For a few months, it seemed like the U.S. was on the path toward post-pandemic life, with constant mask-wearing and endless anxiety largely a thing of the past. Highly effective, widely available vaccines had curbed case counts and allowed people to gather safely across the country throughout the spring and early summer. In May, the Centers for Disease Control and Prevention announced that the fully vaccinated could, for the most part, stop wearing masks indoors. Diners and restaurant workers alike were able to relax as bars and dining rooms filled back up and friends met to celebrate some form of normalcy.
But the emergence of the highly contagious delta variant amid low vaccination rates in certain parts of the country — and a growing body of data indicating that infections among the vaccinated are more common than previously believed — has radically upended the national outlook: Another wave of the pandemic has arrived. Nationally, new cases have been spiking, to a seven-day average of more than 114,000 on August 11 — more than five times the average number of daily cases one month ago. Hospitalizations are surging again, especially in states with low vaccination rates: According to a report in the Washington Post, states with vaccination rates below 40 percent have hospitalization rates four times higher than states with vaccination rates of at least 54 percent.
The tone of public-facing guidance has remained largely calm and reassuring as delta continues to spread — it now makes up 98 percent of COVID-19 cases in the U.S. — but the CDC’s decision to reissue mask-wearing guidance for fully vaccinated people in late July also indicated a level of alarm within the organization. And now it appears that the public health guidance to date may be both overestimating the vaccine’s effectiveness regarding transmission of the delta variant, and underestimating the risk it poses to fully vaccinated people. According to the New York Times, preliminary data in a handful of states — California, Colorado, Massachusetts, Oregon, Utah, and Vermont — indicate that “breakthrough infections accounted for 18 percent to 28 percent of recorded cases in recent weeks,” and “12 percent to 24 percent of Covid-related hospitalizations.” To be sure, such “breakthrough” infections aren’t driving the pandemic, and vaccination continues to greatly reduce the risk of infection and hospitalization. But as David Wallace-Wells recently wrote in New York Magazine, breakthrough infections “do appear prevalent enough to be helping shape the course of the disease.”
Eric Topol, a physician and scientist who works for Scripps Research, estimates that the vaccines’ efficacy against symptomatic transmission of the delta variant in fully vaccinated people is about 60 percent, though he later suggested that it could be as low as 50 percent. A preprint study (meaning it has not been peer reviewed) published by the Mayo Clinic puts that number at just 42 percent. The vaccines’ efficacy against symptomatic transmission of previous strains of COVID-19 in fully vaccinated people was 90 percent or higher. On August 18, the Biden administration announced that all vaccinated Americans will need booster shots, and will be eligible for one eight months after their initial dose.
The key variable in the latest surge is that the delta variant is far more transmissible than the original or alpha strains of the virus, owing at least in part to its much higher viral load — the infected, including the vaccinated, carry massive amounts of virus in their nose and throat (roughly 1,000 times more than the original strain), meaning they can more easily spread the virus to others. “Delta is spreading 50 percent faster than alpha, which was 50 percent more contagious than the original strain of SARS-CoV-2,” F. Perry Wilson, a Yale Medicine epidemiologist, said in conversation with Yale Medicine. “In a completely unmitigated environment — where no one is vaccinated or wearing masks — it’s estimated that the average person infected with the original coronavirus strain will infect 2.5 other people... In the same environment, delta would spread from one person to maybe 3.5 or four other people.” The CDC now estimates that number is actually between five and nine.
The CDC doesn’t provide data for breakthrough infections at the state or local level, and it doesn’t keep a tally of such infections that don’t result in hospitalization or death, so it’s as of yet difficult to understand precisely how common breakthrough infections are. Data provided in an internal CDC presentation in July estimated some 35,000 cases of symptomatic COVID in vaccinated people per week, among 162 million vaccinated Americans, as of July 24. “The message that breakthrough cases are exceedingly rare and that you don’t have to worry about them if you’re vaccinated — that this is only an epidemic of the unvaccinated — that message is falling flat,” Harvard epidemiologist Michael Mina told Wallace-Wells.
If the vaccines gave people a sense of hope after 18 months of uncertainty, then the delta variant has quickly rewritten the rules of risk assessment because it has proven far more effective than any previous strain at infecting fully vaccinated people. A month ago, the conventional wisdom was that fully vaccinated people could safely gather in bars and restaurants, sans masks. A few weeks later, the CDC threw a spanner in the works with its latest guidance around masking, but it still appeared as though it was relatively safe for vaccinated people to gather indoors. The delta variant has shifted the goalposts once again, and it’s clear that the risk calculus for sitting inside a dining room — even a dining room that requires proof of vaccination upon entry — is very different than it was even at the beginning of July.
Restaurants and bars are, once again, caught in the middle of a crisis they have little control over, just as many are attempting to get back on their feet after a calamitous year and a half. While some cities and states have issued updated mask mandates or proof of vaccination requirements, the issue has become so politically charged that governors and local politicians continue to debate whether or not to reinstate regulations — with some leaders even deliberately stoking ire around them for political gain. In Kansas City, Missouri, for instance, a mask mandate went into effect on August 2, but the measure is being ferociously opposed by Missouri’s attorney general, Eric Schmitt, who claims his aim is to protect people’s freedoms — illustrating the deeply uncertain political and regulatory environment hampering the ability of restaurants to protect their staff and recover from the last year of lockdowns.
It’s been clear for some time now that COVID spreads more easily in indoor spaces without adequate ventilation, especially in restaurants, and in many parts of the country, unvaccinated people who choose to drink and dine indoors are at high risk at the moment, according to experts like Jonathan Reiner, a CNN medical analyst and professor of medicine and surgery at George Washington University, who said in an interview with CNN that “if you are not vaccinated right now in the United States, you should not go into a bar, you should probably not eat at a restaurant. You are at great risk of becoming infected.”
Despite the growing fear of breakthrough infections, the risk to fully vaccinated individuals remains relatively low, depending on the rate of transmission in their area. David W. Dowdy, an infectious disease epidemiologist and an associate professor at the Johns Hopkins Bloomberg School of Public Health, emphasizes that the rise of breakthrough cases is not a sign that vaccines are ineffective: The rates of hospitalization remain low for vaccinated people; the chances of contracting COVID have simply gone up as we all come into contact with greater numbers of infected people. “The vaccine is not 100 percent effective, and you’re going to run up against a certain number of unvaccinated people in your daily life,” he says. “Let’s say that in a month you’re going to be in contact with 100 people who are unvaccinated. If one out of those 100 is going to have COVID, and you’re vaccinated, you’re most likely not going to get the disease. But if 10 of those people have COVID, then your risk of getting that breakthrough infection just went up 10 times. Everyone’s risk of a breakthrough infection in the past month has gone up four to fivefold, because we’re just seeing that much more infection.”
Experts encourage those who are vaccinated to take more than their own health into account when making decisions. “It’s a reasonable time for us to be a bit more cautious,” says Dowdy. “If we are talking about groups of people where everyone in that group is vaccinated, the risk to that group and to others around them [in a restaurant], is relatively low — I would say low enough to be something that would be safe.”
Dowdy says that wearing a mask indoors when vaccinated provides additional protection, and encourages others who may not be vaccinated to do the same. When a certain portion of the population takes off their masks, Dowdy says that it becomes more likely that others — including those who are unvaccinated — will follow. “If you don’t want to get sick, and you’re vaccinated, the best thing you can do is your small part to get infection levels down in your community.” According to Dowdy, that means wearing a mask whenever possible. “From a practical perspective, the only way that you’re going to get unvaccinated people to wear masks as a large group is going to be to require that everyone does.”
Over the past month or so, the sense that we’re not out of the woods just yet has grown among restaurant operators, who have begun taking extra precautions beyond state or local mandates, even in areas like Boston where vaccination rates outpace the national average: maintaining distance between tables, prioritizing outdoor dining instead of indoor dining, requiring workers to be fully vaccinated, and requiring diners to wear masks, show proof of vaccination, or both if they wish to eat indoors.
Anthony Caldwell, who owns 50Kitchen in Dorchester, Massachusetts — and has never lifted his restaurant’s mask requirement — told Eater in May that he was nervous about the loosening of state guidelines because he thought it would allow unvaccinated people to behave in a way that wasn’t safe. “It creates an honor system, and we know there are a lot of people who aren’t honest,” he said.
In San Francisco, where community spread is substantial, the Bar Owner Alliance, which represents about 300 bars across the city, recommended in July that local bars check for proof of vaccination before allowing patrons to gather indoors, weeks before the city mandated it. Its president, Ben Bleiman, who also owns a pair of bars, said that checking for proof of vaccination is “what we need to do to protect our staff and families ... The data doesn’t lie. I don’t care what Joe Rogan says. People who are unvaccinated are much, much more likely to hurt somebody who is unvaccinated.”
Across the bay in Oakland — where COVID cases have also spiked in recent weeks — the Kon-Tiki and sibling restaurant Palmetto are requiring that guests show proof of vaccination or a negative COVID test before they enter. Co-owner Matthew Reagan says that it was yet another tough decision after a year and a half of tough decisions, and he knows it will turn some people off, but in the end he and his business partner had to think about the health and safety of their staff and customers. “As much as this can be seen as authoritarianism or altruism, it’s also a business decision,” he says. “We have staff with friends who are vaccinated and testing positive — some with symptoms, others without — and they’re worried ... We don’t want to get anyone sick.”
Without government intervention (on the local, state, or federal level), however, it’s another burden that falls on individual restaurant operators and their overworked staff. Replying to a tweet about the SF Bar Owner Alliance’s decision to recommend its member bars check for vaccination cards back in July, Pim Techamuanvivit, the owner of the critically acclaimed restaurants Nari and Kin Khao, wrote: “Unless the city make[s] it a mandate, then you’re leaving it to vulnerable restaurant workers to face potentially volatile situations on our own.” San Francisco became subject to a mask mandate on August 3, and city officials announced on August 12 that a vaccine mandate would go into effect on August 20.
Throughout the pandemic, restaurant workers have dealt with an epidemic of angry customers over masking requirements and other COVID safety protocols, which sometimes lead to abuse or assault. As long as local and state legislators don’t act to reinstate COVID restrictions, restaurant workers and operators will be the ones tasked with enforcing the rules at individual restaurants that choose to tighten protocols. “Unless there is some concerted effort from the city, from the county, or from the state to help us enforce it, it’s just a paper tiger,” Techamuanvivit told Eater in late July. “Until the city, the county, or the state comes up with some standardized way of proving someone’s vaccination record without violating their privacy, and also make it easy for us to be able to verify these things, then I don’t know how we’re supposed to do it.”
Before San Francisco issued its mandates, guests at Techamuanvivit’s restaurants were still expected to wear masks whenever they weren’t seated at their tables, and staff was required to be fully vaccinated and had to wear masks at all times. But that’s as far as she felt she could go, short of legislative intervention. “When there was a mask mandate, even when it was a mandate from the city and from the county, it was such a mess,” said Techamuanvivit. “And this is even worse, right? Requiring to see someone’s evidence of vaccination or tests?
“You’re creating all of this potential for explosive interactions.”
The situation is more dire in states like Texas, whose legislature has put health and safety at the bottom of its list of priorities throughout the pandemic, and where restaurants risk losing their liquor licenses if they dare to require proof of vaccination. Gov. Greg Abbott — who recently tested positive for COVID-19 — lifted the statewide mask mandate and reopened the state’s economy at 100 percent long before the vaccine rollout began in earnest leaving restaurant workers (and guests, even the angry ones) more vulnerable to the virus in a state with one of the lowest vaccination rates in the country.
Roots Chicken Shak owner and Top Chef contestant Tiffany Derry, who operates restaurants in food halls in Austin and Plano and a brick-and-mortar just outside of Dallas, kept a mask mandate for guests and staff for much of the pandemic, an unpopular decision in the state. In an essay for Eater in March, she wrote that she was “overcome with a mix of emotions — mostly shock, anger, and disbelief” when Abbott rescinded the state’s mask mandate. “In Texas, we are already feeling the effects of Gov. Abbott’s decision,” wrote Derry. “Restaurants like mine are starting to see backlash from guests who don’t want to support us for trying to keep everyone safe. Some businesses have received threats, guests have caused public scenes, and Yelpers are leaving negative reviews based on mask policies.”
Months later, Derry and her business partner Tom Foley continue to recommend that their staff wear masks, but they are no longer requiring that their guests do so. “We take a firm stance that this is a health issue, not a political issue,” says Foley. “But masks have breached and straddled health and politics, and sometimes those recommendations are not understood in terms of health prioritization.” In other words, masking has become such a politically contentious issue in Texas that operators don’t feel as if they can possibly require customers to wear them inside their restaurants, even amid a new surge in COVID cases.
Danny Meyer, one of the most influential restaurateurs in the country, announced in July — before New York City announced its own mandate, which went into effect August 16 — that his New York-based Union Square Hospitality Group would require proof of vaccination from all indoor diners and drinkers, as well as current employees and new hires. “This is the most logical thing I’ve ever seen,” Meyer said on CNBC’s Squawk Box. “I’m not a scientist, but I know how to read data and what I see is that this is a crisis of people who have not been vaccinated, and I feel strong responsibility, on our part as business leaders, to take care of our team and our guests, and that’s what we’re doing.”
For some operators, business has been tough for more than a year, so the latest legislative interventions don’t really change much in terms of trying to remain open — even if their Yelp pages are being flooded by one-star reviews as a result. John and Roni Cleveland, owners of Los Angeles restaurant Post & Beam, told Eater they’ve required that staff and guests wear masks since the beginning of the pandemic. They don’t anticipate that a second mandate — or a proof of vaccination requirement — will affect business any more than the pandemic already has.
Back in Oakland, Reagan of Kon-Tiki noticed that sales had gone down as infection rates began to spike in the Bay Area. But recently, after beginning to require proof of vaccination or a negative test result, according to Reagan, sales, price per ticket, and server tips have already gone up — indicating that where there is some level of assurance about COVID safety, diners may remain undeterred about venturing out. “We’re not taking a position on why or why not to get vaccinated,” says Reagan. “But we’re saying that customers and staff are both demanding it, and we just want to make sure we’re not getting anyone sick.”
Still, the delta variant marks a concerning new twist in the pandemic, and threatens to pull diners, restaurant workers, and business owners alike into further precarity, where one thing remains certain: The best thing anyone can do is get vaccinated and wear a mask.
This story was most recently updated on August 18.