An ongoing dialogue on HIV/AIDS, infectious diseases,
September 13th, 2020
Restaurants Are Hurting — But Dining Indoors Poses Real COVID-19 Risk
As we learn more about transmission of SARS-CoV-2, the news for restaurants goes from bad to worse.
And while there’s a long list of sad things about this pandemic, the decimation of the restaurant business for owners and the people who work there is right up there. The loss of the restaurant experience for us diners is pretty sad, too.
Importantly, restaurant dining isn’t one of those hypothetical risks for COVID-19, such as surface contamination of groceries and delivered packages. It’s a real, well-documented concern with strong supporting evidence.
In a CDC study conducted at 11 healthcare facilities and just published last week, investigators queried 154 people with symptoms consistent with COVID-19 and positive tests, along with 160 control individuals testing negative. They asked about various activities in the two weeks prior to the onset of symptoms — eating out, shopping, going to an office, visiting a hair salon, taking public transportation, attending a religious service, and others.
People with positive test results were more than twice as likely to have reported dining at a restaurant than were those who tested negative. No other activity conferred significant risk.
It’s a small study, and the authors note several potential limitations, but they amplify the message that crowded settings, close contact, and lack of mask wearing indoors increase the risk of COVID-19.
The vagaries of restaurant ventilation — so exquisitely detailed in this investigation of a restaurant outbreak in China — add to the hazards of indoor dining.
Here, one presymptomatic person infected nine other diners, all of whom sat under the the same air conditioning vent that recirculated “old” rather than fresh air.
None of the 68 diners in other areas developed COVID-19, nor did any of the 8 waiters — likely because transient contact is much lower risk.
Meanwhile, Harvard epidemiologist Professor Miguel Hernan compares epidemic curves in New York and Madrid in this fascinating thread:
Look at the shape of these curves.
New York and Madrid had similar epidemics until they spectacularly diverged.
In March, both cities were caught by surprise and shut down because of #COVID19.
In September, the situation is under control in NY and alarming in Madrid.
— Miguel Hernán (@_MiguelHernan) September 11, 2020
What does this have to do with restaurants?
In New York, indoor dining is CLOSED. Indoor dining in Madrid was OPEN at 60% capacity in June. Bar service opened too. Protocols weren’t aggressively enforced. Since June it has been easy to find crowded bars and tables. The contrast with NY was striking as anyone spending time in both places can tell you.
Is it too far fetched to extrapolate from these cross-city comparisons and conclude that opening restaurants played a role? Not really, when you consider how cases in the southern US spiked when bars and restaurants opened in regions that still had significant community transmission.
(And having had the pleasure of dining late — and I mean late — into the evening in Madrid, I can assure you that these meals are the very opposite of transient when it comes to potential exposure time.)
As noted above, all this information about restaurants and COVID-19 risk makes me very sad. Having grown up in New York — arguably one of the world’s great restaurant cities — I love the way a top restaurant experience provides more than just excellent food. The atmosphere, the conversational buzz, the decor, the rituals, and of course the intermingling of so many different cultures enhance our lives in countless ways. Certainly I’m not alone in missing this colorful aspect of life from the Before Times.
Not only that, but my mother worked as a food writer, and for years wrote a weekly column in the New York Daily News on hidden restaurant gems in the city. If a new Ecuadorian restaurant opened in Queens that generated some buzz, you can be sure we’d soon be sampling some empanadas ecuatorianas or llapingachos.
Meanwhile, awaiting a vaccine and other preventive strategies, what can we do now to support these hurting restaurants?
Dine outside while we can. Tip heavily. Order take out. Buy merchandise. Other ideas here.
But skip the indoor dining in restaurants for now. And while we miss it, it might help to remember that eating out isn’t always so great.