On a sunny Saturday in January, Ruth Hatfield was sitting with a friend’s dog on a sidewalk bench in downtown Grand Junction. Back home in Snowmass Village, 120 miles away through winding Rocky Mountain roadways, local officials had just shut down indoor restaurant dining as COVID-19 cases reached some of the highest levels in Colorado.
Here in Grand Junction, though, restaurants were open, and Hatfield had sought out those with the local health department’s “5-star certifications,” a designation meant to reassure people it is safe to patronize businesses during the pandemic.
Those 5-star restaurants are part of an innovative program that allows businesses that agree to follow certain public health protocols to be open with less stringent rules than would ordinarily apply.
At a time when officials in parts of the nation are facing backlash from business owners who have been hurt by COVID-19 restrictions, Mesa County’s 5-star program encourages them to partner with the local health department to promote the directives.
Whether the approach boosts compliance with health directives remains to be seen. This largely rural county of 154,000 people on the Utah border is divided about COVID-19 protocols, with many still skeptical of wearing face coverings.
For example, Hatfield recalled a recent visit to a 5-star certified restaurant in Grand Junction where a party of four ignored a host’s request that they wear masks while waiting to be seated.
“I’m impressed with the 5-star program, but I’m not impressed with the level of mask-wearing here,” she said.
Mesa County public health director Jeff Kuhr and Diane Schwenke, president of the Grand Junction Area Chamber of Commerce, came up with the idea for the 5-star program in June.
“It is a way of encouraging [businesses] to do the right thing, that they could then use as a marketing tool,” Schwenke said.
Businesses interested in the program fill out a form and the health department sends them a list of program requirements, which include mask enforcement for employees and customers, regular cleaning schedules, hand-sanitizing stations and spacing of furniture, Kuhr said.
The program launched in July with about 100 businesses, including restaurants, gyms and bars, and has since grown to around 600.
The Colorado Department of Public Health and Environment was so pleased with the Mesa County program that it unveiled a statewide version in December, with Douglas County becoming the first in the Denver metro area to be approved. Officials in Utah, Michigan and Canada also have expressed interest.
“This whole event is about juggling viral suppression” while preventing economic devastation and the upheaval it brings to families and communities, said Jill Hunsaker Ryan, executive director of the state health department.
The 5-star program has helped keep restaurants open despite rising COVID-19 numbers, but state officials are still analyzing data to see if it helps reduce the spread of the virus, Hunsaker Ryan added.
In practice, public health isn’t just about medicine. It’s about politics too, said Kirsten Bibbins-Domingo, professor and chair of the Department of Epidemiology and Biostatistics at the University of California-San Francisco. Though COVID-19 health directives have sometimes pitted business owners against public health officials, the 5-star program aims to unite the two.
“Ultimately, you have to deal with compliance not just with the hard hand of enforcement, but also with strategies that engage people in the goals of public health,” Bibbins-Domingo said.
Because participation in the program provides the opportunity to operate with looser restrictions on capacity and hours, businesses have incentive to comply, “even if they don’t think that the coronavirus exists — and we still have people here who believe that,” said Bill Hilty, medical director of the emergency department at St. Mary’s Hospital in Grand Junction.
“The program doesn’t impugn people who didn’t believe in COVID or in masks,” Hilty said. “Their freedom was not infringed.”
Any business is eligible for the program, but it is especially appealing to gyms, restaurants and bars, which face restrictions on capacity and, in some cases, hours. For instance, Mesa County’s restaurant capacity limit under current COVID-19 rules is 25 percent, but eating establishments in the 5-star program are allowed to seat up to 50 percent capacity. Schwenke estimated that at least half the county’s restaurants have signed on.
The 5-star program has “absolutely saved us,” said Josh Niernberg, executive chef and owner of restaurants Bin 707 Foodbar, Taco Party and Bin Burger in Grand Junction.
Even so, he said, he has mixed feelings. The program allowed his businesses to remain open, but support in enforcing the rules has been minimal, he said.
Niernberg worries about the risk to his employees, who face “a daily struggle with anti-maskers” who visit his restaurants and demand to know why they’re being asked to wear a mask there, when other establishments not in the program don’t require them.
Even with the 5-star program, Bin 707 is operating at about a 20 percent loss each week, he said. Mesa County’s 5-star restaurants may be allowed 50 percent occupancy, but they’re also required to have 6 feet between tables. That spacing allows just 22 percent occupancy at Bin 707, Niernberg said.
In Mesa County, compliance is enforced by the honor system, reports from the public and occasional compliance checks by health department employees. About 10 establishments have been booted from the program for noncompliance.
Kuhr said his department does not release the names of businesses that have left the program.
On the face of it, loosening rules imposed to slow COVID-19 might seem like a bad idea, but if the 5-star program can produce better compliance with public health rules, it might be a good strategy for slowing the coronavirus, said Bibbins-Domingo of UCSF.
“I don’t want to dismiss the strategy, because buy-in is the holy grail in public health communication,” she said.
At the same time, when cases and community spread reach critical levels, as they did recently in Colorado and across the U.S., then at some point there’s a faulty logic to keeping businesses open, even with restricted hours, which may not do much to slow transmission. Density, on the other hand, “is very clearly related to transmission, so it’s the one thing I’d be very loath to ease up on,” Bibbins-Domingo said.
Whether the 5-star program would nudge businesses to accept public health directives or would simply be used as license to open was something considered as the program was coming together.
“We discussed this early on — who’s going to use this as a loophole and then not require masks,” Schwenke said. “We were worried about that initially, but the interesting thing is that this has seemed rare.”
This story was produced by Kaiser Health News. KHN is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.
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