spread. But will it work?."