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Indoor Dining and COVID-19: Implications for Policy and Decision-Making

December 6, 2021

Last year, Drexel’s Urban Health Collaborative (UHC) partnered with the Big Cities Health Coalition (BCHC) on two projects titled: “Tracking outcomes and inequalities of the COVID-19 pandemic across the 30 cities that participate in the BCHC” and “Tracking equity issues in COVID-19 testing and vaccination access in selected cities”. These projects apply a health equity framework to examine inequities in COVID-19, characterize COVID-19 policies, and identify interventions aimed toward reducing health inequities. These projects have generated several outputs including: a data dashboard, several blog posts, presentations, briefs, and publications. Recently, the UHC team published two manuscripts on indoor dining and COVID-19.

The first article by O’Leary et al. 2021, was published in the International Journal of Environmental Research and Public Health and compares the re-opening of public elementary schools for in-person learning, and re-opening of indoor dining in restaurants across the 30 cities that participate in the BCHC. In the absence of federal guidance on closing and re-opening of essential and non-essential services, many US cities were left to develop their own policies. The authors review policies related to in-person schooling and indoor dining for the summer, fall, and winter of 2020. By fall 2020, indoor dining reopened in all 30 cities, while only 40% of public schools reopened for in-person learning. The researchers found that indoor dining re-opening was far more common than reopening public elementary schools for in-person learning. The research highlights the importance of jurisdictional power challenges, political pressures, and policy factors in state and local decision-making on indoor dining and in-person school policies.

The second article by Schnake-Mahl et al. 2021, was published in Epidemiology, and uses a quasi-experimental design to examine the association between indoor dining closures and COVID-19 rates in large cities across the country. The study compares COVID-19 rates in cities that keep indoor dining to cities that would have kept indoor dining closed but were preempted from doing so by their respective states. Preemption describes the governments’ (in this case, a state) ability to prohibit or limit a lower level of government (in this case, a city) from enacting a policy or program. The authors found that, over a 4-week period, keeping indoor dining closed was associated with a 43% decrease in the rate of new COVID-19 cases compared to cities that reopened indoor dining. These findings suggest that keeping indoor dining closed is an important tool to prevent spread of COVID-19 in cities. This study offers valuable evidence that can be leveraged to inform public health decisions surrounding indoor dining and COVID-19 in cities.