The COVID-19 pandemic has required an aggressive public health response to minimize transmission and prevent deaths. It is clear that the public health response has been successful in “flattening the curve” of new infections, even in the most heavily impacted cities. Although the public health response is warranted, widespread and prolonged social distancing measures have limited the success of food establishments across the country.
While there is much debate about how to balance a public health response with the health of the economy, there is little debate that if a restaurant is identified as a source of COVID-19 transmission in their community, it hurts their business. Successfully reopening requires a strategy centered on reducing risk of COVID-19 to both employees and customers. This requires a clear understanding of how SARS-CoV-2, the virus that causes COVID-19, is transmitted.
How is SARS-CoV-2 transmitted?
SARS-CoV-2 is a respiratory virus. Similar to other respiratory viruses it is mostly transmitted through the respiratory route. A person can become infected when virus comes into contact with their mucous membranes, which include the eyes, mouth, and nose. However, not all exposures result in the same risk. In other words, the likelihood of becoming ill depends on the nature of exposure. In terms of person-to-person transmission, the rate of transmission is highest early after onset of COVID-19 symptoms. It is now understood that virus can be detected in the 2-3 day period before symptoms start, and some people with COVID-19 do not develop symptoms at all. Thus, virus can be transmitted even from those without symptoms.
An infected individual releases small virus-containing droplets from their respiratory tract. Relatively few droplets are released during normal breathing but more release with heavy breathing, talking loudly, or singing; coughing and sneezing increase the number of droplets released significantly.
In the air, droplets generally travel no more than three to six feet but can cause surface contamination on objects within that radius. Very small droplets called aerosols can travel farther, particularly when coughing or sneezing, and sometimes be briefly suspended in the air.
How can transmission of SARS-CoV-2 be prevented in the restaurant?
Providing a safe and enjoyable experience to employees and customers requires a thorough understanding of transmission risk and creative and proactive strategies to prevent COVID-19 infection in restaurants.
Employees must be educated about the signs and symptoms of COVID-19, have a mechanism for reporting symptoms, understand how to test employees, and disincentivize working when sick. Since most infections are passed through people with symptoms, it is essential to limit employees from working or customers from patronizing a restaurant if they might be sick. Customers also must understand the importance of avoiding patronizing when ill. Creating a culture of wellness and personal accountability for both the employee and customer is crucial.
Social distancing guidance
Social distancing (i.e., maintain 6 feet of distance from others whenever possible) is based on the knowledge that droplets typically do not travel more than 6 feet. Thus, restaurants should identify ways to maintain 6 feet of distance among employees and customers whenever possible. This may include keeping tables at least 6 feet apart, minimizing close contact between those waiting in the dining facility, and identifying ways for employees to maintain 6 feet of distance between coworkers and customers without significantly impacting their work responsibilities.
Sanitation + Disinfecting
As mentioned above, surface contamination with SARS-CoV-2 can occur. Infection from contaminated surfaces typically requires contact of hands with a contaminated surface and then contact of contaminated hands directly with the mouth, eyes, or nose. Infection from contaminated surfaces can be prevented through strict sanitization and disinfection schedules for high touch surfaces, particularly customer tables between meals.
It is important to encourage frequent hand hygiene by employees and customers, particularly when entering the facility and after contact with high-touch surfaces. Soap and water, as well as alcohol-based hand rub, are both effective against SARS-CoV-2.
Aerosols are more likely to cause infection when those that are infected spend prolonged periods of time within a crowded and poorly ventilated indoor space. Thus, outdoor customer seating may reduce the impact of spread of infection through aerosols.
A clear barrier to physically stop droplets is a very important strategy to prevent transmission. Plexiglass barriers can be installed in many establishments at points where employees and customers have face-to-face contact.
When worn appropriately (i.e., covering both mouth and nose), masks are highly effective in limiting droplets released into the environment by individuals with COVID-19. In those who are not yet infected, masks can additionally protect the mouth and nose from contact with droplets from those who are infected. Healthcare facilities that adopted universal masking policies have seen significant drops in spread of infection between healthcare workers. In restaurants, masking customers while dining in restaurants is understandably a significant challenge. Thus, it is important to emphasize alternate strategies for infection prevention.
The COVID-19 pandemic presents unprecedented challenges to many industries, and the restaurant industry is no exception. Providing a safe and enjoyable experience to employees and customers requires a thorough understanding of transmission risk and creative and proactive strategies to prevent COVID-19 infection in restaurants.