Many restaurants in all 50 states are open for dining out in some capacity, but health experts are still concerned that some situations could lead to more spread of COVID-19, especially as record cases are reported across the country.
A recent study from the Centers for Disease Control and Prevention (CDC), published on Sept. 11, found that adults who tested positive for coronavirus were "approximately twice as likely to have reported dining at a restaurant" compared to those who had negative test results. Aside from the time spent at restaurants, participants reported "generally similar community exposures."
In the past week, New Jersey and New York have issued curfews and limited indoor dining hours in restaurants and bars, while San Francisco will halt indoor dining all together on Nov. 13.
Experts said that while there is still potential for safe dining — especially in outdoor and distanced settings — it's important that people be careful and aware of their surroundings when dining out.
What makes dining indoors so risky?
According to the CDC, the lowest-risk option is limiting food service to "drive-through, delivery, takeout and curbside pickup" options. Eating outdoors at distanced tables is "more risk," while offering distanced indoor and outdoor seating is "even more risk." The highest level of risk comes from offering both indoor and outdoor seating with no distance or capacity restriction.
A number of factors complicate dining out, especially indoors, including the inability to "effectively" wear masks while eating and drinking. The CDC study also notes that reports of exposures in restaurants have been linked to air circulation, since "direction, ventilation and intensity of airflow might affect virus transmission even if social distancing measures and mask use are implemented."
"I think we are unfortunately at a situation where indoor dining is probably more of a risk than some other indoor activities," said Dr. S. Patrick Kachur, a professor of population and family health at the Columbia University Medical Center. "You have to take off your mask and you're often engaged in conversations in close quarters. There may be ambient noise you're talking loud to talk over, and all of those things can increase the number of viral particles that are expelled in total."
Dr. Dean Winslow, a professor of medicine at the Stanford University Medical Center in Stanford, California, said that another problem with eating indoors is the amount of time you spend in a restaurant.
"Your risk of acquiring coronavirus is a product of both the concentration of the virus that's in the air and the time that you're exposed to it," he said.
"It's honestly one of the more dangerous positions that a person can put themselves in," Winslow continued. "The air is relatively stagnant, which makes it higher risk. We do know now that social distancing by itself, while that protects against transmission from large particle droplets, it doesn't really help with those small particle aerosols generated by speaking ... You can't keep a face covering on while eating and drinking, (so) it's a really high-risk environment."
Winslow said that while he "loves" going to restaurants and bars, he'd be a "little bit reluctant" to eat indoors right now.
"The more you can limit your indoor exposure, the better off you'll be," he said. "Of course restaurants are (limiting capacity), and that helps, but you're still depending on the ventilation system, you're in their buildings, and you're still putting yourself at more risk by going to restaurants indoors."
Do indoor dining precautions work?
Dr. David Dowdy, an epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health, said that there are some indoor dining precautions which can be taken, but none of them will make indoor dining as safe as eating outdoors or getting takeout.
"Facing tables apart, limiting the number of people who can be in given space, requiring people to wear masks when they're not eating, disinfecting tables very proactively between different parties" are all likely to have an effect, he explained.
Some cities and states, like New York and New Jersey, have continued to limit indoor dining and are also implementing curfews that will prevent some establishments from operating indoors after 10:00 P.M.
Dowdy said that while these measures may limit the amount of people in a restaurant and reduce "opportunities for transmission," they won't "make too much of a difference" in safety.
"It's not like it's riskier for someone to eat at 11:00 P.M. as compared to 8:00 P.M.," he said. "The longer the day goes on, the more opportunities for transmission there are, so curfew may have some small effect."
Winslow agreed with Dowdy's assessment of the curfews.
"I'm not really sure about the rationale for it other than it reduces the total number of people that are in an establishment during a 24 hour period," he said. "On the surface of it it doesn't seem to make a lot of sense to me."
Other effective precautions include proper ventilation, having tables and guests spaced apart, and collecting information from diners to aid in any potential contact tracing efforts that may be taken.
Do I have to worry about food or silverware?
Winslow said that while there is some risk in eating out, that risk comes from aerosolized particles, not food, silverware or other surfaces.
"There's really no good data that I'm aware of that shows that the virus is efficiently transmitted by food, and this is primarily an airborne pathogen. I"m personally not paranoid or particularly worried about contaminated surfaces or silverware and things like that," Winslow said.
Winslow noted that the virus is "fragile," and regular soap and water or a dishwasher cleanser would be "more than adequate" for killing the virus on surfaces.
What's the safest way to go to a restaurant?
While the CDC guidance recommends getting takeout or delivery as the safest option, Winslow said that eating outdoors could be safe in most areas, so long as the weather cooperates.
"There is good data to show that it's much safer to be outdoors," Winslow explained. "In the outdoor environment you've got much better ventilation, and these small particle aerosols that we now feel are very important for the transmission of COVID-19, they diffuse much more rapidly outdoors than they do in relatively still air indoors."
If you do choose to eat indoors, protect yourself as much as possible by practicing good hand hygiene and wearing your mask at all times unless you are actively eating or drinking. It can also help to dine out in places that have set up physical barriers between tables, and it's important to select restaurants that are spacing tables at least six feet apart.