THE SCIENCE BEHIND COVID-19 MITIGATION

In-Person Dining and Alcohol Sales

• All in-person indoor dining at businesses in the retail food services industry, including, but not limited to, bars, restaurants, breweries, wineries, distilleries, social clubs, and private catered events is prohibited.   
• Outdoor dining, take-out food service, and take-out alcohol sales are permitted and may continue, subject to any limitations or restrictions imposed by Pennsylvania law, or this or any other Order issued by the Sec. of Health or by the governor.  

Multiple studies have found indoor dining to drive case increases and fatalities. A study by JP Morgan analyzed credit card spending of more than 30 million Chase cardholders and Johns Hopkins University’s case tracker and found that higher restaurant spending in a state predicted a rise in new infections there three weeks later. Additionally, research from Stanford University found that restaurants accounted for a significant amount of new infections while research from Yale University found that closing restaurants reduced fatality rates.

Indoor Gatherings and Events

• Indoor gatherings and events of more than 10 persons are prohibited.  
• Churches, synagogues, temples, mosques, and other places of congregate worship are specifically excluded from the limitations set forth above during religious services, these institutions are strongly encouraged to find alternative methods for worship, as in person gatherings pose a significant risk to participants at this time. While this an incredibly difficult recommendation to make, particularly at this time of year, faith leaders must carefully weigh the health risks to their congregants given the immense amount of community spread of COVID-19.

A new study from Stanford University and published in the journal, nature, used cellphone data collected from 10 U.S. cities from March to May to demonstrate that restaurants, gyms, cafes, churches and other crowded indoor venues accounted for some 8 in 10 new infections in the early months of the U.S. coronavirus epidemic.

Outdoor Gatherings and Events

• Outdoor gatherings and events of more than 50 persons are prohibited.   

According to a Yale University study, limiting outdoor gatherings was among consistent policies found to reduce fatality rates.      

The CDC states that medium-sized outdoor gatherings carry a higher risk of COVID-19 spread, even with social distancing. CDC notes that the more people an individual interacts with at a gathering and the longer that interaction lasts, the higher the potential risk of becoming infected with COVID-19 and COVID-19 spreading, and that the higher the level of community transmission in the area that the gathering is being held, the higher the risk of COVID-19 spreading during a gathering.

Capacity Limits for Businesses

• All in-person businesses serving the public may only operate at up to 50% of the maximum capacity stated on the applicable certificate of occupancy, except as limited by existing orders to a smaller capacity limit. 

The same Stanford University study that collected cellphone data also noted that limiting indoor capacity can reduce COVID-19 transmissions.

Gyms and Fitness Facilities 

• Indoor operations at gyms and fitness facilities are prohibited. 
• Outdoor facilities and outdoor classes can continue, but all participants must wear face coverings in accordance with the Sec. of Health’s Updated Order Requiring Universal Face Coverings, including any subsequent amendments, and practice physical distancing requirements.   

According to a Yale University study, closing businesses like gyms was among consistent policies found to reduce fatality rates.

Additional scienticic sources on the risk of COVID-19 infection    

Closing gyms and restaurants is necessary to keep people from dying.  Studies on the spread of the virus found that the vast majority of new cases – 85 percent of them – were coming from only 10 percent of locations. The study found that opening and closing of restaurants would have the most dramatic impact because 80 percent, 8 in 10, of the cases from COVID-19 were spread in restaurants, gyms, churches and crowded indoor spaces. These places – restaurants and gyms – are where people are getting sick.  

This Nature Journal article details a study showing that restaurants, gyms and coffee shops rank high among locations where the coronavirus is most likely to spread outside the home. That is according to a newly published report based on data from millions of Americans, tracked by their phones as they went about daily life during the pandemic’s first wave. – Washington Post article 

The study found that close contact with people with known COVID-19 or going to locations that offer on-site eating and drinking options were associated with COVID-19 positivity. Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results. - CDC  

A Japan study noted many COVID-19 clusters were associated with heavy breathing in close proximity, such as singing at karaoke parties, cheering at clubs, having conversations in bars, and exercising in gymnasiums. - CDC 

This CDC research letter highlighs that transmission was facilitated by indoor dining in poorly ventilated enclosures. - CDC 

The virus spreads most commonly through close contact, scientists say. But under certain conditions, people farther than six feet apart can become infected by exposure to tiny droplets and particles exhaled by an infected person, the Centers for Disease Control and Prevention said in October. Those droplets and particles can linger in the air for minutes to hours. – Washington Post 

In this county-by-county analysis from the University of Minnesota, more than 3,000 U.S. counties, three Pennsylvania counties are in the top 36 counties for highest % of hospital patients with COVID-19. – Carlson School, University of Minnesota 

The New York Times recently surveyed more than 700 epidemiologists and asked them to pinpoint ways to minimize risk. The first on the list was to avoid spending time in confined spaces where anyone is unmasked -- including restaurants. – New York Times 

It is not enough to be socially distanced in restaurants. A teenager got COVID-19 from being in the same restaurant – 20 feet away from one sick person for only five minutes. In restaurants people take off their masks. And they breathe in the virus. Researchers used cell phone data and cameras from inside the restaurant to establish the transmission.  

Dr. Lee Ju-hyung has largely avoided restaurants in recent months, but on the few occasions he has dined out, he’s developed a strange, if sensible, habit: whipping out a small anemometer to check the airflow. It is a precaution he has been taking since a June experiment in which he and colleagues re-created the conditions at a restaurant in Jeonju, a city in southwestern South Korea, where diners contracted the coronavirus from an out-of-town visitor. Among them was a high school student who became infected after five minutes of exposure from more than 20 feet away.  The results of the study, for which Lee and other epidemiologists enlisted the help of an engineer who specializes in aerodynamics, were published last week in the Journal of Korean Medical Science. The conclusions raised concerns that the widely accepted standard of six feet of social distance may not be far enough to keep people safe. – LA Times 

Epidemiological analysis which alarmingly indicates that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be exceptionally contagious in crowded settings and illustrates how a high-density work environment can become a high-risk site for the spread of COVID-19 and potentially a source of further transmission. - CDC 

CDC MMRW report citing evidence to recommend that U.S. residents should adhere to CDC recommendations for social distancing, avoid gatherings, and follow stay-at-home orders when required by state or local authorities. - CDC 

Study indicating that reopening non-essential businesses, and in particular, indoor dining at restaurants, resulted in excess COVID-19 cases and deaths across the US. Shelter-in-place orders and closures reductions in COVID-19 cases and deaths (decreased growth rate 15.4% and 11.6%). Study contributes to the growing evidence that mask usage is essential for mitigating community transmission of COVID-19. – Springer.com, Journal of Medicine 

Analysis with a danger index on the relative risk-reward for business and social facilities indicates that dining, gyms, and places of worship measure high on the cumulative danger index. – pnas.org 

When community transmission is as bad as it is now – all kinds of life is stopped. When it is as bad as it is now – with community transmission above 10 percent in many counties - people are not alllowed to visit their relatives in nursing homes.  

(Citation: Nursing Home Visitation-COVID-19 (cms.gov) “Facilities should use the COVID-19 county positivity rate, found on the COVID-19 Nursing Home Data site as additional information to determine how to facilitate indoor visitation: • Low (10%) = Visitation should only occur for compassionate care situations according to the core principles of COVID-19 infection prevention and facility policies”)