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Sept 30, 2020

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Risk Factors for COVID-19 Acquisition: It’s Still Takeout Time

Reviewed by Christopher J. Graber, M.D., MPH, FIDSA

As the COVID-19 pandemic continues to evolve, ongoing understanding of behavioral risks of infection acquisition remains critically important in informing public health measures and messaging.

In an article published in the Sept. 11, 2020, issue of Morbidity and Mortality Weekly Report, investigators from 11 Influenza Vaccine Effectiveness in the Critically Ill Network sites around the nation that served as COVID-19 testing facilities surveyed symptomatic adults who tested positive for SARS-CoV-2 along with two negative controls for each positive case based on age, sex, and study location. A total of 615 cases and 1,212 controls were identified and contacted 14-23 days after initial testing regarding exposures and risk behaviors in the 14 days prior to testing; 154 cases and 160 controls agreed to participate and were included in the analysis. Exposures and risk behaviors analyzed included shopping, having 10 or less vs. greater than 10 guests visit subjects’ homes, using public transportation, or going to an office setting, salon, gym, bar or coffee shop, restaurant, or church/religious gathering.

After excluding patients that had a known exposure to a person with confirmed COVID-19 disease, cases were significantly more likely to report dining at a restaurant (adjusted odds ratio [aOR] 2.8, 95% confidence interval [CI] 1.9-4.3) or going to a bar or coffee shop (aOR 3.9, 95% CI 1.5-10.1) than controls.  No other exposures were significantly associated with case positivity. Any area designated by a restaurant for dining (including indoor, patio, and outdoor seating) was included in the restaurant exposure definition, though risk was not broken down by designated area.

Restaurants, bars, and coffee shops appear to pose unique risks for SARS-CoV-2 spread: consumption of food and drink that requires mask removal, a large number of individuals in a relatively small (frequently indoor) space, and persons speaking loudly in order to be heard over the din of usual activity in these settings. As such, it might still be “takeout time” until the pandemic is under better control.

(Fisher et al. MMWR Morb Mortal Wkly Rep. 2020;69:1258–1264.)

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