Eating at dine-in restaurants appears to increase the risk of becoming sick with COVID-19, according to a recent study by the Centers for Disease Control and Prevention (CDC) and Vanderbilt University Medical Center.

The study assessed differences in community and close contact exposures between adults who tested positive for COVID-19 and those who tested negative while matching for geographic location, age and sex. Going to dine-in restaurants was identified as a factor strongly associated with testing positive for COVID-19.

Findings from the study, which appears in this week’s CDC’s Morbidity and Mortality Weekly Report (MMWR), show that adults with COVID-19 were more than twice as likely to report dining in a restaurant in the 14 days before getting sick compared to adults without COVID-19.

“Based on the results of this study, eating at dine-in restaurants appears to increase the risk of becoming sick with COVID-19,” said Wesley Self, MD, MPH, associate professor of Emergency Medicine and senior author of the study. “We think this could be due to people sitting in close proximity to one another in restaurants and not being able to wear masks while eating.”

The authors warned that community and close contact exposures continue to drive the COVID-19 pandemic. Exposures and activities that make it difficult to wear masks and maintain social distancing, including going to locations that offer on-site eating and drinking, may increase the risk for getting COVID-19.

Implementing protective steps to reduce potential exposures to COVID-19 during on-site eating and drinking should be considered to protect customers, employees and communities, the authors advise. The report did not look at specific factors in restaurant operations – such as whether the dining was done inside or outdoors.

“These results also suggest that pick-up and delivery options may lessen the risk for contracting COVID-19 compared to dining in at restaurants,” Self said. “If one chooses to dine in at a restaurant, we think several things could be important for decreasing the risk of COVID-19, including wearing a mask while not eating or drinking, staying as socially distanced as possible, washing hands frequently and not using “self-serve” buffet options (to limit the use of shared utensils, handles, buttons or touchscreens),” he said.

The investigation included adults older than 18 who received a first test for the SARS-CoV-2 infection, the virus that causes COVID-19, from July 1-29 at an outpatient or health care center at one of 11 sites in the IVY Network, a collaborative research group of multiple medical centers in the U.S led by VUMC. The IVY Network is funded by the CDC to conduct research on severe respiratory infections, including COVID-19 and influenza. Kiva Fisher, PhD, from the CDC, is the report’s first author.