Ruminations: Risky Business for COVID Transmission

"In addition to dining at a restaurant, case-patients were more likely to report going to a bar/coffee shop, but only when the analysis was restricted to participants without close contact with persons with known COVID-19 before illness onset."
"Direction, ventilation and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance. Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use."
"Efforts to reduce possible exposures where mask use and social distancing are difficult to maintain such as when eating and drinking, should be considered to protect customers, employees and communities."
U.S.Centers for Disease Control and Prevention study

“Exposures and activities where mask use and social distancing are difficult to maintain, including going to places that offer on-site eating or drinking, might be important risk factors for acquiring COVID-19,” the researchers wrote. Photo by Joe Raedle /Getty Images

A new study released from the CDC (Centers for Disease Control and Prevention) has concluded that people who test positive for COVID-19 were judged to be twice as likely to have eaten out at a restaurant than their counterparts who tested negative for the novel coronavius. Data on 314 adults who, following having experienced symptoms in July, took COVID-19 tests identifying 154 of that number characterized as positive 'case patients', as compared to 160 'control-patients' testing negative.

Tests were conducted at eleven facilities in ten U.S. states: California, Colorado, Maryland, Massachusetts, Minnesota, North Carolina, Ohio, Tennessee, Utah and Washington by health care professionals. It was ascertained that 42 percent of the case-patients had reported close contact with someone known to have COVID-19, in comparison to 14 percent of the control-patients. For the most part, 51 percent of the close contact was among family members.

Of the participants with COVID-19, 71 percent wore a face mask in public, similar in number to those who tested negative, 74 percent of whom also wore face masks. The difference between the two groups was that one contingent dined out at restaurants -- whether indoor dining rooms, patios or other outdoor seating. Prior to becoming ill with the novel coronavirus, case-patients were about twice as likely to report having dined out at some point within that two-week period, as opposed to the control group which did not.

The researchers involved in the study noted that they made no differentiation between what type of dining out was involved in the questions posed to the participants; whether indoor versus patio, an elaboration which might have had a bearing on exposure, while they also conceded that the eleven health centres involved also might conceivably not be representative of people at large. That participants, in addition, knew their test results might have influenced their responses.

new york city bars and restaurants reopen

A New York City restaurant offering outdoor dining. Noam Galai/Getty Images

Limitations aside, eating and drinking at restaurants as highlighted by the researchers, as well as other food service establishments "might be important risk factors" linked to COVID-19 infections, the study points out. Since restaurants have begun reopening on a limited basis, while observing COVID-19 hygiene protocols, the safety of all concerned has been top of mind. It was estimated by Restaurants Canada that ten percent of restaurants have permanently shuttered as a result of COVID-19.

The Canadian Chamber of Commerce feels it possible that by November the number of closures could soar to 60 percent, reflecting the reality that patio dining will become impractical as cold weather enters the picture. In the absence of evidence suggesting COVID is spread by handling or eating food, according to the CDC and the World Health Organization, certain steps are recommended to practise safety from contracting the disease.

At the opposite end of the danger-of-infection-spectrum the CDC identified takeout, drive-throughs and delivery services as posing the lowest infection risk from a restaurant setting as opposed to restaurants with indoor and outdoor dining where tables have failed to be reduced in numbers, nor spaced the obligatory six feet distance from one another. Additional high-risk social activities were identified as gatherings with family and friends, religious functions, and movie theaters or sporting events.

Continuing to practise good hand hygiene, wearing a mask when not eating, avoiding high-touch areas like self-serve touchscreens and shared serving utensils, and critically, maintaining a distance of at least two metres (six feet) from others. "Try to assess the whole environment. Go into something where you're going to feel safe and enjoy yourself", urges Jeffrey Farber, a professor of food microbiology at the University of Guelph.

All is not entirely forbidden by practising cautionary behaviour however; outdoor recreational activities and going to the beach, both while maintaining a reasonable distance, are deemed to represent low-risk by health experts. Air circulation quality has been pinpointed as a culprit in indoor spaces and gatherings, critical in advancing virus transmission. The country hit most seriously in the pandemic is the U.S, reporting over 6.3 million cases and close to 200,000 deaths, according to Johns Hopkins University's tracker.