It all has to do with ventilation, aerosols, and the fact that restaurant workers are stuck in the same air for hours while working indoors

Outdoor restaurant dining is perhaps the closest we’ve come to a return to normalcy since the onset of the COVID-19 pandemic: Sidewalk and patio setups offer a familiar service while, if approached responsibly, mitigate risk. These outdoor dining rooms have remade the landscape of major metropolitan centers and small towns, allowing people to spill into the streets, visit with friends and family, and — for an hour or two — forget about the looming threat of a deadly and highly contagious virus. Outdoor setups have also given restaurants a way to bring back some of their staff and to welcome customers eager for a break from their own kitchens. When restaurateurs and diners alike are mindful and cautious, eating outside has proven to be relatively low risk.

Indoor dining, however, is another story altogether, presenting considerably higher degrees of risk. As temperatures creep lower in parts of the country, and restrictions are loosened in others, dining rooms are reopening: some at a very limited capacity (in San Francisco and New York, for instance), and elsewhere, in states, like Florida and Indiana, with no capacity limits whatsoever. Diners in warmer cities may choose to head indoors simply for a change of scenery as restrictions lift, while those in colder climates won’t have many other options if they want to continue eating out when winter comes.

But a transition indoors should not be treated simply as a continuation of outdoor dining: Indoor reopenings often correlate with spikes in coronavirus cases. A CDC report published in early September found that adults who reported having dined at a restaurant — the report included both indoor and patio diners — were “approximately twice as likely” to have tested positive for COVID-19 as those who did not frequent restaurants. It’s impossible to pin the responsibility for these case spikes on the restaurant industry — nor should we — and in states where cases have risen, other factors may contribute to increased presence of the virus, such as the loosening of other preventative measures such as mandatory mask-wearing and limits on large gatherings. Though correlation doesn’t equal causation, at this point in the pandemic, there is no question that indoor restaurant dining is a high-risk activity, regardless of what controls are in place.

“Anytime you’re opting into sitting down and eating at a restaurant, particularly with people, you’re taking on increased risk,” says Marissa Baker, an assistant professor at the University of Washington’s Department of Environmental & Occupational Health Sciences. And as your risk increases, so too does the risk for the waiters, bartenders, chefs, and dishwashing staff who make the wheels of a restaurant turn smoothly.

Is there a safe way to eat indoors if my state has lifted capacity restrictions and mask-wearing mandates?

To put it simply: no. Any indoor spaces — particularly those where mask-wearing mandates have been abandoned or were never enforced — create an ideal environment for the spread of COVID-19.

Why is indoor dining inherently riskier than eating outdoors?

To understand the risks associated with indoor dining, it’s important to first understand how COVID-19 is spread.

According to the CDC, the virus is predominantly thought to spread from person to person through droplets produced when someone infected with the virus coughs, sneezes, or talks — or, say, raises their voice as they split a bottle of wine over dinner. These droplets, as Penn Medicine explains, “fall quickly to earth,” meaning that, while there is a high risk of contracting the virus when speaking with or in close proximity to an infectious person, droplets alone do not present an extreme risk once that person is no longer present. Unfortunately, that’s not the whole story.

The CDC recently added an update to their coronavirus webpage, acknowledging that it’s also possible for the virus to be spread by airborne transmission. The update notes that infectious droplets and particles can “linger in the air for minutes to hours” and that past instances of airborne transmissions “occurred within enclosed spaces that had inadequate ventilation.” The virus is spread in this way through aerosols, tiny droplets that “remain infectious when suspended in air over long distances and time,” according to the World Health Organization (WHO). The WHO points to a working theory that larger respiratory droplets generate the airborne aerosols when they evaporate, as well as when an infected person breathes and talks.

“Being in an enclosed space where air is recirculated means that if there are viruses suspended in those aerosols in a room, the longer you spend time unmasked in an enclosed space, the higher the risk of contracting the virus,” says Dr. Russell G. Buhr, a pulmonary and critical care physician at UCLA Health. “It’s tough because the type of non-medical face coverings that we use don’t protect well against aerosols; the particles in aerosols are smaller than the pores between the fabric. The way that people get infected is a combination of how long they are in close proximity to an infectious source, coupled with how much virus they are exposed to.”

Even in restaurant settings featuring spaced-apart tables and barriers between diners, the potential for airborne transmission raises some serious concerns. Restaurants’ often-tiny kitchens place cooks shoulder to shoulder, and those in the space can share the same air for hours. The reality is, restaurant employees will spend hours indoors with one another, and with people who take off their masks to eat.

Server wearing a mask and carrying a tray is inside a clear plastic cube, along with germ particles surrounding her.

Some restaurants are touting their HVAC systems as safety measures. Do they work?

On its website, the Environmental Protection Agency stresses the importance of air circulation and filtration in helping to mitigate the spread of COVID-19 in indoor spaces: “Although improvements to ventilation and air cleaning cannot on their own eliminate the risk of airborne transmission of the SARS-CoV-2 virus, EPA recommends precautions to reduce the potential for airborne transmission of the virus. These precautions include increasing ventilation with outdoor air and air filtration as part of a larger strategy.”

Ideally, a restaurant offering indoor dining will at the very least have a powerful HVAC system pulling air out of the restaurant, and pumping fresh air in — not a foolproof solution, but one that does help. But as Baker points out, unless these upgrades are being touted on social media or a restaurant’s website, it’s nearly impossible for a diner to know whether a dining room is being filled with fresh air or is simply pumping recycled air back into the dining room and kitchen.

Some restaurants in New York that have enough capital have invested in ultraviolet lamps and MERV-13 HVAC units (an air filtration measure several degrees less powerful than the ones present in hospitals). Le Bernardin, one of New York’s three Michelin-starred establishments, installed a “Needlepoint BiPolar Ionization system tested and proven effective in independent laboratory tests against COVID-19 virus particles,” according to the restaurant’s Resy page. Photojournalist Gary He reported on Eater NY that the Financial District restaurant Crown Shy spent $40,000 adding a bi-polar ionization system to their HVAC units. He notes that because there are still very few peer-reviewed studies on the technology, the efficacy of bi-polar ionization systems is “still up for debate.”

These kinds of measures will assure some diners, but Baker says others will place more trust in the mom-and-pop restaurants they already know and love, where they feel safer despite potentially limited resources to upgrade air filtration and ventilation. “Especially for eating at restaurants, risk perception plays a really big role as to what actions people are going to take,” she says. “And I don’t think that the average person is very influenced by ventilation in their risk calculation. Things like familiarity are going to drive their decision making.”

I’m only going to restaurants without table service. Why are those places still high risk for workers?

To understand the risks of indoor dining, Buhr says to picture a restaurant as a large cube, which contains a certain number of cubic feet of air. Say, for instance, a restaurant contains 1,000 cubic feet of air: “That same 1,000 cubic feet of air is then being stirred through the air conditioner, and recirculated in the space over and over and over again.” A strong and effective filtration system will filter and circulate fresh air, but even the best air filtration system won’t entirely eliminate risk. The remaining risk, while not insignificant for diners, is even more concerning for restaurant workers.

A diner might be exposed to virus particles in the air, or particles expelled by an infected person nearby, during the hour or two while they’re eating their meal. For an employee who spends hours in the restaurant, the risk is exponentially higher. “It’s not like the same 20 people sit in a restaurant for nine hours,” says Buhr. “One restaurant worker may be exposed to 200 or 300 people [every day] who by necessity of dining don’t have their faces covered.”

In protecting workers, it’s crucial that employers provide masks, and that employees properly and consistently wear them. But even this, Baker says, is not enough to negate all risk associated with working indoors. “The worker is encountering multiple people over the course of their shift. … You’re really upping the chance of coming into contact with somebody who may be asymptomatically, or even symptomatically, carrying the virus,” says Baker. “Most of the time we see workers in cloth masks or maybe surgical masks. And although those are protective, over a long period of time and over multiple exposure events, they are not 100 percent foolproof.”

It’s not just diners who pose a threat to the health of restaurant workers: Coworkers may also put each other at risk of infection. In an industry that provides paltry health care and often low pay, many restaurant workers return to the tight confines of dining rooms and kitchens because they can not afford to stay home, even if they are symptomatic or have been recently exposed to the virus. “You could be working shoulder to shoulder on the line or shoulder to shoulder washing dishes,” Baker says. “It can be fairly physical work, so you’re breathing heavily, which is increasing not only any particles coming out of your mouth, but the number of particles that you are potentially breathing in.”

The risk exists whether a restaurant is offering indoor dining or not, but Baker points out that indoor dining inevitably leads to a higher density of customers, and a more rushed kitchen environment. A higher number of orders and table turnovers are “only going to increase the speed in the back of house both for food preparation, and for dishwashing,” she says. “So you’re either going to increase the speed, or you’re going to increase the number of people [needed to work a shift], both of which are related to increased exposure.”

This puts restaurants — and as a result, their workers — in an impossible position: The best way to prevent the spread of COVID-19 is to limit both staff and customers in a restaurant. But the most viable way to meet razor-thin margins and keep a restaurant afloat is to fill a dining room back up with hungry diners as soon as local mandates allow.

When will indoor dining be safe again? How will I know that moment has come?

Diners should make informed decisions about the risk of indoor dining by looking at the rate of community spread in their neighborhood or city. The CDC describes community spread as the number of people who have “been infected with the virus in an area, including some who are not sure how or where they became infected.” The health experts who spoke with Eater agreed that — until a vaccine is widely available and has been distributed throughout the country — an extremely low rate of community spread is the only way to ensure a truly safe indoor dining experience.

The risk of community spread presents a unique challenge when it comes to restaurant dining. “You don’t only go out to eat in your own neighborhood,” Buhr says of most diners during “normal” times. “You go across town to the restaurant that you really want to go to. And so maybe there isn’t an outbreak in Downtown Los Angeles, but there is an outbreak in Beverly Hills, where you happen to live. And so now you’ve taken somebody who’s coming from a high-probability-of-transmission area, and moved them temporarily to a low-probability area. The problems come when people are mixing, and you have people that are shedding the virus interacting with people who are not infected.” The difficulty of containing COVID-19 hot spots can already be seen in cities like New York, where some neighborhoods have been ordered to shut down indoor dining following upticks in coronavirus cases, while others remain open for business as usual.

Diners who keep an eye on community spread as a measure of indoor dining’s safety should be cognizant of the fact that residents in COVID-19 hot spots could be visiting neighborhoods with otherwise-low community spread. The inherently communal nature of restaurants, coupled with the fact that people will gladly travel across town for a good meal, renders community spread an only somewhat trusty reflection of risk level in any given area.

What will it take to make indoor dining as safe as possible?

For restaurants that do choose to reopen, Dr. Elizabeth Noth, a researcher in environmental and occupational exposure science at UC Berkeley, echoes Buhr and Baker in emphasizing the importance of airflow and ventilation to the relative safety of indoor spaces. “Ventilation and clean air is my biggest concern when it comes to what’s going to make an indoor dining experience risky or less risky,” she says.

Beyond ensuring a restaurant has a powerful HVAC system, Noth says the proper distancing of tables and mask wearing by employees is a good indicator of how seriously an establishment is taking both employee and diner safety. “If [a restaurant] is not doing the basics — places that don’t make you wear a mask while you’re waiting in the lobby, if they don’t have their own servers in masks — then you can’t really expect them to be doing much more.” Noth says these are easier signs to look for when evaluating a restaurant’s safety protocol than, say, snooping around to find the HVAC system and trying to figure out how powerful it is. To protect workers, Noth says proper ventilation and safety measures including diligent mask wearing must extend to worker break rooms and communal spaces, pointing to reports of the increased spread of COVID-19 in a hospital break room, where windows were absent and health care workers were less likely to observe the same precautions they did while working.

To enforce proper ventilation, and ensure employers are providing their employees with protective equipment, Baker hopes to see increased government involvement. “We need regulations from federal and state OSHA (Occupational Safety and Health Administration) to protect workers at work. That’s the only way that we can ensure that the workers in restaurants are getting the adequate personal protective equipment that they need,” she says.

But making indoor dining as safe as possible isn’t just up to government regulators. It’s a matter of personal choice and good judgement for consumers, too. “It isn’t as simple as just being like, ‘I’m comfortable going out to a bar or a restaurant because I think even if I get sick, I’ll probably be fine,’” says Buhr. “That doesn’t work in public health, because you may be exposing other people to your own unknown infection. We’ve unfortunately gotten to a place where I think the number of deaths has gotten so high that we’ve become a little desensitized to it. As if it’s a little bit more inevitable. And it’s just not really the case.”

Diners have a responsibility to follow every possible safety precaution if they choose to eat indoors, acknowledging the risk not just to themselves, but to all of the workers who make their food, serve them, and clean their dishes. That means staying home if sick, and wearing a mask for as much of the dining experience as possible. It means being gracious and understanding if reminded to put on a mask as a waiter approaches, or to move one’s chair farther away from a neighboring table. It means, in short, treating workers with a level of respect they have always deserved, but which is even more crucial now that it is tied to their health.

“We have to be really patient and thoughtful with everyone who’s working in these restaurants, because they are trying to provide a service at some degree of personal risk,” says Buhr. “What I would really like to see is that everybody who decides to go out to eat — which is really a privilege — treats food-service people with the kind of care and respect that we treat our nurses with. We need to shift a little bit away from this ‘customer’s always right’ mentality to the ‘we’re all in this together’ mentality.” Working together to contain the virus, and showing the utmost gratitude to those on the front lines each day, Buhr says, is the key to getting through this pandemic.

Glenn Harvey is a Filipino illustrator living and working out of Toronto.

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