Eating Out/Ordering In-- How Safe Is That?

My friend told me that the local mega-Starbucks in the neighborhood was serving food at tables set up outside the the building. He said all the tables were filled with people. Will it take a million deaths before Americans realize how serious this plague is? Two million? Ten million?

A couple of months ago, Forbes healthcare reports Victoria Forster asked if there is any chance of becoming sick with COVID-19 from eating takeout foods? Although many scientists say we don't know a great deal about this virus, there seems to be consensus that SARS-CoV-2 is not transmitted by eating food-- except, perhaps bat soup or pangolin stew.

Angela Rasmussen, PhD, a virologist in the faculty of the Center for Infection and Immunity at Columbia: "Heat almost certainly inactivates the virus, although studies have not been done to my knowledge describing the specific temperatures or durations at those temperatures at which inactivation occur... Although hot food is less likely to have infectious virus present depending on the temperature of the food, risk of contracting SARS-CoV-2 through eating any food is extremely low. Food is not inhaled into the respiratory tract and any virus present will likely be inactivated in the stomach."

Remember, most food preparers are cooks, not trained chefs. "Some viruses," wrote Forster, "can be transmitted through food and make us sick. Norovirus outbreaks are famous for shutting down restaurants, hotels and particularly cruise ships. Although the coronavirus has definitely spread on cruise ships, there is no current evidence that this was through food. So what are the differences between coronaviruses and noroviruses?

“The SARS-Cov-2 virus and norovirus are different viruses with different outside components. The coronavirus capsid (or protein shell) is surrounded by a lipid envelope that can be dissolved relatively easily by soap and water,” said Mary K. Estes, Ph.D, Professor at Baylor College of Medicine in Texas who researches gastrointestinal viruses. “Noroviruses have a capsid without a lipid envelope,” she added, meaning they are not as easily combated by soap and water.

Norovirus is mainly thought to spread through fecal-to-oral transmission and there have been some cases where the coronavirus has been detected in the feces of those infected, so does this pose a risk?

“Both infectious virus and viral RNA have been detected in the stool of some-- but not all-- patients. This means there is a possibility of fecal transmission. However, it’s critical to note that there is no evidence that fecal transmission has occurred, much less is an important driver of transmission,” said Rasmussen.

The high standard of food safety training for chefs and people who prepare food should mean that they are better than most of us at ensuring hand hygiene, but there are also other differences between the viruses which mean that coronaviruses are far-less likely to pose a risk from consuming food than noroviruses.

“Noroviruses are much more stable viruses [than coronaviruses] and remain on surfaces for quite long periods of time in the environment and in food. Both of these viruses will be killed in cooked food so eating well cooked, hot food should be safe,” said Estes.

“Fecal transmission risks, while likely already low, can be further reduced by practicing good hand hygiene and taking droplet precautions,” said Rasmussen.

Now, as restaurants are beginning to open, the New York Times' Pete Wells, entices readers with the obvious question: Is It Safe to Go Out to Eat?. Key statement: "Just because you can eat out again, though, does not mean that you should. And if you decide to go back before the virus is under control, it will not necessarily be clear which dining rooms are safest. Restaurants will have to navigate a situation that is new to them and to the rest of the world. New guidance for restaurant operators from the Centers for Disease Control and Prevention favors broad principles ('Intensify cleaning, sanitization, disinfection and ventilation') over specific standards."

“There really is no scientific study” on the best ways for restaurants to reopen following a Covid-19 outbreak, said Dr. Robert W. Amler, dean of the School of Health Sciences and Practice at New York Medical College. Nevertheless, doctors and public health experts have some suggestions for handling the risks of dining out while the virus is still a threat.

Dining rooms are open again in several states that have not met the criteria for progress against the virus suggested by the White House for a phased reopening. The states’ reopening is a public-policy decision, but going out to eat is a personal one. At the very least, you should check the latest data on coronavirus cases in your city or county before making up your mind.

“I would certainly want to have some awareness of how much transmission seems to be going on in my community,” said Craig W. Hedberg, a professor in the School of Public Health at the University of Minnesota. “So if you know that there are new cases continuing to be occurring every day in your community, you have to assume there’s going to be a risk for transmission in public settings.”

...Anyone who falls into one of the high-risk categories identified by the C.D.C. should be especially cautious about going out to restaurants. In particular, older people, which the agency defines as those age 65 and above, “really do have to be extra careful, and their family members have to be extra careful,” Dr. Amler said.

Just as you’d interview a babysitter you were thinking about hiring, you can quiz a restaurant’s staff in advance about its safety practices, or look for a summary on its website or social media accounts.

Benjamin Chapman, a professor and food safety specialist at North Carolina State University, who has collaborated on a training program to help restaurants in his state manage their response to the coronavirus, said that among the things he would hope to hear are: “We’re taking this seriously. We’ve trained our staff on how to wear masks, on the importance of hand washing and hand sanitizing. We’ve changed what we’re doing to ensure that we’re practicing social and physical distancing to keep you safe.”

A fast glance can tell you a lot about how thoroughly the management has responded to the pandemic. “A restaurant that looks exactly like it did before is probably not the kind of restaurant I want to go to,” Dr. Chapman said.

Are the tables far apart? Will the chairs permit at least six feet of space between customers? Is the restaurant allowing staff or customers to gather in clusters?

“The biggest red flag would just be crowding,” Dr. Hedberg said. “If people are crowded near the entrance or around the bar, or there’s a lot of interaction going on between staff and customers in close proximity, then obviously they’re not operating in a mode that’s designed to prevent transmission of the virus.”

The virus spreads readily indoors, as shown by a study of a woman who appears to have transmitted it to nine other people who were eating in the same room of a restaurant in China. Recent evidence suggests that the risk of infection may be lower outdoors. Alfresco dining has other advantages. Dr. Chapman pointed out that there may be more space outside to spread out, and that all-weather furniture may be easier to rearrange than a fixed booth in a dining room.

The C.D.C. recommends wearing masks or cloth face coverings when out in public, to keep people who don’t know they’re sick from spreading the virus by respiratory droplets. This applies to restaurant workers. “What that shows is that the business is really trying to take the idea of asymptomatic carriers of the virus seriously,” Dr. Chapman said.

Eating a meal with a mask on is a challenge. Diners should arrive with face coverings, remove them temporarily to eat or drink, and put them on again before talking. A new study shows that in an unventilated room, droplets produced by normal conversation could linger in the air for as long as 14 minutes.

In many places, the law already requires people who prepare food to wear gloves. That hasn’t changed. For hosts and servers in the dining room, however, gloves are not necessary, and some experts believe they’re a bad idea.

“The real problem is, over a period of time, if you’re using these gloves, you’re going to get a false sense of security,” Dr. Amler said. “It’s better to be concerned about your hands’ getting contaminated, and to be washing more frequently.”

Although surface contact is not believed to be the primary way the virus spreads, experts still recommend being careful about surfaces that other people may have touched: tabletops, silverware and so forth. Looking at a chalkboard menu might be safer than picking up a laminated one.

If you do touch common surfaces, wash or sanitize your hands and don’t touch your face. Thoughtful restaurateurs will provide sanitizer throughout the establishment, but it’s a good idea to bring your own. If you need to wash your hands in the restroom, Dr. Hedberg suggested that its condition may give you an insight into the restaurant’s overall commitment to a sanitary environment.

Picking up a French fry or a burger with your bare hands is permissible, once you’ve taken care of personal hygiene. But you were probably doing that before the pandemic, too. “You should always be washing your hands before you eat,” Dr. Hedberg said.

Although we often go to restaurants so we can slow down, unwind and forget our worries, the pandemic makes a more businesslike approach advisable. “The longer you stay in an area where there’s this potential for transmission, the greater the likelihood that something could happen,” Dr. Hedberg said.

In other words: If ever there was a time to eat and run, this is it.