Patients with symptomatic COVID-19 were more likely than uninfected controls to report some form of restaurant dining — including indoor, patio and outdoor seating — in the 2 weeks prior to symptom onset, CDC researchers found.
Compared to controls without COVID-19, case patients were more than twice as likely to have reported dining at a restaurant (adjusted OR 2.4, 95% CI 1.5-3.8), reported Kiva Fisher, PhD, of the CDC, and colleagues.
When the analysis was restricted to case patients with close contact to anyone with confirmed COVID-19, case patients were still more likely to report having visited a bar/coffee shop (aOR 3.9, 95% CI 1.5-10.1) or restaurant (aOR 2.8, 95% CI 1.9-4.3) than control patients, albeit with wider confidence intervals, Fisher’s group wrote in the Morbidity and Mortality Weekly Report.
Not surprisingly a substantially larger proportion of case patients reported close contact with a person with COVID-19 versus controls (42% vs 14%, respectively).
This data was previewed at the National Academy of Sciences and Medicine (NASEM) workshop on airborne transmission as part of the growing “circumstantial evidence” suggesting airborne transmission may play a role in COVID-19 spread.
“Reports of exposures in restaurants have been linked to air circulation,” the authors wrote. “Direction, ventilation, and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance.”
Researchers examined data from adults tested for SARS-CoV-2 at one of 11 Influenza Vaccine Effectiveness in the Critically Ill (IVY) Network sites in July. COVID-19 cases were confirmed via PCR testing for SARS-CoV-2 from respiratory specimens. For every case, control patients who tested negative for SARS-CoV-2 were matched based on age, sex and study location. The investigators then followed up with phone interviews. After screening, Fisher and colleagues had 154 case patients and 160 controls for analysis.
Controls were significantly more likely to be non-Hispanic white, have a college degree or higher and report at least one underlying chronic medical condition compared to cases. Self-reported mask compliance was high in both groups, with 71% of cases and 74% of controls reporting always using face coverings in public. About half of close contacts reported (51%) were family members.
About half of all participants reporting going shopping or visiting someone inside of a home with 10 people or less at least once in the 14 days prior to symptom onset. However, there was no difference between cases and controls in reported shopping, gatherings in homes irrespective of the number of guests, going to an office or salon, using public transportation, patronizing a bar or coffee shop, or attending church/religious gatherings.
Overall, 107 participants said they’d gone to a restaurant and 21 to a bar or coffee shop. Cases not only outnumbered controls in these groups, but were also significantly more likely to report that “almost all patrons” at the establishments weren’t wearing masks or maintaining safe distances.
“Implementing safe practices to reduce exposures to SARS-CoV-2 during on-site eating and drinking should be considered to protect customers, employees, and communities and slow the spread of COVID-19,” Fisher and colleagues concluded.
By Molly Walker, Associate Editor, MedPage Today
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