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Patients with symptomatic COVID-19 were more likely than uninfected controls to report some form of restaurant dining -- including indoor, patio and outdoor seating -- in the 2 weeks prior to symptom onset, CDC researchers found.

Compared to controls without COVID-19, case patients were more than twice as likely to have reported dining at a restaurant (adjusted OR 2.4, 95% CI 1.5-3.8), reported Kiva Fisher, PhD, of the CDC, and colleagues.

When the analysis was restricted to case patients with close contact to anyone with confirmed COVID-19, case patients were still more likely to report having visited a bar/coffee shop (aOR 3.9, 95% CI 1.5-10.1) or restaurant (aOR 2.8, 95% CI 1.9-4.3) than control patients, albeit with wider confidence intervals, Fisher's group wrote in the Morbidity and Mortality Weekly Report.

Not surprisingly a substantially larger proportion of case patients reported close contact with a person with COVID-19 versus controls (42% vs 14%, respectively).

This data was previewed at the National Academy of Sciences and Medicine (NASEM) workshop on airborne transmission as part of the growing "circumstantial evidence" suggesting airborne transmission may play a role in COVID-19 spread.

"Reports of exposures in restaurants have been linked to air circulation," the authors wrote. "Direction, ventilation, and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance."

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Abstract

During January 26–February 10, 2020, an outbreak of 2019 novel coronavirus disease in an air-conditioned restaurant in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.