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CDC Study Shows Counties Allowing In-Restaurant Dining Associated With Increased Daily COVID-19 Case Growth Rates, Cites These Data, Offers These Caveats And Recommendations



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(March 6, 2021) -- The Centers for Disease Control (CDC) has released a study by a team of CDC researchers that indicates (a) requiring masks was associated with a decrease in daily COVID-19 case and death growth and (b) counties allowing on-premises restaurant dining experienced an increase in daily COVID-19 case growth rates.

The CDC study, released March 5 and visible this link, says "mask mandates and restricting any on-premises dining at restaurants can help limit community transmission of COVID-19 and reduce case and death growth rates." The CDC study also found that counties allowing on-premises dining experienced a rise in n daily COVID-19 infections roughly six weeks later, and increased COVID-19 death rates about two months later.

The study doesn't prove cause and effect, but states in pertinent part: "Allowing on-premises restaurant dining was associated with an increase in daily COVID-19 case growth rates 41-100 days after implementation and an increase in daily death growth rates 61-100 days after implementation." The CDC study says "restricting any on-premises dining at restaurants can help limit community transmission of COVID-19 and reduce case and death growth rates."

It included these caveats: "The findings in this report are subject to at least three limitations. First, although models controlled for mask mandates, restaurant and bar closures, stay-at-home orders, and gathering bans, the models did not control for other policies that might affect case and death rates, including other types of business closures, physical distancing recommendations, policies issued by localities, and variances granted by states to certain counties if variances were not made publicly available. Second, compliance with and enforcement of policies were not measured. Finally, the analysis did not differentiate between indoor and outdoor dining, adequacy of ventilation, and adherence to physical distancing and occupancy requirements."

In its discussion section, the March 5 CDC study states:

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Mask mandates are associated with reductions in COVID-19 case and hospitalization growth rates (6,7), whereas reopening on-premises dining at restaurants, a known risk factor associated with SARS-CoV-2 infection (2), is associated with increased COVID-19 cases and deaths, particularly in the absence of mask mandates (8). The current study builds upon this evidence by accounting for county-level variation in state-issued mitigation measures and highlights the importance of a comprehensive strategy to decrease exposure to and transmission of SARS-CoV-2. Prohibiting on-premises restaurant dining might assist in limiting potential exposure to SARS-CoV-2; however, such orders might disrupt daily life and have an adverse impact on the economy and the food services industry (9). If on-premises restaurant dining options are not prohibited, CDC offers considerations for operators and customers which can reduce the risk of spreading COVID-19 in restaurant settings.*** [Triple asterisks link to this page] COVID-19 case and death growth rates might also have increased because of persons engaging in close contact activities other than or in addition to on-premises restaurant dining in response to perceived reduced risk as a result of states allowing restaurants to reopen. Further studies are needed to assess the effect of a multicomponent community mitigation strategy on economic activity.

Increases in COVID-19 case and death growth rates were significantly associated with on-premises dining at restaurants after indoor or outdoor on-premises dining was allowed by the state for 40 days. Several factors might explain this observation. Even though prohibition of on-premises restaurant dining was lifted, restaurants were not required to open and might have delayed reopening. In addition, potential restaurant patrons might have been more cautious when restaurants initially reopened for on-premises dining but might have been more likely to dine at restaurants as time passed. Further analyses are necessary to evaluate the delayed increase in case and death growth rates.

The findings in this report are subject to at least three limitations. First, although models controlled for mask mandates, restaurant and bar closures, stay-at-home orders, and gathering bans, the models did not control for other policies that might affect case and death rates, including other types of business closures, physical distancing recommendations, policies issued by localities, and variances granted by states to certain counties if variances were not made publicly available. Second, compliance with and enforcement of policies were not measured. Finally, the analysis did not differentiate between indoor and outdoor dining, adequacy of ventilation, and adherence to physical distancing and occupancy requirements.

Community mitigation measures can help reduce the transmission of SARS-CoV-2. In this study, mask mandates were associated with reductions in COVID-19 case and death growth rates within 20 days, whereas allowing on-premises dining at restaurants was associated with increases in COVID-19 case and death growth rates after 40 days. With the emergence of more transmissible COVID-19 variants, community mitigation measures are increasingly important as part of a larger strategy to decrease exposure to and reduce transmission of SARS-CoV-2 (3,4). Community mitigation policies, such as state-issued mask mandates and prohibition of on-premises restaurant dining, have the potential to slow the spread of COVID-19, especially if implemented with other public health strategies (1,10).

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The CDC study comes as Los Angeles County may move from the current "purple tier" (most restrictive with "widespread" virus activity) to the less restrictive "red tier" (with "substantial" virus activity.) The Newsom administration has shifted 40% of vaccines to enable increased vaccinations in communities experiencing the highest COVID-19 case rates and as statewide vacccinations hit 2 million (they're about 1.6 million now) plans to change its standards to let counties move into the "red tier" despite a higher COVID-19 new case rate (10 per 100,000) than "red" currently allows (7 per 100,000). As of March 5, Long Beach's case rate was 7.5 per 100,000 population; Sacramento makes its decisions based on countywide, not LB data.

Moving to the "red tier" would allow on Sac'to allowed terms some indoor dining plus reopening of gyms and movie theaters.

The Newsom administration continues to advocate masking (LB requires it in public settings) and now recommends double-masking for added protection, On March 4, the CA Department of Public Health (CDPH) revised the state’s facemask policy to strongly encourage wearing two masks instead of one. Governor Newsom urged Californians to follow that guidelines at least until a higher percentage of CA's population is vaccinated. p>

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