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Tribal casinos across Southern California remained open this week, even as many businesses in the region were forced to shutter or pare back services due to new stay-at-home orders from the state.

On Tuesday night, the Agua Caliente Band of Cahuilla Indians' casino in Rancho Mirage was fairly busy, with visitors playing slots and dozens of people eating at the casino's several indoor restaurants. While waiting to be served, many diners went mask-less.

Over in Cabazon, Morongo Casino Resort and Spa was promoting meal specials for its 16th anniversary. San Manuel Casino in Highland said on social media that it feels confident about the decision to keep operating and about the casino's safety protocols. And Fantasy Springs Resort Casino in Indio is still hosting outdoor live music throughout the week.

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California's latest COVID-19 shutdown, triggered by alarmingly low levels of intensive care unit capacity, has now affected most of the state. The three-week order came into effect for much of the lower half of California late last Sunday. Residents are prohibited from gathering; grocery stores are limited to 35% capacity; bars, salons, and indoor and outdoor restaurant dining have to shut down; and church services must be held outside, among other restrictions.

But Native American tribes, as sovereign nations, are not required to follow the state's stay-at-home order.

More: Why three tribal casinos in Southern California waited until June to reopen

Agua Caliente: Cathedral City casino opens ahead of Thanksgiving

Six separate outbreaks of three or more cases have occurred at Riverside County casinos in the last six months, county officials confirmed to The Desert Sun this week. The highest number of local outbreaks has been seen in grocery stores, with 80 instances since July.

At least one viral infections expert expressed concern that casinos are staying open.

'In my opinion, any crowded indoor activity is a terrible idea at this point,' said Juliet Morrison, a virologist at the University of California, Riverside. 'We are in a pandemic, and we are already seeing new and higher cases of COVID-19. So I don't think they should be open at all.'

Clifford Trafzer, a professor of American Indian Affairs at UCR, also underscored the gravity of the pandemic.

“I believe in tribal sovereignty,' he said. 'I also believe all people of the United States have a civic duty to join in the nationwide fight against COVID-19. This is a war against a virus and every citizen must do their part to fight our common enemy.”

Pandemic approach has varied by casino

When coronavirus first swept the region in March, all tribal casinos in the Coachella Valley voluntarily closed for several months. Many cited a duty to help stop the spread of the virus, even while acknowledging that the lengthy pause in business could be financially crippling for some tribes.

Since those initial closures, each local tribe with a gaming facility has taken a slightly different approach to reopening.

Agua Caliente Rancho Mirage, for one, has continued to offer large, indoor conference areas for private events or meetings. The East Valley Republican Women Federated is one group that has taken advantage of that event space in recent months, hosting a luncheon in early November followed by an election night party.

Photos from that party, included in the group's monthly newsletter, show women sitting and standing closely together around several tables. Many are not wearing masks. The Desert Sun and other local media were denied access to cover the election event 'due to the global pandemic,' an Agua Caliente spokeswoman said at the time.

Agua Caliente Rancho Mirage has postponed some indoor concerts; one originally scheduled for last week was pushed to an undetermined date. But the tribe opened its third casino, in Cathedral City, a few days before the Thanksgiving holiday.

Agua Caliente did not respond to multiple requests for comment about events or operations at its casinos.

Some gaming facilities in the valley have scheduled a regular lineup of outdoor concerts. At Fantasy Springs, owned by the Cabazon Band of Mission Indians, live music shows are held outside several nights of the week, with mask and distancing rules in place. Maximum capacity at those concerts is 1,500, which is 50% of the pre-virus maximum, said Michael Felci, public relations manager for the casino. But so far, attendance hasn't been over 500.

The Fantasy Springs special events center has also been used as a COVID-19 testing area and space for casino employee trainings, like orientation. All employees are tested for coronavirus weekly. The center has not been used for public events such as concerts.

'The Cabazon Band of Mission Indians enjoys sovereignty, just like all tribes do,' Felci said. 'However, our guests, our employees are obviously the most important thing — their health, their safety. So we're following the news, we're getting the latest reports just like everybody else.

'Everything we've seen up until this point has not looked promising for large indoor gatherings.'

As of Friday, Fantasy Springs is planning to continue operating as it has since reopening in June with certain health protocols. Outdoor concerts are still being held.

Six outbreaks at Riverside County casinos

Though casinos in the region have been generally tight-lipped about coronavirus cases at their properties, outbreaks have been documented at some facilities.

Six outbreaks, meaning three or more associated COVID-19 cases, have been recorded at Riverside County casinos between June and November, according to county spokesman Jose Arballo Jr. Four different casinos each had one outbreak, while a fifth casino has had two.

Arballe added that, as is the case with other localized outbreaks, the county does not release the names of the individual casinos.

'We also continue to communicate with tribal officials when it is requested about the best practices to help slow the spread of the coronavirus within their casinos and among the visitors and employees,' Arballo said.

From July to this month, there have been a total of 314 documented outbreaks at a range of different businesses, the county reported. While grocery stores top the list, they're followed by retail stores with 71 outbreaks, warehouses with 46, restaurant and food with 33, and skilled trade and labor with 18.

The county's regular outbreak reports do not include specific numbers for casinos.

Casinos could be considered high-risk environments for COVID-19, as described by six public health experts in a ProPublica article from August, which examined casinos in Las Vegas. Factors that contribute to that risk include being indoors, possibly having crowded areas and people who are 'prone to taking risks,' the article reported.

In a best-case scenario — where mask usage is enforced, there's sufficient space between players, and a dealer, who is also wearing a mask, is blocked by a sheet of plexiglass — the risk level is about a six out of 10, Morrison, the virologist, said.

Add indoor dining, bars and a lack of masks in the casino, and the risk level goes to nine, she said.

'Especially when people are drinking, they're really not paying attention to safety at that point,' she said. 'So that's a really high-risk activity.'

Measures like spacing out customers and using a good HVAC system, or heating, ventilation, and air conditioning, could reduce risk. The U.S. Centers for Disease Control and Prevention suggest that casinos consider improving ventilation in the building in consultation with an HVAC professional.

A general rule of thumb is 'the shorter the distance, the higher the risk,' said Marcus Kaul, an associate professor of biomedical sciences at UCR.

Masks help, he said, 'but if you think about a table game, poker tables, roulette tables, people get in pretty close contact.' Not every casino has reopened table games at full capacity during the pandemic.

People are also potentially touching the same slot machines, cards, chips and other objects, making frequent cleaning and sanitization important.

Overall, open casinos could increase the number of cases in the area, Morrison said. If workers are not adequately protected, they could bring infections back home. Visitors are also increasing their risk of taking COVID-19 back to their communities.

'I think it has the potential for a really negative impact and increasing cases in this pandemic,' she said.

Some casinos strictly enforce mask-wearing, hold regular COVID testing

Every local casino has implemented certain public health measures in the past year, though some to a greater degree than others.

'From day one of the pandemic, we have made health and safety our top focus and we have persistently adhered to the most rigorous of safety standards,' San Manuel Casino wrote last Thursday in its announcement that it would stay open. 'The San Manuel Business Committee and our executive leadership are actively monitoring the landscape and evaluating guidance from our retained medical experts and county public health officials.'

Many casinos have implemented and strictly enforce face mask requirements, temperature checks, some new occupancy limits, hand sanitizing stations and other measures. Agua Caliente and Fantasy Springs promoted new casino apps on Facebook this week, which lets users play slots and table games on their phone. A few casinos are now only offering food from their restaurants to go.

In states like Nevada, where the majority of casinos aren't owned by tribes, more onerous restrictions have been given to all facilities. The state mandated that casinos, and other places like arcades, art galleries and libraries, must reduce capacity to 25% last month. Casinos in Pennsylvania were also forced to close completely for three weeks, starting this weekend, according to PennLive.

Some tribal casinos in Southern California have mandated regular COVID-19 testing for employees.

Felci from Fantasy Springs said earlier in the pandemic that the casino had avoided a 'cluster' situation by starting its testing regimen, enforcing mask-wearing and social distancing, instituting temperature screenings and increased cleanings, and moving entertainment outdoors.

Of the casino's workforce of more than 1,000 people, the percentage of positive cases has been 'super low,' he said last week.

'There's been no significant 'outbreak' of sorts,' Felci said. Employees who test positive are sent home with pay for 14 to 16 days and must test negative twice before they return to work.

'Public health and safety' requirements

Under the Indian Gaming Regulatory Act, every tribal gaming ordinance enacted by a tribe must include a 'public health and safety' protection clause. The National Indian Gaming Commission (NIGC), a federal agency, does not approve an ordinance unless that provision is included, according to a National Law Review article from March.

'So the ordinance does have health and safety standards that the tribal casino and management must adhere to,' said Michael Anderson, founder of the firm Anderson Indian Law in Washington, D.C., and former deputy assistant secretary for Indian Affairs at the Department of Interior. 'But there's essentially no role from the state of California in regulating that conduct.'

If the maintenance or operation of a gaming facility threatens public health and safety, the NIGC has the power to issue a temporary closure order.

With respect to COVID-19, the NIGC published guidance for casinos in March, pointing to recommendations from the CDC for mass gatherings and large community events. The CDC said in guidance released this month that casinos open at full capacity are at the highest risk.

The NIGC also suggested 'swift action' be taken to contain spread if a casino has a presumptive positive case.

It's unclear if the NIGC has issued any closure orders for casinos due to a COVID-19 outbreak or lack of certain virus-related health and safety protocols. The commission did not respond to an interview request.

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'(NIGC) does have the ability to enforce ordinances that contain health and safety standards,' Anderson said. 'But I have not seen any cases to date where the Gaming Commission has stepped in to close a casino on that basis (as it relates to COVID-19).'

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Katherine Spilde, a professor and chair of the Sycuan Institute on Tribal Gaming at San Diego State University, reiterated that tribal governments are seeking to protect public health just like any other government.

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'Tribal governments have the same public health mandates that any government would have, which would be to protect their citizens and residents, protect their employees who come to work at their properties, and to, of course, protect the guests who come to have an experience in Indian Country,' she said.

Gov. Gavin Newsom's administration has held 'government-to-government' conversations with tribal leaders throughout the pandemic, the California Department of Public Health said in an email to The Desert Sun.

With the new stay-at-home orders, the department said, those conversations are now continuing over conference calls.

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Amanda Ulrich writes for The Desert Sun as a Report for America corps member. She can be reached by email at amanda.ulrich@desertsun.com or Twitter @AmandaCUlrich.

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This article originally appeared on Palm Springs Desert Sun: Tribal casinos remain open as Southern California adjusts to COVID-19 stay-at-home order