Will Reopening Restaurants Mean More Coronavirus Cases?

Across America, states that had shut down to flatten the curve of the COVID-19 pandemic are reopening for business—including, to varying degrees, dine-in service at restaurants and bars. But though people can adhere to government guidelines, the coronavirus plays by its own rules. That unfortunate reality was underscored this week with a CNN report that 22 states are seeing upward trends in COVID-19 cases. (The New York Times also presents an excellent visual, state-by-state assessment of these trends.)

Needless to say, we all want to return to restaurants (and, for some us, to an even greater extent, bars), but by doing so, are we potentially contributing to an uptick in coronavirus cases? And if the number of cases is on the rise, are diners putting themselves at risk by patronizing these restaurants that are so desperately in need of our business?

Paradoxically, returning to restaurants—by the very nature of how coronavirus spreads—would seem to inevitably lead to more cases; but at the same time, teasing apart whether restaurants and bars specifically are the cause of any particular increase in cases is virtually impossible.

“We have certainly seen an increase in COVID-19 cases as restaurants and bars reopen across the U.S.” Shira Shafir, an associate professor in the Departments of Community Health Sciences and Epidemiology at the UCLA Fielding School of Public Health, told me via email, “but since those re-openings have not occurred in isolation—they often happened at, or near, the same time as the opening of other venues like parks, beaches, and retail stores—it’s impossible to know contact that occurred in the restaurants or bars was responsible.”

Regardless, the risk factors are there. “Indoor restaurants pose high risk for infection because they are often poorly ventilated and strangers sit in close proximity to each other for long periods of time,” Alicia Riley, a postdoctoral scholar of epidemiology and biostatistics at the University of California, San Francisco’s School of Medicine, explained to me. “Also, one of the main ways to reduce the spread of respiratory droplets is through universal mask wearing. Restaurant workers can and should wear masks, but it is impossible for customers to wear masks while eating and drinking. So yes, there will be transmission through indoor dining.”

At the same time, however, restaurants also have an inherent mitigating factor: Food service establishments are already subject to scrutiny from the health department. Angela G. Clendenin—an instructional assistant professor of epidemiology and biostatistics at Texas A&M University’s School of Public Health who has been working with local health officials—points out this means that restaurant owners are acutely aware of the impact of illness.

“I’ve actually gone out to restaurants here in my community because I am a big believer in trying to support those businesses,” she told me, “and from what I’m seeing, most of the restaurants understand what’s at stake, and they’re doing what they can within the parameters of their operating environment to keep their employees safe and to keep their patrons safe.”

“[All restaurants] have to be inspected by the local health authority,” Clendenin continued, “and if they find out through somebody calling in and saying, ‘Hey, I just had dinner at Restaurant A and they’re not following the guidance that we know they’re supposed to be providing,’ it’s going to result in an inspection and they could get shut down again.”

Shafir reminded me that, in her own city of Los Angeles, where restaurants are also finally reopening, the Los Angeles County Department of Public Health has taken a similar measure, including restaurants on its public list of places that have been associated with COVID-19.

And so, Clendenin suggested any blame for an increase in cases might not lie at the state level, but instead comes down to individual localities and even the individual restaurant. “It’s how well are the proprietors of these restaurants following the guidelines that they were provided by their local health authorities,” she explained. “There are those that have done very well, and they’ve managed to be able to seat people with appropriate distancing. They’ve used appropriate sanitation. Many of them have gone to paper menus, plastic utensils, and disposable plates. And so they’ve been doing their part to try to keep the number of cases down, but that’s not always going to be the case.”

Another issue can easily be overlooked, as well: As Riley emphasized to me, customers may not be the only reason that restaurant reopenings can result in increased coronavirus infections. Undocumented immigrants—a significant part of the restaurant industry workforce—will also be returning to work. These employees weren’t eligible for government financial assistance during closures and many lack access to healthcare. “These workers and their families are at an extreme disadvantage when it comes to protecting themselves from exposure because work is their only source of income,” Riley said. “It is inevitable that as more states reopen, more food industry and restaurant workers will get sick with COVID-19.”

Ultimately though, for consumers, the big question becomes if dine-in restaurants are likely to increase the spread of COVID-19, is it safe to go to a restaurant or not?

“I do not think dining in an indoor restaurant is low-to-no-risk activity or will be anytime soon,” Riley told me. “The risk of infection will vary locally, and it will depend on the physical characteristics of the restaurant (seating spacing, ventilation, and how long people spend there).”

Clendenin agreed risk was involved, but also reminded me that the onus shouldn’t fall entirely on owners. “We’re going to be living like this, and restauranteurs and bar owners can only do so much,” she said. “It really is the individual responsibility of every patron to be compliant with what they are asked to do by the restauranteurs and bar owners, to do those things that are good hand hygiene, wearing masks when they’re out and about, minimizing opportunities for transition to the best of their ability, and that’s the only way we’re going to get ahead of this.”

None of this is to say you shouldn’t support restaurants, many of which are in dire need of your business to stay in business. However, you should consider the risks, especially if you are at high risk. “We will each have to approach dining in restaurants by being mindful of our local situation of COVID-19—which is changing daily—and being mindful of our own vulnerabilities to severe infection if exposed,” Riley continued. “But if you are committed to playing it safe, then takeout is the way to go!”