Updated CDC Guidelines Establish the Riskiest Restaurants to Eat In

Zee Krstic

From Good Housekeeping

  • New CDC rules have been established for restaurants and bars reopening during the COVID-19 pandemic.
  • The federal agency established new criteria for estimating risk at any restaurant, which depends on how the establishment is set up.
  • One infectious disease researcher has five major concerns about eating meals inside restaurants, and explains how you can lower your risk if you eat inside.

Nearly all states across the country have allowed restaurants to once again serve customers in some fashion as the novel coronavirus pandemic continues. According to Eater, 44 states have already reopened dining rooms with new guidance from state leaders and federal experts, including the Centers for Disease Control. Places like New York (the epicenter of the COVID-19 outbreak in the U.S), have yet to announce plans to fully reopen restaurants, as some states are only allowing outside service as well as takeout or drive-thru capabilities.

But updated CDC commentary released in May make it clear that even restaurants that are only doing outside seating could still be harboring elevated risk for diners overall. Safety officials established specific safety guidelines for specific businesses, like transportation providers and hotels, but restaurants have a special section in the six-page guidelines from federal safety officials. Officials released a new "decision" tool designed to help restaurants and bars guide their reopening phases. Ultimately, states have final say over how and when restaurants can reopen — CDC guidance also suggests that frequent hand-washing and mandatory face masks will be required for all employees. Restaurants will most likely space "tables and stools, limiting party sizes and occupancy, avoiding self-serve stations, restricting employee shared paces, [and] rotating or staggering shifts, if feasible." Cleaning will be more frequent, and new ventilation strategies (think: al fresco dining or outdoor seating exclusively) will be implemented.


Is that enough to keep the spread of COVID-19 at bay? Robyn Gershon, MHS, DrPH, a clinical professor of epidemiology at New York University's School of Global Public Health, says that many cities may choose to open restaurants on a case by case basis in each neighborhood. She points out that most states have chosen to keep bars entirely closed, and that restaurateurs may be instructed to spread diners as far apart as possible. But she also stresses the majority of risks for SARS-CoV-2 transmission in a restaurant can occur even if you remain six-feet away from strangers, among other precautions.

Ultimately, the decision to eat inside re-opened restaurants should be weighed against your own risk. "As a public health disaster researcher and educator, I think about the risk to myself, and so every person has to really take stock," Gershon explains, adding that contact tracing is still in early stages across different states. "What if you live with an elderly person or somebody with chronic illness? We've already heard that [if you have] cancer, cardiac disease, diabetes, most any kind of chronic condition, you're at a higher risk for severe complications."

What are the risks of eating at restaurants during the COVID-19 pandemic?

For Gershon, there are five different ways that restaurants pose an increased risk to diners, even with adapted guidelines set forth by state departments and federal guidelines. Below, she recounts how these factors might put you at a higher risk for coming into contact with SARS-CoV-2 while dining inside restaurants.

  • Highly-trafficked surfaces. There are many touch points in a restaurant that you may not even think of, and while staff may try their best to sanitize these areas frequently, there could be elevated risks with these shared surfaces. "What if you want to use the bathroom? The toilet itself, the doorknobs, the sink faucet, these are all things that could present some potential risks of transmission if you aren't careful," Gershon says. This also includes any furniture in the restaurant you may sit on or use to eat your meal, as infectious droplets can also transfer onto other surfaces, including floors and non-porous surfaces like your clothes.
  • Shared condiments and utensils. At your table, there's risk handling things like salt and pepper shakers or ketchup bottles while also using your hands to eat food. Gershon says many restaurants are already pivoting to single-use plastic utensils and dishware during the pandemic to prevent cross-contamination, as any reusable utensils could potentially pose an increased risk of transmission compared to the items you use alone at home.
  • Insufficient sanitation. The task of keeping every single surface as sanitized as possible in between diners is insurmountable for most, Gershon says, even with restaurants doubling their cleaning efforts. There's simply no way to guarantee that every surface is perfectly clean (let alone disinfected) for you throughout a business day.
  • Shared air supply. Many states will require employees to wear face masks while serving diners, but obviously, diners will have to remove their coverings when eating, which may present a risk in confined spaces. "I would avoid large gatherings in a confined space for an extended period of time, anything over 30 minutes," Gershon says, adding that infectious air-borne virus particles can potentially move throughout a space if emitted through a diner's mouth or nose. Furthermore, there may be a risk associated with air conditioning and spreading viral particles through HVAC units, which scientists are studying now after an early CDC-sponsored study was released in April.
  • Interactions with the staff and proximity to other diners. Hopefully, the personnel inside the restaurant will be taking all precautions to prevent the spread of COVID-19, and diners will be separated by at least six feet. That distance can't be kept while you're being served, though, and all the interactions between yourself and your server — taking orders, getting drinks, serving meals, paying a bill — provide more opportunities to be in close proximity to you. Furthermore, Gershon explains that there's preliminary evidence that suggests that open restaurants may draw in visitors from far away places; according to research conducted by the University of Maryland, more than 60,000 out-of-state visitors flocked to Georgia as the state reopened non-essential businesses. Could diners in your vicinity carry germs from other states? It's possible, Gershon says.

Which restaurants are the riskiest during the pandemic?

If you're considering heading out to eat (or even to pick up food and eat outside elsewhere), the CDC has established a set of guidance points to help you understand how risky a restaurant might be. The key to understanding risk is thinking about how long you'll be eating inside or outside, and how intimate your interactions and surroundings are with other diners and staff. These are the four levels of risk by the kind of restaurant you may eat at, according to the CDC:

  1. Lowest Risk: Restaurants that are only open for delivery, curbside pick up, drive-thru, or controlled takeout.
  2. More Risk: Restaurants that provide limited outdoor seating, including those that offer drive-thru pickup, takeout, delivery, or curbside pick up. Seating capacity in these restaurants' outside spaces should have tables spaced at least six feet apart.
  3. Even More Risk: Restaurants that are open for both indoor and outdoor service. They've adjusted their seating plans to allow tables in both spaces to be spaced at least six feet apart.
  4. Highest Risk: Restaurants that are open, with both indoor and outdoor seating, but do not reduce their max capacity or optimize their seating plans. Tables aren't spaced six feet apart.

Minimizing exposure risks while eating at restaurants:

If you decide to head out for a meal at a restaurant, Gershon says there are a few ways you can work to lower your risk while dining out.

  1. Frequently wash your hands, and bring hand sanitizer and alcohol wipes with you to the restaurant. Keeping your hands clean while you move throughout the restaurant and before touching your food is important, Gershon says. Be sure to wash your hands if you use the restroom (use paper towels or your elbow to open the door afterwards) and try to sanitize your hands as frequently as possible. "I might touch things like my credit card when paying the bill that is now contaminated, so to speak, and then reach for my phone, which could be a vector on its own," Gershon explains. "Try to wipe down anything you're touching or use hand sanitizer before touching those items. You want to minimize any chance of spreading germs from the restaurant onto your belongings or back into your home."
  2. Choose to sit outside. If you have the opportunity to sit outside, do so! Gershon says that open air spaces offer diluted air and reduces much of the risk you'd run inside a dining room.
  3. Wear a mask and maintain distance. Whenever you're not eating, this is a courteous thing to do for your fellow diners and the employees serving you, even if it's not required by law. Masks work to prevent you from spewing infectious particles into the air around you. And taking the time to allow people to pass in front of you, or maintaining ample distance while waiting to access your table, can further reduce transmission risk inside a restaurant.
  4. Avoid touching your face, eyes, nose, and mouth. Touching shared common surfaces and then any mucous membranes on your body could be a sure way to later develop COVID-19. Gershon says wearing gloves won't save you from germs, but if they remind you to stop touching your face during a meal, you should do so.
  5. Ask for disposables. Even though it may be wasteful in the long run, asking for single-use condiments and utensils can help reduce risk from cross-contamination between diners. "You can ask for those takeaway packages of ketchup and mustard, or tiny packets of salt and pepper," Gershon says. Some restaurants may honor a polite request to eat a takeout-style meal at a table — i.e. a meal served in cardboard or plastic containers, which are less exposed than traditional cutlery and dinnerware.

As the coronavirus pandemic develops, some of the information in this story may have changed since it was last updated. For the most up-to-date information on COVID-19, please visit the online resources provided by the CDC, WHO, and your local public health department. You can work to better protect yourself from COVID-19 by washing your hands, avoiding contact with sick individuals, and sanitizing your home, among other actions.

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