Dining inside a restaurant is an experience many Ontarians haven’t had in months, since the province entered a state of emergency in March due to the novel coronavirus pandemic.
But now, Ontario is allowing indoor dining to resume in parts of the province as part of Stage 3 as COVID-19 cases have steadily dropped, premier Doug Ford announced on Monday.
As of July 17, restaurants and bars are allowed to welcome patrons indoors, and other businesses, including gyms, can operate at a reduced capacity, too.
Regions including the Greater Toronto Area, Hamilton, Niagara and Windsor-Essex are exempt and will enter Stage 3 at a later date, Ford said.
But is it safe for Ontarians to rush back inside their favourite restaurant? It depends on the protocols in place, experts told Global News, adding there will ultimately be a risk no matter the number of confirmed cases in the region.
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Indoor dining potentially ‘problematic’ and ‘poses a risk’
Ontario is the last to lift restrictions on indoor dining, as other provinces and territories have reopened restaurants at a reduced capacity for weeks.
Parts of Ontario, including Toronto, had higher case counts for much of the pandemic than other parts of Canada, alongside Quebec.
The fact that outdoor spaces are safer than indoor ones when it comes to limiting the spread of the virus is a factor working against restaurants.
“Indoor spaces are very problematic,” said Gerald Evans, chair of the Division of Infectious Diseases at Queen’s University’s School of Medicine.
“They continue to be the kind of thing that we generally asked people to avoid. It poses a risk.”
In indoor settings, poor ventilation can help spread COVID-19. Unlike outdoors, where factors like the wind and sun can hinder transmission, restaurants often have less fresh air.
How well a restaurant is ventilated and its air conditioning system can affect the environment, although it can be hard to assess an establishment’s system, Evans said.
One study out of China looked at a coronavirus outbreak in an air-conditioned restaurant with no windows in Guangzhou, China, involving three family clusters. Researchers found that droplet transmission was prompted by air-conditioned ventilation, and the key factor for infection was the direction of the airflow.
In other words, the AC helped spread infectious droplets to other patrons in the restaurant. The researchers recommended that indoor restaurants have adequate ventilation and that patrons social distance in order to prevent a similar situation from happening.
“That’s the inherent danger, indoor spaces just don’t have that adequate ventilation,” Evans said.
If it wasn’t for the heat, Evans said, the best thing a restaurant could do right now is open its windows if it has any. Having constant fresh air flowing through the restaurant would make it safer, he explained.
Community case count a factor
In areas across the country where there have been no confirmed cases for weeks or months, it’s possible to not see outbreaks due to indoor dining. But don’t let that bring too much comfort, said Evans.
In the months since the pandemic began, it’s been well-documented that indoor spaces are an issue, said Leighanne Parkes, an infectious disease specialist and microbiologist at the Jewish General Hospital in Montreal.
With inter-provincial travel open and available across several provinces without isolation, excluding the territories at the Atlantic travel bubble, it’s likely people from areas with more infections will visit restaurants as tourists, she said.
That increases the likelihood of transmission particularly within an indoor setting.
“Inside closed spaces we have some of our most impressive super-spreading events,” said Parkes. “These are events where the attack rate is much higher than what we would expect, even in a household.”
What primes an indoor space to cause the coronavirus to spread more easily includes if more people are in close proximity, are speaking a lot, are moving around frequently and if the ventilation is poor, explained Parkes.
The more the air changes, the safer the environment becomes. In an indoor space, the air is exchanged less often, which could increase the likelihood of the disease spreading if an individual is infected, she said.
What restaurants need to do
Eating out on a patio in Ontario became an available option in mid-June, although the reopening was staggered based on region. Residents in Toronto and the Greater Toronto Area had to wait until June 24, nearly two weeks after the rest of the province, to experience outdoor service.
Making the leap to indoor dining will require considerable preparation from restaurant owners before they can even think of allowing customers inside, said Zahid Butt, an assistant professor at the University of Waterloo who specializes in infectious disease epidemiology.
Tables need to be six feet apart, high-touch areas need to be constantly sanitized, washrooms need to be cleaned frequently and it could be beneficial for patrons to wear masks when they aren’t eating, Butt explained.
“It doesn’t really depend on how much community transmission is there,” he said. “Anyone could get the virus and come in and spread the virus.”
Even if a region has more community transmission that would raise the general risk of being around others, Butt agrees with Evans in that there is still a risk. Just because an area hasn’t seen new cases in a few weeks doesn’t mean they are in the clear, Butt said.
As Canadians continue to travel to other provinces, restaurants need to have strict protocols if they want to operate indoors, he added.
It’s also important to remember the risk will never be at zero, said Parkes.
“At that point you have to ask yourself: Can we persist like we are now in a state of semi-confinement?” she said.
“Or should we tentatively put our toe in the water and see whether or not we can plunge in?”
— With files from Global News’ Meghan Collie
Questions about COVID-19? Here are some things you need to know:
Symptoms can include fever, cough and difficulty breathing — very similar to a cold or flu. Some people can develop a more severe illness. People most at risk of this include older adults and people with severe chronic medical conditions like heart, lung or kidney disease. If you develop symptoms, contact public health authorities.
To prevent the virus from spreading, experts recommend frequent handwashing and coughing into your sleeve. They also recommend minimizing contact with others, staying home as much as possible and maintaining a distance of two metres from other people if you go out. In situations where you can’t keep a safe distance from others, public health officials recommend the use of a non-medical face mask or covering to prevent spreading the respiratory droplets that can carry the virus.
For full COVID-19 coverage from Global News, click here.