September 11, 2020

Dining at a restaurant is one of the riskiest activities for contracting the novel coronavirus, according to a CDC Morbidity and Mortality Weekly Report published Friday.

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US new coronavirus cases surpass 6.4M, deaths top 191K

CDC's new findings come as U.S. officials as of Friday morning reported a total of 6,416,700 cases of the novel coronavirus virus since the country's epidemic began—up from 6,378,900 cases reported as of Thursday morning.

Data from the New York Times shows there are nine states that have seen comparatively higher rates of coronavirus transmission, meaning they've had a daily average of at least 15 newly reported coronavirus cases per 100,000 people over the past week, where rates of newly reported cases are "staying high." Those states are Arkansas, Illinois, Kansas, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, and Wisconsin.

Meanwhile, the Times' data shows that the daily averages of newly reported cases over the past seven days are "going down" in Alabama, Georgia, Guam, Iowa, and Mississippi, which all had been seeing comparatively higher rates of coronavirus transmission.

The Times' data also shows there are five states that have seen comparatively lower rates of coronavirus transmission, meaning they've had a daily average of fewer than 15 newly reported coronavirus cases per 100,000 people over the past week, but are now seeing those rates "going up." Those states are Alaska, Delaware, New Hampshire, Pennsylvania, and West Virginia.

In addition, the Times' data shows that Puerto Rico; the U.S. Virgin Islands; Washington, D.C.; and 32 states have had comparatively lower rates of new coronavirus cases over the past week, and those rates are "staying low." Those states are Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Indiana, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Rhode Island, South Carolina, Texas, Utah, Vermont, Virginia, Washington, and Wyoming.

U.S. officials as of Friday morning also had reported a total of 191,628 deaths linked to the coronavirus since the country's epidemic began—up from 190,714 deaths reported as of Thursday morning.

According to the Times' data, Guam, Hawaii, Missouri, Montana, Nebraska, North Carolina, Puerto Rico, and South Dakota saw their average daily numbers of newly reported deaths linked to the coronavirus rise over the past 14 days.

Dining out associated with higher risk of contracting coronavirus, CDC finds

Although many areas of the United States still have coronavirus transmission rates that public health experts say are dangerously high, many states are moving forward with plans to reopen nonessential businesses that had been closed to help mitigate the virus' spread—including restaurants, bars, and other eateries for indoor and outdoor dining. But CDC's new report raises questions about whether dining out is safe amid the epidemic.

For the report, researchers from CDC and Hennepin Healthcare set out "[t]o assess community and close contact exposures associated with" confirmed cases of the novel coronavirus by comparing exposures reported by patients who contracted the virus with exposures reported by a control group of patients who were not infected with the virus. According to CDC, the "case-patient" group included 154 adult patients at 11 U.S. health care facilities who were experiencing symptoms of Covid-19, the disease caused by the coronavirus, and who tested positive for the virus. Meanwhile, the control group included 160 patients from those same medical facilities who were experiencing symptoms associated with Covid-19 but who tested negative for the coronavirus.

The patients received polymerase chain reaction tests for the novel coronavirus to confirm whether they were infected with the pathogen. The 11 medical facilities at which the patients received care were located in California, Colorado, Maryland, Massachusetts, Minnesota, North Carolina, Ohio, Tennessee, Utah, and Washington. The dates the patients had received care at the facilities spanned from July 1 to July 29.

Overall, the researchers found that patients who tested positive for the coronavirus were 2.4 times more likely to have reported dining at a restaurant—including indoor, patio, and outdoor dining—in the two weeks before they began to feel ill when compared with the patients who tested negative for the virus. In addition, the researchers found that 71% of the patients who tested positive for the coronavirus reported always wearing cloth face coverings or other face masks in public, compared with 74% of participants who tested negative for the virus.

According to the report, the researchers found "no significant differences" between the patient groups overall in terms of whether they:

  • Attended church or religious gatherings;
  • Gathered with 10 or more people in their homes;
  • Gathered with fewer than 10 people in their homes;
  • Shopped in public;
  • Used public transportation;
  • Went to bars or coffee shops;
  • Went to office settings;
  • Went to salons; and
  • Went to gyms.

The researchers also found that 42% of the patients who tested positive for the coronavirus reported having close contact with a person who was known to be infected with the virus, compared with 14% of the patients who tested negative. When the researchers narrowed their analysis to the 225 patients in the study who did not report having recent close contact with a person who was known to be infected with the virus, they found that patients who tested positive for the coronavirus were 2.8 times more likely to have reported dining at a restaurant and 3.9 times more likely to have reported going to a bar or coffee shop than patients those who tested negative.

What do the findings mean?

The researchers in the report concluded, "Eating and drinking on-site at locations that offer such options might be important risk factors associated with [coronavirus] infection." They continued, "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."
 
But the researchers also noted that their study had limitations. For example, their study "question assessing dining at a restaurant did not distinguish between indoor and outdoor options," and their "question about going to a bar or coffee shop did not distinguish between the venues or service delivery methods, which might represent different exposures," the researchers wrote. In addition, the patients in the study were aware of whether they had tested positive or negative for the coronavirus at the time they were surveyed, "which could have influenced their responses to questions about community exposures and close contacts," the researchers explained. And lastly, the patients' true infection status may not have been known, as tests to detect the coronavirus are "imperfect," the researchers wrote.
 
Separately, the Association of Food and Drug Officials in a statement pointed out that the study involved medical facilities in 10 states that had in place vastly different restrictions on restaurants and other mitigation measures intended to curb the coronavirus' spread.
 
And it's important to keep in mind that, while CDC's findings demonstrated a link between dining at a restaurant and coronavirus infection, they did not show that dining at restaurants caused coronavirus infections, The Hill reports.
 
Nevertheless, Todd Rice, one of the study's co-authors and an associate professor of medicine at Vanderbilt University Medical Center, told NBC News, "If people are going to eat out, they need to be thoughtful about how they're going to do it. Even if I'm sitting at a table and the food hasn't arrived yet, I still wear a mask. I won't sit at a table that's next to somebody else" (Budryk, The Hill, 9/10; Howard, CNN, 9/10; Olson, Minneapolis Star Tribune, 9/10; Owens, "Vitals," Axios, 9/11; New York Times, 9/11; CDC Morbidity and Mortality Weekly Report, 9/11).

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