And more importantly, will they help?

By Claire Gillespie
November 30, 2020
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As the US passes its 13 millionth COVID-19 case, curfews are being put in place across the country, in hopes of reducing the spread of the virus. In California, Governor Gavin Newsom imposed a curfew on all indoor social gatherings and non-essential activities outside the home across most of the state, meaning "nonessential work and gatherings" are banned from 10 p.m. to 5 a.m. A similar curfew was issued by Governor Mike DeWine of Ohio. And in New York, Governor Andrew M. Cuomo directed bars, restaurants, and gyms to close by 10 p.m.

Cue a lot of unhappy people, some of whom have taken part in protests against their local curfews. On Nov. 28, about 80 people gathered at the Santa Monica Pier to protest Newsom's limited stay at home order, a week after a couple of hundred did the same at Huntington Beach Pier. Similar demonstrations have been held in upstate New York and Minnestota.

Some cities have taken a targeted approach, setting a curfew for residents in ZIP codes with surges in COVID-19 cases. But this has created different rules for different places, resulting in confusion—as well as disappointment, especially as the holiday season gets underway. So what's the thinking behind these curfews—and is there actually any science to back them up?

The hope behind COVID-19 curfews is simple: To reduce infection rates

Curfews are in place to reduce opportunities for people to gather. "The hope is that it will discourage and decrease mobility among populations with the highest infection rates who are also most likely to be out late at night," Anne Rimoin, PhD, MPH, professor of epidemiology at UCLA Fielding School of Public Health, tells Health. "The thinking behind this is that people who are out past 10 p.m. and before 5 a.m., doing things other than grocery shopping or other essential tasks, may be out at bars or restaurants or at events where they are likely to let their guard down and be less likely to wear a mask or social distance. The biggest impact of a curfew is likely that it is a signal about the seriousness of the situation—and how we all need to limit contact with others."

Obviously, the best way to get infection rates as low as possible is to go into another lockdown. But that has serious financial implications, not to mention the widespread mental health impact of stay-at-home orders. Dan Tierney, DeWine's press secretary, said a complete closure of Ohio bars, restaurants, and gyms had been considered, but the Governor believed the economic impact would have been too damaging. So the curfew, together with the statewide mask mandate and social distancing, is something of a plan B. "We think we can make a dent in these numbers by doing what we're doing," Tierney told The New York Times, referring to Ohio's surge in COVID-19 infections. As of Wednesday, state health records showed that confirmed cases in Ohio were up to 351,304, along with 6,118 total deaths and 25,069 hospitalizations.

In a statement published on his website, Newsom explained the reasoning behind the curfews in California as well, where the rate of COVID-19 cases increased by approximately 50% during the first week of November. "The virus is spreading at a pace we haven't seen since the start of this pandemic and the next several days and weeks will be critical to stop the surge," Newsom wrote. "We are sounding the alarm. It is crucial that we act to decrease transmission and slow hospitalizations before the death count surges. We've done it before and we must do it again."

While having different curfews in place in different parts of the country, and in adjacent cities and counties, is potentially confusing (particularly when people can still cross county lines, as Dr. Adalja points out), some experts believe it's sensible for each jurisdiction to have its own rules.

"I think it's preferable for each jurisdiction to consider the extent of the pandemic in their local communities and take appropriate steps to intervene, rather than trying to impose a 'one size fits all' approach," Dr. Seidman says. However he adds that it would perhaps reduce the confusion if the guidance was clearer. "It would be very helpful if the CDC and/or State Departments of Public Health established guidelines that could be followed at the state and local level."

The science and data behind COVID-19 curfews, however, are less straightforward

There is some evidence that bars and restaurants are COVID-19 hotspots. In September, a study by the Centers for Disease Control and Prevention (CDC) found that adults who tested positive for COVID-19 were around twice as likely to have reported dining at a restaurant in the 14 days before becoming ill than those who tested negative.

"Contact tracing efforts have shown that the most common sources of the spread of COVID-19 include gatherings at places such as restaurants and bars," Richard Seidman, MD, chief medical officer of L.A. Care Health Plan, the largest publicly-operated health plan in the US, tells Health. "The goal of limiting late night and early morning operating hours of these types of businesses is to reduce the extent to which people are at increased risk of close contact and, therefore, becoming infected."

A recent report from the CDC analyzed trends in percent positivity by age group in COVID-19 "hotspot" counties and found that the highest percent positivity was among the 18–24 years (14%) age group. According to the authors, "addressing transmission among young adults is an urgent public health priority."

But of course, the 10 p.m. closing time put in place by many COVID-19 curfews is confusing to many—especially since the virus isn't limited by time. "There is no time of day or night that the virus is more likely to spread than any other," infectious disease expert Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security in Maryland, tells Health.

However, Dr. Seidman points out that while it's true that the virus behaves the same, day or night, people do often behave differently as the night wears on, particularly when alcohol is involved. In other words, people are more likely to interact closely with others, and be less vigilant in terms of mask-wearing and social distancing, if they've been drinking for a few hours. But that argument doesn't support curfews on gyms and movie theaters, where alcohol isn't involved.

Dr. Adalja says there's no hard data to support the use of curfews to reduce COVID-19 spread, and warns that they might, in fact, have the opposite effect. "Social interaction is what drives spread and curfews might paradoxically drive people to private gatherings—where spread may be more likely," Dr. Adalja warns. While there are rules against at-home gatherings, it's extremely difficult to prevent them. And there's always the risk of the curfews backfiring, if people try to pack into establishments that aren't enforcing COVID-19 safety guidelines (such as social distancing and mask wearing) before the curfew.

Some people are also arguing that it's more important to keep schools open right now and forget about curfews and close bars and restaurants altogether—a view Rimoin can understand. "Personally, I think we should be focusing on finding ways to reduce spread of the virus so we can keep our schools open," she says. "Placing heavier restrictions on activities that present higher risk transmission than schools would be helpful in reducing spread. With the virus spreading so rampantly, we are going to have to make choices—do we want to keep bars and restaurants open or do we want our schools open?"

However, Rimoin points out that there's no "one size fits all" scenario. "High schools can be a source of community spread than elementary schools because the older kids tend to get—and spread—the virus more readily."

Right now we don't have a lot of data on how curfews work as a single measure. There is no one measure that will make a difference, we have to use a layered approach. Curfews can help by reducing opportunities for people to be gathering, but they won't work on their own.

If rates of COVID-19 infections decrease, that's a pretty clear indication that curfews are working, Rimoin says. She points out that curfews—along with other restrictions—have been effective in reducing spread in Europe. But she also notes that a "layered approach" is the best solution. "Curfews won't work on their own, although targeted curfews in places like college towns where you see significant gatherings late at night are potentially helpful," she says. "A national strategy for masks and social distancing is the best option."

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