How risky is dining out right now? Here's the research

By Physician Sense

Published July 9, 2020

Key Takeaways

Of all the simple pleasures of pre-pandemic life, perhaps dining out is the most sorely missed. Even sitting down at an Olive Garden without fear of dying would be nice right about now. But can you do so without risk? And should you? All signs seem to point to no.

First, there are the obvious problems — even for outdoor dining. We’ll circle back to that later, but first, let’s focus on indoor dining. Indoor dining means proximity, which in turn means diminished social distancing. Also, eating is usually a requisite component of indoor dining. Last we checked, it’s difficult to eat through a surgical mask. That’s problematic, since masks are necessary for curtailing the spread of the virus.

For example, a recent Proceedings of the National Academy of Sciences of the United States of America (PNAS) study showed that while social distancing is effective, social distancing combined with mask-wearing is even better. Researchers concluded that “wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic.”

Air-conditioned hot zones

Summertime also means heat. Ovens and stoves make restaurants hot, even on cool summer days. That means indoor dining will almost always require air conditioning. This is problematic, as highlighted by a research letter published in Emerging Infectious Diseases early in the pandemic.

Researchers investigated the transmission of COVID-19 in a Guangzhou restaurant. Among the 10 people who contracted the disease there, they determined that the source of this outbreak was a patron who had recently traveled from Wuhan. The restaurant’s air conditioning system exacerbated the droplet transmission from the traveler, carrying viral particles between tables, infecting one or more person(s) at each table.

This initial study stands against a backdrop of increasing concern about COVID-19’s potential airborne transmission. 239 researchers recently sent an open letter to the WHO, saying that it’s time to look more closely.

The letter highlights the following troubling findings:

Simply talking releases microdroplets that can float between 1-2 meters from an infected person.
When reviewing video footage from the restaurant study above, researchers saw no person-to-person contact between patrons.
If COVID-19 behaves like similar viruses, then it’s possible that “viable airborne viruses can be exhaled.”

The scientists wrote:

“We appeal to the medical community and to the relevant national and international bodies to recognize the potential for airborne spread of COVID-19. There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission.”

Don’t spray it

Another problem with airborne transmission is that it isn’t an isolated event. Aerosolization (like what happened in the Guangzhou restaurant) keeps viral particles aloft longer. The PNAS research article cited above explains that large droplets, such as those from a cough or sneeze, settle comparatively faster.

“In contrast, aerosols are efficiently dispersed in air,” researchers wrote. “While transmission via direct or indirect contact occurs in a short range, airborne transmission via aerosols can occur over an extended distance and time. Inhaled virus-bearing aerosols deposit directly along the human respiratory tract.”

All of this seems to indicate that going to Olive Garden — or any indoor restaurant for that matter — may mean putting your life at risk. And is it really worth risking your life over Olive Garden?

Speaking of risk, it turns out that in the age of COVID-19, eating a non-home–cooked meal can be broken into three different risk profiles. According to the CDC, they are:

Lowest risk: Drive throughs and takeout.
More risk: Outdoor setting with lower capacity and 6 feet of space between tables
Highest risk: Indoor and outdoor dining with normal capacity and no spacing.

Surface and service tension

Top-of-mind for many would-be restaurant patrons is surface transmissibility. Can I contract coronavirus from touching chairs, plates, utensils, etc.? According to the CDC, surface transmission of COVID-19 is possible; however, “the primary and most important mode of transmission for COVID-19 is through close contact from person-to-person.” In keeping with other respiratory diseases, the CDC says you could catch COVID-19 by touching an infected surface, then touching a mucus membrane.

Speaking of “close contact from person-to-person,” would you like fries, chips or a side salad with your ICU stay? Many would-be patrons are also concerned about contracting the virus from restaurant staff. An infected waiter—who would need to be closer than the recommended 6 feet to serve your food—could hypothetically be a source of infection, with likelihood increasing if they’re not wearing appropriate PPE, such as a mask, face shield, or gloves.

A Nature Medicine study from earlier in the pandemic showed that at and just prior to the onset of symptoms, COVID-19 patients pose the highest risk of infection. This is when the viral load in the upper respiratory tract is greatest. So hypothetically, the waiter who comes to work despite feeling slightly off is the one you need to look out for.

And what about a sick cook? The CDC says that as of right now, there’s no evidence linking food to COVID-19 transmission.

“Because of poor survivability of these coronaviruses on surfaces, there is likely very low risk of spread from food products or packaging.”

Let’s take this outside