Indoor dining, bars: How to manage California’s COVID wave

With the super-infectious Omicron subvariants spreading across California, it’s hard to know what actions are still safe or smart.

Experts say that people who are vaccinated and unvaccinated are still better protected against serious diseases. But given the now dominant BA.5 subvariant, which is particularly good at avoiding vaccines or recent Omicron infection, these groups are still susceptible to COVID-19.

“Everyone should be wary of it — BA.5 and these new variants — but not afraid of it,” said Dr. Peter Chin-Hong, an infectious disease expert at UC San Francisco. “If you’re up to date on your vaccines, it won’t make you very sick.”

But for those who are unvaccinated or not vaccinated at all, Chin-Hong said the risk of severe disease remains a concern during this wave, which is less deadly than in the past. This vulnerable group currently makes up the majority of COVID-positive ICU patients, he said.

Experts say there are many reasons why people are stepping up other protections, including masking, testing and increasing ventilation, when transmission is so high:

  • Some studies show that to reduce the risk of long-term COVID, which affects almost 25% of infected people
  • to avoid secondary COVID infections, which are associated with an increase in other adverse health outcomes
  • to protect vulnerable members of society, such as the immunocompromised or the elderly, who are more susceptible to disease or death
  • to avoid disruptions to daily life, including childcare arrangements, unemployment or travel plans
  • reducing the ability to develop new options

“When the incidence is really high, we would be foolish to be complacent. … This is a dangerous virus,” said Los Angeles County Public Health Director Barbara Ferrer. “If we can slow down transmission, there’s a good chance we’ll prevent some deaths in the coming months.”

Ferrer may implement a nationwide mask mandate this week if hospitalizations do not decrease in the coming days. While this may change the precautions taken in indoor public spaces, it still leaves plenty of room for people to make decisions about gatherings with friends and family, dining out, summer travel and more.

“Getting vaccinated and wearing a mask indoors are two relatively good things that carry a lot of weight,” said Dr. Peter Katona, professor of epidemiology at UCLA. “At the end of the day, it’s your risk tolerance that determines what you do or don’t do.”

Even among public health experts, there are differences in what is considered dangerous during this latest wave. But in general, health officials said people should take into account the transmission of the virus — which is now very high — how close they are to others under certain circumstances and how much air is circulating around them when deciding where to go and how to interact.

“We’re stuck with ‘everybody wants it to go away,’ but it won’t go away,” said Dr. Kimberly Schreiner, an infectious disease specialist at Huntington Hospital. He said that during this upheaval and any future occasions, people should be prepared to continue using weapons for greater protection until things start to sink in.

“Like rainy weather, you can go inside or use an umbrella,” Schreiner said. “We’re in the middle of a wave, and I’m going to step up some things to protect myself. … We have the tools to deal with this, even if our tools are not perfect.”

internal nutrition

“If you really think about it, you don’t need to run away [indoor dining] like in the old days, because you have too many tools, even for an unvaccinated person,” said Chin-Hong. He suggested choosing a place with ample and ideal airflow, such as near an open window, and wearing a mask when walking around a restaurant, such as when going to the bathroom.

Dr. Robert Wachter, chairman of the Department of Medicine at UC San Francisco, said it’s uncomfortable to eat in a crowded restaurant, which is still closed, but he said it’s unreasonable for people to do so. He said about 5% of hospital patients are testing positive for COVID-19, even if they are not seeking treatment for COVID-19, and he doesn’t like the possibility of eating right now.

“In a gathering of 50 people, it’s safe to say that at least one person has COVID,” Wachter said.

Schreiner said people should expect the next few weeks to be a wave, but the weather is bad.

“In restaurants, people are talking loudly and standing close together, and this particular variant, BA.5, is more contagious than measles,” Schreiner said. “The next seven to 10 days is the peak of this wave; this is not the time to go to a closed restaurant.’

open meetings

Public health experts say open gatherings remain the safest option, although the latest subspecies are so contagious they can spread outside. But no one recommends wearing a mask outside, unless it’s in a crowded place.

“I still think it’s relatively safe,” Chin-Hong said, but he found the scenario — “a mosh pit at Coachella on a windless day” — to be troubling.

Wachter agreed, but said there was a level of security outside as well. “Outside is much better than indoors, but better with more space, better if people don’t yell at you, better if there’s wind.”

He says if he’s at the ballpark, he’ll have a mask in his pocket in the bathroom or the hotdog line is jammed and crowded.

Schreiner said that for large events, even outdoors, it may not make sense to delay them for a week or ask people to test beforehand.

“An over-the-top wedding where there’s a nice breeze … it’s a lot safer,” Schreiner said. “Is it completely safe? Horse.”

large domestic events

Experts recommend wearing a proper mask at large, indoor events. But Wachter said there are other precautions people and facilities can take, such as increasing ventilation with fans, open windows or air filters, and asking people to take a quick test before participating.

“You can make them safe, but you can’t make them completely safe,” he said.

Chin-Hong says he’s heard of people strategically planning to beef up their defenses before a big event or trip. He also suggested planning how and where to get Pfizer’s COVID pill, Paxlovid, which can reduce the worst symptoms if someone gets infected after a major event. He said if someone lives with grandparents or other high-risk individuals, it’s wise to get tested and monitor symptoms for a few days after the events.

“You have these few tools. You don’t go crazy, but you use them … and you get involved in life,” Chin-Hong said.

travel or summer camp

For air travel, experts recommend wearing a mask at the airport and on the plane, especially during take-off and landing.

“I don’t worry too much about flying in an airport,” Schreiner said. “We can all be exposed to the virus all the time, but you have to have a certain amount of the virus to be infected.”

Katona said there’s no reason to stop or stop traveling, but there are ways to be smart like opening the windows and wearing a mask in a taxi or Uber.

“A car is very concentrated air,” he said.

Both Ferrer and Chin-Hong say it’s a good idea to test before taking a big trip and do the same for kids going to summer camp and back.

“The best advice is to actually vaccinate your kids and then boost them if they’re fit,” Chin-Hong said. “It gives you peace of mind they won’t be so sick.”

bars or clubs

Going out to crowded bars or nightclubs remains the most dangerous activity for catching and spreading the coronavirus, health experts warn.

“These are very dangerous congregational settings. You have people who are very close, they’re having a good time, they can be a little uninhibited,” Schreiner said. He’s heard some people say they can “figure it out and get it over with,” but he called that reasoning flawed, especially now.

“It doesn’t work because with this option you can go out and get it over and over again,” Schreiner said.

Chin-Hong, however, said there are ways to make it safer to go out. He suggested avoiding crowded, poorly ventilated bars and staying away from crowds.

“There’s still a lot of joy when you’re on the edge or outside,” said Chin-Hong, who recommends sitting by the windows or outside.

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