RISKY BUSINESS?
Experts split on the risk of dining indoors even if vaccinated
“When people congregate in restaurants, it sends a message that it’s OK for everyone to do those things, when the reality is, we still only have a little less than a quarter of the population that has received one dose of the vaccine. Short of large gatherings, dining in restaurants is one of the most risky situations to be in.”
— Craig Shapiro, pediatric infectious diseases specialist
Once you’re vaccinated, the Centers for Disease Control and Prevention have officially OK’d having friends over for dinner if they’re vaccinated, too.
The guidelines also say that once vaccinated, you can have a mask-less, indoor hangout even if your guests aren’t vaccinated, as long as you’re gathering with people from a single household, and no one in that household (or anyone they live with) has an increased risk for severe illness from COVID-19. In other
words, even if you’re weeks away from that first shot, you needn’t necessarily wait to break bread with your vaccinated parents or grandparents.
It’s something we’ve all been yearning for, and in many ways, it feels like the first step toward a return to some sort of normalcy. But what about indoor dining at a restaurant, where you won’t be able to predict the vaccination statuses of other patrons and staff? The CDC guidelines don’t specifically address this topic. They do, however, encourage everyone, vaccinated or not, to continue avoiding medium- and large-sized gatherings, and wear a mask and social distance when in public spaces.
In mid-March, the CDC also published a report that concluded, “mask mandates and restricting any on-premises dining at restaurants can help limit community transmission of COVID-19.” It looked at 2020 county-level data from March 1 to Dec. 31 and found that on-site dining
was linked to an increase in case counts and death rates 41 to 80 days after reopening. While the study doesn’t prove cause and effect, it adds to existing research that indoor spaces make it easier for the virus to spread.
Yet, this data was captured before wide-scale vaccinations started rolling out. Today, more than a million people a day are getting their first shot. Opinions about the safety of indoor dining after you’re fully vaccinated aren’t universal. We talked to experts across the spectrum to weigh in on the risks, and what would make them feel comfortable dining inside a restaurant.
The end of this pandemic finally feels within view, but some experts would like to see the country get closer to herd immunity before returning to indoor dining.
Herd immunity is considered to be achieved when between 70% to 90% of the country has been vaccinated or recovered from COVID-19 infection.
Effective, but
“The vaccines are very effective but they’re not 100-percent, and we do have variants that are circulating and still being researched,” says Darren Mareiniss, an emergency medicine doctor at Einstein Medical Center. “If our case numbers and our positive tests rates were significantly lower, let’s say below 2 or 3%, then I might be more apt to eat inside.”
On the other hand, some experts say you don’t need to wait, given the vaccines’ effectiveness, both in clinical trials and in emerging real world studies. This is assuming health department guidelines are being followed, like table distancing and mask wearing.
“I would feel comfortable indoor dining with a small group, and by small group, I mean one other person or family that’s at low risk of having any complications,” says Neal Goldstein, an assistant research professor of epidemiology and biostatistics at Drexel University. “This is based on the effectiveness of the vaccination and the current minimal risk. And that’s the fine line. I’d love to say that there’s no risk here, and I can’t say that. But there’s minimal risk, and that’s what we’re going to have to deal with for the near future.”
Wrong message
There’s no doubt that once you’re vaccinated, your risk significantly drops, whether you’re headed into the grocery store or your favorite restaurant. To some degree, your decision-making will depend on your tolerance for the risk that remains. But there are other factors to consider, too.
“I don’t dine in person, but it’s not because I’m concerned about my personal risk,” says Craig Shapiro, a pediatric infectious diseases specialist at Nemours/Alfred I. duPont Hospital for Children. “When people congregate in restaurants, it sends a message that it’s OK for everyone to do those things, when the reality is, we still only have a little less than a quarter of the population that has received one dose of the vaccine. Short of large gatherings, dining in restaurants is one of the most risky situations to be in.”
By nature, restaurants bring together multiple households in the same space, without everyone wearing masks. The more people in the restaurant, the greater the risk, especially now, when the majority of the country remains unvaccinated.
“Even if you’ve been vaccinated, there’s a risk of you potentially becoming infected, and we’re also concerned you could still transmit asymptomatically to other people in the restaurant,” says Mareiniss.
No vaccine is ever 100% effective, and researchers are still studying how effective the COVID-19 vaccines are against multiple circulating variants, as well as if you can be a silent carrier when you’re vaccinated. Until there’s more data, Mareiniss encourages caution.
Bigger risks
However, early research in both of these areas is pointing in a positive direction, and Goldstein says there are bigger risks we must tackle — the main one being vaccine hesitancy.
“Unfortunately when we tell people, ‘Why get vaccinated if nothing changes?’, it seems to disincentivize getting vaccinated, and vaccination is the best tool that we have right now to get back to normal,” says Goldstein. “Once vaccinated, you dramatically lower the risk to yourself and others and should be able to enjoy eating in a restaurant.”
Preliminary data from Israel suggests that people vaccinated with the Pfizer vaccine have a viral load four times lower than unvaccinated people, which may indicate it’s less likely that you could transmit the virus.
“It’s not clinical trial evidence — those studies are still underway — but I’m optimistic that a vaccinated person won’t spread the virus, and with the right safety precautions at the restaurant, I believe it’s a minimal concern,” says Goldstein.
Shapiro also believes this isn’t a primary concern, but says community transmission rates aren’t yet low enough to let down our guard. There are other ways vaccinated people can spread the virus — and that’s if you get infected. Current variants make it challenging to predict your exact risk of getting infected.
“You’re not likely to need hospitalization or die , but does that mean you couldn’t spread it to someone else? No, and you’re increasing that risk by entering an environment that we know is particularly risky,” says Shapiro.
“It’s a tightrope we’re walking. We want people to get vaccinated, we want to give them hope, and getting the vaccine does make it safer to do more things,” says Shapiro. “If you are going to dine in, the most important things are going to be spacing, mask wearing, ventilation, and the cleaning processes.” Shapiro recommends calling in advance. If a place can’t communicate their safety measures, choose another restaurant.
Is outdoor OK?
As the weather heats up, outdoor dining becomes a more practical option, and the good news is that even many of the most cautious experts say they’d feel comfortable dining outdoors once fully vaccinated.
“I’d be totally fine eating outdoors and with low risk people,” says Mareiniss. “But everyone in their household must be low risk. If grandma’s at home, I wouldn’t eat with them.”
Goldstein says he’d choose outdoors, too, if sharing a meal with people who aren’t yet vaccinated. And Shapiro says he’d always recommend outdoor dining over indoor when it’s an option. As more people become vaccinated, advice is expected to evolve.
“At some point, we also have to understand this virus isn’t disappearing,” says Shapiro. “It’s going to become part of our daily lives, just like influenza or any other respiratory virus, and at some point we are going to have to accept those risks, albeit hopefully when they become even smaller, but that risk is never going to be zero. Once we can be in an environment and know everyone is vaccinated, that’s the best that we can do.”