On March 8, the Centers for Disease Control and Prevention published its first recommendations outlining low-risk activities for fully vaccinated people, offering a hopeful vision of the not-so-distant future. The CDC says that fully vaccinated people from separate households can gather indoors without masks or social distancing, and can even do so with unvaccinated people from a single household “who are at low risk for severe COVID-19 disease.” The guidelines do, however, encourage vaccinated people to avoid medium- and large-sized gatherings, and advise continued mask wearing and physical distancing in public spaces.
While this might be the encouragement you’ve been waiting for, consider holding off a little while longer before rushing back to your favorite restaurant for an indoor meal. Even among experts, risk tolerance and safety assessment varies. Of the doctors and health experts I’ve spoken with, some have entirely avoided restaurant dining since March of 2020, while others have, on occasion, dined outside with their families. Notably, every expert I spoke with said they did not feel comfortable dining indoors, a position that’s been supported by study after study. But with highly effective vaccines becoming available to some diners, the risks associated with restaurants are changing — especially in cities like New York and San Francisco, where restaurant workers are eligible for vaccination. But at this moment, a turning point in a year-long pandemic, is it too soon to safely return to dining rooms?
Promising early research suggests vaccinated people are less likely to asymptomatically carry the virus. But as vaccination rollout ramps up, only about 12 percent of the U.S. population has been fully vaccinated, with 21 percent having received their first of a two-dose regimen. Where restaurant workers are eligible to receive a vaccine, this number includes some waitstaff, cooks, and dishwashers. In many states, where a portion of diners may be vaccinated, the people cooking and serving food are still mostly unprotected. And while vaccination seems to cut down on viral transmission, the possibility of a vaccinated person passing on a case of COVID-19 still exists. This makes the safety — and the ethical considerations — of indoor dining anything but simple.
To better understand the changing risk levels of restaurant dining during vaccination rollout, I spoke with two experts: Dr. Dean A. Blumberg, chief of pediatric infectious diseases at UC Davis Health, and Dr. David W. Dowdy, an infectious disease epidemiologist and the B. Frank and Kathleen Polk Professor at Johns Hopkins Bloomberg School of Public Health. These conversations, edited lightly for clarity and length, are a reflection of the experts’ assessment of the current risks associated with restaurant dining.
Eater: How is your own risk assessment of social situations changing as people get vaccinated?
David Dowdy: Now that I’m vaccinated, if there are people who have also been vaccinated, I’m happy for them to be in my house, and we don’t have to be wearing masks. Or if we’re outside, we don’t have to necessarily be wearing masks if we’ve all been vaccinated. And to that extent, I’m even having some larger gatherings — by larger I mean five or six people, all of whom are vaccinated. But in terms of my engagement with public activities, including eating out, being vaccinated has not yet changed what I do.
Dean Blumberg: I think the main thing to consider is that the vaccines work very well. And so most people who are vaccinated have quite good protection. But they still may get infected, and they could transmit to others. So the major risk of not social distancing and not masking when interacting with people outside your household is going to be to those who are unvaccinated, not to the vaccinated individuals.
Without knowing what portion of a restaurant’s staff or the surrounding diners are vaccinated, is there a safe way for vaccinated people to start thinking about indoor dining?
DB: The main risk is going to be to the unvaccinated individuals, whether that’s the restaurant staff or other diners who are not vaccinated. If you are vaccinated, then it’s likely okay [for you] to be in a public space, like a restaurant. You will be exposed to other people, but you’re relying on the vaccine’s protection.
In restaurants, even as people are vaccinated, you still want the tables to be six feet apart. And we would hope that everybody who you’re dining with, at one table where you’re closer than six feet, is a vaccinated adult. In general, a restaurant needs to be following best practices: make sure that patrons at other tables are at least six feet away; make sure that the waitstaff is masked; make sure that people are masked when they’re in congregate areas like the waiting area, or when they’re going to the restroom. If all of these measures are in place, I think that the risk level will be similar to in-home dining with other vaccinated individuals.
The risk will be higher for other patrons who are unvaccinated, and for the staff who weren’t vaccinated, even though they’re wearing masks.
DD: From the perspective of the person who has been vaccinated, the risk is actually pretty low. If you’ve been vaccinated, especially if you’ve gotten your second dose of a two dose series, then your risk of getting very ill is extremely low. But it is still possible that you could be infected without knowing it, or have very mild symptoms and therefore be contagious at a lower level. And nobody is going out there with a big ‘V’ on their forehead saying “I’m vaccinated.” So as people are looking around, if they’re seeing that everyone is gathering in these very crowded restaurants, there’s a message that’s being sent.
If I were talking to someone who had been vaccinated, would I say that you absolutely cannot eat indoors? No, because I want people to feel like there’s some hope. And I want them to feel like the vaccine does provide protection. But would I say that you should be going out all the time? Probably not. I, myself, have been vaccinated. And I would feel personally safe going to a restaurant, but I still feel like it doesn’t necessarily send the right message. And so I haven’t yet. But it’s a personal decision. Everyone’s in a different situation, and has different considerations.
It’s great that indoor dining is low risk for vaccinated individuals. But what’s the risk faced by surrounding diners, cooks, and other restaurant workers who aren’t yet vaccinated?
DB: They’re at risk. Vaccinated diners or workers may be carrying the virus and they can potentially infect others: The waitstaff is probably going to come within six feet of diners. The highest risk would be posed by unmasked unvaccinated patrons, but there’s still some risk of unmasked vaccinated patrons spreading the virus.
DD: I feel like that risk is low, but it’s not zero. I personally feel like we should be thinking about moving as a society as a whole, not a society of vaccinated versus unvaccinated people. As more people in our society become vaccinated, everyone should feel like they can slowly get back to activities that pose some risk. I would like us to be thinking of how we can get more and more people vaccinated, so that at a policy level, we can safely allow everyone to get back to something resembling our pre-pandemic lives, as opposed to this entirely being a question of individual choice.
I think that a lot of these discussions start to get at how we as individuals consider our roles in a broader society, and a society where both risk and opportunity for vaccination are not necessarily fairly distributed. In many cases, I think this is more of an ethical than an epidemiological consideration.
Epidemiologically speaking, if a restaurant’s tables are going to be filled by diners either way, does having vaccinated people fill them act as insulation against the potential spread of infection?
DB: Yes. That’s how herd immunity works. The higher proportion of vaccinated and immune individuals that are in the restaurant, the less chance that an unvaccinated person is going to come into contact with somebody who’s transmitting the virus.
I’m curious, for you personally, what will it take to return to indoor dining?
DB: The way I’m thinking of it is, you have to just take small steps. Once people get used to having another couple over for dinner, and being unmasked in somebody else’s presence, then you take these baby steps. You kind of reintegrate into society. As the weather’s getting better, people are going to be dining outdoors, and then after a while, people will be indoors at restaurants. So I think it’ll be just a slow progression back to feeling normal.
I’m hoping that COVID-19 will, in the long run, be similar to things like seasonal influenza, and other viruses where there’s always a risk of getting infected in public, but a low enough risk that we can go about our everyday activities. I’m ultimately hoping that we will be able to go back to exactly the kind of mass group gatherings that we used to experience. But that’s not to say that everybody is going to be comfortable doing so.
DD: There may be a difference between what we say in our ideal world and what we do in reality, and I think this is true for everyone right now. In an ideal world, the point at which I’d feel comfortable would be either when the risk of disease became so low that I felt like all of society should be willing to tolerate that risk, or, when we have gotten to a point where everyone who wanted a vaccine could get it. But in terms of the actual decisions that people make, we need to recognize that there is going to be some degree of fatigue and some degree of wanting to go back to doing these things that we’ve been unable to do for so long.
At some point, people are going to say, “Look, it’s my birthday, I’m going to go out, and I’m going to celebrate.” That’s going to happen, and we can’t tell people not to. I think it’s about choosing those events or times when we are willing to tolerate a little bit more risk. But just because I go out and celebrate for my birthday, doesn’t mean I’m suddenly going out every night. It’s not an all or nothing sort of situation.
How do variants play into your risk assessment for vaccinated diners, and for the safety or workers?
DD: I should say, I do fall on one end of the scientific spectrum here: I’m much less concerned about some of these variants than others are. I look to the U.K., Ireland, Denmark, where these variants are clearly dominant, and these places are not experiencing explosions of the virus. It’s partially because they’re still stringently locked down, but I’m not seeing the sort of dramatic uptick in case numbers that I would expect. I do think that these variants are more transmissible, but I don’t think that that increased transmissibility is resulting in huge epidemics at the population level. We shouldn’t be dismissive of their potential threat, but to me, variants don’t change the risk calculus all that much.
DB: The variants are wildcards. The variant first found in the U.K. (B 1.1.7), and some of the others, are more transmissible — B.1.1.7 has an up to 50 percent increased rate of infection compared to the previous strain. That means that there’s more risk of infection if some of these strains take hold, and the CDC estimates that the U.K. variant will be the predominant strain that’s being transmitted in the U.S. [as of] this month. Another issue will be if the strains escape vaccine-induced immunity. The current vaccines protect against the U.K. strain, but the strains originating from South African (B.1.351) and Brazil (P.1) do appear to somewhat evade vaccine-induced immunity. And we’re just not exactly sure how big of an effect that will have at this point.
So that’s the short term, of the next few months or so. But I am optimistic that in the long term, if the variants are resistant to the current vaccine-induced immunity, the vaccines can be updated very rapidly. We can keep up with the variants, and the vaccines might provide reduced protection, but they’re not going to have zero effect. Even if variants do escape a vaccine-induced immunity, I’m still confident that vaccination is going to have a very positive effect, and that the pandemic is going to get under control. As we fine-tune and update the vaccines, we’ll eventually end the pandemic.