Even if you’re vaccinated, indoor dining is still complicated

Faced with this new reality, I asked public health experts if it’s natural to be hesitant about our new dining normal (it is) and whether eating at restaurants indoors is still risky (you probably shouldn’t if you’re not fully vaccinated, and you should still mask indoors if you are).

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But at the heart of this debate, and of my hesitance, is the question of how we navigate our newfound freedom, what we need to relearn, and whether we should be doing so in the first place. Despite the restaurant reopenings and general excitement, the answer might not be one we’re ready to hear.

Indoor dining is inherently very risky when it comes to Covid-19

The way epidemiologists currently look at dining — indoor dining specifically — is different from the way most of us probably look at it. They see a full dining room and think about the prolonged amount of time people are spending together unmasked, eating and talking and laughing and sending tiny particles into the air. They remember that a little over half of all American adults have had at least one vaccine dose, which means unvaccinated people may be among those who are eating and talking and laughing in that dining room. They also look at the number of windows in the dining room and whether they’re open.

All of these factors combine to make indoor dining a coronavirus hazard.

“It’s not just that indoor dining checks one box, it’s that it checks many of them,” said Saskia Popescu, an infectious disease epidemiologist at George Mason University. “All of those things make it higher risk.”

These risks make decisions such as fully opening restaurants without any safety protocols — see Texas and Mississippi — concerning for Popescu and her public health colleagues. According to a study released by the Centers for Disease Control and Prevention on March 5, counties that opened restaurants for on-premises dining saw a rise in daily infections roughly six weeks later and an increase in death rates about three weeks after that. The findings were in line with those of a July 2020 study, which found that “going to locations that offer on-site eating and drinking options were associated with COVID-19 positivity.”

While the CDC study doesn’t assert a cause-and-effect connection, the agency has emphasized that the risk is present. Public health experts have been urging lawmakers and diners to use extreme caution since the pandemic began.

The complicated new wrinkle in these warnings is that Americans now have access to very effective vaccines that protect against both hospitalization and the most serious Covid-19 symptoms. The messaging about risk becomes cloudy when combined with the extremely positive messaging about vaccines, especially when people have been waiting to resume their normal lives.

In response, public health experts have had to thread the needle about maintaining caution without compromising the positive messaging about vaccines, and vice versa.

Popescu said she’s focused on vaccination status. Current health advisories from the government and the CDC suggest that people who are fully vaccinated can go and mingle with others who are also fully vaccinated. And people who are fully vaccinated can visit an unvaccinated household, provided no one is at high risk for severe disease.

“You don’t know any of that information in a restaurant,” Popescu told me, explaining the CDC currently estimates that around 30 percent of the American population and 38 percent of Americans older than 18 are fully vaccinated. She also said we have to keep in mind that scientists are still studying the efficacy of vaccines against new variants, and that while the vaccines we have are safe and effective, a small number of breakthrough infections, where vaccinated people still catch Covid-19, have occurred.

“You don’t know the vaccination status of other people in a restaurant, and to start requiring that, I think, would be a huge issue in terms of equity. I can’t even imagine going down that route,” Popescu said.

Marissa Baker, an assistant professor in the Department of Environmental and Occupational Health Sciences at the University of Washington, echoed Popescu’s sentiments: In indoor restaurants where not everyone is fully vaccinated, the risk isn’t zero — and the risk to unvaccinated or partially vaccinated individuals is one of her main concerns.

The higher the fully vaccinated percentage rises, the more comfortable Baker, Popescu, and their public health colleagues are with indoor dining. What troubles them is the number of restaurants that are open without any restrictions while vaccination numbers remain where they are, and that there are still states where Covid-19 cases are high.

Figuring out a vaccination percentage that public health officials feel is safe and considered herd immunity is what Baker calls the “billion-dollar question” of the moment.

“All I can say is that we definitely aren’t there yet,” she said, urging patience and pointing out that each day means more people vaccinated, one step closer to herd immunity, and one step closer to possibly eating at The Cheesecake Factory indoors, unmasked, with friends. The problem is that America’s track record with the pandemic and patience hasn’t been stellar.

When it comes to risk, everything is personal

In separate interviews, Popescu and Baker both said they weren’t personally comfortable yet with indoor dining. They also said that someone’s risk tolerance is a personal, individual decision. They can’t stop anyone from dining out and, say, enjoying burgers if that is what the person’s heart desires.

What they urge, though, is that everyone considers these risks and how to mitigate them before making their decisions.

“I try to be mindful of teetering that line about really reminding people that vaccines are the best tool we have. They’re really amazing and efficacious. But they’re also not sterilizing immunity,” Popescu explained. “They’re close but not perfect. They’re a risk reducer, not an eliminator. And that is even that much more of an important nuance when we’re not at herd immunity when we don’t have global equitable distribution.”

Instead of thinking about vaccines as magic bullets, public health experts urge us to think about them in conjunction with other tools in our repertoire — tools that we’ve been using for the past year, like maintaining distance, socializing in pods, ventilation, and masking.

“People should be looking for restaurants that have really good airflow, that their waitstaff is consistently wearing masks, and that they’re expecting their patrons to wear masks, and that they’re conscientious about their Covid controls as well,” Baker said.

While some of this can seem superfluous, especially to those feeling confident about their fully vaccinated status, these precautions help with the bigger picture of reducing transmission and achieving herd immunity. Herd immunity isn’t thinking about our individual selves, but what we can do for our communities.

“When thinking about going out to eat or going to a restaurant or a bar, it’s important to keep in mind that there’s, of course, you and the other patrons in those spaces. But there’s also the workers in those spaces,” Baker said.

Baker urges that when we eat out, we should really think about if we are keeping servers, runners, bussers, cooks, and restaurant staff safe. There’s a chance some waitstaff might not be fully vaccinated, and regardless, they’re likely interacting with many people a day and therefore have a higher risk for exposure. By taking individual precautions, diners can make it safer for those serving them.

But that isn’t often the reality.

“I don’t mean to overuse this word or use it lightly, but the past year was pretty traumatic working in the restaurant and dealing with customers,” Amanda Cohen, the James Beard-nominated chef and owner of Dirt Candy, a restaurant in Manhattan’s Lower East Side, told me.

She explained that in addition to the stress of keeping her restaurant afloat, she often had to tell customers to put on their masks, maintain distancing, and often repeat and remind customers of her restaurant’s Covid-19 protocols and rules.

“I certainly felt like I was the Covid police. And in a way — and I get it — nobody was prepared for the pandemic,” she said. “But I wish the city, and I think most people in most cities felt like this, had really stepped up and put the onus on the customers who are going out to eat, to follow the rules and not the restaurant to have to be the one to implement them. You know, I don’t like being the Covid police.”

Dirt Candy hasn’t yet resumed indoor dining because Cohen is still figuring out the best way to implement protocols to keep her customers and her staff safe.

Cohen’s experience isn’t unique. Servers and restaurant staff often have to remind customers about masking and protocols and are put into uncomfortable situations for having to do so. Dirt Candy has a no-tipping policy (which existed pre-pandemic) and aims to pay its staff a living wage. In restaurants where reprimanding someone about masking could adversely affect tips, it becomes even more difficult for servers and staffers to remind patrons of the rules.

“As the people frequenting those spaces, we can make it so the server doesn’t have to make that choice and just be conscientious and wear a mask as much as we can,” Baker said, explaining that eating and drinking unmasked is fine but to think about wearing a mask when interacting with servers (during ordering, during bussing, paying the bill, etc.) and moving about the restaurant.

“It’s the conscientious thing to do. And it’s kind of a show of respect, as a way of saying ‘we don’t know each other’s vaccination status, so we’re doing what we can to take care of each other.’”

Patience is key

That narrative about caring and supporting each other extends to the relationship between diners and the restaurants they love — even beyond Covid-19 protocols.

The pandemic has seismically ravaged the dining industry, permanently shutting down many restaurants. That doesn’t just affect owners and chefs, but all the staff — the US Bureau of Labor Statistics reports that in 2020, food and beverage servers make a median of $11.63 per hour, or $24,190 per year. Instead of coming to their aid, the federal government has, in your correspondent’s blunt opinion, done barely anything, and for the past year has left the fate of restaurants in diners’ wallets and the delivery companies that stack surcharge upon surcharge on restaurants.

“There were times when I certainly felt like, I’m only gonna be able to rely on my customers to get me through this. And I felt like so much of the burden all of a sudden was put on the population and not the government,” Cohen told me.

Restaurants that did survive are facing a new and not-improved financial reality. They’re making less money. That money goes to procuring ingredients, yes, but it also goes to paying all the staffers, the rent, the insurance, the electric bills, the everything, Cohen explains. And because capacity is reduced and tourism is down — depending on city or state restrictions — it’ll be a long time before many restaurants will make the kind of money they were making before the pandemic.

As we’ve learned to think about our own relationship to supporting restaurants and how fragile and important restaurants are to us, thinking about the health of the people who keeping them running is just as important.

“We’re all a little worried about serving indoors and what that’s going to be like. Because while we’re vaccinated, we’re still indoors, and not everybody who’s eating in the restaurant may be vaccinated. The risk isn’t zero,” Cohen said. “I think people forget that, and I get it. It’s been a really hard year — I’m still processing the fact that this has gone on for over a year. But you can see everybody relaxing their guard a lot, and that makes me nervous.”

Cohen urges diners to be flexible, patient, and empathetic. Restaurant staffers want to get back to “normal” life as much as, if not more than, diners do. And it helps to keep in mind that chefs and owners like Cohen as well as her colleagues and everyone in the restaurant industry are trying to hit a moving target of keeping their businesses alive, keeping their customers happy, and keeping everyone safe at the same time.

That might mean being more patient when it comes to indoor dining and waiting just a little longer for case numbers to go down and vaccination rates to go up. Each day that passes, more Americans are vaccinated. And in many parts of the country, the weather is, thankfully, allowing for safer outdoor dining.

“It’s still going to be much safer to eat outdoors,” Baker told me, explaining that distancing and crowding protocols should still be maintained outdoors. “And to the extent that you can do that and will do that, you’re not only protecting yourself and the people you’re eating with, but you’re also protecting the folks who work in those establishments — people who have had a lot of ups and downs in the last year in terms of their employment.”