An indoor bar opening event in rural Illinois in February was linked to 46 cases of COVID-19, a new study finds, highlighting the dangers indoor gatherings in places like bars can pose.

The study from the Centers for Disease Control and Prevention (CDC) found that the event was linked to 26 COVID-19 cases in patrons at the bar opening and three in bar staff, who then spread the virus on to an additional 17 people who were not at the bar opening, known as “secondary cases.”

Showing the ripple effects one event can have, those secondary cases included 12 people across eight households with children, two on a school sports team, and three in a nursing home, the study found. A school serving 650 students was closed as a result of the outbreak, and one nursing home resident was hospitalized.

The results serve as a warning as many states lift restrictions on bars and other businesses. Illinois recently delayed a further reopening step as hospitalizations rose, but bars and restaurants are currently open with capacity limits.

“These findings demonstrate that opening up settings such as bars, where mask wearing and physical distancing are challenging, can increase the risk for community transmission,” the study states.

The CDC recommended a range of measures to help reduce risk in settings like bars, including reducing occupancy, spacing people at least six feet apart, improving ventilation and emphasizing outdoor seating, which is significantly safer.

The virus was introduced to the nursing home through an attendee of the bar event who worked in the nursing home and was asymptomatic, resulting in an additional staff member and two residents getting infected. None of the four were vaccinated, even though all staff and residents of the nursing home had previously been offered the vaccine, the study said, which appears to highlight the problem of vaccine hesitancy.

The study also shows the importance of staying home when sick or when diagnosed with COVID-19. According to the study, one attendee of the bar event, who was asymptomatic, had been diagnosed with COVID-19 the day before the event. Another four people had symptoms while attending the event and were diagnosed with COVID-19 afterward, the study said.

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